This year’s Black Maternal Mental Health Week carries the theme “Rooted in Legacy: Honoring Our Stories, Healing and Thriving Together for Generational Impact.” It is a call to celebrate the organizations, practitioners, and community leaders who have long supported Black mothers through pregnancy and postpartum, often filling gaps left by formal systems of care.
These organizations know something that the maternal mental health field increasingly recognizes: healing happens in relationships. It happens through trusted peers, culturally rooted practices, community networks, doulas, faith leaders, support groups, and organizations that understand and adapt their support to the lived experiences of the communities they serve.1,2
Yet many of these community-rooted models face a paradox. The very qualities that make them trusted and responsive—local adaptation, cultural tailoring, and deep community relationships—can make them difficult to evaluate using the evidentiary standards that often determine funding decisions. As a result, some of the promising approaches to supporting Black maternal mental health struggle to access the philanthropic and public funding needed to grow and sustain their impact.
As a field, we should ask whether current definitions of evidence are helping us identify what works or unintentionally limiting whose work counts.
When “evidence-based” becomes a barrier
Across philanthropy and government, there is understandable interest in funding evidence-based interventions. Rigorous evaluation helps ensure resources are directed toward programs that improve outcomes, and randomized controlled trials (RCTs) remain an indispensable tool for establishing causal impact. Many state Medicaid programs, including new federal maternal health models, condition reimbursement for services like doula and community health worker support on evidence-based status.
But RCTs are not the only way to generate meaningful evidence, and they are not equally accessible to every organization. Community-based organizations (CBOs) often operate with limited evaluation budgets, lean staffing, and data systems designed primarily for service delivery rather than research. Conducting a large-scale experimental evaluation may simply be out of reach. Even when funding for evaluation is available, the time, technical expertise, and infrastructure required can be prohibitive.
A second challenge, which is especially relevant in maternal mental health, is that community-rooted programs are intentionally designed to adapt: their approaches evolve in response to local culture, community priorities, participant feedback, and changing needs, and this flexibility is often central to their success. Traditional efficacy studies, however, are typically designed around implementation fidelity: if a program demonstrated impact under a particular set of conditions, future implementation should closely resemble the evaluated model. But for community-rooted approaches, their strength often lies in maintaining core principles while allowing communities to shape the delivery. This creates an uncomfortable tension: the very adaptations that build trust and relevance may make a program less amenable to traditional evaluation and less likely to be recognized as “evidence-based” under conventional funding criteria.
What’s more, the tools used to measure maternal mental health outcomes carry their own limitations. Many standard screening instruments—including the Edinburgh Postnatal Depression Scale—were developed and validated primarily among non-Hispanic white women, yet the symptoms they prioritize and the language they use may not fully reflect how Black and Hispanic birthing people experience or describe maternal mental health challenges. Promising efforts are beginning to address these gaps. At the Policy Center for Maternal Mental Health’s 2026 Forum (MMH Forum), researchers from Virginia Commonwealth University highlighted the EPDS-US, an adaptation of the Edinburgh scale that uses clearer, more accessible language and reframes screening as the start of a person-centered conversation rather than a checklist. Other researchers are expanding what is measured altogether. For example, the recently validated Prepartum Form for Evaluating Race-Related Psychological Stressors (PP-FERRPS) captures race-related stressors experienced by Black pregnant women that traditional depression screening tools may miss.
Why this matters for Black maternal mental health
This conversation has particular urgency for Black maternal mental health. Black mothers continue to face significant disparities in maternal health outcomes while also navigating longstanding inequities in access to culturally responsive mental health care. Compared with white women, Black women are about twice as likely to experience maternal mental health conditions, and about half as likely to receive treatment3. Experiences of racism, stigma, bias, and historical mistrust of healthcare institutions influence whether women seek care, remain engaged, and feel supported throughout pregnancy and postpartum.
Community-rooted organizations are often uniquely positioned to bridge these gaps. Because they are embedded within the communities they serve, they build trust over time and provide support that extends beyond clinical care to include social connection, advocacy, care navigation, and holistic well-being. At the MMH Forum, several organizations illustrated this approach in practice. The Perinatal Health Equity Initiative described how years of community partnership have enabled programs like Sisters Who Breastfeed to foster lasting peer networks among Black mothers, while its Mamas in Bloom program pairs nurse oversight with community health workers who help families navigate systems where they are too often unheard. Our Roots, a California-based peer coaching organization, similarly emphasized that healing extends beyond symptom reduction, combining peer support with navigation, advocacy, and community connection. These models demonstrate that if we want better maternal mental health outcomes, we must invest not only in clinical services, but also in the community infrastructure that makes those services accessible, trusted, and effective.
While many community-based organizations have compelling stories, strong community relationships, and years of practice-based learning, what they often lack is the type of evidence that funding systems are designed to reward. If our evidence standards systematically privilege organizations with research infrastructure over organizations with deep community trust, we risk overlooking innovations that could strengthen maternal mental health ecosystems, particularly for populations who have historically been underserved.
A role for catalytic philanthropy
This is where philanthropy has an opportunity to lead. Rather than asking community organizations to fit into existing evidence frameworks, funders can help evolve those frameworks to better match the realities of community-based, culturally-relevant innovation.
That could mean investing in evaluation capacity alongside program delivery. It could mean supporting developmental or participatory evaluation approaches that generate actionable learning while respecting local adaptation. And it could mean recognizing that causal attribution is not the only standard of rigor: theory-based evaluation and contribution analysis can test whether and how a program contributed to change even without a control group, while process evaluations, implementation science, qualitative outcomes, community-defined measures of success, practice-based evidence, and evidence syntheses round out a fuller picture of what’s working, for whom, and why. Washington, D.C.’s Mamatoto Village offers one example: an evaluation of its Mothers Rising home visiting program found improved birth outcomes among Medicaid-eligible Black mothers, evidence that helped inform the District’s 2024 legislation extending insurance reimbursement for home visiting services.
Perhaps most importantly, philanthropy can create space for organizations to learn and improve without requiring every promising model to first clear the same evidentiary hurdle. Funder collaboratives are also moving in this direction: the Maternal Mental Health Equity Fund, a collaborative of thirteen national, regional, and state funders, invests directly in community-rooted organizations serving Black and brown communities, including several of the examples above, and pairs that support with funding to build data and evaluation capacity.
This is not an argument against rigor. It is an argument for a more fit-for-purpose evidence ecosystem. Different decisions require different kinds of evidence. A national policy recommendation may warrant one level of proof, while a decision about whether to expand a promising community-based model may call for another. Building an evidence ecosystem that values both scientific rigor and community relevance will require expanding our standards.
An invitation to think and measure differently
We do not believe there is a single answer. Instead, there is an opportunity for the maternal mental health field to ask new questions together.
What would a more inclusive evidence ecosystem look like? How might funding practices better recognize community-rooted innovation while maintaining accountability for outcomes? What can maternal mental health learn from adjacent fields, such as substance use and behavioral health, that have embraced practice-based evidence, participatory research, or adaptive evaluation models? And how can philanthropy help create pathways for community organizations to demonstrate impact without asking them to become research institutions?
During Black Maternal Mental Health Week, we are reminded that lasting change depends not only on developing new interventions, but also on recognizing and investing in the wisdom and leadership that already exist within communities. If we want to improve maternal mental health outcomes for Black families, we should ensure that our definitions of evidence are broad enough to recognize the approaches communities already know are worth trusting.