Philly’s Prenatal Care Revolution … and What Still Needs to Change

The Power of One: JoAnne Fischer. The Power of One is an occasional series highlighting people and organizations making a difference in Philadelphia and across the country.

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The Power of One: JoAnne Fischer

JoAnne Fischer knows that bright futures start long before birth. Children born to healthy, prepared mothers are more likely to thrive. And the sooner struggling families receive much-needed intervention, the better chances kids have of beating the cycle of poverty.

If that sounds obvious, it wasn’t always.

Maternity Care CoalitionAs the executive director of the Maternity Care Coalition, Fischer has spent nearly 30 years fighting an uphill battle for better care for mothers and babies in the Philadelphia region. In January, Fischer will retire. She’ll leave MCC in good hands, but her impact will live on, in families that have received lifesaving services thanks to the advocacy of Fischer and her team.

When Fischer first got involved with MCC in the 1980s, the organization’s focus was on infant mortality: a big problem for Philadelphia, but one City Hall kept failing to address. In some Philadelphia neighborhoods, the infant mortality rate was as high as 50 per thousand. “It rivaled those of developing countries,” Fischer said. “Now, things have changed dramatically, and we are at around nine [per thousand].”

Fischer discovered the difference was prenatal care. But to win resources for pregnant mothers, women’s rights and health care advocates had to battle the stigma surrounding pregnancy. “Back at that time, it was a challenge to get men in the delivery room,” Fischer said. “It was a challenge to get people to have a say in their own care and for policymakers to see pregnancy as wellness rather than disease.”

Fischer recalled a demonstration during the 1980s at the Hospital of the University of Pennsylvania, which had begun to require preadmission deposits from pregnant women who didn’t have health insurance. This clearly created a barrier to entry that put women’s and infants’ lives at risk.

“It was unbelievable,” Fischer said. “And you know what the worst part is? It’s happening again with immigrant women who don’t have insurance, at various places in this region. I look back and go, ‘Oh my God, this is where we started.’”

To provide services directly to communities, MCC moved from a pure advocacy model to a hands-on one. Fischer had served as the director of Parenting Programs at Booth Maternity Center, a former midwifery hospital. “Booth was truly a place where, if you were a poor teen from West Philly, a college professor from the Main Line, or a Muslim woman coming for care, you all got the same quality treatment,” Fischer recalled.

She also had a background in community organizing. Among other things she worked on the 1988 Dukakis presidential campaign. Fischer brought this knowledge to MCC’s MOMmobile program, which delivers pre- and postnatal services to pregnant women in Philadelphia’s at-risk neighborhoods.

“On the campaign trail, I learned about voter registration, ‘get out the vote’ efforts, and using sound and visuals [to better communicate] in low-income communities,” Fischer said. “So, the original MOMmobile was bright yellow. We had sound machines, and we would go through low-income communities, meet people on the streets, and get them to sign up for the benefits they needed.”

At the time, traditional social services waited for people to show up at impersonal, intimidating offices, where they waited in line and risked being snubbed. Fischer saw the result: women deterred from seeking help. Plus, social workers didn’t see  the full picture of a family’s day-to-day struggles. “You don’t know what’s going on with those kids if they’re just coming to your office!” she said. So, she implemented a home visit strategy. Staffers also kept tabs on when clients didn’t show up for health care appointments because they had been treated badly or experienced cultural communication gaps.

Today, MOMmobiles aren’t quite so flashy, but they continue to transport MCC advocates from home to home, where they offer education, lactation counseling, supplies such as diapers and formula, and other scaffolded support. “We have curricula, and a lot of it is also modeling: getting down on the floor to play with the baby, bringing an educational toy. Or we’ll talk about strategies for sleep, or how to swaddle a baby,” Fischer said.

In the 1990s, MCC’s focus changed from simply preventing infant mortality to improving maternal health and childhood well-being in general. “People were so focused on the babies, because they were the innocents. There was less interest in the women, who were viewed as bad mothers,” Fischer said. “But, of course, you can’t focus on one without the other, because infants are dependent on their parents.”

Recently, MCC partnered with Children’s Hospital of Philadelphia on a research project to explore the impact of postnatal weight management. They found that when mothers maintained a stable weight after pregnancy, they were less depressed. “Depression impacts bonding with the infant. It’s all so interconnected!” Fischer said.

The interconnectedness makes MCC’s mission more necessary and daunting. Still, Fischer says she has a lot of hope for the future. In 2016, MCC made nearly 12,000 home visits; 2,466 cribs were given to families in need; and 19 community doulas oversaw 130 births. MCC even designed and staffed the first-ever breastfeeding stations at the Democratic National Convention, providing much-needed services to attendees. And this summer the organization (which grew from three to over 150 staffers during Fischer’s leadership) merged with the Bucks County nonprofit Child, Home and Community (CHC).

Fischer believes the public is gaining awareness about the importance of prenatal care and maternal well-being. “It’s been our strength to see these things as a package,” she said. “I feel encouraged that more people realize what we’ve known all along.”

Five Questions for JoAnne Fischer

JoAnne Fischer
JoAnne Fischer (Photo from Generocity Philly)

Where do you call home? I am a Philly girl!

Who inspired you as a child? What did they inspire you to do? My mother was a strong role model of an independent woman. She was loving and accepting of her four daughters and encouraged our respect of others regardless of background, religion, ethnicity, color, or gender. She put her words into action, mainstreaming girls with disabilities into our Girl Scout troop, and was the go-to mom to bring lunch for kids at our elementary school who may have forgotten theirs.

What person/event led you to a career in child advocacy? I began as a women’s health advocate. Through understanding the power of the mother-child bond and how the interests of children were best served through the support of their parents, I became an advocate for children and families.

If you had to do it over again, what would you change? More recently brain science and trauma research has helped us understand intergenerational impact. I wonder how things would be now if we understood earlier how the interests of parents and children were connected rather than separate.

Biggest career regret? I would have liked to have been more involved in global efforts advancing the interests of women and children.

Biggest career accomplishment. Building a highly passionate, innovative, and impactful organization that has directly touched the lives of over 100, 000 families and influenced social policy and research.



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