The state is shifting to a system of community care, one that could be a model for rural healthcare nationwide.
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Melissa Marie Lopez-Sullivan sat on a park bench near the parking lot of Memorial Medical Center in Las Cruces, New Mexico, sipping on a Diet Coke. It was 11 a.m. on a Friday, and the first hot sun of spring scorched the asphalt. She’d barely slept in the last 48 hours.
“I’ve been here since Wednesday night at 7 p.m., I hope to go home by midnight tonight,” Lopez-Sullivan said. “Might or might not happen.”
The maternity ward had been short-staffed and had multiple patients in labor. Because Lopez-Sullivan’s client was not an urgent birth, they were waiting on a “long, slow train.” At the 36-hour mark, they were all exhausted. The staff had turned over three times while Lopez-Sullivan remained by her client’s side.
“We were part of something collective, a small, intentional community gathered to support the emergence of new life, each of us carrying a different piece of care, but all rooted in the same purpose,” Lopez-Sullivan said. “And at the same time, I was aware of the system around us, how much of birth is shaped by timelines and expectations that don’t always honor the pace of a human body.”
Doulas like Lopez-Sullivan provide non-clinical support to patients in the form of education, emotional and physical support. And in a state where access to maternal care is not a guarantee, doulas hold together a fraying system.
New Mexico faces a severe maternal health crisis, with a maternal mortality rate of 28.0 per 100,000 births — almost double the national average. According to a March of Dimes report, over one third of its counties are classified as maternity care deserts. These deserts are counties with no hospitals or birth centers offering obstetric care. Nationwide, over 2.3 million birthing people live in these deserts, which severely limit access to prenatal care and delivery services. In New Mexico and in the wider United States, it has been estimated that over 80% of pregnancy-related deaths are preventable, according to the American Medical Association. These deaths are driven by limited care access, substance abuse and systemic inequities.
The U.S. has the highest maternal mortality rate among high-income countries. The Commonwealth Fund found that this rate is three times higher than Canada’s and six times that of Australia and Germany’s. The maternal mortality crisis disproportionately affects women of color, particularly Black and Indigenous women, as a result of historical and systemic disparities, which persist even when education and income are considered.
Attacks on reproductive health have changed the landscape for providers, and are further worsened by proposals from the Trump administration. Most recently, President Donald Trump proposed slashing $990 billion from Medicaid over the next ten years in his “One Big Beautiful Bill Act.” The maternal health crisis is also impacted by proposals for the FY26 budget, which recommends the elimination of ERASE MM, which supports maternal mortality review committees, perinatal quality coalitions and the CDC’s Safe Motherhood Initiative. For New Mexico, cuts like this push an already vulnerable state to a breaking point.
For New Mexico, cuts like this push an already vulnerable state to a breaking point. Medicaid plays an influential role in accessing reproductive care, as the state ranks first in the U.S. for the share of women of childbearing age (15–49) with Medicaid coverage.
On April 16, The Department of Health and Human Services Secretary, Robert F. Kennedy was questioned by a House committee on his commitment to addressing the U.S. maternal mortality rate — a goal that was supposed to be achieved as a part of “Make America Healthy Again” (MAHA) policy agenda. The Committee pressed him on the administration’s funding cuts to research and safety initiatives; he answered that these actions reduced “duplication.”
Birthing people have better outcomes when doulas are involved. The National Institute of Health found that women who had doula care had 52.9% lower odds of cesarean delivery and 57.5% lower odds of postpartum depression and/or anxiety, both life-altering issues for birthing people in America, particularly those of color.
In New Mexico, doulas act as first responders and critical advocates for their clients, often providing their services at low or no cost. They are key pillars of community-centered birthing services, a holistic model of maternal care that prioritizes continuity of care, addresses social determinants of health and draws its providers from within the community itself.
For years, being a doula has meant little state recognition and stigma — no Medicaid reimbursement, limited formal pathways for training, denial from hospitals during the pandemic and low pay. Until now.
In the wake of the Trump administration’s cuts, doulas in New Mexico, led by Lopez-Sullivan, demanded change. In the 2025 legislative session, the Doula Credentialing and Access Act (HB214) was signed into law by Governor Michelle Lujan Grisham. The legislation establishes a credentialing pathway for doulas that allows them to become Medicaid providers and receive reimbursement for their essential services.
A month after the birth, Lopez-Sullivan reflected on the difference this bill has made. “Ten years ago, sitting on that bench might have also come with the awareness that this labor, 36 hours of presence, care and attention would likely go uncompensated or under-compensated,” Lopez-Sullivan said. “It was and is work rooted in commitment, yet often unsupported by systems.”
Experts have proposed a range of solutions to the maternal health care crisis: reducing care gaps through increased access to midwives and doulas, increased insurance coverage, building of free-standing birth centers and creating specialized postpartum care models. But, New Mexico, at the crisis’ ground zero, may already hold some of the answers on how to fix it.
A Status Quo of Closure
In rural America, particularly in New Mexico, access to health care is not a guarantee. The state has become no stranger to watching the doors close on some of its most needed medical services. Within the last five years, 36% of rural New Mexico hospitals that offered birth services and free-standing birthing centres, have closed or diverted laboring patients because of staffing shortages and the cost of maintaining obstetric services.
Closures of maternity services are contributing to the widening gap in access to maternity care for birthing people across the country. Across the nation in 2025, 27 rural hospital labor and delivery units closed or were planned closures, and nearly 24 freestanding birth centers closed or are currently facing substantial financial pressure. One of these birthing centers, Dar a Luz, is located in Albuquerque, New Mexico.
A cluster of maternity care deserts sits in rural Northeast New Mexico, spanning five counties and 10,000 square miles. Located in this desert is Ratón’s Miners Colfax Medical Center, the only hospital with an obstetric unit for 100 miles. The nearest alternatives are in neighboring states — to the East, Amarillo, Texas and to the North, Pueblo, Colorado.
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For miles leaving Taos, the nearest major city to Ratón, the land stretches over the horizon with dispersed gas stations and rest stops as the only signs of life as the road climbs into the Sangre De Cristo Mountains. On the way, drivers pass through Cimarron, a town known as where “the Rockies meet the Plains.” To reach the Medical Center from the south, this must all be navigated before a provider sees their patient.
In a maternal health care desert, maintaining an OB department is accompanied by extreme financial strain. Chief of Nursing at Miners Colfax Rhonda Monoit explained the hospital spends nearly $3 million a year to maintain its services; most of which they do not get back. On staff, the hospital has two alternating OBGYNs, one flying in for her 15-day shift from the Pacific Northwest.
Monoit emphasized the difficulty of finding doctors who are willing to do rural health care because of the dangers it brings — lack of access to neonatologists, limited blood availability and a helicopter required to transfer patients to a larger hospital. The rural location also leaves them at risk of receiving patients in imminent labor. Monoit explained that her OB manager, Dr. Jessica Roberts, “sacrifices” her life to the department and “does whatever it takes” to provide care in the region.
“Dr. Roberts literally just delivered one [a baby] literally off the highway,” Monoit said. “She was in labor and they were traveling. Thank goodness there was prenatal care. But, she literally delivered as she walked in the door.”
Despite financial difficulties, the hospital’s team is committed to keeping its OB unit open, knowing that if it were to close, patients would have to travel over 200 miles to a new hospital to receive care. With roughly two-thirds of U.S. rural counties losing population between 2010 and 2020, Moniot believes that without the availability of quality OB and prenatal care, these areas may “shrivel up and die.”
Monoit wishes that insurance companies and policy makers would have to walk a day in rural hospital administrators and providers’ shoes. “We struggle to fund having providers, to keep our doors open and the lights on,” Monoit explained. “It’s sad because it is where the future generations are being born.”
Brian Cotter, the Center’s CEO, shared that some of the biggest challenges they face are Medicaid reimbursement rates and insurance denial rates. These issues are particularly prominent when payer agreements are challenged or approval processes are delayed. Cotter explained that although a hospital may get authorized to provide care for a Medicaid-covered patient, the rates negotiated in payer contracts — which are individualized to hospitals — are low in comparison to the costs the hospital endures. His hospital faces a 15–20% denial rate for insurance claims, this sits near the 18% average for rural hospitals which is much higher than the 10% denial rate for urban hospitals.
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“You got something that’s going downhill and you’re trying to save it, but it’s always like you’re pushing that boulder up the hill constantly,” Cotter said as he explained what it is like to run a rural hospital.
Miners Colfax has been designated as a ‘critical access hospital,’ which reduces financial vulnerability, allows it to provide 24-hour emergency services and receive cost-based Medicare reimbursement. But, this designation is rare. Cotter has seen other similar institutions without this designation be acquired by private equity firms, at the cost of the communities they serve.
“Rural and urban hospitals have been closing their OB units left and right for the last several years because more and more private equity that gets into hospital ownership,” Cotter said. “They typically want to turn and burn hospitals to squeeze their profits.”
Nationally, private equity firms are increasingly acquiring hospitals, with investment in health care reaching an estimated $104 billion in 2024. Once under private equity ownership, the least profitable units are usually the first ones to go. Often, this is the obstetric unit. As maternity wards and other reproductive health care facilities disappear, they continue to contribute to and further worsen the crisis of maternity care deserts. These acquisitions have been nationally linked to declining quality, with some studies suggesting higher patient mortality rate, reduced staffing and rising costs for care.
In the face of this, Monoit and Cotter have made it clear that they will not eliminate their obstetric or reproductive care services. After referencing their oath as nurses, they explained that their purpose as human beings is to protect and care for others.
“Community need is really what drives a hospital,” Cotter said. “We are here because of the community, the community is not here because of the hospital. That is a big distinction.”
Located in the outskirts of Albuquerque, Dar a Luz Birth Center caught — or the word that midwives use instead of‘deliver’ to highlight the active work of the laboring person — their first baby in April 2011. Over 15 years, the team expanded to become one of the nation’s longest operating state-licensed birth centers, participating in the birth of 2,775 babies. As a freestanding birth center, they offered families a third space, one that bridged the gap between home birth and hospital settings. In December of 2025, the center lost its namesake.
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In early 2023, executive director and co-founder of Dar a Luz, Abigail Lanin-Eaves, realized that the math would not add up anymore. The increasing costs of medical malpractice insurance, low Medicaid reimbursement rates and the high burnout rate of midwives began to pile. It was clear to Lanin Eaves that they could not continue offering birthing services.
“I could see with the changes in health, the maternal landscape, our politics and healthcare that being a small health care organization with our healthcare system in this country is nearly impossible,” Lanin Eaves said. “If you look around, there’s almost not a single small health care business that is not doing medical spa stuff.”
The pivot from birth to a women’s health center happened in a matter of months. The team had their last birth in December of 2025, and quickly renovated their birthing suites to ketamine therapy rooms. This offering assists the Center in maintaining financial stability, so the team can continue to offer other reproductive care services.
Lanin Eaves, a retired clinical nurse midwife, has advocated for increased state support for midwifery as well as increased Medicaid reimbursement rates for doulas and free-standing birth centers, like her own. She believes that, for as strong of a maternal health care community New Mexico has, the state could do more to support it. Without further funding from federal and state entities, she fears that birthing centers may continue down a path of closure, and may cease to exist entirely.
“I’m so enraged and I’m so brokenhearted at what’s happening,” Lanin Evans said as she wiped a tear from her eye, her hand and voice shaking. “When I look at what’s happening to women and their babies after doing this for 15 years, thinking that somehow it would get better, to watch it fall apart in the way it has is such a sad place [to be].”
Lanin Evans has spent most of her career lobbying for state and federal policy changes. Yet, she continues to see articles published about New Mexico and maternal health care deserts nationwide. Despite her passion for birthwork, sometimes she feels helpless.
“We are a country that, at its core, does not give a crap about women,” Lanin Evans said. “How we care for pregnant people and their babies in this country, the services that we offer them, the way that they can give birth, where they can give birth and how their providers are reimbursed is so broken that it’s no wonder we have the highest maternal mortality rate of any industrialized nation.”
The “Course Correction of Care”
Prior to New Mexico’s statehood, the maternal health landscape was in the hands of the local community. Practices were rooted in Indigenous traditions and those of the Hispano population — native residents of the Southwestern United States descended from Spanish settlers. For centuries, curandera-paternas (Hispanic midwives) led birthing services, with more than 800 pateras practicing in the state in the early 20th century. With statehood, tradition and culture were no longer at the forefront of maternal healthcare.
New Mexico is the ancestral home of the Pueblo, Navajo and Apache people — to this day, it spans 23 sovereign nations, each with unique heritages. The state has also become a melting pot of migrant communities, with nearly 10.2% of the state’s residents foreign-born in 2023, according to the American Immigration Council. Over time, these communities have had to adapt to medicalized practices and lost their traditions.
Alongside Lopez-Sulivan’s advocacy for Medicaid reimbursement, she is leading the charge in the reestablishment of community-centric care in New Mexico. She explained the vital role of returning to a “village” model for providing maternity and reproductive care services.
“The reality is when we go back and we look at our history, this is how we gave birth, before medical industrial projects. Birth was in community with your sisters, mothers, aunties or grandmothers,” Lopez- Sullivan said. “We’ve lost that.”
The debate in New Mexico, she added, is over determining who determines what care looks like, and confronting the ‘medical industrial complex’ — or networks of for-profit corporations that supply health services. According to the National Library of Medicine, 98.4% of births in America take place in hospitals, but in New Mexico, this was a forced norm that does not always reflect the cultural practices and traditions of local cultures. Rather than accepting this, providers are making health care work for the clients they serve by connecting culture to care.
New Mexico consistently ranks amongst the top three of the poorest states in America, with a poverty rate that sits at 16.2%, according to the U.S. Census Bureau. Birthing people in New Mexico face devastating challenges during pregancy, ranging from long-distance travel to appointments to high rates of untreated mental health conditions. A March of Dimes report found that 23.3% of birthing people in New Mexico recieve inadequate prenatal care, this is significantly higher than the 14.8% national average.
Maternal mental health conditions like postpartum depression and anxiety impact an estimated one in five mothers in the United States — making mental health disorders a leading complication of birth, according to the Policy Center for Maternal Mental Health. The New Mexico Commision on the Status of Women found that mental health complications contribute to more than a third of pregnancy-related deaths in the state.
While state funding availability for initiatives in maternal health care are slim, private investment in community-centric care has been leading change. The W.K. Kellogg Foundation serves as a key investor in maternal and child health in the state. Their funding is directed to community-based organizations, including baby-friendly hospitals, doula services and breastfeeding support.
Michelle Gutiérrez serves as a Senior Program Officer for Kellogg foundation, in New Mexico her work is focused on addressing the lack of cultural inclusivity practices in health care. To do this, Gutiérrez looks back to history.
“We are going to need our providers and institutions to understand the true history of medicalization of birth in New Mexico,” Gutiérrez said. “All the things that we had before, how those things were dismantled, why they were dismantled and what we are going to do about it now to create an equitable, integrated system of care.”
The medicalization of birth sits at the forefront of many providers’ minds as well as Gutiérrez’s. Not as something that has just affected New Mexico, but the whole nation’s access to care. She believes that although many American communities understand how mental, physical, emotional and spiritual health are all intertwined, the system that serves them does not.
According to Gutiérrez, when culture is centered in care, there are better health outcomes. She has seen it herself. Gutiérrez explained that providing extra support in a state that is geographically vast with limited financial resources can be a challenge, particularly with federal impacts and anticipated cuts to Medicaid. But, she highlighted that New Mexico is often painted with a “lack” perspective, and she believes that the conversation needs to be balanced.
“I’ll speak for New Mexico, but I think this could be across the country. For many of our communities, we’ve been forced or we’ve been assimilated into this dominant ‘US American cultural system’ that isn’t necessarily ours,” Gutiérrez shared. “That misalignment is creating some of the health disparities that we are seeing currently.”
Disconnection between patient needs and clinical environments can lead to mistrust and inequalities in care. Research by the Kellogg Foundation found that in maternal and infant health, specifically, the intersection of race, gender, poverty and other social factors shapes individuals’ experiences and outcomes.
As one of the most diverse states in the nation, with 50% of its population identifying as Hispanic/ Latino and 11.2% Indigenous according to the Department of Health and Human Services, providers are prioritizing care models that reflect the traditions and cultural practices of birthing people.
Gutiérrez explained that although New Mexicans face real financial disadvantages, in terms of relationships and resilience, they excel. She shared that community bonds and human capital are often undervalued in conversations of wealth, but for New Mexicans, they are immeasurable.
At the policy level, Gutiérrez and the Kellogg Foundation are working within the budget and tax space. They are advocating for the reallocation of resources unique to the state, like oil and gas revenue. Behind Texas, New Mexico is the second-largest crude oil producing state in the nation. According to the New Mexico Oil and Gas Association, the industry generated $13.1 billion in state and local revenues in the 2025 fiscal year. Community-centric investors and organizations are looking for funding answers within the state rather than relying on volatile federal resources.
Alongside this financial investment, Lopez-Sullivan is working on the ground to collaborate with doulas across the state to create a new status quo of care, one that prioritizes the community it serves. Their work focuses on centralizing the patient through building relationships, prioritizing trust, culturally and trauma-informed care and expanding the birthing and care options available to clients.
“We are rebuilding the matriarchy, the village, the community and the relationships that actually sustain us,” Sullivan said.
To do this, providers across the state have found answers in coalitions.
“There has been a shift in unity,” explained Monica Esparza, the executive director of Changing Women Initiative, a non-profit organization seeking to renew cultural birth knowledge and reclaim indigenous sovereignty of women’s medicine. “Community-led initiatives served in silos, and so there was a replication of efforts and then decreased funding. Now I feel like community-led organizations have transitioned into working and collaborating together.”
She believes that it is important to support initiatives like theirs because it allows communities to reclaim birth led by the parent, rather than by practitioners.
“The medicalization of it [birth] should be as a backup, should be in case of something of the need, in case of the need versus the norm,” Esparza said.
According to a 2021 survey done by the New Mexico Pregnancy Risk Assessment Monitoring System, one in every three women statewide and about one in two Indigenous women did not receive prenatal care during their first trimester. Esparza and the Changing Women Initiative are cultivating a model for communities to grow their own lactation care support, midwives and birth teams. She sees this as a sustainable way to confront maternal mortality but also increase access to culturally informed care.
“We’re still seeing those high numbers of moms that are dying, and so there has to be a change, and there has to be a shift,” Esparza explains. “I highly believe that working with community, working with community practice providers in all formats around birth is going to help us shift those numbers.”
For over twenty-five years, Bold Futures has worked to build reproductive justice in New Mexico for women and people of color. To do this, they work in policy and advocacy, but also in cultivating a culture shift. Danica Terrones, a birth justice manager at Bold Futures, explains what she is seeing now is a “course correction” of maternal health care in the state.
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“There is this emphasis of engaging with providers across the board about what New Mexican families need, based on research, the culture shift and on the conversations we’ve had throughout the years,” Terrones said.
When partnering directly with organizations like Bold Futures on the ground, Gutiérrez has a three-pronged approach that focuses on geography, community engagement and race equity.
“When we think about racial equity, we think about our communities here in New Mexico, the majority of folks are communities of color or low income,” Gutiérrez said. “So we’re looking at the most vulnerable and marginalized populations, those who have not been present, particularly in decision-making roles.”
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The subtle transformation of how care is designed in New Mexico is an approach that is not singular to the state. By aligning with the values of the local populations, providers are able to give direct care that is tailored to those they serve. Providers do not believe it is too “late” to course correct, and is an approach that can be used nationwide.
“It is not saying death to health care institutions. We need our health care institutions, we value our health care institutions, but we also value our communities,” Gutiérrez explained. “The current system is not working for us. So, what else do we need to be able to do to transform a system?”
Reclaiming Birth
In New Mexico, community change and advocacy begins by gathering. In the mid-1980s, women from Indigenous communities across the state sat around kitchen tables and on living room couches to discuss domestic violence, substance abuse, sexual assault and divorce. Beginning as a general support group, the founders of Tewa Women United (TWU) realized there was no space for Native women to share their experiences.
TWU’s headquarters in Española is located in the heart of Tewa-speaking communities, and directly borders or is within a few miles of multiple Tewa Pueblos. After becoming a nonprofit organization in 2001, they have dedicated themselves to ending all forms of violence against Native women and girls, Mother Earth and to promote peace in the state.
Executive Director Dr. Corrine Oqua Pi Povi Sanchez and Reproductive Justice Manager Wendolyne Omaña explained their work is derived from surveys and discussions with Indigenous communities like the ones that led to their founding. Sitting around a couch with sunshine pouring in the windows at TWU’s office in Española, the women sipped on their fresh, still steaming coffee and discussed their work in improving the experiences of birthing people. They shared how the generational effects of forced sterilization, genocide and colonization still impacts how Indigenous women experience birth.
Sanchez explained that for decades, Indigenous women’s option for birth was the Indian Health Facility in Santa Fe, which acted as a “militarized service of the government.” For these women, perinatal care meant traveling outside of their local community and not likely receiving culturally informed care. Now, they are reconnecting care to their culture.
“We’ve gone from ground zero of not having anything to reclaiming birth and our language. The strength of our organization is reclaiming our cultural practices,” Sanchez said. “We are creating multidisciplinary teams, investigation protocols; we are influencing training for law enforcement, mental health and child protective services.”
Changing Women Initiative is also expanding upon this mission to support indigenous and migrant communities to reclaim their own birthing practices and experiences. Part of this includes decentering fear in conversations about birth, creating space for ceremonial practices and limiting unnecessary medical intervention.
“It’s been a medicalized, colonized way of practicing birth. Reclaiming gives the communities back more of their power, culture and more of their ability to make their own decisions about their bodies and the bodies of the next generations that’s coming forth,” Esparza said.
Their doula training and reproductive services reach families in central, northern and western New Mexico. In response to growing maternity care deserts and the extended travel times for birthing people to receive care, Changing Women Initiative provides services at low to no cost. Their goal is to “grow” providers within their own communities, meaning care is not outsourced and access gaps are narrowing. Although their work is centered in New Mexico, these strategies could be translated into other indigenous and marginalized communities across the country.
“Grow their own midwives, lactation care providers and their own birth team in a way that is sustainable. But, also in a way that helps keep families in their community, in their village, where they can receive the care and support they need,” Esparza said.
Within their model, they also offer “decolonized” midwifery programs, which have been provided to over 300 families, with 98% of those receiving free care. These programs have also trained over 86 Indigenous doulas.
“We know that people feel more comfortable and are willing to feel that higher level of trust when they’re being served by someone who looks like them,” explained Esparza.
Omaña, a doula herself, was born and raised in Mexico. She is Indigenous to the Mixteca traditions, and works to intertwine her grandmother’s teachings with Western medicine. She takes this perspective as she trains other medical professionals. Her curriculum is intentionally designed for northern New Mexico and providers ranging from doulas to surgical residents who are already in the region. To her, this partnership is what it means to provide community care, and she believes that it is not just up to one kind of provider to save the system.
Partnerships between medical providers and doulas are crucial, for some of Omaña’s clients, birth is their first time in a hospital. Recently, the organization has begun to go into clinics and community colleges around the state to teach informed consent and culturally appropriate care. After one of Omaña’s training in Santa Fe, the front desk representative approached her.
“He ran and said ‘thank you, we needed this, thank you,’” Omaña shared. “Even though it was not a medical professional following up to say thank you, it was a male that recognized that this was so needed.”
Nationwide, TWU is leading the initiative in cross-training medical professionals and integrating traditional indigenous models with clinical practices. TWU and the providers they work with are trained in full-spectrum birth services, including abortion. New Mexico has established itself as a “reproductive safe haven” for these services. Governor Lujan Grishman has signed legislation and enacted executive orders that prevent cooperation with other states’ investigations against patients or providers, with specific protections for abortion access. In the state, abortion is legal and available at any stage of pregnancy.
As they developed an indigenous curriculum for abortion support training, Sanchez and Omaña explained the critical nature of understanding abortion as a political term. Recently, they held collective conversations around advocating for the use of an alternative term, “pregnancy release.” TWU has long advocated for abortion care, but as an Indigenous organization, this is complicated by histories of persecution and sterilization. To them, providing these services means honoring personal sovereignty.
“We are going to continue to advocate for abortion care, pregnancy release care and holistic care for families,” Sanchez said. “We know what it is like to have other people judge, stigmatize and take away our rights.”
TWU is also involved in the creation of the Building the Fire Fund (BFF), which is a women-led fund focused on reproductive justice across Turtle Island (North America). The fund supports grassroots organizing, infrastructure and uplifting Native women and birthing people within the broader reproductive justice movement. This unprecedented pot of money is working to cultivate interstate coalitions with BIPOC leaders. Sanchez explained that this work is particularly relevant to the political environment of the United States.
“Every single area is under attack. We’re attacked for being women, for being brown and for our environment. It’s really critical in time to recognize that misogyny is happening,” Sanchez said. “We’re at this 30-year flux in movements where we think we’ve secured rights, secured legislation and we’re going backwards.”
These organizations are at the forefront of creating equitable care for indigenous women in New Mexico, but also demanding a new standard of care for Native women across the country. To these providers, reproductive and birth justice connect back to one thing: choice, in every sense.
“Having a real choice of all their options, and at every step of the way being explained what those options are, in a way they can truly say and decide for themselves what the care looks like,” Esparza shared. “That, for me, is birth justice.”
The Dollar Figure
For doulas, there is no such thing as a traditional 9–5 job. Their days depend entirely on the patient they are supporting. They provide care essential to closing maternal mortality gaps and ensure safer outcomes for people of color.
“When I say ‘doulas save lives,’ I’m speaking from the reality that too many people in this country are still dying during pregnancy, birth and postpartum,” Lopez-Sullivan said. “Those outcomes are not evenly distributed. Black, Indigenous, rural and low-income communities are carrying the greatest burden.”
When Lopez-Sullivan became the executive director of the New Mexico Doula Association in early 2019, earning just $3,000 a year, achieving Medicaid reimbursement was at the top of her five-year plan. She worked to get a reimbursement rate that would allow doulas like herself to put food on the table for their families and be away for days at a time while providing for clients across vast distances.
Medicaid covers more than half of all births in the state, according to the New Mexico Health Care Authority. As one of the highest rates in the nation, the coverage is particularly prevalent amongst Indigenous women (81.8%) and Black women (61.1%). These are also the populations with the highest rates of maternal mortality.
With this coverage, providers in New Mexico are able to redefine what it means to provide maternal health care in a state and nation that have been designated as a crisis. By repositioning their communities at the forefront, they are making healthcare work for them, rather than the inverse.
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“I keep thinking about spaces like that birth [at Memorial Medical Center], the way a student doula, a mother and a care team can come together to hold someone through one of the most transformative moments of their life,” Lopez-Sullivan said. “That’s what’s possible when care is rooted in community. That’s what we’re trying to build, not just in individual rooms, but across systems.”
Whether it be midwives, doulas, rural hospital nurses or indigenous organizations, providers are leading a subtle transformation of care. This is one that most people do not know about, but could change the way diverse communities in America experience maternal health care.
Often, the vital work of doulas goes unrecognized or unsupported by formal medical structures. During the pandemic, doulas were not allowed in some hospitals in the state. It was not until Lopez-Sullivan found a loophole that she was able to support her client — a midwife wrote a “prescription” for a doula. Still, some medical practices in the state explicitly state that they do not accept doulas.
“It’s a particular kind of invisibility to be essential in practice, but not recognized in structure,” Lopez-Sullivan shared. “Even now, while there are changes happening, we’re still navigating that gap between what we know this care provides and how it’s understood or valued more broadly.”
It was not until the Doula Credentialing and Access Act that the work of doulas was formally recognized by the state. The Act created a voluntary credentialing pathway for doulas to enroll as Medicaid providers and receive Medicaid reimbursement. This also included a mandate that hospitals and birthing centers allow patients to choose their own doulas during pregnancy and birth.
National funding cuts to Medicaid puts New Mexicans at substantial risk, according to a statement by Alanna Dancis, the Chief Medical Officer of New Mexico Medicaid. She explained that Medicaid is “more than a safety net” and serves as the “backbone of health care” in New Mexico’s rural communities. With the possibility of increased cuts to Medicaid, doulas may not be able to provide essential services, not only in New Mexico but also across the country.
These cuts are occurring as more states recognize doulas financially and systemically. As of March 2026, 26 states and Washington, D.C. provide Medicaid coverage for doula services. In New Mexico and across the country, this has been advocated for and won by doulas, midwives and practitioners themselves. For these providers, the question has always been: how do we make Medicaid work for us?
Alongside providers from across the state, Lopez-Sullivan is working to build infrastructure to support doula reimbursement, as being a doula now includes elements of financial viability. She believes that it will open a career path that does not require a college degree, taking loans and has extensive community needs.
“For me, as someone who has provided a ton of care at virtually no or low cost for many years, it’s changed my life,” Lopez-Sullivan said. “I know it’s going to change many, many others because the pathway is now open for a career path.”
This year, The New Mexico Doula Association and Bold Futures New Mexico are working to create a billing entity that certified doulas can use. Lopez-Sullivan likened it to a “doula agency model;” this way doulas can focus on the care they provide, not whether or not they will get paid.
“So, I see that as a growth opportunity for the association to carry the burden of that infrastructure and be able to provide a much-needed service to the doula.,” Lopez-Sullivan explained, “because many of them don’t want to be responsible for the billing.” This is the model she uses at Las Cruces Doula, and imagines it rolling out similarly in the state.
Now, doulas are facing their next challenge — letting communities know that they are available. With the reimbursement, Lopez-Sullivan explained that they are facing a parallel truth: many people don’t know doulas are an option, or how to access them, even with reimbursement available. So while the reimbursement supports conditions of care, they are working to make doulas more accessible and visible, especially in marginalized communities. Doula care is often characterized as a “luxury” for the wealthy, but growing Medicaid and insurance coverage is shifting this narrative and correcting health disparities — particularly those with roots in racism and misogyny.
TWU was part of the coalition that advocated for doula reimbursement. Sanchez explained that the fight began with the decriminalization of abortion care in New Mexico. For almost 10 years, providers across the state looked to see what they could learn from the achievements and the shortcomings of other states.
“Our power has always been with the people,” Lopez-Sullivan said. “This moment is asking us to build systems that reflect that truth.”
Building out the Medicalized “Village”
The northeast of New Mexico is a desert not just in landscape, but also in maternity care. The five counties representing this area: Harding, Union, Colfax, Mora and Taos, have been designated as high risk due to the rates of poverty and long travel distance. In response to the risks and the closure of hospitals, rural clinics and labor and delivery units, the Rural OB Access & Maternal Service program was created.
Executive Director Colleen Durocher explained that the ROAMS project has created a system like nothing before in New Mexico — and likely the nation. To improve maternal health services, three medical centers — including Miners Colfax Medical Center — joined to create ROAMS, which provides telehealth services and home kits, lactation consultants and family navigators for at no cost to clients.
“What’s radical and difficult [is that] these are hospitals and centers that don’t normally interact, that don’t share patients or information, and don’t work together,” Durocher said. “You don’t usually see any health care organizations in any place, in any state, that are working with another healthcare organization outside of their umbrella.”
Through this coalition, patients with higher risk pregnancies are able to connect with maternal fetal medicine providers in Santa Fe or Albuquerque without having to drive two or more hours each way. Patients also receive home telehealth kits that allow them to take appointments from home and measure vital signs like blood pressure and fetal heart rate. The program, in total, has saved ROAMS patients 5,000 hours in driving time and 426,000 miles.
The project serves around 500 unique clients a year as a pilot program of the Health Resources and Services Administration (HRSA) in partnership with the Federal Office of Rural Health Policy. However, consistency of funding remains an issue as President Trump’s FY26 budget proposes the elimination of HRSA and some of its programs, including grants to rural hospitals.
Durocher calls their program “low-hanging fruit” because of its impact and easy implementation, at low cost, when they have funding. She is not satisfied with this program solely existing in northeast New Mexico and believes that it could be implemented statewide.
“If I had a magic wand, every OB desert in New Mexico would have a telehealth program with the nearest labor and delivery hospital where the moms are likely to deliver,” Durocher said. “It’s not that hard to do and it is our big push. Now we’re trying to get other partners to buy into this expansion.”
Durocher explained that the community “spirit” that the project creates is beneficial for providers and patients, and could be a model beyond New Mexico. But providers have to be willing to break traditional barriers particularly in a time when financial stability is not a guarantee.
“It can be done and it can really serve the patients, but it’s hard in rural America. Some of these clinics, sometimes I think of as a sinking lifeboat,” Durocher said. “They’re in a lifeboat and they got a leak, and they’re trying to stay alive, and I’m trying to come to them and say ‘Hey, let’s expand!’”
In the state, social determinants of health significantly impact pregnancy. This includes housing instability, limited access to transportation, food insecurity and poverty. These determinants are the primary drivers of U.S. maternal health disparities. Family navigator, Lauren Bailey, has found that there is an “overwhelming need” for families and perinatal populations to have these resources. When working with birthing people, she asks a simple, but oftentimes life-changing question.
“What can we fix to make your pregnancy a little easier? Even if it’s just one thing off of your to-do list, let me take that,” Bailey said. “I am the assistant to not only the patient, but also the clinicians.”
Due to national and local provider shortages, Bailey has found that sometimes clinicians do not have the bandwidth to assist their patients with Medicaid or other federal programs. She works to connect families with programs ranging from SNAP to Church donation boxes. Simultaneously, she follows their appointments and works alongside other providers to track blood pressure, family dynamics and nutrition.
Beyond pregnancy outcomes, Bailey believes that this program in turn will have positive impacts on education and health care as a whole; as the program aims for New Mexicans to be “taken care from pregnancy all the way until the child is fourteen.”
“If ROAMS could be all over New Mexico, it would be so unreal and so cool,” Bailey said. “To have such an opportunity for for a state that’s last in education to say, ‘No, these kids are going to be taken care of, these pregnant populations are going to be taken care of, and we’re going to be the driving force of the United States to do that.’”
Setting The New Standard
As Dar a Luz Health Center closes its birthing services, two other centers are rising to take its place. In southern New Mexico, Vida Birth & Health Center opens this May, followed by Ocotillo Reproductive and Wellness Center in the fall. Together, they hope to establish an updated benchmark for reproductive care services in the state.
32 out of 33 counties in the state are designated as health professional shortage areas; this shortage contributes to access barriers and creates maternity care deserts. These birth centers are opening to fill gaps in one of the state’s most high-risk and diverse communities. With a population of 111,000, Las Cruces is the second-largest city in New Mexico and is about 40 miles from the Mexican border.
Vida Midwifery first began as a solo practice, and quickly evolved into a group one with the three women serving as co-owners — Sabrina Paulos, Emily Levingston Luna and Angela Avent. As a group practice, they were able to expand their network of care while also limiting burnout rate, which is prevalent amongst midwives. New Mexico and Oregon have the highest rates of midwifery workforce indicators in the United States, with 24% of all births (32% of vaginal births) attended by midwives. Avent shared that midwives often practice for five to seven years before taking a break or pivoting careers.
In their group practice and in their forthcoming birth center, they are leading with the midwifery model of care which Levingston Luna explained is a holistic approach that prioritizes informed choice and bodily autonomy.
“Some of our clients kind of laugh at us because every time before we touch their belly or anything like that, we always ask,” Levingston Luna said. “Some people will say, ‘No one’s ever asked me that before’ or ‘It’s so nice of you to ask because people don’t usually ask.” At Vida Midwifery and Health Center, communication is fundamental to their practice.
Their office, located in the heart of Las Cruces, is reminiscent of a home and purposefully so. Patient rooms have worn-in couches and toy boxes spilling out across the floor for children to play with during their parent’s appointments.
The three women sat knee to knee on a maroon couch in their consultation room after their weekly Friday debrief meeting. They easily settled in next to each other as they shared their mission at Vida Midwifery — to provide personalized care to birthing people, and to fill gaps in equitable access to reproductive health care for rural communities.
Before the opening of the health center, they served clients within an hour and a half radius, often pushing to two hours. Levingston Luna, Avent and Paulos see their patients 24 hours after the baby is born and then again at three days, five days, seven days, two weeks and any time in between if the birthing person is concerned. There was one week in which Avent drove 1,910 miles to see clients in rural communities over six days. They explained that this will be something that they will continue to do with their birth center model because, oftentimes, their patients do not have the resources to come to them.
The importance of birthing centers became clear to the midwives as they reflected on the dangers of birth in rural communities that are far from any emergency services. Levingston Luna, Avent and Paulos have an ongoing joke that the stress that these births cause gives them a “whole bunch of new grey hairs” or makes them “lose three years off their life.” Beyond stress, these rural births can be dangerous.
During a birth that required emergency medical support, Avent’s assistant had to run from room to room inside the house to get a cell reception to call for support. It then took 36 minutes for the emergency services to get to them, then another 30 minutes to get to the smaller hospital that would transfer them to a larger one. By opening a third space to give birth in their health center, the women hope to limit these types of situations.
The midwives shared that their first meeting with their contractors began with a crayon drawing on a piece of paper. Their birth center model currently does not exist in Las Cruces, and they want to offer a choice besides home and hospital birth to clients. They explained that state regulations prevented centers from opening previously, and it was not until they were able to receive a Delivery Fund Grant were they able to explore the idea. The New Mexico Rural Health Care Delivery Fund is a state-funded proram that provides around $50 million in grants to support rural health care providers. Avent explained that because midwives are fairly integrated into the system, they are able to work within the system, rather than fight it.
Beyond birthing services, they will be offering full-spectrum reproductive, menopausal and gender-affirming care. Levingston Luna explained that the center will allow them to practice to the fullest extent of their practice. She shared that they keep asking themselves, “What else can we do? What else can we offer? Who else can we invite into this space to feel at home?”
Simultaneously, Ocotillo Reproductive and Wellness Center is preparing for its opening. Born out of a partnership between doulas, midwives, Planned Parenthood of the Rocky Mountains, Strong Families New Mexico, University of New Mexico Health Sciences Center and Bold Futures New Mexico, this Center will be the first of its kind. It was seeded with $10 million in funding from the Governor, and provides care that centralizes doulas and midwives from day one. Doulas will be available to patients for pregnancy-related services, but also for well woman care appointments, including those for sexually-transmitted infection (STI) testing and contraception.
However, this center is not designed to operate in a silo, rather as a partner to other providers and hospitals. Lopez-Sullivan described this as a revolutionary model of care.
“We just don’t have enough gynecologic care, sexual health care at all,” Lopez-Sullivan explained. “So this will be a really different, exciting, new model of care that really centers both the patients and the providers. We’ve spent these years negotiating, what does it look like to provide care together?”
Integrated models of care are rising as the future of reproductive care in the nation, particularly for rural communities, and provide multidisciplinary support for diverse populations. New Mexico’s providers are paving the way for the nation and proving that care can be decided from the bottom, up. These birth centers are risky, with the average lifespan teetering around three to five years. Their longevity requires sustained support and investment. With each birth center door that closes, so does an option of care for those going through labor.
“How you treat pregnant people in pregnancy, during birth and that newborn period says a lot about the health of your community and the health of your wider healthcare and country landscape,” Lanin Evans said.. “That’s why if we don’t support community centers in opening, more people are going to die.”