Welcome to another episode of Relocalizing Health! This week, Dave Chase sits down with Allison Duncan, founder of Anau and architect of transformative maternal health models, to explore why the current U.S. maternity system is failing women by design and how we can radically improve it. From her eye-opening journey mapping world-class maternal care in Brazil to building community-driven solutions in Pickens County, South Carolina, Allison Duncan shares powerful insights about the cost, human toll, and missed opportunities in our current system. Together, they discuss how integrating social care with clinical support, rethinking payment structures, and harnessing local leadership can revolutionize birth outcomes and create brighter futures for mothers, babies, and communities everywhere. If you care about the future of healthcare and want to learn what it takes to reclaim maternal health from the ground up, you won’t want to miss this conversation!
Timestamps:
00:00 Exploring maternal care issues
07:15 Challenges in Indigenous Maternal Healthcare
09:17 Innovative maternity care in Brazil
11:55 Rising Risks in Pregnancy and Birth
16:51 Addressing maternal mortality causes
20:00 Cost of NICU and preterm births
22:01 Reducing preterm birth costs
26:09 Finding a local design partner
27:55 Helping women achieve economic independence
33:37 Redesigning healthcare payment models
35:34 Introducing Strong Mama, Strong Babies
38:01 Issues in Payment Model
Transforming Maternity Care: Key Insights from "Relocalizing Health"
Understanding the Crisis in the U.S. Maternity System
In the latest episode of "Relocalizing Health," Allison Duncan, founder of Anau, joined host Dave Chase for a critical discussion on the current state of the U.S. maternity care system. The conversation opened with an eye-opening statistic: seventy percent of women report suffering a life-altering morbidity during pregnancy. Allison Duncan emphasized that this is not just a failing system but one failing by design. She highlighted the urgent need for change, as the U.S. consistently ranks fifty-fifth globally in maternal and infant mortality, despite being a developed nation. The root of this crisis lies in how healthcare is financed and delivered, with payers often dictating models focused more on addressing complications than on preventing them.
Lessons from High-Performing International Maternity Models
Looking for answers, Allison conducted a global search for effective maternity care systems. She found inspiration in Brazil at Hospital Sofia Feldman, which maintains a remarkably low C-section rate and specializes in high-risk pregnancies while actively supporting traditional midwives and indigenous communities. This hospital’s approach stands out because it humanizes birth, keeps care local, and fosters community outreach. She underscored the stark contrast with U.S. hospitals, where such community-centered care is rare.
What she found most surprising was the hospital’s commitment to supporting home births and working directly with vulnerable populations. Their model blended advanced clinical care with deep community involvement, resulting in outstanding health outcomes at significantly lower costs.
The U.S. Maternal Journey: Financial and Human Costs
The conversation shifted back to the United States, where Allison Duncan and Dave Chase examined the devastating financial and human costs associated with poor maternity outcomes. More than half of U.S. pregnancies are paid for by Medicaid, which often does not cover the full cost of care. This leads to cost shifting to employers and local buyers, increasing financial pressure across communities.
A single preterm birth can result in NICU stays costing tens of thousands of dollars per day. Allison pointed out that as preterm and high-risk births rise, so do the associated costs and long-term health consequences for both mothers and babies. Morbidity rates, untreated postpartum mental health issues, and increased prevalence of chronic conditions all burden families and healthcare systems alike.
Social Care: A Foundation for Healthier Outcomes
One of the episode’s pivotal insights was the importance of social care as the bedrock for improving maternal health. Most U.S. models prioritize clinical care with only minimal social support. Allison Duncan shared that successful international models invert this focus, placing social support first and integrating clinical care as needed.
Drawing from her work in Pickens County, South Carolina, Allison detailed a program at the Dream Center called "Strong Mamas Strong Babies." This initiative provides a thousand-day wraparound journey for pregnant women, addressing not just medical needs but housing, economic stability, mentorship, and community support. The model demonstrates that comprehensive social care can prevent adverse outcomes, reduce the need for expensive interventions, and enhance overall well-being for families.
Strategies for Local Transformation and Replication
Toward the close of the episode, Dave Chase and Allison Duncan discussed what makes a community a beacon for health innovation. The answer lies in visionary leadership, an uncompromising commitment to action, and the ability to build replicable, contractable community-support models. The Dream Center’s sustainability through local funding, volunteers, and donor support was highlighted as a powerful example.
Allison Duncan called on civic leaders, employers, and community members to acknowledge the brokenness of the current maternity system and to embark on specific, actionable projects for change. Attending gatherings like Rosetta Fest and exploring partnerships such as the sister county approach are essential first steps.
Conclusion
This "Relocalizing Health" episode offers a roadmap for revolutionizing maternity care, highlighting the need for prevention, community-driven approaches, and the integration of social and clinical support. By embracing common sense, compassion, and collaborative local efforts, communities across the country can drive down costs, uplift families, and set new standards in maternal health.
Learn More:
RosettaFest 2026 - https://rosettafest.org/
Health Rosetta - http://healthrosetta.org/
Nautilus - https://www.nautilushealth.org/
Kynexions - https://kynexions.com/
Dave Chase - https://www.linkedin.com/in/chasedave/
Podcast Website - https://relocalizinghealth.com/
Allison Duncan - https://www.linkedin.com/in/allisonduncan1/
Anau Inc. - http://anau.com/