How this United Way Coalition Improved Birth Outcomes by Listening to Mothers

How the United Way used an online course to better listen to community voices and foster collaboration.

January 04, 2015

After completing a Master's degree in economics and doing research on labor markets in southeast Asia, Elaina Mulé saw it as the “logical next step” to enter into a career in international development. However, while working with a charitable organization in her hometown of Buffalo, New York, she was confronted with the needs of the community where she grew up. “Birth outcomes in some of our neighborhoods in Buffalo were worse than some developing nations. This really gave me pause -- to realize that such significant problems existed in a place I called home,” she recalls. This led her to imagine how she might bring the innovative ideas she had encountered in her international work to the poverty in her own backyard, and pivot her career towards helping find solutions to local problems.

Shortly after transitioning into a full-time role at the local United Way in Buffalo, Elaina was introduced to the concept of Human-Centered Design (HCD) by her manager. “It was a new way of thinking after all my years of pure quantitative training, and the concepts really resonated with me,” she explains. She started imagining how HCD might be applied to United Way’s work as part of a coalition in the Buffalo area working on access to prenatal medical care for low-income high-risk pregnant women.

In a stroke of excellent timing, the United Way led coalition soon discovered (and won) a grant from the National Center for Mobility Management to fund their project using the principles of HCD. Now they had the funding and a team, but they needed a better understanding of how to use HCD to tackle this challenge; here’s where +Acumen came in.

"I discovered the +Acumen Human-Centered Design course online and we jumped into it as a team, realizing we could use our prenatal care access priority as our design challenge. This meant applying the concepts from the course to our next steps each week, with the expertise and guidance coming straight from +Acumen.”

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The team was diverse, made up of community health experts, regional transportation officials, financial partners, health insurance companies, and other community organizations. They began with the numbers: 30% of Buffalo women didn’t have prenatal care in the first trimester, mostly due to transportation barriers; Buffalo women were also ultimately 25% more likely to have premature babies than the average New York state mother, leading to an average $58,000 increase in health care costs in the first year (per premature birth).

Pregnant woman in front of clock trying to make her appointment


While everyone agreed the goal was to get mothers to every prenatal appointment, Elaina describes that early on each team member brought her own ideas about which solutions would work best. After the first few meetings, however, the team entered into the information-gathering stage of the course; this meant going into hospital clinics and prenatal networks to interview pregnant women.

“We started sharing our initial interviews and you could see that shift happening: people were starting to understand the challenges from the mothers’ perspective.” Elaina reflects on how difficult it would have been to effect that mindset change without the concepts they were learning in the +Acumen HCD course; particularly important was the emphasis on listening deeply to users, in this case the mothers in Buffalo.


Pregnant woman walking through snow in effort to make her prenatal screen

“We ran into a lot of people who assumed that women didn’t make it to their medical appointments because they simply didn’t care,” she recalls. These stereotypes were crushed early on in the course. Elaina still vividly remembers an interview the team conducted in a clinic waiting room on a freezing January day. “The pregnant woman we spoke to had just walked five miles through the snow, partially on highways and in just a thin jacket, because she was so committed to getting to her prenatal appointment and didn’t have the money to take a bus or get a taxi. Moments like that will never leave my mind, and nothing could have done more to dispel the stereotype that these mothers didn’t care about getting to their medical visits.”

Elaina and her team eventually rolled over their work into the +Acumen prototyping course as they continued to refine proposed solutions. These focused on affordability and access, and included a pilot for a transportation savings program (involving ride-sharing), as well as a ‘navigator’ system to ensure mothers would be paired up with a transport counselor from the very beginning of their pregnancies.

Because of this work, the coalition was held up as a leader amongst their cohort of Human-Centered Design grantees. They led webinars to explain how they were using HCD principles in their work, and were awarded additional grant money in order implement the program starting in May 2017 as well as to ensure that community voice would continue to inform further iterations of the program design.

“Human-Centered Design, and everything I learned in +Acumen courses, continues to provide the philosophy behind my work,” says Elaina, who now leads the Social Innovation and Collective Impact department at the United Way of Southern Nevada. Her focus is on building new evaluation and information systems that rely more heavily on community voice. “It’s impacted everything that I do,” she explains. “I come from a quantitative background where numbers were all that mattered to me. But now I understand how much human voice and collaboration matters, and that marrying those things with numbers can build the right solutions.”

1 United Way of Buffalo and Erie County is part of an international network of charitable organizations focusing on education, income, and health.

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