Prioritize Doulas In Black And Brown Communities

Recent data from the Centers for Disease Control and Prevention continues to tell the same bleak story we’ve been hearing for years: Black women suffer far worse maternal health outcomes than their White counterparts. The new figures released in a February 2022 report reveal that outcomes aren’t improving, despite growing public awareness of the issues Black mothers face. According to the report, in 2020, the maternal mortality rate for Black women was 55.3 deaths per 100,000 live births—nearly three times higher than the rate for White women. And what often gets missed from these statistics are the near-death experiences—according to one study, Black women are likely to experience a severe maternal morbidity event at a rate of 2.1 times that of White women.

We’ve been circling these same statistics for far too long. We don’t need any more data to tell us what’s happening because we have enough. What we need are solutions. It’s time we focus on how we’re going to make meaningful change for Black and Brown people as they give birth.

Actions For Meaningful Change

As the leaders of organizations that serve marginalized races and genders, we know the role policy can play in helping improve these outcomes. While the April White House proclamation for Black Maternal Health Week 2022 offered some solutions to improving maternal health outcomes, there’s more to be done.

One pathway to better outcomes is to invest in doulas, professionals who are trained to provide emotional and physical support during pregnancy, childbirth, and postpartum. Doulas have always been a part of communities of color, and they can step into a role that allows them to advocate for a mother at her most vulnerable. Of course, this isn’t to say that doulas can singlehandedly fix everything, and they shouldn’t be tasked with trying to. We still need to hold medical institutions accountable for their role in the current state of outcomes. Real lasting change will require us to examine every part of our health care and medical processes that touch a pregnant person both in and out of the delivery room—including the roles of clinicians from her dermatologist to her primary care doctor—to make sure long-held biases and stereotypes aren’t showing up during routine visits, both pre- and postpartum. This includes requiring implicit bias training, more patient feedback surveys and bedside data, early screenings for treatable health conditions, and extended postpartum coverage to a full year, to name a few.

That said, elevating the work of doulas is one part of the birthing process in which we can affect change immediately and in which we have research to show it makes a difference. In fact, one 2013 study found that doula-assisted mothers were four times less likely to have a low birthweight baby and two times less likely to experience a birth complication involving themselves or their baby. A separate 2016 study led by the University of Minnesota School of Public Health found that women with doula care had 22 percent lower odds of preterm birth. The study’s researchers theorize that “doula support during pregnancy may influence this constellation of risks for preterm birth by reducing stress, improving nutrition, improving health literacy, providing referrals and connections to resources, and improving emotional well-being.”

Plus, doulas can serve as a point of checks and balances to hold medical institutions accountable. They provide power and choice to a birthing person to ensure their birthing plan is executed. And when that plan cannot be executed as envisioned, doulas ensure patients understand their options and make an informed decision about their individual best course of action.

Despite the positive impact doulas can have and their growing popularity, not everyone who wants a doula currently has access to one. The reasons for this are often twofold: Not all insurance carriers cover the costs of doulas, so expectant parents have to pay out of pocket, which can be cost prohibitive. The other factor is that there simply aren’t enough trained doulas to service women in need. Numbers vary state to state, but many programs highlight the need for more training to expand the doula workforce.

In 2017, one of us, Spivey, founded I Be Black Girl (IBBG), an Omaha, Nebraska-based nonprofit that serves as a collective for Black women, femmes, and girls to actualize their full potential to authentically be, through autonomy, abundance, and liberation.

With $715,000 in new funding, we’re launching the Doula Access Fund in August 2022 to cover the costs of doulas in Nebraska in an effort to help improve outcomes for local mothers and birthing people as well as building a doula pipeline program to increase the capacity of available practitioners. We believe every birthing person should be matched with a doula of their choice, to be paid for by the fund along with copayments and lactation consultants if a parent needs it. The goal is simple: Remove financial barriers that stand in the way of better, more comprehensive care.

IBBG is only one example of a local group’s effort to close the gap that many states have yet to address. Nebraska Medicaid, for instance, doesn’t reimburse doulas at all. And only three states—Oregon, New Jersey, and Minnesota—cover doula services for pregnant women enrolled in Medicaid (in New Jersey, this applies to members of their federal- and state-funded health insurance program, NJ FamilyCare). New York City just announced the launch of its Citywide Doula Initiative to provide mothers with free access to doulas with a focus on neighborhoods with the greatest social needs. The initiative aims to train 50 doulas and reach 500 families by the end of June.

Although these individual state and city efforts are important, federal policies are critical to ensuring expectant parents no longer have to pay out of pocket or rely on doulas who volunteer their time or go without this critical piece of labor health care. We need to pass legislation at the state and federal levels that will cover doula care, so doulas can be properly reimbursed at a rate that allows them to thrive and the profession to expand in ways that increase access. Once we can allocate state dollars in Nebraska’s budget to cover this via Medicaid, we’ll start to see more sweeping adoption of doula care and, as a result, better birth outcomes.

Ultimately, if we truly want to support Black women and help reverse unacceptably poor maternal health outcomes for people of color, prioritizing doula care is one policy action we should all be able to get behind. We have to trust Black women and birthing folks to lead. Because they are the closest to this crisis and have seen the benefit of evidence-based policies they know what will work.