The United States has one of the highest maternal mortality rates among developed nations. Black mothers, in particular, have a maternal mortality rate three to four times higher than White mothers (Zhang et. al). However, doula care can help reduce these disparities.
Doulas are non-clinical health care professionals who provide physical, emotional, and informational support before, during, and after delivery. They offer breathing techniques during labor, empower mothers to advocate for their health preferences, facilitate communication between care providers, and provide breastfeeding assistance (Health Affairs).
However, not many birthing mothers use doulas. As of 2015, only 6% of them received doula care (Health Affairs). This could be because of a lack of awareness of doula services and their lack of recognition in Medicare coverage in some states meaning that they cost a high out-of-pocket expense. Because of this, more likely for affluent, white mothers to use doulas.
But, increasing doula services can play a key role in improving maternal health equity. By supporting mothers to advocate for their personal preferences, doulas can help combat institutional racism that occurs in larger, hospital contexts. They can provide mothers with information to help inform their own health decisions. Within BIPOC communities, doulas can be a source of trust where distrust in the traditional medical system is common due to either generational or first-hand racism from healthcare providers. Doulas of color can also be able to connect to mothers from their own racial, ethnic, and cultural communities, establishing a sense of trust and comfort during the childbearing process.
Including doula services as a part of Medicaid coverage can be a large step toward maternal health equity. Medicaid programs could cover prenatal, labor and delivery, and postpartum doula care, extending to the full postpartum year. Potential federal policy strategies to achieve this goal include Congress designating doula care as a mandated Medicaid benefit. Although ambitious, a national policy would be able to serve all communities of color, as some Medicaid benefits vary from state to state. These efforts would encourage meaningful access and better birth outcomes specifically for communities of color.