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Government investment in doulas could improve Black maternal health outcomes


Black women are more than three times as likely to die from pregnancy-related complications as White women. Doulas are one way to improve these outcomes for Black women.

Government funding to support the development of and access to doulas could help improve poor maternal outcomes for people of color, according to a Health Affairs Forefront article.

Doulas are professionals trained to provide essential emotional and physical support during pregnancy, childbirth, and the postpartum period. Doulas could offer much-needed support to improve the health of Black and Brown mothers, an area of increasing focus of President Joe Biden's administration.

Black women experience worse maternal health outcomes compared to White women. According to a 2022 CDC report on U.S. maternal mortality rates for 2020, the maternal mortality rate for non-Hispanic Black women was 55.3 deaths per 100,000 live births. This rate was 2.9 times the rate for non-Hispanic white women.

Regardless of income and education, Black women are more than three times as likely to die from pregnancy-related complications as White women, according to President Biden.

In April 2021, Biden officially recognized Black Maternal Health Week to raise awareness for the crisis of Black maternal mortality and morbidity.

The Biden administration has collaborated with U.S. departments to develop actions to address maternal health, including a $4.5 million investment in doulas, who have a historical significance in communities of color, Ashlei Spivey, founder of I Be Black Girl, and Elizabeth Barajas-Román, CEO of the Women’s Funding Network, wrote in their article for Health Affairs Forefront.

According to the Health Affairs article, doula support has multiple positive impacts on mothers.

Mothers assisted by doulas were four times less likely to have a low birthweight baby. The likelihood of experiencing a birth complication for the mother or baby was also reduced for doula-assisted mothers. Additionally, doula-assisted mothers had 22% lower odds of preterm birth, according to research from the University of Minnesota School of Public Health.

That same research suggested that doula support reduces stress; improves nutrition, health literacy, and emotional well-being; and provides referrals and resources. All of these factors can reduce the risk of preterm birth.

The U.S. Department of Health and Human Services (HHS) reports that “women who receive continuous support during childbirth from both health care professionals and doulas are more likely to have spontaneous vaginal birth, shorter labor duration, and are less likely to need a cesarean birth.”

Doulas also serve as advocates in ways that reduce contributing factors of maternal mortality and morbidity in healthcare settings, particularly for Black women. Doulas also assist mothers in understanding their options and making decisions regarding the execution of their birthing plans.

Despite the benefits of doulas, a substantial portion of women cannot access doulas due to costs and insufficient skills to meet demand.

Not all insurance companies cover the cost of doulas. Oregon, New Jersey, and Minnesota are the only three states that cover doula services for women enrolled in Medicaid. Out-of-pocket costs are often cost prohibitive for women in need. Some nonprofits and cities have created initiatives to increase affordable access to doulas, but access is still limited nationally.

Furthermore, there are not enough trained doulas to meet the demand for their services. Additional training and resources could expand the workforce.

Federal and state legislation to cover the costs of doula care would improve access to doula services and expand the profession, the authors of the Health Affairs article noted. These policies could directly address negative birth outcomes and improve the health outcomes for Black women.

HHS has allocated $4.5 million to invest in the hiring, training, certifying, and compensating of doulas. The funding will focus on community-based doulas in areas with high rates of adverse maternal and infant health outcomes.

This funding is part of the Health Resources and Services Administration’s (HRSA) Healthy Start Initiative, which aims to reduce racial and ethnic disparities in rates of infant deaths and adverse mental health outcomes. The total number of Healthy Start doula programs will increase from 25 to approximately 50 across the nation.

According to Health Resources and Services Administration Administrator Carole Johnson, HHS is “committed to improving Black maternal health and overcoming the social and structural inequities,” and investing in doulas is part of that commitment.

The funding initiative is only one of multiple actions intended to expand access to maternal care, reduce heath care costs, and drive down mortality.

Other actions announced by the Biden administration include the proposal of a “Birthing-Friendly” Hospital Designation and Maternal, Infant, and Early Childhood Home Visiting (MIECHV) Programs, among others.

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