Advancing Birth Justice: Community-Based Doula Models as a Standard of Care for Ending Racial Disparities

This report published by Every Mother Counts discusses doula care, which includes non-clinical emotional, physical, and informational support before, during, and after labor and childbirth. Doula care is covered by state Medicaid fee-for-service plans, managed care organizations, or both, in some states. This report highlights that doula care improves childbirth outcomes, increases quality of care, and can achieve cost savings by avoiding unnecessary medical procedures and complications. It also reduces rates of cesarean deliveries, prematurity and illness in newborns, and the likelihood of postpartum depression, but doula care services are largely underutilized in the United States largely due to barriers of access and cost. This report uses New York State as a case study for demonstrating the ways in which community-based doula programs have been strategically implemented to serve families at the highest risk for poor maternal and infant health outcomes. Community-led doula services, as seen in New York, can increase human rights and reproductive justice principles and can be expanded across the United States as a way to address the maternal health crisis. The report makes seven key recommendations for states planning to provide coverage of doula care: adjust reimbursement rates, collaborate with community-based programs, support best practices, develop a comprehensive approach to wellness, provide funds to train and certify a diverse doula workforce, incorporate community engagement, and take active steps to raise awareness about doulas.