Doulas Can Improve Maternal Health Yet Are Out of Reach for Most

The National Partnership for Women & Families, in collaboration with HealthConnect One, the National Health Law Program, and Tewa Women United, released today a new report, Improving Our Maternity Care Now Through Doula Support, highlighting how doula support can make a critical difference in improving outcomes for pregnant and birthing people and their babies. As the maternal health crisis continues to escalate — especially in communities of color — this analysis underscores how important doulas could be as part of the solution — a solution that an increasing number of birthing families are eager to access, if only doulas were available and affordable. The report includes a map that shows where doula support services are available by state.

This analysis found that doula support — which often includes helping pregnant people prepare for labor and delivery, providing support during the birthing process, and advocating for them with medical professionals–offers a range of benefits to childbearing families. Doula support during birth decreases cesarean births, reduces the use of pain medication, and increases birthing peoples’ satisfaction with their childbirth experience. Parents who received an extended model of doula support throughout pregnancy and into postpartum, are less likely to have preterm birth and low birth weight babies, and more likely to initiate breastfeeding, which has enormous long-term health benefits for both baby and mom. Moreover, doula support, when provided by culturally congruent practitioners, can be a powerful tool in fighting the racial bias birthing people of color often face in medical settings as well as for mitigating the effects of structural racism.

Despite the accumulating evidence of the value of doula support in producing measurable improvements in the health and wellbeing of birthing families, and their increasing desire to include doulas in their birthing teams, doula services are out of reach for most. There are not enough doulas, and even when they are available, they are far from affordable, because most health insurance will not cover them. To help address this mismatch, the report provides recommendations for key decisionmakers to support and increase access to doula services.

The National Partnership's Vice President for Health Justice, Sinsi Hernández-Cancio, hailed doula support as an invaluable tool for tackling our nation’s maternal health crisis. "The risk of dying from pregnancy and childbirth in the US continues to escalate, as well as the odds of near-fatal complications that can have long-term effects on the mom and family. These odds are even worse for Black, Indigenous and other People of Color. Doulas provide sorely needed emotional support and reinforcement for pregnant people in a maternity care system riddled with inequities that have been further exacerbated by the ongoing COVID pandemic. Furthermore, following the Supreme Court’s overturning of Roe v. Wade, many childbearing people are faced with acute needs for safety, support, and well-being — lending further urgency to increased access to the services that doulas provide from pregnancy onward.”

Twylla Dillion, PhD, HealthConnect One Executive Director said, “Community based doula support is a vital tool in mitigating the harm caused by racism that is deeply embedded in health care and other systems impacting pregnant and postpartum people. Accessible doula support, covered by public and private insurance, must become the norm to support healthy births for Black, Latinx, Native, and immigrant communities.”

"As Medicaid advocates who have been working on expanding access to doula care, we are thrilled about the publication of this report. It combines the expertise of four organizations and leading doulas for a comprehensive look at doula care in the United States," said Amy Chen, senior attorney at the National Health Law Program. "In particular, we are proud that the report incorporates many of the prominent lessons learned regarding implementing Medicaid doula programs as found in NHeLP's Doula Medicaid Project. As more states implement doula programs, the experiences of doulas, advocates, and pregnant individuals will be invaluable if we hope to have equitable access to doula care for all people in all parts of the country."

Corrine Sanchez, PhD, of Tewa Women United, added, “We know the positive impact that culturally — rooted, community-based doula programs have on the health and well-being of families and communities. We’ve witnessed these benefits during the 14 years that our Yiya Vi Kagingdi Doula Project has been serving our communities. This report uplifts the experience and expertise of organizations and practitioners in this ever growing landscape. There remains a critical need for culturally congruent doulas and doula programs in this country, especially for and in rural and tribal communities. We hope this report helps to leverage support and encourages continued investment for doula care in every community. Doula care is community care.

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About the National Partnership

The National Partnership for Women & Families is a nonprofit, nonpartisan advocacy group dedicated to promoting fairness in the workplace, reproductive health and rights, access to quality, affordable health care and policies that help all people meet the dual demands of work and family. More information is available at NationalPartnership.org.

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