How Doulas Can Help Improve Birth Equity

Black women in the United States face significant disparities in maternal health, and calls for additional support and changes to existing models of care could provide much needed relief. One way to help address the Black maternal health crisis is through investing in doula care. Doulas are trained professionals who can help support pregnant people during pregnancy and even throughout the postpartum period in major ways. Equipped to provide physical and emotional support before, during, and after labor, here’s why investing in doula care can increase patient access to care and improve birth equity overall.

The current state of Black maternal health

According to a recent report by the CDC, maternal mortality rates have been rising overall in the U.S. from 2018-2021. Even more disturbing are the racial disparities that persist – approximately 30% of Black, Hispanic, and multiracial mothers reported experiencing mistreatment during maternity care, and 40% of these same groups reported discrimination. Additionally, Black women are three times more likely to die from maternity related complications and experience disproportionately worse maternal and infant health outcomes than other racial/ethic groups. There are several factors that contribute to these disparities: dismissal of pain by providers, limited access to quality care, and higher rates of chronic health conditions, among others. Studies show that Black mothers are twice as likely to report being ignored by the healthcare system in regards to their concerns over pain and other symptoms. This dismissal can have devastating consequences, leading to missed opportunities for treatment and prevention. The high maternal mortality rates for Black women highlight the need for better care and support throughout the childbirth process.

The impact of doulas

For Black women and other women of color, doulas can play an especially important role in bridging gaps in care and providing essential physical and emotional support. Doulas can help the mother’s voice be heard before, during and after childbirth and provide support so that their specific needs are being met. Studies show that mothers matched with a doula have significantly better birth outcomes compared to those without doula support. Doula-assisted mothers are:

• Four times less likely to have a low-birth-weight baby
• Two times less likely to experience a birth complication
• Significantly more likely to initiate breastfeeding

Black families often are inequitably supported, included, or prioritized in decisions about their own health and wellbeing, showing the need for new solutions that are grounded in social support and center community perspectives and values. As Dr. Joia Crear-Perry, Founder and President of RH Impact (formerly the National Birth Equity Collaborative) explains, doulas are so successful because they provide social support that many pregnant women lack, particularly those underserved by the healthcare system. Doulas can also help combat issues like medical gaslighting that disproportionately impact women of color. By having an advocate present, patients are more likely to have their voices heard rather than dismissed. Additionally, through extending the provider network through doula support, patients are more likely to receive racially concordant care which improves outcomes.

This extended support from conception through postpartum facilitates a deeper relationship and understanding of the birthing parent’s needs while also promoting the health and safety of both mother and child. Their inclusion before, during, and after childbirth is a step towards more equitable care and better outcomes.

What health plans can do

Here are some steps health plans can take to improve birth equity:

1. Increase access to doulas and community care networks

Covering doula services provides wider access for marginalized groups who are at higher risk for complications. Developing care networks centered on community health workers, doulas, midwives, and lactation consultants is also a critical step towards improving health outcomes for your entire population.

If covering the cost of doulas is too large of a hurdle, providing access to peer care providers who have shared experiences with patients is an impactful first step. For example, in addition to being registered nurses, many Ovia Health coaches are mothers from diverse backgrounds who often share their personal experiences with members to create deeper connections and facilitate the best possible care.

2. Implement a Respectful Maternity Care Framework

What is a respectful maternity care framework? It’s a theoretical framework based on the birth experiences of Black mothers to inform the ways hospitals and health systems can better provide respectful, affirming care to pregnant people throughout their maternity care. This framework complements existing provider educational tools and promotes anti-racist and birth equity practices, such as shared decision making.

To learn more about this framework, check out the Respectful Maternity Care Framework guidelines
interview we did with RH Impact (formerly the National Birth Equity Collaborative).

3. Invest in preventative, personalized digital health solutions

At Ovia, we offer a platform that supports the full spectrum of women’s and family health, serving as an essential companion to help improve health outcomes and support equitable family journeys. Investing in end-to-end digital solutions that deliver 1:1 connections with care experts improves health literacy and self-advocacy, supporting individuals who might otherwise be anxious to discuss issues with their providers or feel dismissed by them. A 2023 survey of Ovia members found that those who interacted with the Care Team were more likely to report taking control of their health. For example, compared to Ovia users who did not engage with the Care team, members who did reported they were:

• 270% more likely to report that Ovia Health helped them answer a pressing health question
• 79% more likely to report that Ovia Health helped them self-identify a health
  condition/symptom
• 136% more likely to report that Ovia Health encouraged them to reach out to their provider
• 36% more likely to use employer/health benefits

Solutions that leverage patient-reported data can provide early identification of rising risks and alert individuals to seek care when they need it. Digital health solutions like Ovia can empower coaches with these insights to also ask critical questions of members and equip individuals to advocate for themselves when it comes to their health. Our focus on prevention, backed by human-centered guidance, isn’t just meant for one moment in a member’s life. It helps members from preconception through menopause.

With Black mothers facing disproportionately worse outcomes, action must be taken to provide better care and support. As studies show, doulas play a key role in improving birth equity and overall maternal outcomes. Health plans have an opportunity to be part of the solution by increasing access to doulas throughout the pregnancy and postpartum journey, promoting respectful maternity care practices, and investing in preventative digital health solutions. With coordinated efforts combining these actions, we can work to improve maternal health for all.

To learn more about the work Ovia does to support Black maternal health and what your organization can do, schedule a demo with a member of our health plan team.