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accessHealthNews.net
May 2023
Volume 9 | Issue No. 70
B
irth doulas play a vital role in improving pregnancy and
birth outcomes, especially for birthing people of color, by
advocating for and empowering their patients. Birth Doulas
Addressing Systemic Racism in Underserved Communities,
a webinar from the Health Workforce Technical Assistance
Center (HWTAC), explored recent studies detailing the
essential role of birth doulas in improving perinatal health
disparities and ideas for supporting doulas through the
expansion of services and system-level changes.
The webinar featured Paula Kett, Ph.D., MPH, BSN, IBCL
and Grace Guenther, MPA -- two research scientists for
the Center for Health Workforce Studies at the University of
Washington. The discussion also included Amy Chen, J.D.,
a senior attorney for the National Health Law Program who
oversees the Doula Medicaid Project, which launched in
2019.
Racism Drives Maternal Health Disparities
Significant health disparities exist in birth outcomes in
the U.S. with maternal mortality rates typically two to
three times higher among Black, Brown, and Indigenous
people compared to white populations. According to
Guenther, stress associated with exposure to racism is a
major underlying factor in these disparities, contributing
to higher rates of preterm births and low birth weight in
infants, depression and PTSD in birthing parents, and lower
odds of breastfeeding.
Patients of color specifically have reported greater
instances of delayed care, gaps in communication with
providers, shorter encounters with their providers, and
extended wait times for appointments, compared to
white patients.
Birth doulas, particularly doulas who can address and
relate to the effects of structural racism on pregnant and
birthing people, are proven to have a positive impact
on birth outcomes by helping decrease maternal stress,
reduce rates of C-sections and unnecessary interventions,
and increase overall satisfaction with the birth experience.
"Having access to doulas who understand and have
experienced the effects of systemic racism increases the
patient's trust and engagement with care and strengthens
their agency and decision-making processes," Guenther
said. This trust then builds a foundation for patients to be
more transparent about their health history, needs, and
concerns, thus better informing doulas on how to provide
support most effectively.
Though research shows doulas are effective in improving
birth outcomes, policymakers are still in the dark regarding
how to expand access to doula services due to two major
challenges:
• Identifying how to best provide training and
compensation support for doulas working in
underserved communities.
• Providing doula training that is specific to the needs of
underserved communities, to replace current training
that has historically focused on the experiences of
upper-class white women..
"The solution to the underlying racism that plagues America's maternal
health care system can't simply be throwing doulas at the problem. As we do
this work, we have to remember this and continue to work in other ways to
seek out and eradicate racism in all its forms."
- Amy Chen, J.D., Senior Attorney for the National Health Law Program
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