(see Poster Gallery) Doulas: A Possible Solution to Birth Inequities Among Families of Color

It has been widely documented that in the U.S. families of color face birth inequities such as higher maternal mortality, infant mortality, and low birth weight. Despite this, few solutions to this disparity have been offered. The utilization of doulas, birth workers who provide care during pregnancy, birth, and postnatally, has been correlated with better birth outcomes such as shortened labor, fewer caesarian sections, and reductions in birth complications. These findings suggest that doulas services, which have often been seen as being for white women, could play an important role in reducing birth inequities for women/birthing people of color.

This paper adds to nascent literature about the experiences of practicing doulas who identify as women of color and primarily work with women of color. We sought to learn more about the experiences of doulas including their pathways to birth work, engaging communities of color, and about doulas’ experiences working with women of color, including successes, such as methods of enhancing engagement, and barriers to care.

Methods

Two semi-structured focus groups, with ten practicing doulas, were conducted. All of the participants reported being women, 70% were African-American/Black, and 30% were other (non-white) races/ethnicities. Most of the doulas (80%) had been practicing for 3 years or less. Participants, who were also part of a larger project on incorporating doula services into a state program, received an email invitation to join the focus groups and were offered a $50 gift card incentive. Focus groups were transcribed verbatim and utilizing an inductive approach rooted in grounded theory the transcripts were thematically coded using NVivo 12.

Results

Several salient themes emerged. Doulas described a variety of pathways to becoming doulas such as long-standing interest in birth work and a desire to help ameliorate the birth disparities faced by women of color. Participants talked about the importance of doula training that emphasizes race/ethnicity and birth disparities. They also indicated a strong passion for their work because of the difference they can make for families in their communities, and that being of a shared community allowed them to establish trust with families. Doulas further discussed how racism in medical settings is a hurdle for providing care. Findings suggest that doulas see themselves as providing invaluable care that can lead to better birth outcomes.

Conclusions and Implications

This qualitative study adds to emerging literature on the potential role that doulas have to help improve birth disparities for families of color. Doulas in this study not only see themselves as helping families, but as being positioned to provide life-saving support. They indicated that comprehensive training and shared community can help doulas provide care while facing issues like medical racism. The implications for policy, practice, and research are far-reaching. Policies that allow doula services to be included in medical coverage could increase access substantially, and social work practitioners can advocate for doula services when working with pregnant women/birthing people. Moreover, further research on the role of doulas could begin to offer solutions to birth disparities for families of color.