A growing body of evidence underscores the value of birth work in combating our nation’s worsening maternal health crisis. According to Harvard Health, a 2023 analysis found that doula support was linked with better birth outcomes, such as fewer c-sections and premature deliveries, and shorter length of labor. Additionally, researchers found that the emotional support provided by doulas was associated with less anxiety and stress in birthing people. It is important to note that the scope of doulas’ impact is not limited to the event of birthing alone. Among low-income women, doula support was shown to improve breastfeeding success. In a historic effort, Senator Samra G. Brouk and New York Governor Kathy Hochul joined forces to heighten the accessibility of this valuable resource.
Not only did Hochul announce an $8 million investment towards improving maternal and infant health outcomes, but she also established a standing order to ensure access to prenatal care and doula services for birthing parents in need. It is important to note that New York City is among the places of highest need, as the city faces glaring racial disparities. From 2018 to 2020, New York State recorded a pregnancy-related mortality ratio of 18.5 deaths per 100,000 live births. Black non-Hispanic women experience maternal mortality at nine times the rate of their White counterparts, at the very least—unveiling deep racial inequities.
We observe disparities in New York among other lines. According to a Forbes report, research analyzing trends from 1969 to 2018 indicates that birthing people in impoverished and underserved areas have a greater risk of maternal mortality when compared to birthing people from affluent areas. The Bronx, which is the most impoverished county in New York City, has the highest maternal mortality rate, which aligns with this finding.
We must also account for another glaring reality in our analysis. The insulating nature of wealth does not shield Black women and birthing people from the pernicious effects of our current system. According to the same report by Forbes, a 2022 study found that the highest-income Black women experienced worse infant mortality rates than the poorest white women.
As we celebrate this historic feat, we should take time to commemorate the organizations, birth workers and advocates on the ground fighting for better realities for women and birthing people everywhere. Many efforts to establish equitable pay and optimal working conditions for birth workers have been led by organizations like Health Leads, the Maternal Health Quality Improvement Network (MHQIN), Healthy Start Brooklyn, and the New York Coalition for Doula Access (NYCDA). The NYCDA has been advocating for Medicaid reimbursement for doulas for over a decade, and in their efforts, have partnered with organizations like the Mama Glow Foundation to get to the finish line.
Their endeavors honor the reality that reimbursement alone is not enough. The NYCDA has been striving for an equitable reimbursement structure that adequately pays birth workers. The Medicaid reimbursement structure for New York State doulas they proposed last year was set at $1,930 per birth, including 8 prenatal or postpartum visits—making it the highest rate in the nation. The cost of living in New York is high. A family of four estimated monthly costs are $6,142, not inclusive of rent. A single person’s estimated monthly costs are $1,659, not including rent. We must consider the toll of high touch work on birth workers who are working with Medicaid populations and continue to advocate for higher pay.
As we strive to address disparities in maternal health outcomes and improve the United States’ maternal health landscape overall, this substantial effort kills two birds with one stone. Not only is ensuring free doula access in alignment with the overarching principle of providing superlative care to those of highest need, but it also addresses the longstanding issue of birth worker burnout, which is partially attributable to suboptimal working conditions and low pay. New York state is setting a promising example. If we are to see large scale changes in the future, then policymakers, healthcare providers, and communities in other regions of the United States must follow suit.
