Our nation is in the throes of a maternal health crisis. Not only does the United States have one of the highest rates of maternal mortality among more-developed countries, but it also has a biomedical system that often unveils, and in some cases reproduces, existing racial inequity. Black birthing people are three to four times more likely to die from pregnancy-related complications than their white counterparts. Unfortunately, this gap is only a baseline. In our nation’s hardest hit regions, the disparity is more pronounced. Among these regions is New York State, where Black birthing people are eight times more likely than white birthing people to die of a pregnancy-related cause.
Fortunately, New York’s officeholders and policymakers are making maternal health a priority. This past Thursday, the New York State Senate voted on the One-house budget, which, thanks to the tireless efforts of the New York Coalition for Doula Access (NYCDA), includes Medicaid Reimbursement for doula services at a rate of $1,930 and $10 million of budget appropriations. Established in 2011, the NYCDA has been advocating for Medicaid reimbursement for doulas for over a decade.
Reimbursement alone is not enough. The NYCDA has been striving for an equitable reimbursement structure that adequately pays birth workers. Today, the Medicaid reimbursement structure for New York State doulas is set at $1,930 per birth, including 8 prenatal or postpartum visits—making it the highest rate in the nation.
This investment will enable the state to not only address maternal health conditions, but also bridge racial gaps in maternal health outcomes. Research indicates that doulas positively impact maternal and infant health conditions and experiences. Their empowering roles can connect birthing people with tools and resources to support healthy pregnancies and birthing experiences. Additionally, they can also address the role of implicit bias at the source by supporting patient preferences, needs, and concerns in clinical settings where patients’ voices, unfortunately, are not always honored. People who have the support of a doula are less likely to need a cesarean section or have a preterm delivery. Additionally, they are better able to manage the symptoms of postpartum depression.
The consequences of inaction in the sphere of maternal health have been highly visible in New York. The deaths of Sha-Asia Washington at the hands of a physician at a Brooklyn hospital; Amber Rose Isaac, who died during a C-section at Montefiore Medical Center; and Cordielle Street, who died after experiencing complications a week after giving birth, all highlight a devastating, yet preventable, trend that requires intentional effort on the part of policymakers.
This is a historic win for the coalition and birthing people of all backgrounds in New York State, and it is an approach that underscores the necessity of working at the margins. It is a historic win for low-income Black and Indigenous birthing people, whose racial and financial backgrounds often thwart their efforts at accessing quality maternity care. It is a historic win for birth workers, who face high rates of burnout because of pay rates that are incommensurate with the nature of the work. New York State’s investment is a major step in making doula care more accessible to birthing people and more sustainable for our invaluable birth workers in the fight against maternal mortality. It is our hope that other states follow suit to improve maternal health outcomes across the nation.