Advancing Birth Equity Through Expansion of Doula Care
Special Projects Fund
September 25, 2023
Nationally, Black women are three times more likely to die from pregnancy-related causes than white women; in New York State, they are five times more likely.
Most maternal deaths and complications are preventable, but they stem from a mix of complex factors, including bias and structural racism. Doulas have emerged as an innovative strategy to address inequities for birthing parents. Doulas are trained childbirth professionals who provide physical, emotional, and informational support during and after pregnancy. Use of doulas is associated with lower rates of preterm birth, low birthweight, and postpartum depression. Despite these benefits, doulas are underused, and people of color and with low incomes have limited access to them. One reason is that New York’s Medicaid program—which covers more than half of births in New York State—has historically not covered doula services. However, the New York State FY24 budget expanded Medicaid coverage for doula services for all pregnant and birthing people through 12 months postpartum, along with increased reimbursement rates. While this is a promising development, the State must take numerous steps to implement the coverage expansion effectively. In 2023, NYHealth awarded Health Leads a grant to promote broader use of doulas across New York State through effective implementation of the Medicaid coverage expansion for doula care and by establishing a set of standards for a statewide doula-friendly hospital designation.
Under this grant, Health Leads will educate providers, payors, patients, and doulas about the State’s new Medicaid benefit and hold regular coalition meetings with the New York State Department of Health. Health Leads will train community-based doula organizations to meet enrollment requirements of State-approved Medicaid providers, to bill for doula services, and to create systems to integrate doulas into care teams. Additionally, Health Leads will work with coalition members to create standards for a doula-friendly hospital designation. Standards will cover criteria such as laboring techniques that support doulas, systems to track patients’ birthing experiences, staff training about a doula’s role, and referral systems. It will identify a hospital that has already developed initial doula standards to pilot the model. Health Leads will also create a compendium of resources and share best practices to help foster the adoption of doula care. Lastly, Health Leads will partner with Columbia University to track the project’s impact.