Welcome to an important conversation about doula care, equity, and the systemic issues that affect access to these essential services. Doulas play a vital role in providing physical, emotional, and informational support to birthing individuals and their families during pregnancy, labor, and the postpartum period. However, disparities in access to doula care persist, often disproportionately affecting marginalized communities. In this blog, we’ll delve into some of the systemic barriers that hinder equitable access to doula services and explore potential solutions to address these issues.

Doula Care: A Transformative Support System

Doulas are people who offer continuous, non-medical support to birthing individuals. Their presence can have a profound impact on the birthing experience, leading to reduced interventions, improved satisfaction, and positive birth outcomes. (SOURCE: National Library of Medicine, SOURCE: DONA International, SOURCE: Evidence Based Birth) Yet, despite the significant benefits, access to doula care remains limited for many, particularly those facing systemic barriers.

The Barriers to Hiring a Doula

Postpartum Essentials - a line art drawing of a baby being cradled with a parent's hand on their head with a very light pink background with peach water color circles and gold glitter accents

1.  Cost and Financial Barriers: One of the most significant barriers to doula care is the cost. Many doula services are not covered by insurance, and the out-of-pocket expense can be prohibitive. This financial barrier disproportionately affects low-income individuals and communities, often making doula care a privilege rather than a right.

Solution: Advocate for insurance coverage for doula services and explore community-based doula programs that provide low-cost or free support. Additionally, consider crowdfunding or seeking grants that can help cover doula fees for those in need. Washington will start allowing doulas to apply to become eligible to accept Medicaid October 1, 2023. Open Arms Perinatal Services provides free perinatal services including access to doulas in the Seattle area.

2.  Racial Disparities: Racial disparities in maternal and infant health outcomes persist in the United States, with Black individuals experiencing higher rates of maternal mortality and morbidity. Access to doula care can help mitigate these disparities, but racial bias often limits access to these services.

Solution: Support efforts to increase the representation of doulas of color and culturally competent doula care. Advocate for anti-racist practices within healthcare systems, including diversity training for healthcare providers and administrators. 

3.  Lack of Awareness and Education: Many individuals are unaware of the benefits of doula care or don’t fully understand what doulas do. This lack of awareness can lead to underutilization of doula services, particularly among those who could benefit the most.

Solution: Increase education and awareness about the role of doulas in childbirth and advocate for informed choice in maternity care. Community workshops, informative websites, and partnerships with healthcare providers can help disseminate information about doula care.

Geographic Disparities: Access to doula care can be limited in rural or underserved areas where there is a shortage of doula practitioners. This geographic barrier can leave individuals in these regions without access to critical support.

Solution: Promote doula training programs and incentives for doulas to work in underserved areas. Telehealth options for doula support can also bridge the gap in remote areas, ensuring that no one is left without access to care.

Cultural and Language Barriers: Cultural and language barriers can deter individuals from seeking doula care, as they may fear a lack of understanding or cultural insensitivity from their doula.

Solution: Encourage diversity in the doula workforce and support cultural competency training. Promote doula services that are available in multiple languages and ensure that doula practitioners are well-versed in addressing the unique needs of diverse communities.

Exclusiveness of Doula Certification: The exclusiveness of doula certification can be a systemic barrier in itself. Some certification programs can be costly and time-consuming, creating a barrier for individuals who may not have the resources to undergo formal training. The emphasis on certification can also perpetuate a white supremacist characteristic of valuing certificates over lived experience and cultural competency.

Example: Many aspiring doulas face the challenge of having to choose between pursuing a costly certification or providing support based on their lived experience and cultural competence. This emphasis on certification may exclude individuals from underserved communities who have valuable knowledge and skills but lack formal certification.

Solution: Understanding that when you hire a doula, a certification is not the end all be all (see our blog here for more information about doula certification).

A Call for Equity

Equitable access to doula care is not just a matter of convenience; it’s a matter of human rights and social justice. Here are some steps we can take as individuals and communities to address these systemic barriers and promote doula care as an inclusive and essential component of maternity care:

Support Advocacy Efforts

Advocate for policies and initiatives that promote doula care as an essential service and push for insurance coverage to make it more accessible to all individuals, regardless of their economic status. Join or support organizations that work toward these goals. Washington is on their way thanks to the efforts of the Queer, Trans, Black, Indigenous, and People of Color-led Doulas for All Coalition.

Fund Community-Based Doula Programs

Invest in community-based doula programs that focus on serving marginalized communities. These programs often provide low-cost or free doula support to individuals who may not otherwise have access. Donate to or volunteer with these organizations to amplify their impact.

Educate and Raise Awareness

Educate yourself and others about the benefits of doula care. Share information within your community and with expectant parents to raise awareness of the positive impact doulas can have on birth experiences. Consider hosting information sessions or workshops in your local community to reach those who may not have easy access to information.

Support Diverse Doula Practitioners

Promote diversity within the doula workforce by supporting training and mentorship programs for individuals from underrepresented communities. Encourage and celebrate doulas of color and those from various cultural backgrounds. Advocate for equitable pay and recognition for all doula practitioners.

Advocate for Anti-Racist Healthcare

Demand anti-racist practices within healthcare systems to address

Postpartum Essentials - a line art drawing of a mother and father cradling each other and a newborn on the father's shoulder with a beige background with green water color circle and gold glitter accents

the racial disparities that affect maternal and infant health outcomes. Advocate for culturally competent care for all individuals, including mandatory training for healthcare providers, equitable access to care, and the dismantling of systemic racism within healthcare institutions.

Access to doula care is a critical component of equitable and respectful maternity care. By addressing the systemic barriers that hinder access to these services, we can work toward a more just and compassionate healthcare system where every birthing individual has the opportunity to receive the support they deserve. Doula care is not a luxury; it is a human right, and it’s time we ensure it’s accessible to all. Let’s stand together to dismantle these barriers and create a more inclusive and equitable maternity care landscape for everyone.