When it comes to the United States’ Black maternal mortality crisis, dismantling systemic racism is the ultimate solution. But until that happens, it’s becoming clear that policymakers increasingly see doulas as one immediate way to save lives.
New York mayor Eric Adams announced on March 23, a citywide doula program that will provide families access to free doula services.
Doulas are companions who provide physical, emotional, and informational support to birthing people throughout their pregnancy, birth, and postpartum. Research shows that doulas promote positive birth outcomes; such as decreasing the risk of cesarean section.
The Big Apple’s Citywide Doula Initiative will focus its offerings on 33 neighborhoods, including East Harlem, Bedford Stuyvesant, and Coney Island. The city’s Taskforce on Racial Inclusion & Equity identified these neighborhoods as most impacted by health and socioeconomic disparities.
Priority will be given to those eligible for Medicaid, giving birth for the first time, having previous traumatic birth experiences, having no other labor support, living in a shelter, being in foster care, or having a high-risk medical condition.
The initiative seeks to certify 70 uncertified doulas and train 50 community members in order to increase capacity toward its goal of reaching 500 families by the end of June.
“The root causes of racial disparities in maternal health are real, so it’s time we do right by every mother and every baby, no matter the color of their skin or the language they speak,” Mayor Adams said in a statement.
In New York City, Black women are nine times more likely to die of a pregnancy-related cause than white women.
The city’s step toward maternal mortality and morbidity prevention comes after several states announced doula coverage programs — including California, Minnesota, and Oregon.
Overall, the United States has the highest maternal mortality rate among the developed nations, with 23.8 deaths per 100,000 births. Black women, however, die at over twice the national rate.
Black women are nearly three times more likely to die from pregnancy-related causes than white women. The CDC reported 55.3 deaths among Black birthing people per 100,000 live births in 2020 — a disparity largely due to conditions caused by generations of systemic racism.
“Systemic racism should not be a New Yorker’s first experience upon coming into the world,” New York City Department of Health and Mental Hygiene Dr. Ashwin Vasan said about the introduction of The Citywide Doula Initiative. “The voices of midwives and doulas must be included in the work we are doing to lower the glaring inequities in complications from childbirth.”
New York City is also rolling out a Midwifery Initiative, which will allow the New York City Department of Health and Mental Hygiene to collect data on births and care with midwives — who have been known to also lower rates of cesarean births and unnecessary interventions. According to NYC.gov, pregnant people are also less likely to report disrespectful care when supported by midwives.
The program will also create partnerships with midwife organizations, private practices and community members, and develop a report on midwives in the city.
The Maternal Hospital Quality Improvement Network (MHQIN), the third part of the three-pronged initiative, seeks to reduce preventable maternal morbidity and mortality while focusing on racial and ethnic disparities. The clinical-community initiative is expanding to 23 additional birthing hospitals. By doing so, it will reach all 38 birthing facilities in New York City.
“These expanded initiatives will strengthen support for expectant people, advance expertise at DOHMH, and take tangible steps towards tackling health disparities,” Deputy Mayor for Health and Human Services Anne Williams-Isom said in the statement.
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