New York’s can’t ignore it’s worsening maternal mortality rate—that’s why we need expanded access to doula care

By Senator Samra Brouk | April 12, 2023

We already know that the United States is the most dangerous place in the developed world for a person to give birth. For Black women, the stakes are even higher. According to New York’s Maternal Mortality Review Board, Black New Yorkers are five times more likely than their white counterparts to die as a direct result of a pregnancy complication–in New York City, that rate jumps to eight times higher. More than three quarters of these deaths are considered preventable.

What’s more alarming is that these disparities persist despite income and education levels–meaning that there is no procedure, provider or some other step that a person can take to counteract their Blackness in the birthing process.

Black parents and Black babies deserve better. That’s why the New York State Budget needs to expand Medicaid to cover doula care—an often underutilized type of care that is proven to save lives.

A doula is a nonclinical professional who provides physical, emotional and informational support to the birthing parent and partner before, during, and after labor.

Doulas are perhaps the strongest tool in our toolkit for addressing New York’s worsening maternal mortality crisis. Data from the American Pregnancy Association and the Journal for Perinatal Education demonstrate that doulas are linked to lower c-section rates, shortened labor times, fewer epidural requests, reduced rates of postpartum depression, and more. In fact, birthing parents who use a doula are two times less likely to experience a complication at all. However, despite these significant, life-saving benefits, doula care has historically been reserved for those who can afford it, and those who know where and how to find a doula.

In 2019 New York State launched a Medicaid Doula Pilot Program to cover doula services for Medicaid-enrolled pregnant people living in Erie County. As of January, the program has helped more than 900 people, and survey results show that 97% of participants say having a doula improved their childbirth experience. But the challenges that the pilot has faced with enrolling providers has mostly been related to the reimbursement rate – one that is woefully too low for the prenatal, labor and postpartum support a doula provides.

In this year’s budget, we are attempting to learn from our mistakes with an opportunity to expand Medicaid to cover doula care to a much bigger population and at a higher reimbursement rate. With nearly 50% of all births in our state covered by Medicaid (March of Dimes, 2020), this is the best way to ensure that doula care is accessible to as many birthing people as possible. And in a time when the rights of women and birthing people are under attack across the nation, we have an obligation to invest in measures that can improve health outcomes for those most at risk.

An equitable rate of Medicaid reimbursement for doulas cannot be less than $1,930. According to the National Health Law Program, doulas spend anywhere from six to eleven times more time with their clients than medical staff, both before, during, and after birth – providing personalized care that is focused on relationship building.

The data is clear. Broadening access to doula services – especially for the vulnerable New Yorkers who are enrolled in our state Medicaid program – has tremendous potential to improve maternal and infant health outcomes and help mitigate the disadvantages that Black women experience in the healthcare systems today. New York state has an obligation to reverse the trends and make New York a leader in addressing the maternal health crisis so that we are a safer and more equitable place to give birth.

Samra Brouk represents New York’s 55th Senate District.