Expanding Doula Access to Improve Birth Outcomes in Rural Areas
“2.2 million American women live in maternity care deserts — with no hospital or birth center with obstetric care, or obstetric providers.”
Doulas lead to better birth outcomes…
The ICS Policy Research team has released a new report detailing the positive impacts of expanding access to doulas in rural South Carolina.
Doulas contribute to a number of positive birth outcomes for mothers and their babies. They provide crucial emotional support and advocacy before, during, and after childbirth. Mothers who have the support of a doula experience a number of positive birth outcomes including:
- Lower rates of C-sections
- Shorter labors
- Fewer birth complications
- Higher 5-minute Apgar scores for newborns
- Better childbirth experience for mothers
…But access to maternal care is lacking
However, access to prenatal and maternal care in rural areas is a tremendous challenge. Over one-third of all counties in the United States are designated as “maternal care deserts”, with no hospital or birth center with obstetric care, or obstetric providers. This affects nearly 2.2 million women.
Many other factors contribute to the challenge of accessing care: transportation, affordability, lack of trust of health care providers, and more. In addition, these factors are systemically exacerbated for Black mothers in the United States. ICS investigated the current landscape for Black birthing mothers in South Carolina, and discovered that although 22% of all birthing mothers received “inadequate care” (as defined by ACOG), 27% of Black birthing mothers received inadequate care — which is higher than the share of Black mothers receiving “adequate care”. Nearly 50% of both Black and White birthing mothers received “adequate-plus care”. However, there is still a large gap that must be addressed to ensure all mothers are receiving better care, particularly Women of Color who face systemic barriers to care.
“Black birthing mothers in South Carolina were more likely to receive inadequate care, than to receive adequate care (as defined by ACOG).”
ICS created a “composite index” that accounted for key outcomes for maternal care, and mapped this onto the state of South Carolina by county. We assembled three main indicators which, taken together, paint a picture of insufficient maternal care for Black mothers across the state, leading to significant negative effects for their babies.
The indicators include:
- 50% or more of births to Black mothers
- 33% or more of mothers receiving “inadequate care”
- 15% or more babies are placed in the NICU
The map reveals a large number of counties with either one factor (yellow), two factors (orange) or all three (red). We are highlighting these highest-risk areas as “hotspots” urgently needing intervention, and we believe that expanding doula access to these key areas will have a large impact in addressing the urgent need for adequate maternal care across the state.
Hot spot mapping of zip codes by composite index.
What can be done to expand rural doula access?
There are a number of innovations and interventions that can be introduced to help address this urgent need by expanding rural doula access. Below see a brief list of the key takeaways we describe for various groups, that can come together to form a web of support to prevent mothers and their babies from falling through the cracks during and after pregnancy.
Government
- Provide access to doula services though Medicaid
- Streamline billing process by creating CPT codes for doula services
Philanthropic foundations
- Support the doula workforce pipeline
- Support doula enrollment & certification processes
- Help doulas navigate liability insurance challenges
Health systems
- Education & awareness within health systems
- Expand telehealth services
Community-based organizations
- Help provide safety nets to address barriers such as housing insecurity, poverty, and mental health issues
Doulas
- Educate the broader community about the benefits of doulas
- Explore opportunities to partner with nonprofits and governments to expand the reach of their message and services
Read the full report to learn more
Read our report to learn more about the challenges and opportunities of expanding access to doulas.
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