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  • Writer's pictureDeShanti Jones

The Role of Doulas in Maternal Health: A Necessity or a Luxury?

Updated: Jan 23


Many studies have proven that doula support is integral to the improvement of maternal & infant mortality rates in the United States. According to the Center for American Progress, “when low-income women, including Black women, were provided with family-centered care, including a midwife, doula, and lactation specialist, there were zero infant & maternal deaths.” Having continuous support throughout the perinatal period can provide a sense of empowerment to expectant parents. But what happens when you live in a country that doesn’t prioritize community birth workers for low-income families? This contributes to the common misconception that doulas, midwives, lactation consultants and others are reserved for the wealthy. Some may view this as a luxury, creating a dangerous dynamic for families hoping to also reap the benefits of doula support while struggling to afford it. It amazes me how many times I’ve heard “…I don’t think I can afford that” or “that sounds pretty expensive!” when explaining my services to someone. This can be the biggest reason many families are discouraged from even looking into doula support.


Thankfully, maternal health has recently become a hot topic for many state legislators which will hopefully lead to more advocacy and equity. The state of Pennsylvania, where my clients & I reside, is .currently in the process of making doulas more accessible with the opportunity for Medicaid reimbursement. “House Bill 1175 requires Medicaid to reimburse for doula care and it really is centered around the issue of maternal mortality.” Hopefully this encourages the private insurance companies to do the same. Recently there was also an official launching of The Pennsylvania Black Maternal Health Caucus in October of 2023. The goal of the caucus is to boldly address the disturbing trends of Black maternal mortality and morbidity. While these are amazing steps in the right direction, unfortunately this doesn’t mean that doulas will immediately become more accessible to families. We know that legislative changes don’t happen overnight and can sometimes be a tedious process, leaving many expectant parents vulnerable in the mean time. There are many local programs that provide community doulas at no cost, however these programs often have limited services, specific eligibility requirements and/or extensive waitlists.


Many doulas, myself included, struggle to find the balance between equity and fair compensation for the important yet challenging work that we do. Some offer discounts, sliding scale payments, gift certificates and even free support. We do this simply because we understand just how much of an impact we have on our clients, regardless of their economic status. This is what inspired my online merch store where we create products for parents & babies. We recently launched our first round of baby products, custom bibs and onesies. We have some other exciting designs and new products in the works as well. I decided to contribute 15% of all product proceeds towards our Equity Fund which will help offset the costs of my doula services for families with financial burdens. If you’d like to make a private donation, please contact me. While this might not be a permanent solution to the birth worker affordability crisis, I think it is a great start. It’s also a beautiful demonstration of this quote that I love:



thanks so much for reading!


☮️ &💜 shanti fatou

doula/childbirth educator

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