Doula support may help low-income, racially and ethnically diverse pregnant women address the effects of social determinants of health and improve birth outcomes.

Background

Social determinants of health (SDOH) contribute to racial and ethnic disparities in maternal and infant health outcomes. Doulas provide non-clinical maternal support before, during, and after childbirth and may help address gaps in support that are not typically met through medical care alone. This qualitative study explored findings from focus groups of racially and ethnically diverse low-income women on how access to doula care may address the effects of SDOH.  

Findings

Researchers conducted four focus groups with 13 low-income pregnant women. Seventy-seven percent were receiving doula support during their current pregnancy. Participants shared perspectives on how doulas mitigate SDOH impacts, including how doulas address health literacy and social supports needs that then improves maternal health care. While doulas are not clinical providers, doula interventions can facilitate better patient and provider interactions that lead to better quality of care and health outcomes. Participants also noted the significance of a culturally concordant doula who shares beliefs about childbirth and safety.

Program/Policy Takeaways

At the time of this study, most research on doula care was conducted among higher-income populations, and there was very limited Medicaid coverage for doula services. This study contributed to the conceptual model for how doula services could directly address SDOH that impact birth outcomes and reduce maternal health disparities. Notably, doula participation may improve clinical encounters specifically around informed consent and patient satisfaction.