The Harvard Public Health Review, a student-led journal at the Harvard T.H. Chan School of Public Health, recently published an article written by Tyler Fox, Program Assistant at GHELI. In the article, Fox provides a general background on maternal death in the U.S., highlighting the historical and modern instances of racism and its impact on maternal health, examines the use of doulas as an intervention to reduce maternal death, and discusses the potential implications of a national expansion of Medicaid-reimbursed doula programs aimed at improving maternal outcomes countrywide. A doula is a professionally trained companion who supports women during the pre- and post-natal periods and labor and delivery. This healthcare worker provides guidance and encouragement to the mother while also working within the healthcare system to advocate for and, in some cases, to protect her.
The U.S. has one of the highest maternal mortality ratios of any country in the Organization for Economic Cooperation and Development (OECD) at 17.4 deaths per 100,000 live births as of 2017—far more than Canada, Sweden, Australia, or Germany. There is a significant racial disparity in maternal mortality within the United States, with non-Hispanic Black Women more than three times as likely to die from a pregnancy-related complication as non-Hispanic White women. Further, similar trends are seen in non-Hispanic American Indian and Alaska Native women, whose pregnancy-related mortality ratio is more than twice that of non-Hispanic White women. Doulas work within the structures perpetuating these disparities in maternal death, seeking to support the mother through labor, but to also aid in the dismantlement of a rigid, biased, and at times, overtly racist medical system to provide the best possible birth outcome for their client.