Against a backdrop of growing U.S. maternal mortality, North Carolina is in the unique position to pioneer state-level legislation that addresses the social and structural determinants driving disparities at the state-level. In a new article in HPHR, GHELI Program Coordinator Tyler Fox and co-author Rishika Reddy examine the role of doulas in reducing racial disparities among birthing persons in the U.S., focusing primarily on how these care providers offer support to pregnant people during the pre-, intra-, and postpartum periods. The article delves into specific maternal mortality trends in North Carolina, the determinants—including racism—that contribute to these outcomes, and the potential a Medicaid-reimbursable doula program has to reduce maternal deaths in the state.
North Carolina House Bill 488, note Fox and Reddy, is poised to meaningfully impact maternal and infant health outcomes in the state. Introduced in April 2021, the proposed bill directs the North Carolina Department of Health and Human Services (NCDHHS) to explore the scope of current doula services statewide, promote the availability of these services, and ultimately provide coverage for doula support under the Medicaid program. To be successful, North Carolina must learn from the legislative shortcomings in Oregon and Minnesota, financing the intervention so doulas are adequately paid for their services and do not face financial barriers when meeting state Medicaid registration and licensure requirements. Further, North Carolina has a tremendous amount to gain from implementing Medicaid-covered doula services, including improving birth outcomes for mothers and infants, lowering costly medical interventions during delivery—such as cesarean sections—and potentially creating financial savings for the state’s Medicaid program.