This month, the Washington state legislature passed a law which aims to expand access to doulas for pregnant people insured under Medicaid, a publicly funded health care program for low-income people. Doulas help pregnant people before, during and after birth, providing physical and emotional support as well as key information about pregnancy and childbirth.
Studies have shown that access to doulas can significantly boost maternal and infant health. However, for many parents, cost is a significant barrier, as hiring a doula can cost hundreds — if not thousands — of dollars. This is especially important for Black and Indigenous communities, who face large maternal health disparities as a result of medical racism.
Between 2014 and 2016, 60 percent of pregnancy-related deaths in Washington State were deemed preventable. According to a Department of Health report, 64 percent of the people who died were on Medicaid. Indigenous pregnant people were nearly nine times more likely to die as white people, while Black people were twice as likely to die.
According to Dur’Shrika Moore, a birth doula, lactation peer counselor and midwife assistant, doulas are vital for improving birthing people’s health outcomes. “It’s crucial to the survival of the birthing person,” Moore said.
“The mortality rate for Black women is one in four birthing people lose their lives during birth. So it is important for us to be there to ensure that everything is going smoothly for that birthing person, that their life is being taken care of and that they’re being heard and supported during the process.”
Before 2019, Medicaid did not insure doula care, meaning that 47 percent of families in Washington had to pay out-of-pocket to hire a doula. In response to the lack of coverage, Gov. Jay Inslee signed a budget proviso authorizing Medicaid to reimburse doulas. However, there wasn’t infrastructure set up to make it easy for doulas to bill Medicaid, forcing them to have to go through a doctor or midwife to get paid.
The new law sets up a voluntary pathway to certification, allowing doulas to become credentialed by demonstrating necessary skills. Once credentialed, doulas will be able to bill Medicaid directly.
According to Jasmyne Bryant, a doula and birth justice organizer with Surge Reproductive Justice, the voluntary, competency-based credential system is designed with racial justice concerns in mind.
“We see so often that credentialing pathways erase, or create barriers for, Black and Indigenous professionals,” Bryant said. “We did not want this to be a part of that history of erasure.”
Bryant helped organize the Doulas for All Coalition which advocated for the passage of the law. She said that the bill comes amid a revival of traditional knowledge and practices of birth work, which have been appropriated by the mainstream perinatal care industry.
“I think that what’s happening in the doula world is a reclamation of Black and Indigenous ancestral knowledges … the industry of doulas really took from ancestral practices that Black and Indigenous folks were already doing in their community,” Bryant said.
As hospitals took over the process of birth in the 20th century, they displaced traditional birth workers such as granny midwives, who were Black Southern women with deep rapport in their communities. According to a study in the Columbia Journal of Race and Law, this medicalization led to white women dominating the midwife profession and becoming the main recipients of perinatal care.
Aijanae Young, a doula and member of the Doulas for All Coalition, said that having doulas be legally recognized as a profession would be “huge” and could double the amount of people she is able to support.
According to a 2019 survey by a master’s student at the University of Washington School of Public Health, about 67 percent of doulas in Washington are white, compared to less than 15 percent who identified as Black, African American or African.
Moore says that statistics undercount the number of doulas of color because of the current certification system which relies on white gatekeepers.
“There are a lot more BIPOC doulas out there than statistics show,” Moore said. “The reason why the statistics are showing so high [a proportion] of white folks being out there is due to the fact that of how you have to be certified.”
“You have to go through a white-led organization ... and go through these tests and pay money out in order to be considered a doula,” she said.
Bryant and other doulas hope that the new law will not only encourage more people to become doulas but also make it easier for doulas from Black, Indigenous and queer communities to make a living.
“It’s really not just that we need doulas,” she said. “We need doulas from our neighborhoods, from our communities. People who look like us and understand our ways of being.”
Guy Oron is the staff reporter for Real Change. He handles coverage of our weekly news stories. Find them on Twitter, @GuyOron.
Read more of the Mar. 30-Apr. 5, 2022 issue.