To help address maternal health disparities in access to quality health care for Black, Hispanic, and indigenous communities in Pennsylvania, the state’s department of human services is expanding doula access, effective Feb. 1.
The Centers for Disease Control and Prevention reports that nationally, Black women are three times more likely to die from pregnancy-related causes.
According to the March of Dimes 2023 State Report Card for Pennsylvania, the infant mortality rate among babies born to Black women in Pennsylvania is twice the state rate, and preterm birth rates are 1.5 times higher. The leading causes of infant mortality include preterm birth, low birth weight, and birth defects; the environmental factors impacting healthy birth outcomes most include mental health and substance use.
Doulas are non-medical professionals who provide emotional, physical and educational support for mothers and their families during and after pregnancy; doula care has been shown to improve birth outcomes.
The state’s new certification process, through the Pennsylvania Certification Board, will allow doulas to be recognized by and paid through medical assistance programs such as Medicaid.
That said, “it's not the solution to racial disparities,” said Pennsylvania Doula Commission president Gerria Coffee, emphasizing that doulas alone won’t solve systemic dysfunctions that contribute to poor health outcomes in marginalized communities. Coffee was involved in shaping Pennsylvania's policy.
“There are so many other moving parts to an individual's experience when they're giving birth and when they're pregnant or postpartum or experiencing a loss,” she said.
Sally Kozak, deputy secretary for the Office of Medical Assistance Programs in the state Department of Human Services, said the state has been working with partners such as the Pennsylvania Doula Commission for the past several years to develop and implement this expansion of access to doulas.
“We know that outcomes are improved with women who have a doula associated with their childbearing process,” Kozak said.
She explained that it is not yet a mandatory, state-covered service.
“There is not a sufficient number of doulas certified across the state yet to add them to our state plan so that they are a fully recognized provider type,” Kozak explained. “But we hope to be able to do that by 2025 or 2026 as we continue to work with the association to expand the number of doulas available to us."
The application process to become a certified doula has also been simplified — two years of work experience or a college degree are no longer required — and the nonprofit Pennsylvania Doula Commission is offering subsidies for applicants.
So far, 67 doulas have registered — about a third are in the Pittsburgh area.
Coffee stressed that even though Pennsylvania is walking doulas into more accessible, recognized, certified and therefore billable roles, “doula work isn't regulated, and it shouldn't be.”
“We're making sure that we respect people who have ancestral knowledge that's passed down through generations, people of indigenous backgrounds who have always had this work in their community at their fingertips, who are carrying on tradition, and people who have either gone to a training but didn't get a certificate, and individuals who did go to a training and received their certificate,” she said. “We've considered all these pathways to make sure that no one gets left behind.”
