Implementing doula care programs in Medicaid to advance racial equity in severe maternal morbidity

Dates: 2023-2028

Background:
Racial disparities in severe maternal morbidity and mortality have been well documented. Doula care –care from birth workers who are outside the traditional medical care system to support people during pregnancy and postpartum – has been shown to benefit birth and postpartum outcomes by intervening on systemic barriers to health. Michigan and other states have recently included doula care as a Medicaid-covered benefit.

Objectives:
This multistate project aims to:

1. Evaluate implementation of new state Medicaid doula programs, including efforts focused on racial health equity and Medicaid beneficiary experience of connecting with and using doula care in the postpartum period.
2. Estimate the effects of state Medicaid doula care programs on racial equity in postpartum severe maternal morbidity and mortality.
3. Evaluate the extent to which doula care facilitates equity in the quality of postpartum care, postpartum treatment for chronic conditions (cardiovascular and mental health/substance use disorders), and experiences of postpartum care.

Research Topics & Methods:
The project involves tracking of Medicaid doula policies and program implementation; interviews with a cohort of doulas to understand experiences as a Medicaid doula provider; and detailed analysis of Medicaid administrative claims to document the impact on severe maternal morbidity and mortality.

Implications:
Findings from this project will strengthen the evidence base around doula care, particularly its impact on reducing racial disparities in severe maternal morbidity and mortality. Findings also will identify policy and programmatic features that will best support doulas who want to serve the Medicaid population.

Collaborators:
AcademyHealth leads this project, which includes university researchers and community doula organizations in six states.

Funder:
The project is funded by the Patient Centered Outcomes Research Institute (PCORI).