Health Workforce Challenges Impact the Development of Robust Doula Services for Underserved and Marginalized Populations in the United States

Abstract

Evidence of doulas’ positive impacts on maternal health outcomes, particularly among underserved populations, supports expanding access. Health workforce-related barriers challenge the development of robust doula services in the United States. We investigated organizations’ barriers regarding training, recruitment, and employment of doulas. We conducted literature and policy reviews and 16 semi-structured interviews with key informants who contribute to state policymaking and from organizations involved in training, certifying, advocating for, and employing doulas. Our study shows barriers to more robust doula services, including varying roles and practices, prohibitive costs of training and certification, and insufficient funding. This study underscores the importance of doulas in providing support to clients from underserved populations. Health workforce-related challenges remain, especially for community-based organizations seeking to serve underserved communities.

Medicaid Reimbursement for Doula Care: Policy Considerations From a Scoping Review

“…One record called for the consideration of such requirements by both large and community-based organizations training doulas (Van Eijk, Guenther, Kett, et al, 2022). Another underscored the workforce diversity-related implications of the prohibitive costs of training and certification for community doulas serving populations historically underserved by the maternal health care system (Van Eijk, Guenther, Jopson, et al, 2022). Those authors, who collected semi-structured interview data from key informants representing a variety of perspectives reflecting those who contribute to state policymaking, found that community-based, relative to mainstream, doula training organizations tended to recruit trainees from underserved communities identified as in need of doula services—which are often communities of color (Van Eijk, Guenther, Kett, et al, 2022).…”

“This work that we're doing is bigger than ourselves”: A qualitative study with community‐based birth doulas in the United States

“…For recruitment, we built upon our previous national study in which we interviewed members of organizations that train, recruit, and employ birth doulas. 23,28 Drawing on these relationships and network connections, as well as directories provided by national associations which support and fund doulas of color and additional keyword searches, we identified over 75 individual birth doulas and doula organizations working with underserved and historically excluded populations across the country. We created a matrix with their names, email addresses, occupational settings (including self-employment), and location.…”