Getting Doulas Paid Policy Brief 

Published February 23, 2023 under Publications

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In recent years, there has been growing momentum around improving maternal health and addressing longstanding inequities in maternal health outcomes in the United States, including expanding access to doula care. Doulas provide non-clinical emotional, physical, and informational support before, during, and after labor and birth and have been consistently shown to improve birth outcomes and experiences of care. The community-based doula model responds to the disinvestment within Black, Brown, and Indigenous communities by providing culturally reflective support and access to information and referrals at little to no cost. Despite the essential role of community-based doulas in reducing the impacts of structural racism and addressing disparities in maternal health, this model of care continues to lack sustainable and equitable public funding. Legislation is urgently needed to support the growth of a robust community-based doula workforce and provide sustainable federal funding for this community-based work in perpetuity.  

In this policy brief, we define the services offered by and the role of community-based doulas and explore the key considerations for doula Medicaid reimbursement that are unique to this doula care model.

The contents of the brief are as follows:  

  • First, we outline the approach and scope of practice of community-based doulas and highlight the importance of the community-based doula model in meeting the community’s needs while supporting doula work in a sustainable and dignified manner.  
  • We review the current state of reimbursement rates for Medicaid coverage of doula support, the current state of inclusion of community-based doulas in legislation regarding Medicaid coverage, and the current reimbursement rates proposed by several U.S. states.  
  • We summarize results from a community-based doula time-use study conducted by the SisterWeb San Francisco Community Doula Network (SisterWeb) to illustrate the extensive work outside of direct client care that community-based doulas do to support communities of color. 
  • We highlight the various activities beyond direct client care, such as administrative work, training, and research, the importance of compensating doulas for these activities, and considerations for government funding opportunities.  
  • We discuss how current doula reimbursement models targeted toward private doula care do not adequately reflect community-based doulas’ high-touch model of care.  
  • Finally, we put forth recommendations to move forward with universal recognition and compensation for the work of community-based doulas. 

This policy brief is a collaborative effort between HealthConnect One and the following partners and members of the Doula Data + Compensation Consortium:

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