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Paying Doulas What They're Worth Would Help Address Our Horrific Maternal Mortality Rate

At this increasingly perilous time to be a pregnant person, states need to invest in expanding access to doulas by paying them a reasonable rate.

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It’s no secret that the United States has the highest maternal mortality rate in the industrialized world, and the risk of pregnancy and birth-related death is substantially worse for Black women, women of color, and pregnant people who contract covid. Pregnancy-related deaths notably surged by about 20% across the board in 2020 at the height of the covid pandemic (25% for Black women). And research has shown states with more abortion restrictions, which continue to be enacted at staggering rates across the country, have higher rates of maternal mortality, too.

States like California are taking action to try and address the nation’s maternal mortality crisis amid ongoing federal inaction: Last year, California Gov. Gavin Newsom signed into law a “Momnibus” bill covering doula services for low-income pregnant people enrolled in Medi-Cal, the state’s Medicaid health insurance program.

Doulas are trained professionals who offer physical, emotional, and informational support to pregnant people throughout all stages of pregnancy, childbirth, and shortly after childbirth, and research has shown doulas and midwives can significantly help reduce the risk of death and complications for pregnant people—particularly for Black women, whose lives are often placed at risk by health care workers and a greater medical system that demonstrates blatant disregard for their safety and comfort.

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But low pay and systemic devaluation of their services could be forcing many doulas out of this line of work at a critical time.

California’s doula program, set to take effect this year, has now been delayed twice as doulas in the state protest the obscenely low rate the state is proposing to pay for their services. California initially offered doulas a flat rate of just $450 per birth, which California Healthline notes would entail “all prenatal and postnatal visits, on-call time during the pregnancy, and labor and delivery—which often lasts 12 or more hours.” Doulas are wildly underpaid across the country by states that cover doula services, but California’s proposed $450 rate is especially low. Rates in other states range from $770 to $900 per birth, while Rhode Island will offer $1,500 per birth come July. Oregon is the only state that offers doulas an even lower rate than California, at just $350 per birth.

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Black women have long shared horrifying pregnancy and birth stories of doctors minimizing their pain or concerns about their pregnancies, sometimes leading to dangerous complications and even death. Notably, Black women are two to three times more likely to die of pregnancy and childbirth-related causes than white women, and a 2016 survey of medical professionals revealed about half still hold the dehumanizing belief that Black people are less likely to experience pain than white people.

Doulas play a pivotal role in advocating for pregnant people of color who may struggle to advocate for themselves, and could even save their lives. Yet doulas remain chronically underpaid by the same state governments that claim to care about addressing the nation’s inherently racist, anti-Black maternal mortality crisis.

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One maternal health strategist and doula in California who became a doula to support other women of color, TaNefer Camara, called the state’s proposed $450 rate “laughable.”

“You don’t need to go into poverty to try and fix a situation such as maternal health care,” Camara, who charges $3,000 per birth for doula work, told California Healthline.

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Across the country, rates for doulas can range from $1,600 to $2,000 in cities like Los Angeles and New York, to about $500 in other parts of the country. Groups like the Groundswell Fund and its Birth Justice Fund, as well as Black Women Birthing Justice in California, offer direct financial support to help low-income, pregnant people of color afford life-saving doula services.

It’s an increasingly perilous time to be a pregnant person in the United States of America. The Supreme Court seems to believe forcing someone to give birth is admissible because adoption is an option, and states are racing each other to enact one abortion ban after another, with criminalization, fetal personhood, and full dehumanization of pregnant people at the finish line. What often gets lost in all of this endless and jarring politicking is how dangerous it already is just to be pregnant in a country where health care is wildly expensive and inaccessible, and dignified maternity and family leave policies are nonexistent.

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Coverage of doula services is the bare minimum that states should be offering pregnant people. And for doulas to be able to offer their life-saving services, any state that claims to value the lives of pregnant people—and especially pregnant people of color—needs to actually invest in and pay doulas what they’re worth.