At Greater Risk: COVID-19 and the Amplification of Inequalities in Birth

Pandemics have the power to suspend normal rituals, including those surrounding birth and death. Doulas, labor assistants dedicated to providing continuous emotional, physical, and informational support to pregnant and laboring people, found their work of “mothering the mother” (Raphael 1973) disrupted by the impact of the pandemic, which stripped people of communal identity-making rituals such as births, weddings, and funerals. And while many birthing people were confronted for the first time with the inability of our healthcare system to deliver quality care, for others the pandemic added another level of fear for those already receiving inadequate care due to biases and medical racism (Davis 2019). Early reports detailed the ways this pandemic widened inequalities such as disproportionate death rates based on race and ethnicity (Andaya and Bhatia 2021) as well as increasing gender and income inequality (Ralph 2020; Villarosa 2020). It also deepens these inequalities among some of the most at-risk populations, in particular, pregnant and laboring people (Davis-Floyd, Gutschow, and Schwartz 2020). Our research focuses on doulas working on the frontlines of birth with many expectant people and families, who speak to the way COVID-19 exacerbated stratified reproduction (Colen 1995; Ginsburg and Rapp 1995). Using a mixed methods approach including surveys and interviews from hundreds of doulas in the United States, we demonstrate how doulas can help center conversations on inequalities in birth for people most at risk