EXPANDING THE USE OF DOULAS TO IMPROVE MATERNAL AND BIRTH OUTCOMES IN NORTH CAROLINA

Maternal mortality rates in the United States far exceed that of other industrialized nations and the rates are worsening. Over 80% of pregnancy-related deaths in the United States are considered preventable. The maternal mortality risk for Black women/birthing people is three times that of White women/birthing people, while the risk for Indigenous women/birthing people is two times the rate for White women. North Carolina ranks in the bottom half of all states for maternal mortality and has wide Black-White maternal mortality and morbidity disparities. Previous studies of low-income women suggest that doula support can improve maternal and birth outcomes for these populations, especially if the support extends beyond labor and delivery to include prenatal and postpartum assistance. Expanding Medicaid coverage to increase access to doula support would improve maternal and birth outcomes for Medicaid beneficiaries in North Carolina and across the United States.This research explored strategies that could help overcome barriers and leverage facilitators for extending Medicaid coverage for doula services in North Carolina and for enhancing their adoption. It is based on key informant (KI) interviews of policy makers and policy entrepreneurs. The results indicate that doula and maternal health advocates should focus on: 1) developing standards and structures for doula training, education, certification, scope, oversight, as well as credentialing and claims; 2) building awareness and understanding of doulas and doula services; 3) pursuing an inclusive and coordinated advocacy effort; 4) navigating a complex political environment; and 5) identifying financial and in kind-support for the effort.Kingdon’s Multiple Streams model was used to develop a plan for change to guide maternal health advocates in North Carolina and in other states that seek Medicaid coverage for doula services. A comprehensive Doula Advocacy Roadmap was also developed to help maternal health advocates effectuate needed changes. The study results will better position doula and maternal health advocates to extend Medicaid coverage for doula services. While the task is challenging, improving maternal and birth outcomes for all women/birthing people—especially among populations with higher disparities—will make the effort worthwhile.Doctor of Public Healt