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An Opportunity to Promote Birth Equity Through Increased Access to Doula Services

By: Kezia Ofosu Atta, Policy Assistant, Groundwork Ohio

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As we recognize National Doula Week, it’s crucial to acknowledge the role that doulas play in supporting pregnant women, contributing to stronger maternal and infant health outcomes, and promoting birth equity for Black moms and moms of color. A doula is a highly trained experienced labor and birth professional that assists expecting mothers and families with pre-delivery, delivery, and post-delivery services.

For years, various lawmakers have made pivotal strides to pass legislation making doula care accessible. In 2022, the Ohio House of Representatives successfully passed legislation allowing Medicaid coverage for doula services; however, this progress was put on hold when it failed to pass in Ohio Senate before the end of the legislative session. Fortunately, in 2023, after numerous bipartisan efforts by multiple lawmakers, there is continued momentum and renewed energy to pass the legislation.

Last month, a bipartisan, bicameral group of legislators – along with a collective of maternal and infant health stakeholders – announced their plans to reintroduce the legislation this session. Since then, Sen. Michele Reynolds (R-Canal Winchester) and Sen. Paula Hicks-Hudson (D-Toledo) have introduced Senate Bill 93, stand-alone legislation to provide Medicaid reimbursement for doula services, and Rep. Andrea White (R-Kettering) and Rep. Latyna Humphrey (D-Columbus) have introduced the details of House Bill 7, their maternal and infant health bill package which includes the doula services language.

Additionally, the House of Representatives included the Doula Medicaid coverage bill language in the current Ohio House Budget Sub-Bill 33. The decision to include the bill language in the budget bill is a significant legislative move in recognizing the importance of doulas in the healthcare system, especially in the maternal and child health field, that could accelerate the progress on getting the bill passed this session. If passed through one of these legislative avenues, Ohio would join a growing number of states that have provided Medicaid reimbursement for doula services.

This new development comes at a time when research and evidence have been released to support the crucial role that doula services play in promoting birth equity and stronger maternal and infant health outcomes. The Prenatal to 3 Policy Impact Center recently released research highlighting the impact of community-based doulas. The evidence from their findings revealed that community-based doulas are effective in improving parental health and developmental outcomes. This means that Ohio will be on the right path to championing maternal and young child health if its lawmakers pass a budget that includes the doula services Medicaid coverage bill language.

Among other findings, the PN3 report found that community-based doulas are specially trained for culturally sensitive care and focus on birthing people who are more likely to experience discrimination and racism in traditional healthcare settings. The evidence suggests that the involvement of community-based doulas may decrease disparities in birth outcomes for mothers and infants.

The report also highlighted how the involvement of community-based doulas in pregnancies leads to an increased attendance of medical appointments and childbirth education classes. Statistically, community-based doulas lead to a “10 percent increase in attendance at four or more well-child visits within the first six months of life.” This is the same percentage of impact for maternal postpartum visits within 60 days of delivery.

Additionally, community-based doulas have been shown to contribute to a more positive birth experience and better health outcomes, including an 11.4 percent decrease in epidural use and lower rates of preterm birth, low birthweight, and NICU admissions, according to their study. Doula care is part of a package of services, that if made available to pregnant women and babies most at-risk of poor health outcomes, can complement clinical care, support pregnant women, and improve maternal and infant health outcomes. As we face a maternal and infant mortality health crisis, which has large and alarming racial disparities in outcomes, increasing access to doula care is even more critical.

In light of the doula bill being included in the Ohio House’s version of the budget, the legislature now has an opportunity to swiftly advance this policy to make doula services more accessible. As the budget is now being deliberated in the Senate, it is our hope that the final bill will support the health and well-being of pregnant women, young children, and families across Ohio. Be sure to sign up for our email updates to stay updated on the progress of this legislation and other key legislative measures impacting our youngest Ohioans.

For more information on the Prenatal-to-3 Policy Impact Center’s research, you can access their recently released study on community-based doula care here.


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