My name is Tammy Brown. I am on the board of directors of The Womxn Project. The Womxn Project is a statewide organization focused on leveraging the power of art, activism, advocacy and education to advance the principles of reproductive justice, which demands that we all have the right to determine when and how we build our relationships, families and futures and that we have the ability to live and raise our children with dignity.
We commit to centering the people most impacted, leveraging the collective strength of the community, and working to directly take on and eliminate systems of oppressions.
We envision a future where we can all live with health and dignity. I am proud to be here to testify in support of S. 2124, which would make doula services eligible for reimbursement through private insurance and Medicaid programs.
Women of color are more likely to struggle with maternal health issues and face a much higher rate of death as a result of pregnancy and child birth. In fact, research has shown that Black women in the US are as at least 3 to 4x more likely to die from pregnancy-related causes. Racial disparities exist even when socioeconomic status is accounted for.
The fact is that systemic oppression pushes out of reach the services and care that we need when we are trying to plan our families, have a healthy pregnancy and raise our children in safety and with dignity. Racism is pervasive not only in the provision of health services, but also in the way that care has been medicalized to push birth workers out of the process.
Doulas are people who have done community based training to provide non-clinical emotional, physical, and informational support before, during, and after labor and birth. Doulas work with pregnant people to help them experience care that is customized to their needs to make sure it is safe, healthy, and equitable. Doulas can be particularly helpful for women of color and women from low-income and underserved communities to help reduce health disparities by ensuring that pregnant people who face the greatest risks or who may have historically faced systemic and cultural barriers in the traditional medical systems have the added support they need.
Extensive, reliable research shows that doula care improves childbirth outcomes, increases care quality. A recent review published in 2017 looked at data from 26 different studies involving more than 15,000 women.
The review found numerous benefits to continuous labor support and no known harms of such care, including:
- 39% reduction in the likelihood of cesarean births, which are more expensive, more complicated and have a longer and more difficult healing process with the potential for complications;
- 15% greater likelihood of a spontaneous vaginal birth, which is not always an option for everyone, but has significant benefits, including the baby receiving beneficial bacteria, fluid being squeezed out of the baby’s lungs, shorter recovery time, and less likelihood of future complications in pregnancy;
- 10% reduction in the use of pain medications;
- Shorter labor by an average of 41 minutes;
- Increase the initiation and duration of nursing by allowing parents to start earlier; and
- 31% reduction in reporting a negative birth experience simply by having support from an informed birth worker who can help a birthing parent navigate this experience.
Making sure that people can access a doula has also been shown to have the potential to achieve cost savings. Doula support during pregnancy, birth, and the postpartum period also reduces rates of prematurity and illness in newborns, and the likelihood of postpartum depression, which when treated appropriately will raise costs and create additional struggles for families.
Cost analyses have found that doula care can reduce overall spending by avoiding unnecessary medical procedures and the potential complications and chronic conditions that may result, and reducing NICU admissions.
Despite the numerous, well-documented benefits of doula care, the services remain widely underutilized. A number of barriers contribute to poor access, but cost is most significant obstacle to obtaining doula services. Medicaid coverage would eliminate this barrier making doula support accessible to those who need it most.
Extensive research has been done in recent years to try to identify ways to improve health outcomes for women living on the margins. There are lessons to be learned to help turn the tide and ensure that women of color in our state cannot only survive, but thrive. This bill is a critical first step.
We urge you to support S. 2124. Affordable access to birth workers has been shown to improve health outcomes and help women and families. We owe it to the families who have lost loved ones to do all we can to address the issue of maternal mortality and create effective strategies to deal with this critical public health issue. Thank you.
Contact: Tammy Brown