Racial Disparities in Perinatal Health, A National Crisis: Concordant Perinatal Doulas are Making a Difference

Proposal: The U.S. has the highest rates of maternal mortality and morbidity among wealthy countries. Black women and their babies in the U.S. die at three to four times the rate of Non-Hispanic White women (CDC, 2017). According to the CDC, North Carolina's maternal mortality in 2013 - 2017 was 56.8 (per 100k) for Black women compared to 19.8 for White women. In 2019, the infant mortality disparity ratio for Black babies in Durham County was 4.42. This means that Black babies die at >4 times the rate of White babies. While our nation needs to work on addressing infant and mother morbidity and mortality overall, it is clear that Black women and infants suffer disproportionately high rates of mortality and morbidity in N.C., including the counties in and around the Triangle. Controlling for education and socioeconomic status does not change this shocking health disparity. Doulas have been shown to improve birth outcomes. The American College of Obstetrics and Gynecology confirmed that improved perinatal outcomes, including decreased medical interventions and cesarean deliveries, are improved when doulas are a part of the maternity care team.  Our goal is to continue to improve the birth outcomes of Black women giving birth in our area by increasing their access to social, emotional, and educational support from trained Black doulas. To accomplish this goal, we will continue the perinatal doula training program designed by Black women for Black women. We will continue to increase the pipeline of Black doulas to attend births of Black families within the Healthcare System. This project's unique strength is our diverse team and our holistic approach to addressing perinatal morbidity and mortality in the Black community. Our team of instructors has taken the time to build a supportive group structure, establish communication pathways, and review and enhance the project plan in real time. We have shown that the Black families who received supportive care from one of our program doulas had fewer medical interventions, fewer birth complications, and were more likely to breastfeed, all leading to decreased maternal and infant mortality and morbidity rates. We certify through DONA International, which is considered the "gold standard" in doula training and is likely the certification that third-party payers will require if doula services become an allowable expense. Based on our direct contribution to the conversation, United Health Care recently approved covering doulas as a value-added service for its vulnerable, underserved population.