Health Equity Considerations in State Bills Related to Doula Care (2015–2020)

S. Michelle Ogunwole, J'Mag M. Karbeah, Debra G. Bozzi, Kelly M. Bower, Lisa A. Cooper, Rachel Hardeman, Katy Kozhimannil

Research output: Contribution to journalArticlepeer-review

Abstract

Introduction: Racial inequities in birth outcomes persist in the United States. Doula care may help to decrease inequities and improve some perinatal health indicators, but access remains a challenge. Recent doula-related state legislative action seeks to improve access, but the prioritization of equity is unknown. We reviewed recent trends in doula-related legislation and evaluated the extent to which new legislation addresses racial health equity. Methods: We conducted a landscape analysis of the LegiScan database to systematically evaluate state legislation mentioning the word “doula” between 2015 and 2020. We identified and applied nine criteria to assess the equity focus of the identified doula-related legislative proposals. Our final sample consisted of 73 bills across 24 states. Results: We observed a three-fold increase in doula-related state legislation introduced over the study period, with 15 bills proposed before 2019 and 58 proposed in 2019–2020. Proposed policies varied widely in content and scope, with 53.4% focusing on Medicaid reimbursement for doula care. In total, 12 bills in 7 states became law. Seven of these laws (58.3%) contained measures for Medicaid reimbursement for doula services, but none guaranteed a living wage based on the cost of living or through consultation with doulas. Only two states (28.6%; Virginia and Oregon) that passed Medicaid reimbursement for doulas also addressed other racial equity components. Conclusions: There has been an increase in proposed doula-related legislation between 2015 and 2020, but racial health equity is not a focus among the laws that passed. States should consider using racial equity assessments to evaluate proposed doula-related legislation.

Original languageEnglish (US)
JournalWomen's Health Issues
DOIs
StateAccepted/In press - 2022

Bibliographical note

Funding Information:
Funding Statement: S. Michelle Ogunwole is supported by a training grant from the Health Resources and Services Administration (Institutional National Research Service Award: T32HP10025BO ) J'Mag Karbeah is supported by the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) under Award Number T32HD095134 . This project also benefited from support provided by the Minnesota Population Center ( P2CHD041023 ), which receives funding from the NICHD. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

Funding Information:
Funding Statement: S. Michelle Ogunwole is supported by a training grant from the Health Resources and Services Administration (Institutional National Research Service Award: T32HP10025BO) J'Mag Karbeah is supported by the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) under Award Number T32HD095134. This project also benefited from support provided by the Minnesota Population Center (P2CHD041023), which receives funding from the NICHD. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

Publisher Copyright:
© 2022 The Authors

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