Dr. Katherine Ahrens, Assistant Research Professor of Public Health in the Muskie School of Public Service, will serve as co-investigator on a major, $11 million research project looking at whether Medicaid-funded doulas can help improve the health of Black women and people of color after pregnancy.
The project, funded with a $10.7 million grant by Washington D.C.-based Patient-Centered Outcomes Research Institute, will look at the care of hundreds of thousands of women in six states over the next five years. All six states — Kentucky, Maryland, Michigan, Pennsylvania, South Carolina, and Virginia — have recently implemented policies allowing Medicaid recipients to use doula services.
“It’s a good idea. It’s a huge project,” Ahrens said. “I think it has great potential.”
Doulas are trained professionals who provide support during pregnancy, during labor, and after delivery. Postpartum doulas, for example, might help with breastfeeding, flag health concerns with the newborn or mother, and assist with the early days of baby care.
In the United States, women of color have disproportionately high rates of maternal mortality and severe morbidity. In 2021, according to mortality data from the National Center for Health Statistics, Black women died at two-and-a-half times the rate of their white counterparts, with a maternal mortality rate of 69.9 per 100,000, compared to 26.6 per 100,000. A recent study looked at birth certificate data from 2012 to 2016 and found Black women were 60% more likely to experience a severe maternal morbidity event than white women.
Rates are even higher among those on Medicaid.
While doula care has been shown to improve health outcomes, state Medicaid programs have generally not paid for doulas. That is starting to change. But what is the most effective way Medicaid programs can implement doula care specifically to improve maternal health for people of color? Researchers hope this sizeable study will find out.
“You can say you’re adding a (doula) policy, but it kind of depends on how you’re actually implementing that and if it’s actually used by your population,” Ahrens said. “It’s more complicated than just having coverage for it.”
The study’s results could have far-reaching implications for Medicaid, health care, and people of color throughout the United States.
“If we show it works in these states and actually improves health and reduces disparities, I think it would be attractive for other states to implement this coverage,” Ahrens said.
Nearly 20 people from around the country will be involved in the research — including four advisors, three project directors, and 12 researchers — plus a half-dozen doula organizations. The study begins this summer.