Bridging the Gap: Doulas’ Views on Access for Minority Women

Background The United States faces a maternal health crisis marked by stark racial disparities. Minority women experience maternal mortality rates nearly two to three times higher than their non-minority counterparts. Research shows that doula care improves maternal outcomes, decreases cost, and improves maternal satisfaction. Recognizing these benefits, a majority of states now cover doula services under Medicaid. However, utilization remains low, with only 6% of eligible beneficiaries accessing the benefit. Research to examine what drives access and uptake is limited. This qualitative study explored the barriers and facilitators to doula care for Black women in Baltimore from the doula’s perspective. Methods This study, conducted in Baltimore, Maryland, employed a qualitative approach that utilized focus groups and interviews to explore barriers and key facilitators related to doula care. Participants included 21 doulas with at least two years of experience. Data were coded and analyzed within a Socioecological framework, which identified themes across individual, community, and systemic levels. Results Findings highlighted structural and cultural barriers and facilitators that shape access to doula care for minority women in Baltimore. Five barriers emerged: (1) limited public awareness of doula services; (2) under-compensation relative to the time required; (3) feeling undervalued or misunderstood by clinical colleagues; (4) difficulty balancing small business demands with a commitment to service; and (5) gaps in training and mentorship. Three facilitators were identified: (1) urgency of the Black maternal health crisis motivating families to seek doula support; (2) increased visibility through celebrities and social media; and (3) endorsements by family, friends, and others in a person’s social network. Conclusions Doulas pointed to improved reimbursement, mentorship, and business support—along with public awareness and stronger collaboration with other healthcare professionals—as central needs to expand equitable access. These findings inform policy and practice reforms in Medicaid reimbursement, public awareness of doula services, and culturally congruent care. Incorporating doulas into clinical teams, ensuring fair payment, and investing in workforce development (especially for doulas of color) are key components of an equitable, community-based model of maternity care.