Continued and increasing racial inequities in severe maternal morbidity and mortality constitute a public health crisis in the U.S., whose rates of maternal mortality far exceed those of comparable high-resource counties. Indeed, Black people in the U.S. experience pregnancy-related mortality rates approximately 3 times higher than white people – 55.3 and 19.1 per 100,000, respectively. Rates of severe maternal morbidity (SMM), which encompasses life-threatening conditions during pregnancy and postpartum, have increased by nearly 200% in the past 20 years and further reveal significant racial inequities. Because state Medicaid programs comprise the largest single source of healthcare coverage in the U.S., including covering 68% of pregnancy care among Black people, these programs hold great potential to implement structural interventions to advance racial equity in healthcare and health outcomes during pregnancy and postpartum, such as doula care services.
With support from the Patient-Centered Outcomes Research Institute (PCORI), AcademyHealth’s Evidence-Informed State Health Policy Institute and the University of Pittsburgh are conducting a study to identify the most effective ways that state Medicaid programs can implement doula care to improve postpartum health among Black people and people of color. The research will be conducted by university research teams from the Medicaid Outcomes Distributed Research Network (MODRN), who operate in six states in various stages of implementing Medicaid doula care programs: Kentucky, Maryland, Michigan, Pennsylvania, South Carolina, and Virginia. This community-engaged research will include partnerships with 9 doula organizations, as well as engaging with Medicaid patients and state Medicaid agency officials.
This first-of-its-kind study will draw on the research infrastructure and existing partnerships of MODRN, as well as perspectives and lived experiences from doulas and Medicaid patients, to provide much-needed evidence on how doula programs can promote positive birth outcomes and reduce racial disparities in SMM.
You can learn more about this study at Open Science Foundation (OSF).