Doula Care as Reproductive Justice in Maryland

By Lucy Font

Despite the fact that the United States spends more on maternal health than any other country, our healthcare system is consistently failing to provide quality care to pregnant persons and their families. Compared to the United States, 36 nations have a lower infant mortality rate and 62 nations have a lower maternal mortality ratio, and the rate of occurrence of “severe maternal events” in the U.S. is rising[1]. Further, there are profound maternal health disparities for people of color and low-income individuals. For example, Black women are 2 to 6 times more likely to die from complications of pregnancy than white women[2]. The National Partnership for Women & Families attributes these gross disparities to systemic barriers, such as racism and sexism, that contribute to income inequality and affect the way the medical community treats people of color[3].

A proposed way to improve maternal health outcomes and eliminate racial and socioeconomic health disparities is through community-based doula services. The word Doula is a Greek word that means women’s servant[4]. With our modern understanding of gender identity, it would be more fitting to alter our interpretation of this translation: doulas serve individuals of all gender identities, which includes those that can become pregnant, as well as their partners. Doulas provide emotional, physical, and informational support throughout each stage of pregnancy and pregnancy loss. Doulas also provide resources and support to newly pregnant individuals that want to know all of their options. And yes, this includes abortion care.

Abortion doulas are of paramount importance to the pro-choice movement and efforts to advance reproductive justice. Also referred to as “abortion emotional support persons”, abortion doulas accompany pregnant people to their abortion care appointments, where they “emotionally and physically support someone through the process of an abortion, either surgical in a clinic or medical at home”[5]. These services are especially important in light of the rise of anti-choice rhetoric and legislation in recent months[6]. Dr. Diane Horvath, an OB-GYN physician at Whole Woman’s Health of Baltimore, expressed her appreciation of abortion doula services. “Every time I see [the doulas] there, I know my day is going to go better”, Dr. Horvath explained. “[The doulas] are not only great for the patients, but really nice for the staff”.

“Being a doula is first and foremost holding space for another person, which means providing unconditional support and positive regard for your client”, says Clare Donofrio of the nonprofit, the Baltimore Doula Project. Donofrio was drawn to doula work because of her own difficult experiences navigating the healthcare system, after which she became “passionate about…helping people navigate the often traumatizing and disempowering experience of seeking reproductive healthcare”.

“We believe that every person is the expert of their own lives and in charge of their own bodies.”

“Being a doula is first and foremost holding space for another person, which means providing unconditional support and positive regard for your client”, says Clare Donofrio of the nonprofit, the Baltimore Doula Project. Donofrio was drawn to doula work because of her own difficult experiences navigating the healthcare system, after which she became “passionate about…helping people navigate the often traumatizing and disempowering experience of seeking reproductive healthcare”.

Skeptics criticize doulas because they are not medically trained; however, working outside of a medical institution is perhaps a doula’s greatest asset. “We are not a part of the medical industrial complex, nor are we obligated to follow hospital or state outlined protocols,” explains Donofrio, who has worked with clients that have been both verbally and physically abused in the medical system. “Our only allegiance is to the client and their best interest”.

“Being a doula is a way to validate and return power and dignity to people experiencing a marginalized health event like an abortion.”

Nora Simmons, a former NARAL Pro-Choice Maryland intern, recently completed an abortion doula training conducted by the Carolina Abortion Fund. Considering the role of doulas as advocates, Simmons says, “Being a doula is a way to validate and return power and dignity to people experiencing a marginalized health event like an abortion”. Like Donofrio, Simmons also acknowledges the importance of doulas working independently from any medical institutions: “Doula services are important because they acknowledge the human thoughts, feelings, histories, etc. that get erased from western healthcare”.

Doula support is invaluable in the fight to improve health equity. Another downfall of our healthcare system is the profound lack of access for vulnerable and disenfranchised individuals, namely those experiencing poverty, homelessness, and/or incarceration; people of color; and members of the LGBTQ community. Doulas bridge the gaping chasm between these individuals and quality reproductive healthcare. Firstly, doula services are affordable and often free, which eliminates the primary barrier to healthcare for individuals living in poverty. Secondly, doula work is trauma-informed, and therefore offers compassionate, informed, and holistic support to individuals that have experienced traumatic life events. “It was a really beautiful reproductive justice approach to abortion that centered race and gender”, Simmons says of her doula training.

BDP doulas offer a bimonthly support group for inmates that are pregnant or parenting. Inmate populations are often overlooked when it comes to adequate and modern healthcare, and reproductive care is no exception.

The Baltimore Doula Project also provides much-needed support to incarcerated pregnant individuals at the Maryland Correctional Institute for Women (MCIW). Their work at MCIW includes education, presence during labor and delivery, and postpartum visitation. Additionally, BDP doulas offer a bimonthly support group for inmates that are pregnant or parenting. Inmate populations are often overlooked when it comes to adequate and modern healthcare, and reproductive care is no exception[7].

There are several ways to help advance this critical work. Donofrio encourages community members to “support training efforts and organizations lead by doulas of color, and full spectrum doula collectives like the Baltimore Doula Project”. If you do have the budget to hire a doula, pay them well for their services.

As of July 2019, doula support is not covered under Medicaid in the State of Maryland, despite ample evidence that Medicaid coverage of doula care can reduce healthcare disparities for people of color, improve pregnancy health outcomes, and reduce state spending on avoidable pregnancy complications[8]. Community-based doulas often offer their services on a volunteer basis in order to continue to support vulnerable and low-income individuals. If Maryland were to join states like Minnesota, Oregon, and New York in passing Medicaid reimbursement for doula care, doulas would be fairly paid for their labor and the state would see an improvement in maternal and child health outcomes.

Doula care has the potential to revolutionize our healthcare system.

Doula care has the potential to revolutionize our healthcare system, eliminate the maternal and child health inequities for people of color, and, ultimately, provide compassionate and supportive care to people that need it the most. For more information about doula care in the State of Maryland, research and support The Baltimore Doula Project.

Thank you to Clare Donofrio, Nora Simmons, and Dr. Diane Horvath for their valuable contributions to this post.

[1] Childbirth Connection, Choices in Childbirth, National Partnership for Women & Families. (2016). Overdue: Medicaid and Private Insurance Coverage of Doula Care to Strengthen Maternal and Infant Health.

[2] Flanders-Stepans, M. B. (2000). Alarming racial differences in maternal mortality. The Journal of Perinatal Education , 9 (2), 50–51.

[3] National Partnership for Women & Families. (2019). Black Women’s Maternal Health: A Multifaceted Approach to Addressing Persistent and Dire Health Disparities. Retrieved July 19, 2019, from http://www.nationalpartnership.org/our-work/health/reports/black-womens-maternal-health.html

[4] American Pregnancy Association. (2017 22-July). Having a Doula: Their Benefits and Purpose. Retrieved 2019 26-June from americanpregnancy.org: https://americanpregnancy.org/labor-and-birth/having-a-doula/

[5] Campoamor, D. (2019). Abortion AMA: What Is An Abortion Doula? Retrieved July 19, 2019, from https://www.bustle.com/p/abortion-ama-what-is-abortion-doula-17293033

[6] Law, T. (2019, June 4). Here Are the Details of the Abortion Legislation in Alabama, Georgia, Louisiana and Elsewhere. Retrieved July 1, 2019, from time.com: https://time.com/5591166/state-abortion-laws-explained/

[7] https://www.rjinside.org/

[8] Childbirth Connection, Choices in Childbirth, National Partnership for Women & Families. (2016). Overdue: Medicaid and Private Insurance Coverage of Doula Care to Strengthen Maternal and Infant Health.

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The political leader of the pro-choice movement in Maryland.

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