Legislation: Allowing Medicaid to cover doula services will improve outcomes for pregnant women and reduce costs
The legislation is particularly important for women of color, who are three to four times more likely to die for pregnancy-related reasons than white women.
“Doulas have been shown to make real, measurable improvements in the health outcomes for women and babies during pregnancy and childbirth, preventing complications, and reducing the cesarean and preterm rates. They are cost-effective, ultimately saving medical dollars because patients using them require less medical intervention overall,” said Representative Marcia Ranglin-Vassell (Democrat, District 5, Providence). “All women, but particularly women of color, who are three to four times more likely to die for pregnancy-related reasons than white women, should be encouraged to use a doula during pregnancy and childbirth.”
Doulas are trained professionals who provide continuous physical, emotional and informational support to women during pregnancy, childbirth and the first few postpartum weeks. They assist in making women as comfortable as possible during birth, providing help with breathing techniques, massage and advice, and can help advocate for the woman during the birth. Births assisted by doulas have significantly lower rates of cesarean section, with one study showing a 39 percent reduction.
The National Partnership for Women and Families, which has advocated for coverage of doula services for improved health outcomes, estimates the reduction in cesarean births that could result from public and private coverage nationwide could save Medicaid at least $646 million per year, and about $1.73 billion for private insurers.
At 23.8 per 100,000 live births in 2014, the United States has the highest maternal mortality rate in the developed world, and, along with Serbia, is one of only two developed nations whose rate has been rising, having increased 26.6 percent between 2000 and 2014.
In Rhode Island, the maternal mortality rate between 2013 and 2017 was 11.2 per 100,000 live births.
Nationally, maternal mortality is far higher for black women than white women. According to the Centers for Disease Control, from 2011 to 2014, the mortality rate for black women was 40 per 100,000 births, compared to 12.4 per 100,000 for white women. Studies have suggested that racial bias and unequal treatment of black women exist in the health care system, often resulting in inadequate treatment.
Under the bill (H5609), services from a trained, qualified doula would be eligible for coverage through private insurance and Medicaid, including the state medical assistance program, for up to $1,500 per pregnancy. The bill, which would take effect July 1, 2020, would also set industry standards and create a statewide registry of doulas to assist women in connecting with qualified professionals, while simultaneously helping to assure that doulas are fairly compensated for their work.
Currently, Oregon and Minnesota permit Medicaid coverage for doula services and New York City has launched a pilot program.
Companion legislation has been introduced in the Senate by Senator Ana Quezada(Democrat, District 2, Providence). The bill has bipartisan support in the House.
“Planned Parenthood of Southern New England believes that carrying a pregnancy to term should not put women’s lives at risk. As a member of the Rhode Island Coalition for Reproductive Freedom, we will fight to ensure black women receive the high-quality care they deserve, and perinatal doulas are fairly compensated for the care they provide. Maternal mortality in the United States is a public health crisis and its severe impact on black women is unacceptable,” said Kavelle Christie, Public Policy and Organizing Specialist of Planned Parenthood of Southern New England. “In partnership with SisterSong, leaders in the reproductive justice movement, and Rhode Island social justice and health care organizations with a long history of advocating on behalf of their communities, the Rhode Island Coalition for Reproductive Freedom will work to ensure women of color are seen, heard, and provided the high-quality health care they deserve.”
The bill was announced at what may have been the first press conference held at the Rhode Island State House in which all of the speakers were women of color.
The press conference was emceed by Aniece Germain, president of Hope and Change for Haiti. Hope and Change for Haiti is a member organization of the Rhode Island Coalition for Reproductive Freedom.
“I always think that if I knew of doula services I would have had a different experience when I had my children,” said Germain. “I remember having questions unanswered by fear to look stupid. I remember I fell in the bathroom at the hospital one day after giving birth. I kept asking myself what could have been done to prevent that from happening. Was there anything that could support me? I am sure I was neither the first nor the last black woman experiencing this situation. Having a compassionate doula culturally integrated with me would have made a difference.”
“I had my son in ’97. I was 17 years old. I was a black teen by herself, and I was afraid and I was alone” said Felicia Love, Co-President of Rhode Island Doulas. “I had no idea about doulas. I had no idea about the resources that were available to our community. In 2013 I got pregnant again and I knew I wanted to have a completely different experience. So I did my research, and I found a doula.”
The problem was, Love lacked the money to afford a doula. Eventually a doula offered her services to Love for free.
“A doulas work does come from the heart,” said Love, “but we shouldn’t have to sacrifice our family for other families.” It is important that doulas are adequately compensated for the work they do.
Love became a doula herself because she wanted to give the experience of her second child’s birth to other people.
Senator Quezada didn’t know about doulas until she was asked to introduce the bill in the Senate. Since then, Quezada has educated herself about the importance of doulas.
“That reminded me about a story my mom told me when she had her first baby many years ago in the Dominican Republic“, said Quezada. “When she was pregnant she didn’t know how she was going to have that baby. She thought she was going to throw up and the baby was going to come out. That was her real belief, because she didn’t have anybody around her to support her… She was a very innocent person…
“Then I remember my husband telling me his mom had seven children at home, without care, without medical, without anybody there but her mom… that was in Guatemala.
“As a woman of color, coming to this country and knowing what so many women go through in other countries, it’s very hard for me to not support a bill like this…”
Jennifer Rourke, a member of The Womxn Project, told her harrowing story of having her symptoms ignored after she gave birth before she was finally told, after days of being run around and flirting with death, that she was suffering from post-partum preeclampsia. Rourke is the mother of four children.
“Having someone there to advocate for me would have been fantastic,” said Rourke. “I have private insurance. I actually have the ability to pay for a doula, I just didn’t think I needed it. And I just think back to when I was 16 and I gave birth to my oldest son, and I’m like, what if that was a young girl in the hospital, like me, and she didn’t know what was going on? If she didn’t have someone by her side?
“This bill is so important for some many people, but mainly for black women. Because black women are four times more likely to die giving birth…”
“Motherhood is difficult. Giving birth is traumatic. It’s the closest thing to death,” said Providence City Councilor Nirva LaFortune (Ward 3). “Because when you go into a hospital, a birthing center and you decide to give birth, you’re not sure you’re going to make it out. You hope you will and you also want someone to be there that’s going to support you.”
LaFortune made an important observation during her speech: “Having birthing options and support should not be a privilege, it is a right!”