Role of Doulas in Improving Maternal Health and Health Equity Among Medicaid Enrollees, 2014‒2023
Among Medicaid enrollees, doula care was associated with a 47% lower risk of cesarean delivery, a 29% lower risk of preterm birth, and a 46% higher likelihood of attending a timely postpartum visit, indicating improved maternal outcomes.
Maternal morbidity, mortality, and disparities remain major public health concerns in the United States particularly among Medicaid-enrolled individuals. Doulas have emerged as a promising strategy to improve maternal outcomes and reduce health disparities, but prior evidence has been limited by single-state studies, small samples, or self-reported data. As Medicaid coverage for doula services has expanded, claims data now allow for more rigorous evaluation.
Published in the American Journal of Public Health, this study examined doula use and maternal outcomes among Medicaid managed care enrollees across multiple states from 2014 through 2023. Using propensity score-matched claims data, this research found doula-supported pregnancies had lower risks of cesarean delivery and preterm birth and higher postpartum visit attendance.
Related Public Policy Research
Late Medicaid Enrollment During Pregnancy Increases Risk of Mortality
Early enrollment into Medicaid managed care during pregnancy is important for timely access to prenatal care. This paper provides evidence that enrolling into managed care late in pregnancy impedes opportunities to identify serious conditions and therefore could increase the risk of mortality after delivery.
Doula Access Through Medicaid Managed Care Improves Maternal Health
Doulas serve as an effective strategy to address disparities in maternal health. This evaluation provides evidence that women with doula care experience reduced risk of maternal morbidity, compared to women without doula care.
Addressing Maternal Health Disparities: Doula Access in Medicaid
Several states reimburse for doula services for pregnant women enrolled in Medicaid. Analysis of utilization and outcomes in three states indicates that women receiving doula support have lower odds of cesarean delivery and postpartum depression and anxiety and are more likely to attend their postnatal visit than women not using doulas.