The U.S. Department of Labor’s Women’s Bureau (WB) recently conducted listening sessions with doulas and doula service organizations to address the job quality gaps and state-by-state variations in insurance reimbursement. The primary aim was to explore how expanding Medicaid and private insurance reimbursement for doula services could benefit the industry. This initiative aligns with the White House Blueprint for Addressing the Maternal Health Crisis, which aims to improve maternal health outcomes and reduce racial disparities.
The Role of Doulas and Existing Challenges
Doulas are nonclinical birth workers who provide continuous physical, emotional, and informational support to women during the prenatal, birth, and postpartum periods. Unlike licensed midwives, doulas do not offer clinical support but serve as advocates and guides through the maternal health system. Despite the growing recognition of their importance, the doula workforce remains small and predominantly white, mainly due to limited insurance coverage and insufficient reimbursement rates. This restricts access to doula services to those who can afford to pay out-of-pocket, leaving low-income women and women of color underserved.
Impact of Insurance Reimbursement
Doula participants from states with varying insurance policies (Birmingham, Alabama, and Providence, Rhode Island) noted several potential benefits of widespread Medicaid and private insurance reimbursement. These benefits include increased access to doula services, improved maternal health outcomes, and enhanced job quality for doulas. Furthermore, insurance reimbursement could lead to a more diverse doula workforce, which is crucial for better health outcomes, particularly for women of color.
Implementation Challenges
However, implementing insurance reimbursement is fraught with challenges. Key considerations include reimbursement rates, the structure of reimbursement, and training and certification requirements. For Medicaid reimbursement to be adequate, rates must be competitive with private pay, and the reimbursement structure must accommodate clients’ diverse needs, including prenatal and postpartum care. Additionally, minimizing administrative barriers and providing inclusive training pathways are essential for encouraging doulas to participate in insurance programs.
Beyond Insurance Reimbursement
The listening sessions also highlighted other factors affecting doula recruitment and retention, such as access to childcare, trauma-informed mental health support, and education of clinical staff on the doula’s role. Participants discussed the demanding and unpredictable nature of doula work, which often requires being on-call and providing highly personalized care. This intensity, coupled with the need to supplement income through additional jobs, leads to burnout and financial instability for many doulas.
Conclusion
To improve doula job quality and expand access to their services, it is crucial to address the identified challenges comprehensively. This includes setting appropriate reimbursement rates, creating flexible reimbursement structures, reducing administrative barriers, and providing broader support for the doula workforce. By doing so, we can ensure that more families benefit from the invaluable support that doulas offer, ultimately leading to better maternal health outcomes and a more diverse and resilient doula workforce.
Source: Women’s Bureau Issue Brief on Doulas and Insurance, May 2023
https://www.dol.gov/sites/dolgov/files/WB/WB_issuebrief-doulas-v3.pdf
