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Commentary: It’s time to recognize that doulas are vital community health workers

Tennessee Lookout. By Elena Ferguson - February 22, 2021

Doula Miajenell Peake (left) walks with her client Jasmine Worles at Shelby Farms Park in Memphis, Tennessee on January 24, 2021. As a doula, Miajenell will support Jasmine with many aspects of her pregnancy and after delivery. ( © Karen Pulfer Focht)

This legislative session, Rep. London Lamar introduced a resolution to recognize doulas as vital birth and community health workers in Tennessee. For millions of families who are expecting or will be expecting soon, this would be one of the first steps toward realizing a Tennessee where all expectant parents have access to the full range of reproductive health care and support.

In recent years, as the global maternal mortality rates are trending downward, the United States’ rates are headed in the opposite direction. Not surprisingly, these oftentimes preventable deaths hit Black and Brown communities the hardest. Black, American Indian, and Alaska Native (AI/AN) women are two to three times more likely to die from pregnancy-related causes than white women, and this disparity increases with age.

Maternal mortality is one of the widest of all racial inequities in reproductive health. Troublingly, this is not just a national crisis, but a local one as well. Tennessee grapples with staggering health care inequities that create a maternal and infant health crisis fueled by structural racism. In 2017 and 2018, Black women in Tennessee were three times as likely to die from pregnancy-related complications than white women, and these pregnancy-related deaths were 100% preventable. Like mothers, infants in Tennessee do not fare much better. According to the CDC, Tennessee has one of the worst infant mortality rates in the country with 6.9 infant deaths per 1,000 live births in 2018. Black babies bear the brunt of this harm. In 2015, Black infants had twice the mortality rate of white infants.

It is unacceptable that so many birthing people, particularly Black women, are dying when their deaths are largely preventable. The reality is that for women of color, especially Black women, this kind of injustice is part of a generational cycle of inequality that persists because an inherently racist medical system enables the deaths of countless Black women. While it will ultimately take a radical, organized, and collective imagination to overhaul this system, doulas can represent a path forward to immediately improve birth outcomes and reduce Tennessee’s high rates of maternal and infant mortality.

A doula, unlike a midwife, is a trained, non-medical person who provides ongoing emotional, physical, and informational support before, during, and after labor and birth. Before I began working in the reproductive justice policy sphere, I, like many members of the general public, was unfamiliar with doulas. I began to understand the nuances of the term once I started my fellowship with Healthy and Free Tennessee, a statewide reproductive freedom advocacy organization.

According to the CDC, Tennessee has one of the worst infant mortality rates in the country with 6.9 infant deaths per 1,000 live births in 2018. In 2015, Black infants had twice the mortality rate of white infants.

Doulas can have a tremendous impact on birth outcomes. They not only guide the pregnant person through the pregnancy process by fostering healthy practices like breastfeeding and designing personalized pregnancy care plans, but their presence alone can have a financial impact in helping families and the state avoid the cost associated with low birth weight babies, cesarean births, and other pregnancy-related complications.

Community-based doulas can be particularly effective for low-income and communities of color, where paying out-of-pocket is simply not an option. Community-based doulas belong to the community they serve, share the same background, culture, and/or language with their clients, and have additional training that supplements the traditional doula education curriculum. Tennessee already has great examples of community-based doula providers through Homeland Heart Birth and Wellness Collective in Nashville and Birth Strides in Memphis. We need to amplify the impactful work that they are doing and bring in new Black and Brown doulas to expand this network.

When we support and create access to the full range of reproductive health care for everyone, we start to unravel the systemic oppression that the current COVID-19 pandemic has made even more stark. The time is now to make proactive change to save lives in Tennessee. I do not want to see more people who look like me, my sister, and my mother die prematurely, and doulas can save lives in our Black, Indigenous, and communities of color. It is for that reason that I believe it is my duty to fight so that every pregnant person in Tennessee has access to doulas as well as safe, dignified, and respectful care.


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