The Case for Doulas: Cost Savings & Improved Outcomes
Summary
In 2024, Creating Healthier Communities (CHC) committed to codifying a case for support for investing in a doula workforce, linking birthing outcomes and health care cost savings to a fair doula compensation mode through the Doula Workforce Model Community Leadership Action Lab (CoLAB) . This effort will build upon the success of the Black Birthing Initiative and center the voices of 200 Cuyahoga County, Ohio doulas in creating a compensation model that is sustainable and relevant to the local community context before scaling to Marion County, Indiana and Fulton Country, Georgia by 2025. It will also serve as a baseline for policy recommendations for doula compensation and reimbursement in communities across the country thereby promoting women’s economic empowerment, improving individual-level maternal health outcomes, and dismantling systemic barriers to sustained improvements in population-level maternal health outcomes on a national scale
Approach
Building on the successful Black Birthing Initiative (BBI) , CHC: Creating Healthier Communities will develop the Doula Workforce Model Community Leadership Action Lab (CoLAB) . The CoLAB will evaluate the effectiveness of the BBI doula compensation model for growing a robust doula workforce using Cuyahoga County, OH as the case study.
As a CoLAB, this project will allow doulas to develop their own funding structures, a process from which they have been historically excluded. The qualitative data gathered from lived experiences of doulas will inform the methodology for growing and sustaining the doula workforce in the resulting case for investment. This research is backed by quantitative data from the BBI which showcases the healthcare cost savings of doulas’ work and the effects on reducing Black maternal health disparities.
CHC’s 2024 CTA goes beyond data collection and analysis, the case study will be promoted within the nonprofit and healthcare sectors as an evidence-informed model to address maternal health disparities through investments in doula workforces. Knowledge translation and knowledge transfer are key to helping CHC achieve the overall intent of our birth equity and maternal health work – to support adoption of tested interventions and improve the standards of care for Black birthing people.
Utilizing an implementation science approach, CHC will develop a dissemination and diffusion strategy (using passive and active approaches) to translate the scientific knowledge from the CoLABs into practice and transfer the knowledge to help improve birth outcomes by 2025. The range of dissemination/diffusion approaches include: capacity building and coaching activities- digital and in person; developing integrated advocacy and policy agenda for local implementation; skills enhancement/nonprofit leadership focus; professional development for nonprofits/doulas; media training nonprofits; advancing culturally and gender considerate health promotion messaging and programming; applying lifestyle change and reproductive justice frameworks; and shaping funding and research priorities.
Action Plan
CHC and its partner Birthing Beautiful Communities will ensure that the experiences of those providing this life-saving maternal care are centered in building a resilient doula workforce. The data doulas provide will be instrumental in driving and maximizing future improvements to maternal health payment models, with results presented as a case study and policy recommendation from CHC.
Q1- Planning
Secure MOUs with local evaluation, research, and implementation partners
Develop data collection and methodology for CoLabs and listening sessions.
Create a schedule of data collection and evaluation.
Begin conducting qualitative data collection.
Continue analyzing quantitative data.
Develop diffusion and dissemination strategy.
Recruit and establish CoLab participants and schedule of activities/events.
Q2 & Q3- Implementation
Conduct CoLab activities.
Continue qualitative and quantitative evaluation.
Writing case study.
Validate case study with CoLab partners.
Q4- Dissemination & Diffusion
Implement dissemination and diffusion strategy.
CHC believes this case for a sustainable doula workforce will be foundational to securing innovative system improvements and lead to a future of equity and health for Black mothers and infants in Cuyahoga County, OH and beyond. The case study, once complete, will be promoted on national platforms within the nonprofit and healthcare industries as an evidence-informed model to address maternal health disparities through investments in doula workforce. Because a central value of CHC is data sovereignty and equity, local doulas and community partners will have full access to all case study data to be used as they see fit.
Background
The correlation between positive birth outcomes and doulas has been widely studied. For example, a recent study published by the National Institute of Health (NIH) found women receiving doula support with Medicaid saw an overall 52.9% decrease in the risk of cesarean surgery and a 57.5% decrease in rates of postpartum depression/postpartum anxiety. Another recent study published by NIH, found that on average, doula-supported deliveries among Medicaid beneficiaries regionally would save $58.4 million and avert 3,288 preterm births each year. Yet, only about half of states provide Medicaid coverage for doula care. Furthermore, reimbursement rates vary widely from state to state from $450-$3,000 per delivery (Georgetown University) . In some Midwest states this amounts to a few dollars a day in reimbursement during the duration of an aided pregnancy.
Low reimbursement rates coupled with complex systems for receiving reimbursement which can take as long as six months for doulas to receive reimbursement, high caseloads, and demanding certification requirements, have created barriers for doulas to enter and remain in the workforce. Our current systems have stunted the doula workforce across the country.
Progress Update
Partnership Opportunities
Currently, the BBI is philanthropically funded, with the three-year seed funding in its last year. The current philanthropy-funded doula workforce model will sunset at the end of this three-year grant if sustainability funding or a new revenue model is not adopted. We seek financial resources and media support to raise awareness for this need., With its implementation partner Birthing Beautiful Communities, CHC is co-creating a set of best practices for developing and sustaining a place-based doula workforce. Birthing Beautiful Communities is a CHC grantee who receives capacity building support and subject matter expertise from CHC staff as they conduct BBI related maternal health interventions.