Doulas for Disparity: How a New Tri-faceted Model for Individualized Care will Save Lives 

By: Sophie Frankenthal  |  May 15, 2022

By Sophie Frankenthal, Staff Writer

One of the most tragic realities is the loss of life at the exact moment in which a new life is expected to enter the world. Thanks to medical and technological advancements, infant and maternal mortality, which plagued humanity for centuries, has been significantly reduced. We tend to take for granted the level of miracle that is involved every time both mother and infant survive pregnancy and delivery. However, it is frightening that there exists significant disparity in the experience and outcome of childbirth, depending largely on one’s race. With this in mind, I believe that in order to truly address the issue of maternal-infant mortality, we must prioritize the delivery of individualized, patient-centered care, which is why one recently implemented NYC Initiative stands out as one of tremendous potential. 

The CDC reports that pregnancy-related deaths are three times more common amongst black women than white women. The majority of these deaths are completely preventable, as most of them can be attributed to structural racism and lack of quality healthcare, whereas only a few are the result of underlying medical conditions. 

In New York City, the statistics are even more shocking. According to the NYC Department of Health and Mental Hygiene (DOHMH), the rate of pregnancy-related deaths in NYC is nine times higher for black women than for white women and the infant mortality rate is upwards of three times higher. It is for this reason that on March 23, 2022, NYC Mayor Eric Adams announced a city-wide expansion of three initiatives specifically designed to combat maternal and infant health inequities in NYC

The first of these initiatives is the Citywide Doula Initiative, which aims to increase the number of practicing doulas (individuals who are trained to provide physical and emotional support during both pregnancy and childbirth) throughout NYC, as well as to provide doula services to eligible families, free of charge. These services include prenatal consultations, active assistance throughout labor and delivery (whether in the clinic or at home), and postpartum care. The second initiative, termed the Midwifery Initiative, seeks to research and integrate current midwifery care models with the goal of improving prenatal care and delivery outcomes in both clinical and home-based environments. The final initiative, the Maternity Hospital Quality Improvement Network (MHQIN), focuses on developing strategies to monitor and resolve racial inequities in the clinical setting, primarily by means of expanded staff training in areas such as racial equality, unconscious bias, and patient-centered care (an approach to care that is informed by the needs, preferences, and values expressed by the patient). 

What is both unique and encouraging about the expansion of these initiatives is the emphasis it places on systemic causes of racial discrepancies in healthcare. Much of the discussion regarding health disparity is focused on the lack of affordability and accessibility to healthcare for individuals of a lower socioeconomic status. While this is undeniably a troubling aspect of the American healthcare system, it is not necessarily something that can be addressed on a state-based level. Additionally, when it comes to racial disparities in particular, it is a difference in treatment quality that creates the biggest rift, rather than lack of affordability. The American Heart Association explains that black women often experience bias and stereotyping within the healthcare setting– even if they are wealthy and successful. Systemic racial bias within healthcare is often implicit, and it mainly manifests in the undervaluing and dismissal of expressed patient worries and needs. According to both the AHA and the CDC, the fact that the concerns and symptoms of black mothers are taken less seriously than those of white mothers results in a lower level of care, and is one of the primary reasons that black women are more likely to die of a preventable pregnancy-related cause. 

Mayor Adams’s recognition of systemic bias as the root cause of the disparity in maternal healthcare is what makes this initiative so exceptional. The expansion functions as a tri-faceted model, with each component combating the issue from a slightly different angle.

The main objective of the Citywide Doula Initiative is to provide pregnant women with personalized attention and care through an individual who is specifically trained to be attentive to the emotional and psychological needs of the mother. Collaboration between midwives and physicians, as prescribed by the Midwifery Initiative, is expected to add an element of individualization and compassion to the typically sterile healthcare provided clinically. Lastly, the MHQIN seeks to address the crux of race-related health disparities, by implementing sensitivity training across various levels of the healthcare system in the hopes that implicit prejudice can ultimately be eradicated. Mayor Adams has introduced an extraordinary program, with the potential to ensure that no woman loses her own life or the life of her infant solely because she didn’t receive the highest possible level of care. Perhaps even more promising is the fact that, on a broader scale, action is now being taken to ensure that every woman feels comfortable, safe, and– most importantly– heard, regardless of her race or ethnicity. At the end of the day, it is crucial that we strive for every infant not only to survive, but to live and thrive in a world in which they, their voices, and their needs will be attributed infinite worth, without exception.