Building Health Equity and Health Care Systems: The Importance of Doulas and Midwives as Community Birth Workers in Maternal and Child Health
March 2022

By the Evidence and Implementation team at the Association of Maternal & Child Health Programs (AMCHP).


Doulas are trained in a non-clinical setting and provide support to the person giving birth. They provide emotional and physical support as well as information for people throughout the whole birthing process, including prenatal and postpartum care. Their training equips them to be attuned to understanding the needs of the person giving birth. Doulas in particular have a long history of providing extra support to those in underserved communities where pregnant people are often people of color and have low incomes.

Midwives share some similar responsibilities to doulas because they also support the birth in the prenatal and postpartum periods. However, midwives are trained differently and can directly assist with the birthing process. They can practice solo or in spaces where physicians also work. They also can prescribe certain medications to their patients. Although doulas are solely focused on the wellbeing of the person giving birth, midwives extend their care to the baby and have received more traditional clinical training.

Both occupations are considered types of birth workers. Their presence in communities of color helps supplement and improve the quality of care that these communities otherwise may not receive. Their roles in the world of childbirth are vital to helping reduce health inequalities, addressing the maternal mortality crisis, and bridging the gap to provide quality care in the communities they serve.

The current maternal mortality crisis in the U.S. underscores the need to integrate birth workers into health care systems, similar to the standard global childbirth model of care described in the paragraph that follows. A 2020 report released by the National Center for Health Statistics shows that the U.S. experienced an increase in maternal mortality rates from 2019 to 2020. In 2020, the U.S. reported 23.8 deaths per 100,000 live births (compared to 20.1 in 2019), with Non-Hispanic Black mothers dying at rates three times higher than Non-Hispanic White counterparts (Maternal Mortality Rates in the United States, 2020).

The WHO Recommendations: Intrapartum care for a positive childbirth experience publication provides guidelines highlighting the importance of -centered care that takes a holistic, human-rights-based approach. These recommendations are grounded in the standard global childbirth model of care and “ensure good-quality and evidence-based care irrespective of the setting or level of health care” (World Health Organization, 2018). These obstetric models of care are evident in one of New Jersey’s current Medicaid policies, which recently expanded to support the use of doula services in response to the rising maternal mortality rate. Similar to the global childbirth model of care, New Jersey’s model shows that integrating doulas into the health care system can have a positive impact on preventing maternal mortality.

To support the policy to include doula services, the New Jersey Department of Health was awarded funding to establish the Doula Learning Collective, which provides sustainability training and resources to community doulas and doula organizations throughout the state. The partnership was established under the Expansions of Community-based Doulas through Medicaid Reimbursement, which states: “community doulas have the inherent local knowledge and understanding that enables them to provide equitable and culturally responsive care to mothers during pregnancy, birth, and postpartum which can potentially lower rates of maternal and infant health complications.”

This collaboration between New Jersey and community-based doulas focuses on building systemic change to improve maternal and child health outcomes and demonstrates the positive impacts that integrating doulas into health care systems can have on preventing maternal mortality. (To learn more about this policy and other policies, visit the MCH Innovations Database).

The COVID-19 pandemic has illuminated existing disparities in maternal and child health care and underscored the need for patient-centered care models that address the social comorbidities birthing persons face. Integrating and adapting health care systems to incorporate a Reproductive Justice framework and include global childbirth models of care can help prevent maternal deaths, especially during COVID-19. This knowledge can motivate us to consider what we can do about the maternal mortality crisis within our own local communities.


We encourage you to explore insights from global childbirth models of care and consider how these models can be used as guidance for Title V and its partners to address the maternal mortality crisis. How can you start? Good news! AMCHP’s Global Health Initiative will be hosting a webinar on April 21, 2022, which will focus on how global childbirth models of care and the role of doulas and midwives have shifted, adapted, and developed during COVID-19. Hear perspectives from speakers on what they have seen and experienced and what they are advocating for as birth workers and MCH professionals in this work.

This webinar is the third of an ongoing webinar series by the AMCHP Global Health Workgroup. The series aims to identify and share culturally appropriate best practices, bright spots, and insights from the global community with Title V and its partners. With each subsequent webinar, we hope to build on the knowledge from previous events and serve as a space for learning for anyone interested.

Register for this webinar today using this link and stay tuned for more event details!


Contributors: AMCHP’s Evidence and Implementation team would like to thank the Women’s and Infant Health team for their support and resources contributed to this PULSE Issue.