Thank you to Chair Rivera and Chair Brouk for this opportunity to provide testimony. As Brooklyn Borough President, I represent the New York City borough with the highest maternal mortality and morbidity rates. In NYC, Black and Latinx women experience maternal mortality and morbidity at 9.4 times the rate of their White counterparts. Contributing to this disparity are social and systemic inequities that continue to deplete these communities of necessary resources, ranging from healthcare to education. We can rectify these injustices and reverse these trends when we provide adequate preventative and supportive services to women and birthing people.
Doula care is a cost-efficient preventative and supportive service that enables birthing people to receive appropriate, individualized and culturally sensitive care; make informed decisions; and have positive birthing experiences. Doula services have been proven to lead to lower rates of Cesarean births, preterm births, low birth rate and postpartum depression, as well as increased rates of breastfeeding – which collectively curb maternal and infant mortality rates, improve mother-baby bonding, and enhance child developmental outcomes. According to a 2017 report by Cochrane, birthing people with doula support are 39% less likely to have a caesarean section, 15% more likely to give birth without needing drugs or labor-inducing techniques, and 72% were able to more effectively communicate their needs.
In order to effectively integrate doulas into our health care system, I urge New York State to consider the following:
- Extend Medicaid and private insurance to provide full coverage for doula care.
Currently, Medicaid and private insurance in New York do not cover doula care, and doula care is an unaffordable option for many. According to the 2019 NYC Department of Health & Mental Hygiene Doula Report, 9 out of 10 doulas had to turn clients for reasons that included service affordability. Eleven states are already actively reimbursing for doula care, and there is no reason that we continue to put the lives of our birthing people at risk by extending institutional barriers. We need to ensure that doula care is a covered service within the prenatal and postpartum care spectrum. - Provide an equitable reimbursement rate that comprehensively incorporates all services offered through community-based doula care.
I support the NY Coalition for Doula Access (NYCDA) recommendations for an equitable reimbursement rate of $1930 to adequately cover the full scope of doula services, which includes 8 prenatal and postpartum visits, labor and delivery support, referrals, case support and other administrative costs. In order to offer effective care, doulas can manage a limited number of clients per month; adequate compensation is required to provide focused, individualized services for each client instead of overextending case capacity to make a living wage. The importance of an equitable reimbursement rate was further highlighted through the failure of the 2018 Medicaid pilot program to cover the doula services in Kings County, which was unable to enroll enough doulas due to insufficient reimbursement rates. We cannot make this mistake again. As we aim to recruit a representative workforce that also speaks the languages of the Black, Caribbean, and Latinx communities highest impacted by maternal mortality and morbidity, we must ensure that we are fairly compensating this workforce that has traditionally been underpaid compared to their White counterparts. - Fund community-based doula organizations that train, support, and manage community-based doulas to offer culturally-competent care.
Community-based organizations (CBOs) that have the capacity to train and support a doula workforce should be fairly funded to offer continued doula training, mentorship and professional development that enables doulas to offer safe, culturally-sensitive and respectful client care. CBOs may also be able to directly hire doulas, offering more sustainable support for doulas who no longer have to consider uncompensated administrative costs and serve as independent contractors. While there are different operating models, these programs can serve as centralized administrative hubs for group billing, the data collection and evaluation, and outreach – creating more robust integration of doulas into the overall healthcare system. Additionally, they can help identify doulas from within the communities that speak much-needed languages like Haitian Creole and Spanish to fill the dire linguistic needs of a majority-White, English-speaking doula workforce.
Thank you again for the opportunity to provide testimony. I look forward to working together to ensure that doulas can be adequately integrated into our healthcare system, and to make Brooklyn – and New York State – the safest place to give birth.
