Caring for Black Birthing Families Requires Cultural Responsiveness

For Black birthing families, care that embraces cultural sensitivity is not a luxury—it is an urgent necessity. As maternal health disparities remain at the forefront of public health discussions, doulas continue to prove their critical role in reshaping outcomes. These professionals provide more than emotional support; they become advocates, educators, and bridges between families and health care systems that have historically overlooked their voices.

Cultural responsiveness in doula care is reflected in simple yet impactful practices that resonate with the diverse needs of birthing families. This might include doulas being familiar with specific postpartum recovery traditions, such as preparing nourishing soups or herbal remedies that align with cultural practices. It could mean respecting and incorporating birthing rituals, like affirmations, prayers, or songs, into the labor process. For Black birthing families, this often involves doulas acknowledging the historical mistrust in medical systems and acting as trusted advocates to ensure their clients’ voices are heard.

Another important aspect of cultural responsiveness is language accessibility. Families who speak languages other than English benefit immensely when doulas are fluent in their native language or work with interpreters, helping to navigate complex medical settings. Even subtle actions, like addressing clients by their preferred pronouns or using inclusive language, contribute to creating a supportive and empowering birthing experience.

“Think of us like your maternal guidance counselor,” says Shariah Edwards, a certified full-spectrum doula for Altruism, Inc., a 501(c)(3) nonprofit. “I can’t give you medical advice, but I can give you evidence-based information so that you can make the best decision for you.” Edwards emphasizes the importance of empowering birthing individuals through informed decision-making and holistic support.

Proven Benefits of Doula Support

The profound impact of doula care on maternal and infant health outcomes is backed by rigorous research. According to a systematic review published by the Patient-Centered Outcomes Research Institute (PCORI) in 2023, doula-supported births reduce rates of medical intervention by nearly 30%, significantly improve maternal satisfaction, and foster stronger family engagement in the birthing process. Such findings underscore the undeniable value of integrating doula care into broader health care strategies aimed at closing equity gaps.

The systemic inequities Black birthing families face today are deeply rooted in historical injustices. During the early 20th century, Black midwives were central to maternal care in their communities, providing culturally sensitive support despite systemic barriers. However, the medicalization of childbirth and exclusionary policies marginalized these practices, leaving a void in culturally responsive care. Today, doulas are reclaiming this legacy, bridging the gap between traditional practices and modern health care systems. This historical context underscores the importance of integrating doula care into maternal health strategies to address the long-standing disparities that disproportionately affect Black families.

For Black families, the benefits of working with culturally matched doulas extend beyond measurable health outcomes. These doulas often share lived experiences and cultural understandings that resonate deeply with the families they serve. This connection fosters trust, reducing the fear and anxiety that systemic bias in health care can perpetuate. Culturally matched doulas might incorporate traditional postpartum customs, such as preparing nourishing soups or herbal remedies, or honor birthing rituals like affirmations, prayers, or songs. These practices help families feel seen and respected, creating a sense of safety and empowerment.

LaTasha Williams, a mother from Vancouver, Washington, experienced firsthand the devastating consequences of systemic shortcomings in her pregnancy, losing her daughter Essence due to delayed care. Determined not to relive that tragedy, LaTasha sought the guidance of a certified obstetrician-gynecologist (OB-GYN) and a culturally responsive doula for her next pregnancy. With this support, she felt empowered to advocate for her needs and delivered a healthy baby boy, Mekai. Her story is a testament to how culturally responsive doula care can transform outcomes for Black birthing families.

The enduring impact of doulas extends well beyond the moment of birth. Their presence has a measurable ripple effect, shaping not only health outcomes but also the narratives surrounding childbirth experiences. For many Black birthing families, doulas serve as both a shield and a bridge—shielding them from systemic biases and bridging gaps between medical professionals and families. This dual role becomes particularly critical in addressing long-standing health disparities.

In 2024, research from the American Journal of Public Health highlighted that Medicaid-covered doula services led to a 29% reduction in preterm births for Black birthing people compared to those without such support. This significant outcome underscores the potential of Medicaid expansion to ensure that culturally matched doula care reaches those who need it most. Additionally, a longitudinal study from the National Partnership for Women & Families found that doula-supported families reported significantly lower postpartum depression rates and higher breastfeeding success rates—factors closely tied to long-term well-being for both parent and child.

It is critical to recognize that cultural competency is not merely about understanding differences but about embracing them as assets. Black-led doula initiatives, in particular, exemplify this approach by integrating historical knowledge, traditions, and even storytelling into care models. These practices honor the lineage of Black birthing traditions while addressing the immediate challenges of modern health care.

The postpartum period exemplifies how doulas enhance care continuity, especially for Black mothers. Historically marginalized by health care systems, many Black birthing families face heightened risks during this period, including increased susceptibility to complications like postpartum hemorrhage. By maintaining an active role in this critical window, doulas mitigate risks and offer culturally attuned guidance for recovery. Simple practices such as advocating for rest, community meals, and protective rituals can have profound effects on maternal health, as affirmed by veteran doula Shafia Monroe in her continued advocacy.

Medicaid Expansion and Doula Access in Missouri and Kansas

In Missouri, Medicaid expansion has been a pivotal step forward in addressing maternal health disparities. Programs like MO HealthNet now reimburse for doula services, providing critical support to Black birthing families. According to the Missouri Pregnancy-Associated Mortality Review, 84% of pregnancy-related deaths in the state were deemed preventable, with Black mothers disproportionately affected. However, recent legislative proposals to scale back Medicaid funding threaten to undermine this progress, jeopardizing access to life-saving doula care.

Organizations like the Missouri Community Doula Council have been pivotal in ensuring Black families receive culturally matched doula care. In one case highlighted by the Council, a St. Louis mother credits her doula with helping her navigate an under-resourced health care system. “Our doula gave us the tools to advocate for ourselves and ensured we felt seen in a space that often erases us,” she shared. In Kansas City, BJC HealthCare has also taken steps to address maternal health disparities by partnering with community organizations to integrate doula care into their maternal health services. These initiatives illustrate the transformative potential of locally driven solutions for bridging systemic gaps.

In Kansas City, Missouri, stories like Geornesha Clayton’s highlight the life-changing impact of culturally responsive care. Facing overwhelming prenatal anxiety during her pregnancy, Geornesha found solace and strength through a local maternal mental health program and the support of a doula. “I needed that kinship; the family that I really found was from Strength Through Story. Knowing that I wasn’t alone … Honestly, if it weren’t for that and medication, I’m not sure me or my daughter would still be here,” Geornesha shared. Her experience underscores how doula care can be a lifeline, especially for Black mothers navigating systemic health care inequities.

Kansas, on the other hand, has only recently begun to expand Medicaid coverage for doula services under its KanCare program, effective July 2024. This policy shift, announced by the Kansas Department of Health and Environment, aims to improve maternal health outcomes by recognizing doulas as non-physician providers. While this is a step in the right direction, the lack of comprehensive Medicaid expansion in Kansas continues to leave many families without access to equitable care.

Protecting Progress and Advocating for the Future

The political landscape further complicates these issues. The current administration’s proposed federal budget cuts to Medicaid risk destabilizing programs like Missouri’s expanded coverage, which relies heavily on federal funding. These cuts could force states to reduce Medicaid benefits, disproportionately impacting Black families and exacerbating maternal health disparities, according to an analysis by the Kaiser Family Foundation. Maternal health advocates argue that such policies not only undermine progress but also reflect a troubling disregard for the health and well-being of marginalized communities.

Advocates emphasize that safeguarding state and federal funding for programs like Medicaid and maternal health initiatives is not only essential but also a collective responsibility. According to the Guttmacher Institute, restricting Medicaid further widens the gap in health care access, disproportionately impacting marginalized communities and exacerbating systemic inequities. 

To ensure continued progress, individuals can support policies that prioritize women’s health and advocate for equitable maternal care. Engaging with policymakers, attending public hearings, and voicing the importance of programs like Medicaid-funded doula services are critical steps to maintaining this momentum. At the community level, forming coalitions and amplifying the voices of those directly impacted by systemic inequities can further strengthen these efforts. Protecting these resources requires a united front—one that recognizes maternal health as a cornerstone of a healthier, more equitable society for all.