A California county board hopes to address birthing health disparities for BIPOC individuals through a pilot program funding doula services and training.

On March 1, 2022, the San Diego Board of supervisors approved a $400,000 doula pilot program. The proposal recognizes the findings by the Center for Disease Control (CDC) that “Black birthing people are three times more likely to die from pregnancy-related causes than white birth people.” In addition, such disparities also exist for Indigenous individuals and other people of color. While these deaths are often preventable, a variety of factors contribute to them such as lack of access to appropriate and high-quality care and lack of knowledge among patients and providers.

Doulas are one mechanism communities are leveraging to address birthing health disparities, but doula care is often inaccessible because of cost, absence of providers, inadequate or lack of coverage through medicaid or insurance, or general lack of access to health care.

The San Diego doula pilot program seeks to improve access to doulas for BIPOC individuals. Through contracts with community-based doula businesses, these funds will cover services during pregnancy, birth and delivery, and postpartum care. In addition, some funds will be earmarked to cover doula training costs.

“This program will enable these organizations to serve more individuals at no cost to the clients, train more doulas to serve the community, and promote better health outcomes.”

County Board of Supervisors Agenda Item

The pilot program seeks to simultaneously address birthing health disparities while prioritizing equity and community-based care. Organizations are chosen to join the pilot program with the following criteria:

  • Organizations with demonstrated experience providing birthing services to BIPOC individuals.
  • Diverse and traditionally underrepresented businesses such as businesses owned and operated by BIPOC individuals.
  • Organizations offering culturally-responsive doula training and/or certification to BIPOC individuals.
  • Existing small, community-based San Diego County organizations.

The county will collect survey data of participants, including the organizations, to inform future policy decisions. These surveys are to include data around effectiveness, the experience of participants, demographics, and evaluations of whether the funding is adequate to cover the costs of providers, and are to be shared with the Board of Supervisors.

This program is part of San Diego’s continued efforts to address issues around perinatal and infant health. Efforts at the city or county level can be an often overlooked avenue of advocacy, but the San Diego program may serve as an example of a program doula’s could seek to implement in their community.

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