Enabling Policy to Advance Black Maternal Health Equity Through the Use of Doulas in Indiana

Abstract

Disproportionately high maternal mortality rates (MMR) among Black women continue to be a significant public health equity concern in the United States, particularly in the state of Indiana, where Black women experienced the highest MMR at 156.3 deaths per 100,000 live births in 2021. In comparison, White women experienced 90.7 deaths per 100,000 live births in the same year (Indiana Department of Health, 2024). Equity recognizes that high-risk populations have different needs and disadvantages and aims to address disparities by providing targeted opportunities, resources, and support to account for these differences. Health equity is achieved when everyone can attain their full potential for health and well-being (World Health Organization, n.d.). Equality refers to equal access for everyone, which in turn perpetuates inequities. While not the sole solution to Indiana’s Black maternal health equity crisis, Doulas are an evidence-based solution to reducing racial disparities in maternal health outcomes. Building on the current body of literature, this dissertation explores how Indiana can enable policy to expand access to Doula care and integrate Doula services into maternal healthcare systems. Through the employment of qualitative, semi-structured interviews with Doulas and other key stakeholders, findings identified that current barriers in Indiana include a lack of a supportive environment to legitimize the profession, lack of Medicaid reimbursement and inadequate private insurance coverage, processes that “medicalize” Doula care, and the need for collaborative efforts with Doulas when crafting Doula-related policies. By leveraging a policy and stakeholder analysis, an implementation plan was developed to provide recommendations on how Indiana policy can advance Black maternal health equity through the use of Doulas. This research's importance lies in its potential to inform policy and practice in Indiana and provide foundational information for other states that have yet to begin incorporating Doula care into policy to advance maternal health equity.