A look at the healing legacy of doulas — and ‘Strengthening Black Maternal Health Through Collective Action and Advocacy’

Health Forward Foundation celebrates Black Maternal Health Week, held annually from April 11 through April 17. The week-long campaign was established by Black Mamas Matter Alliance (BMMA), a 501(c)(3) nonprofit whose mission is to create awareness, activism, and community-building to amplify the voices, perspectives, and lived experiences of Black mothers and birthing people. This is mission critical as Black women and birthing people have nearly a three times higher mortality rate than their white counterparts in Missouri and more than two times the rate in Kansas.

This year’s theme is Healing Legacies: Strengthening Black Maternal Health Through Collective Action and Advocacy. It centers the power of Black-led perinatal, maternal, and reproductive health organizations to drive systemic change and foster community healing. But it’s impossible to do this work without the help of  Black doulas — a profession that has stood the test of time well before it permeated Western culture.  BMMA’s 2025 theme captures a sense of urgency to address deep-rooted, persistent, obstetric oppression, reproductive injustices, and disparate mortality and morbidity rates for Black women and birthing people. Doulas play a crucial role in addressing these disparities. 

From ancient Greece to the 1970s, a little doula history.

Doulas have been a part of the pregnancy journey since ancient Greece. “Doulē” is the Greek word for doula and is translated as female servant. Even then, doulas were known to provide emotional support, guidance, and comfort during labor and delivery.  This legacy of women supporting women during childbirth has persisted throughout history. However, as modern medicine emerged, and hospital births supplanted home births, the role of the doula diminished.  It wasn’t until the 1960s that the word doula was coined in the U.S. 

More than a decade later, the medical community began documenting the health benefits of having doulas support labor and delivery in hospital settings; women who had a doula experienced better health outcomes. This was thanks to the late Dr. John H. Kennell, a pediatrician, researcher, and founder of DONA International, the leading organization for evidence-based doula training, certification, and continuing education. He is also known for a simple but poignant quote, “If a doula were a drug, it would be unethical not to use it.” Since the 1970s, the U.S. has seen a gradual re-emergence of doulas that has morphed into a steady movement that continues to gain strength.

Doulas inextricably improve maternal and infant health outcomes.

Today, doulas are trained professionals who provide emotional, physical, and informational support to birthing people and their families during the prenatal and postnatal journey. This includes providing comfort measures at bedside during labor and delivery, as well as working alongside medical professionals to support positive birthing experiences — often advocating on behalf of the birthing person. For Black birthing people, this advocacy is crucial.

BMMA’s 2025 theme captures a sense of urgency to address deep-rooted, persistent, obstetric oppression, reproductive injustices, and disparate mortality and morbidity rates for Black women and birthing people. Doulas play a crucial role in addressing these disparities. 

New CDC data  reveals a continued surge in maternal mortality rate for non-Hispanic Black women, escalating to a flagrantly high 50.3% deaths per 100,000 live births from 2022-2023. For white, Asian, and Hispanic women and birthing people, mortality rates have dropped. These jarring mortality figures clearly demonstrate the importance of doulas, along with an ever-increasing need for the services they provide, which are endorsed by the American College of Obstetricians and Gynecologists.

Evidenced-based research concludes that doulas provide the following benefits:

• Reduce mortality and morbidity rates among Black women due to the supportive and advocative role they play. This includes addressing providers’ implicit biases that increase maternal morbidity and mortality rates.
• Provide emotional and physical support that includes comfort measures at bedside along with techniques to mitigate discomfort throughout the labor and birthing process.
• Improve maternal and infant health outcomes as doulas are linked to reduced cesarean births, preterm births, low birth-weight babies, and other complications while increasing breastfeeding rates and reducing postpartum depression.
• Empower birthing people to have more agency over their birthing experience, which is especially important for Black women and birthing people who have experienced mistreatment by a health system. According to a CDC report, about 30% of women of color report mistreatment during pregnancy and delivery.
• Address health care inequities by bridging gaps between the birthing person and the provider in a culturally relevant manner to open communication channels and build trust.
• Promote cultural sensitivity through shared language and personal experiences, and an understanding of the unique needs and desires of Black women and birthing people.
• Advocate for and represent the birthing person to ensure their voice is heard and their preferences are respected.

This Black Maternal Health Week, Health Forward and #BMMA25 are advocating for healing at both individual and community levels while addressing the need for restorative approaches to maternal health care. It celebrates the leadership and expertise of Black community-based organizations as the foundation for advancing equity and ensuring transformative, sustainable improvements in Black maternal health. 

A call to action.

As work is being done in the Kansas City region to address flagrant disparities among Black women and birthing people, a village approach is necessary to address inequities through a spirit of collaboration.  Health systems and community organizations are asked to coalesce around these action items:

1. Increase awareness of the beneficial roles that doulas and perinatal community health workers (PCHWs) play in advancing improvements in maternal health outcomes.
2. Address the chasm between health systems, nursing teams, and doulas that too often frustrates the cohesion necessary to bring about improved maternal and infant health outcomes.
3. Galvanize health systems to integrate doulas (and PCHWs) into their care teams in collaboration with community-based doula organizations.
4. Develop community partnerships that couple birth work organizations with mental health providers to identify and address maternal mental health conditions, from the perinatal period throughout postpartum.
5. Advocate against cuts to Medicaid. Contact your elected officials and let them know how crucial this benefit is to women and birthing people – https://house.gov/representatives and https://congress.gov.
6. Continue to fight to expand Medicaid in Kansas. Join the advocacy effort.
7. Advocate for the permanency of Missouri’s Special Plan Amendment to reimburse doula services through MO HealthNet. Its expiration date is March 28, 2025.

For tools and resources to promote #BMMA25, visit https://blackmamasmatter.org/bmhw25/.

Tonia Wright is the CEO of Altruism, Inc., a 501(c)(3) nonprofit that provides support to women and birthing people with the help of doulas, perinatal community health workers, mental health providers, as well as many other services that promote whole-person care. Altruism, Inc. opened its pregnancy center, The Maternal and Infant Health (MaIH) Center in 2023, and serves both rural and urban communities.