Black and brown parents, queer families, and people living in poverty face serious risks during pregnancy and childbirth. According to the Centers for Disease Control (CDC), Black women are three times more likely to die from pregnancy-related causes than white women. Immigrant and LGBTQIA+ communities also face higher rates of medical mistreatment and worse outcomes. These numbers reveal a system that fails many. One proven solution? Doulas.
Doulas provide non-medical support before, during, and after childbirth. They offer emotional care, advocate for patients, and make sure families feel heard and respected. Studies show doulas reduce medical interventions like C-sections and improve birth experiences overall. But most doulas work privately and charge between $800 and $3,000 — putting them out of reach for many families who could benefit the most.
That’s where community-based doula programs come in. These programs close the gap by offering free or low-cost services to families who can’t afford private care. But they’re not just about saving money — they prioritize cultural understanding and trust. Many programs recruit and train doulas from the same communities they serve, helping clients feel safe and understood in ways they often don’t in medical settings.
In San Francisco, SisterWeb provides free doula care to Black, Latinx, and Pacific Islander families. Their doulas are trained in anti-racist and trauma-informed practices and paid a fair wage — something rare in a field where many struggle to make a living. SisterWeb partners with hospitals to make doula care a consistent part of the birthing experience, not just a luxury.
“There’s a massive mismatch between who needs doula care most and who can actually afford to give or receive it,” said Ellyn Wyam-Grotham, a queer birthworker and founder of Nisse Body and Birth. “The people most impacted by racism and medical bias are the same ones priced out of support.”
In Portland, the Community Doula Alliance (CDA) focuses on Black, Indigenous, immigrant, and LGBTQIA+ families. Their doulas speak multiple languages and are trained to support a wide range of cultural backgrounds. CDA is one of several organizations working to get doula services reimbursed by Medicaid — a critical step toward making this care sustainable and widely available.
The impact of this care is best understood through the work of doulas themselves. In Syracuse, New York, SeQuoia Kemp supports birthing people not just during labor but throughout the emotional and mental challenges of pregnancy. As profiled in NPR’s “Through Community-Based Care, Doula SeQuoia Kemp Advocates For Radical Change,” she helps clients navigate a healthcare system that often overlooks or dismisses their needs. Her approach shows how doulas fill gaps in medical care misses, offering personalized support that helps families make informed choices.
“We’ve seen some amazing changes,” Wyam-Grotham said. “But they’ve mostly come through the tireless work of Black and Brown organizers and healers — and they’re still vulnerable to shifting public interest and changes in government.”
In Memphis, Tennessee, a new initiative is testing how Medicaid-covered doula care can improve outcomes for Black mothers and babies. Shanille Bowens, founder of Naturally Nurtured Birth Services, is leading the city’s first doula support center and serving as a community liaison for a pilot project. The program provides doula care to Medicaid recipients, offering emotional, informational, and advocacy support throughout pregnancy and the postpartum period. Early signs show these efforts may significantly reduce maternal and infant mortality rates among Black families.
Community-based programs are also driving deeper change. CDA, for example, trains hospital staff on how to work with doulas and understand the unique needs of diverse communities. These partnerships are shifting hospital culture — making care more inclusive and responsive for families who have traditionally been left out of the conversation.
But this work is hard to fund. Many programs rely on grants or donations, making them vulnerable to budget cuts. Both SisterWeb and CDA emphasize that sustainable public funding — especially through Medicaid — is key to growth. And while some states are starting to reimburse doula care, the process is slow and full of red tape. Doulas often face low pay, complex paperwork, and long delays in getting approved by systems that weren’t built for them.
There’s also the issue of professional recognition. Community doulas often draw on lived experience and cultural knowledge that doesn’t always align with state certification requirements. As a result, some of the most effective, community-centered doulas struggle to qualify for Medicaid funding.
Despite these challenges, the work is making a difference. These programs aren’t just supporting people through birth — they’re building systems of care rooted in dignity, cultural relevance, and equity. When families get the support they need and deserve, outcomes improve. Experiences improve. And people begin parenthood with greater confidence.
“They say you can’t just throw money at a problem,” Wyam-Grotham said, “but it also feels like they haven’t even really tried, you know? Send money and let folks determine their own needs.”
What makes these solutions powerful is that they come from the ground up. They’re led by people who’ve experienced the gaps — and who are working to close them. There’s no quick fix, but community doula care is a proven step in the right direction. With sustained funding, strong partnerships, and public support, it can help make birth safer, more equitable, and more empowering for all — not just the privileged few.
Kat Harttrup just earned her BA from the Journalism and Public Interest Communication program at the University of Washington. She predominantly writes about human rights and lives in Seattle with her husband and their daughter.
Kat was a student in Hugo Balta‘s solutions journalism class at UW. Balta, is the Publisher of the Latino News Network, and an accredited solutions journalism trainer with the Solutions Journalism Network.