Role of Doulas in Improving Maternal Health and Health Equity Among Medicaid Enrollees, 2014‒2023

Abstract

Objectives. To assess the relationship between doula utilization and health outcomes of females enrolled in Medicaid-affiliated plans in the United States. Methods. In this retrospective, observational cohort study, we used Medicaid claims data from a national health insurer to compare health outcomes between females who used and who did not use a doula (2014-2023). We conducted propensity score matching using a 1:1 case‒control match, without replacement, and fit logistic regressions to analyze the relative risks for maternal health outcomes. Results. The study population included 722 matched pairs with and without a doula. Results indicate females with doulas had a 47% lower risk of cesarean delivery and a 29% lower risk of preterm birth, and were 46% more likely to attend a postpartum checkup (all differences P < .05). Conclusions. Doula care is associated with improved health outcomes among Medicaid enrollees. Public Health Implications. Doulas have garnered increasing interest from policymakers as a strategy to address increasing trends in maternal morbidity and persistent health disparities. This study provides evidence from Medicaid enrollees across the United States that doula care can improve maternal health. (Am J Public Health. 2024;114(11):1275-1285. https://doi.org/10.2105/AJPH.2024.307805).

FIGURE 1—

Study Population Attrition of Women Enrolled in Medicaid-Affiliated Plans in the United States: 2014–2023 ^aThe study population was restricted to members in 9 states (CA, NJ, MO, TX, WI, and 4 other states located in different US regions; some states could not be named because of health plan compliance rules that prohibit us from identifying specific states without their approval.) where doula care was provided (either as a legislated benefit or alternatively funded via pilots, grants, etc.).