In Effort to Address Maternal Inequities, New York City Expands Access to Doulas

While many doulas are eager to participate in the program, at least one lawmaker says it falls short

Tasha Phifer (left) and Miranda Padilla (right) manage The Mothership’s baby shower. Jamaica/Queens, NY. Wednesday, March 30, 2022. Riley Farrell for NY City Lens.

As part of a $30 million expansion of maternal care services, New York City will increase access to doulas in the coming months. On March 23, Mayor Eric Adams announced the citywide plan, which aims to decrease racial and socioeconomic disparities in complications from childbirth.

The doula program will now offer doulas to 500 families in the next three monthsfocusing on 33 underserved neighborhoods with the highest rates of maternal mortality and undertreated postpartum depression. The Department of Health and Mental Hygiene (DOHMH) will train 50 new doulas and certify 70 uncertified doulas, in hopes of reaching 500 families by the end of June.  

Doulas, who serve as birth coaches and provide postpartum support, are increasing in popularity in New York City. While most pregnant people do not use doulas, more seem to be enlisting their services, according to the National Partnership for Women & Families. Doulas, who can attend hospital births and assist with pregnancies and postpartum care for mothers, can be especially valuable for immigrants and refugees who may not speak English and aren’t accustomed to the U.S. health care system.

The Mothership, a Harlem-based pregnancy care center, partnered with the doula program on Feb. 8. Doulas in the city, especially community-trained doulas of color, came out in droves to be a part of the expanded initiative, said Tasha Phifer, a doula. Phifer and her co-founder at The Mothership, Miranda Padilla, are both “experienced” doulas, which means they have successfully assisted over ten births. 

A mother collects diapers from The Mothership’s community baby shower. Jamaica/Queens, NY. Wednesday, March 30, 2022. Riley Farrell for NY City Lens.

The city’s investment in this multifaceted initiative aims to reduce the inequities in maternal deaths, life-threatening complications from childbirth, and infant mortality, said Padilla. In New York City, Black birthing people are eight times more likely to die from pregnancy than their white counterparts, and three times more likely to develop a life-threatening complication during delivery, according to the Centers for Disease Control and a 2020 DOHMH study. 

“There’s a lot of fear from Black and brown birthing people going into medical institutions,” said Padilla, whose traumatic pregnancy during the 2020 COVID-19 lockdown further ignited her passion for healthcare equity.

Doulas in the initiative collect data from each birthing client and enter it into the city’s program database to optimize perinatal health outcomes for the 120,000 infants born in New York City, annually. Beyond the babies, four postpartum visits, focused on the mother’s mental and physical health, are included in the initiative.

The Mothership Doula Tasha Phifer sets up wet wipes and parenting supplies at a community baby shower. Jamaica/Queens, NY. Wednesday, March 30, 2022. Riley Farrell for NY City Lens.

“We’re here to serve birthing people, give them a safe place to bring their children into the world and prepare them for this experience that they deserve to have,” Phifer said. “We help the transition to parenthood to be beautiful.”

That transition to parenthood can be a complicated family issue, said Dr. Pria Alpern, a clinical psychologist affiliated with Postpartum Support International. BIPOC birthing people in New York City encounter the intersection of disparities in obstetric care and mental health care, extending into the first year of their children’s lives. Dr. Alpern defined postpartum depression as a serious phenomenon that falls under the umbrella of perinatal mood and anxiety disorders, impacting 15 to 20% of mothers.

Dr. Alpern, who used doulas for all three of her children’s births, supports the doula expansion program. Doulas are protective of under-resourced birthing people, said Dr. Alpern. Through her platform on TikTok, where she has 39,600 followers, Dr. Alpern called doulas the “missing link” to address systemic birthing issues.

Assemblymember Jessica González-Rojas, who represents District 34 in Queens, identified herself as “a reproductive justice advocate first,” but said she has mixed feelings about the doula initiative. The doula program, she said, does not address the shortcomings of previous doula expansion efforts, referring to the state’s 2019 Medicaid-backed doula pilot program. Designed as a year-long pilot in Brooklyn, that program largely fell flat in implementation after an insufficient number of doulas signed up, she added. 

“It seems untenable for fifty doulas, all of whom are required to be full-spectrum doulas, to provide prenatal, birth and postpartum doula care to 500 families in three months,” González-Rojas said.

The 33 blue sections represent neighborhoods impacted by the citywide doula initiative, which will provide free access to doulas for birthing families “with the greatest social needs.” Via New York City’s Taskforce on Racial Inclusion & Equity.

Earlier this year, González-Rojas was the main sponsor of the Assembly version of Senate Bill 7753, which requires the New York State Office of Mental Health (OMH) and the Department of Health to conduct a study on the inadequacies of postpartum depression screening tools. González-Rojas said a universal, single-payer healthcare system that covers doula, midwifery, comprehensive prenatal and postpartum care would improve outcomes.  

In the predecessor pilot program, Brooklyn doulas were only reimbursed $600 by Medicaid, when they are typically paid over $2,000 per client. This time around, in the citywide program, Adam’s budget aims to cover the full cost of doulas’ services. 18 local doula services, including The Mothership, chose to enroll in the expansion program. Believing this program improves on the Brooklyn pilot program, Phifer said The Mothership was motivated to join by the network of connections that come from being part of Adam’s initiative.