The United States faces a maternal health crisis that disproportionately affects Black and Brown communities.
The United States faces a maternal health crisis that disproportionately affects Black and Brown communities. Despite being one of the world’s wealthiest nations, America’s maternal mortality statistics reveal a troubling pattern of racial inequality that demands immediate attention and action.
Doulas are powerful bridges—offering support, advocacy, and care that help close the gap in birth inequities and ensure every parent is seen, heard, and valued.
The Stark Reality of Racial Disparities
The numbers tell the story. In 2023, Black women in the United States died during childbirth at a rate of 50.3 deaths per 100,000 live births—more than three times higher than White women at 14.5 deaths per 100,000. Hispanic women experienced 12.4 deaths per 100,000 births, while Asian women had the lowest rate at 10.7 deaths per 100,000. These disparities represent not just statistics, but real families devastated by preventable losses.
The gap has widened over recent years, with Black women facing increasingly disproportionate risks. This maternal mortality crisis affects not only mothers but entire communities, leaving children without mothers and families shattered.
A Global Perspective: Where America Falls Short
When looking at maternal health through an international lens, the United States’ performance is even more concerning. The overall U.S. maternal mortality rate of 22.3 deaths per 100,000 live births significantly exceeds that of other developed nations. Countries like Australia and New Zealand maintain rates as low as 3 deaths per 100,000 births.
Interestingly, many countries with predominantly Black and Brown populations achieve better maternal health outcomes than the United States despite having fewer economic resources. Sub-Saharan Africa, while facing significant challenges with 454 maternal deaths per 100,000 births, demonstrates that targeted interventions and community-based care models can make substantial improvements. Several African nations have made remarkable progress through focused maternal health programs, midwifery training, and community health initiatives.
The Problem
These disparities stem from multiple interconnected factors including systemic racism in healthcare, socioeconomic barriers, geographic access challenges, and implicit bias among healthcare providers. Black and Brown women often face dismissal of their concerns, inadequate pain management, and substandard care quality. Additionally, social determinants of health—including housing instability, food insecurity, and chronic stress from systemic racism—contribute to higher risk pregnancies and complications.
Doulas: A Path to Equity
Doula services represent a powerful intervention that can help bridge these gaps and improve maternal outcomes. Doulas are trained birth companions who provide continuous physical, emotional, and informational support before, during, and after childbirth. Their culturally competent care model addresses many of the systemic issues contributing to maternal mortality disparities.
Research consistently demonstrates that doula support leads to:
- Reduced cesarean rates and shorter labor times
- Decreased need for pain medication and medical interventions
- Lower rates of preterm births and low birth weight babies
- Improved breastfeeding success rates
- Better maternal mental health outcomes
- Enhanced communication between patients and medical providers
For Black and Brown women specifically, doulas provide crucial advocacy and emotional support in healthcare settings where they may otherwise feel unheard or dismissed. Doulas help ensure that women’s voices are respected, their birth preferences are honored, and their concerns are addressed promptly.
Building a Better Future
Community-based doula programs, particularly those led by doulas of color, show tremendous promise in reducing maternal mortality disparities. These programs combine clinical support with cultural understanding and community connection, creating a comprehensive care model that addresses both medical and social needs.
Expanding access to doula care through insurance coverage, Medicaid reimbursement, and community programs represents a critical step toward maternal health equity. When combined with broader healthcare system reforms, improved provider training on implicit bias, and addressing social determinants of health, doula care can help ensure that all mothers receive the support they deserve.
The maternal health crisis in America requires urgent, comprehensive action. By embracing evidence-based interventions like doula care while addressing systemic inequities, we can work toward a future where every mother—regardless of race or background—has access to safe, respectful, and culturally competent care. It’s time for change.
References
- Hoyert, D.L. (2025). Maternal mortality rates in the United States, 2023. NCHS Health E-Stats. Centers for Disease Control and Prevention.
- Centers for Disease Control and Prevention. (2025, February 10). Working Together to Reduce Black Maternal Mortality. Women’s Health.
- Thomas, M.P., Ammann, G., Brazier, E., Noyes, P., & Maybank, A. (2017). Doula services within a healthy start program: Increasing access for an underserved population. Maternal and Child Health Journal, 21(1), 59-64.
- Campbell, D.A., Lake, M.F., Falk, M., & Backstrand, J.R. (2006). A randomized control trial of continuous support in labor by a lay doula. Journal of Obstetric, Gynecologic & Neonatal Nursing, 35(4), 456-464.
- Kozhimannil, K.B., Hardeman, R.R., Attanasio, L.B., Blauer-Peterson, C., & O’Brien, M. (2013). Doula care, birth outcomes, and costs among Medicaid beneficiaries. American Journal of Public Health, 103(4), e113-e121.
- National Health Law Program. (2024, September 10). Doula Care Improves Health Outcomes, Reduces Racial Disparities and Cuts Cost.
- Bohren, M.A., Hofmeyr, G.J., Sakala, C., Fukuzawa, R.K., & Cuthbert, A. (2017). Continuous support for women during childbirth. Cochrane Database of Systematic Reviews, 7, CD003766.
