Center for Reproductive Health Research in the Southeast (RISE), Emory University, Atlanta, Georgia, USA.
Healthy Mothers Healthy Babies Coalition of Georgia, Atlanta, Georgia, USA.
Perspect Sex Reprod Health. 2023 Sep;55(3):200-209. doi: 10.1363/psrh.12241. Epub 2023 Aug 2.
In Georgia, maternal mortality is relatively high, and Black women are three times as likely to die from pregnancy-related causes as white women. Doulas can improve perinatal health and reduce disparities, but doula accessibility in Georgia is unclear.
This community-engaged mixed methods study surveyed and interviewed 17 doulas in Georgia. Surveys included structured questions on demographics, businesses, clientele, training, and challenges; we analyzed them using descriptive statistics. In-depth interviews included open-ended questions on doula care benefits, building their businesses, and improving access to doula care. We analyzed the content of transcripts using coding and memoing.
Our diverse doula participants described providing life-saving services including education, referral to care, and patient advocacy. Yet they described numerous challenges to providing care and building their businesses. Almost all participants reported having fewer than their ideal number of clients and all reported being insufficiently paid for their services. Although training, mentoring, and networking help build their businesses, many doulas want to serve Black women, transgender men, gender non-binary individuals, and families living on lower incomes. Participants suggested Medicaid reimbursement and community health worker models as potential interventions for increasing equitable doula care access.
Doulas can improve perinatal health outcomes and are urgently needed. Yet they face challenges in building businesses and finding clientele, especially from communities and groups at highest risk of negative outcomes during pregnancy, childbirth, and the postpartum period. Identifying avenues for supporting publicly-funded reimbursement, expanding equity-focused doula training, and fostering stronger doula networks with mentorship appears warranted.
在佐治亚州，孕产妇死亡率相对较高，黑人女性死于与妊娠相关原因的可能性是白人女性的三倍。导乐可以改善围产期健康状况并减少差异，但佐治亚州的导乐可及性尚不清楚。
这项以社区为基础的混合方法研究对佐治亚州的 17 名导乐进行了调查和访谈。调查包括有关人口统计学、业务、客户群、培训和挑战的结构化问题；我们使用描述性统计对其进行了分析。深入访谈包括有关导乐护理益处、建立业务和改善导乐护理可及性的开放性问题。我们使用编码和备忘录对转录本的内容进行了分析。
我们多样化的导乐参与者描述了提供救生服务，包括教育、转介护理和患者宣传。然而，他们描述了提供护理和建立业务的众多挑战。几乎所有参与者都报告说他们的客户人数少于理想人数，而且所有人都报告说他们的服务收费过低。尽管培训、指导和网络有助于建立业务，但许多导乐希望为黑人女性、跨性别男性、性别非二元个体以及收入较低的家庭提供服务。参与者建议医疗补助报销和社区卫生工作者模式作为增加公平导乐护理可及性的潜在干预措施。
导乐可以改善围产期健康结果，目前非常需要。然而，他们在建立业务和寻找客户方面面临挑战，特别是在怀孕、分娩和产后期间，来自风险最高的社区和群体的客户。为支持公共资金报销、扩大以公平为重点的导乐培训以及培养更强大的导乐网络以提供指导，似乎是合理的。
