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United States Doula Programs and Their Outcomes: A Scoping Review to Inform State-Level Policies
Gabriela Alvarado1, Dana Schultz1, Nipher Malika1
1The RAND Corporation, Santa Monica, California.
Summary
The United States has poor maternal health outcomes. While doula care shows promise and is being adopted by Medicaid programs, evidence on its effectiveness is limited and requires further research for optimal implementation.
Area of Science:
- Maternal Health
- Public Health Policy
- Health Services Research
Background:
- The United States faces significant challenges in maternal health compared to other industrialized nations.
- Emerging evidence suggests doula care can improve maternal and infant outcomes.
- State Medicaid programs are increasingly incorporating doula care into their services.
Purpose of the Study:
- To conduct a scoping review of U.S. doula programs and their outcomes.
- To inform state policymakers considering laws and programs related to doula care.
- To describe the current landscape of doula care literature.
Main Methods:
- Scoping review of academic databases and gray literature.
- Inclusion criteria applied to 740 identified records, with 100 meeting criteria.
- Literature search conducted between January 1, 2012, and March 10, 2022.
Main Results:
- Outcomes data were predominantly clinical, despite doulas not being clinical providers.
- Limited evidence suggests associations between doula care and improved clinical outcomes for birthing people and infants.
- Doula workforce diversity, equity, and payment models remain underexplored, with qualitative data available.
Conclusions:
- Policymakers must acknowledge evidence limitations regarding doula care's narrow focus on clinical outcomes and cost savings.
- Conflicting conclusions exist on doula care's impact, necessitating further research.
- Engaging doulas in compensation discussions and developing improved metrics are crucial for successful implementation and understanding maternal health outcomes.
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