Thursday, August 9, 2012
Disparities in the Doula Model of Care
After the Community Health Worker training that ended today, I'm faced with the reality of how many gaps there are in not just health care, but doula care. Health disparities are everywhere, and there are amazing organizations and agencies out there gathering funding to provide free preventative health care to the under- and uninsured. When it comes to doula care, however, access is limited to those who can pay out-of-pocket. Painfully ironic is the fact that those who can afford it are in need of it the least.
That's not to say that the privileged pregnancies that are on the receiving end of a doula do not deserve it. But populations, particularly teens and women of color, who see the most health disparity and the worst maternal and infant health outcomes, are the most underserved by doulas. How do we, as doulas, approach this? Many of us offer our services for much less than what we should be making even for our full-paying clients. If we have a particular interest in working to solve health disparities and applying social justice to our work, we work for next to nothing. I've done many births where, in the end, I was getting paid a shocking hourly wage for expert advise, 24 hour on-call availability for weeks on end, and physically strenuous overnight hours- much less than minimum wage in the end. This is not rare. Ask the doula next to you if this is the case and you will likely get an emphatic "YES".
What is the root of this? My belief is that it stems from doula care existing in a for-profit model (as much of health care is, but that's another blog post). That doulas have settled on charging their clients directly undercuts the potential of doula care- applying the benefits of doula care on populations that see the worst outcomes in order to make the most amount of change. Taking a new approach is critical in improving outcomes. But it will require doulas rejecting the for-profit model that so much of us have accepted. We need to explore new options in receiving funding for our work, to generate public and private interest in doula care from stakeholders in maternal and infant health, and to work together, and not in competition like so much of the for-profit model encourages, to make our work sustainable for not only our clients but ourselves.
We know the benefits of our work. It's time for doulas to get out of our comfort zones, advocate for those benefits, and start creating change. We are at the forefront of improving outcomes with our unique advantage to spend time educating and empowering patients. A public health approach to doula care is desperately needed if we actually want to see our work make a difference.
(If you know of a fabulous community doula project, or have seen doulas used by public health agencies, please leave some information in the comments!!)