Read our open letter.

This letter received over 900 signatures from supporters, and this widespread support was a huge part of the effort behind finally passing the doula bill. We are no longer seeking additional signatures… but you can sign up on the form below to receive occasional updates about doula care coverage

Dear Governor McKee, House Speaker Joe Shekarchi, Senate President Dominic Ruggerio, Senate HHS committee chair Joshua Miller, and House Finance Committee Chair Marvin Abney,

We, the undersigned, write in strong support of insurance reimbursement for doula services in RI, and we ask you to commit to passing HB5929 and S0484 “The RI Doula Reimbursement Act” in 2021. 

The United States has a perinatal morbidity and mortality crisis, and Black, Brown, and Indigenous birthing people and their babies are bearing the brunt of it. Rhode Island is no exception. According to the Center for Disease Control, Black birthing people are three to four times as likely to die from pregnancy-related causes as their white peers. Similarly, in Rhode Island, there has been an increase in severe maternal morbidity rates, particularly among Black birthing people (306.0 /10,000) compared to white birthing people (179.4/10,000).  Black pregnant people in the United States also suffer life-threatening pregnancy complications twice as often as white pregnant people. 

There is no reasonable excuse for these dismal statistics, and especially not for the associated racial disparities. It is important to note that Black, Brown, and Indigenous people have worse perinatal outcomes regardless of access to care, education level, zip code, or income. This lack of correlation to healthcare access, points to a healthcare system with a racism problem. 

Studies show that access to doula care mitigates preventable perinatal trauma, injury, and complications, as well as the associated racial disparities. Doula care is also associated with fewer early deliveries, fewer incidences of low birth weight, better infant feeding outcomes, and better perinatal mood outcomes, all of which are essential to getting babies and families on the right track for a great start. The presence of a doula also reduces expensive medical interventions.  

Doulas are trained professionals who provide continuous physical, emotional, and informational support to pregnant individuals from antepartum, intrapartum, and up to the first 12 months of the postpartum period. Doulas also provide assistance by referring childbearing individuals to community-based organizations and perinatal professionals in multiple disciplines. A 2017 Cochrane systematic review revealed that continuous support during labor may improve outcomes for women and infants, including increased spontaneous vaginal birth, shorter duration of labor, a decrease in cesarean birth, and higher five-minute Apgar scores. In Minnesota, women who received doula support had lower preterm and cesarean birth rates than Medicaid beneficiaries regionally (4.7% vs. 6.3% and 20.4% vs. 34.2%). Data from this study also demonstrated that women with doula care had twenty-two percent (22%) lower odds of preterm birth.

As trained advocates, doulas are one of many modalities needed to reduce the racial disparities by serving their clients' needs directly, not under the umbrella of a broader institution. While many doulas do invest in cultural competency trainings, clients are best served by doulas who have direct shared experience in regards to race, culture, language, gender, sexuality, and other identity based demographics. This underscores the need for RI to invest in and support a diverse workforce of doulas, especially Black doulas and doulas of color,  to best serve our diverse population of birthing people. 

At present, despite research showing that doula care significantly improves health outcomes, it is not covered by health insurance in Rhode Island. This means that clients have to pay out-of-pocket for this much needed service, and it is therefore not accessible to most Rhode Islanders. In an effort to increase access to services, many doulas provide services at deeply reduced rates, and are often not fairly compensated for the work they do. Because there is not meaningful support for doula care in RI, only a small percentage of families receive this care. 

The 2021 RI Doula Reimbursement Act would mandate RI health insurance reimburse for doula services. Insurance reimbursement would be a step toward creating more access to doula care for more RI birthing people, and toward creating a more equitable wage for doulas. Wage inequity leads to a less robust and diverse doula workforce. Investing in access to doula care, and a sustainable and diverse workforce of doulas is an investment in public health, and in the health of Rhode Island’s future: its families. 

Families have invested in their care, community organizations and individuals have given to scholarship funds, doulas have volunteered or worked at discounted rates. We have done our part. It is time for you to do your part.  We urge you to work to pass this urgent legislation this year. The longer we wait to expand access to doula care, the more birthing people and babies are harmed. 

Thank you,

Friends of The RI Doula Reimbursement Act