Role of Doulas in Improving Maternal Health and Health Equity Among Medicaid Enrollees, 2014‒2023.

Abstract

<b>Objectives.</b> To assess the relationship between doula utilization and health outcomes of females enrolled in Medicaid-affiliated plans in the United States. <b>Methods.</b> In this retrospective, observational cohort study, we used Medicaid claims data from a national health insurer to compare health outcomes between females who used and who did not use a doula (2014-2023). We conducted propensity score matching using a 1:1 case‒control match, without replacement, and fit logistic regressions to analyze the relative risks for maternal health outcomes. <b>Results.</b> The study population included 722 matched pairs with and without a doula. Results indicate females with doulas had a 47% lower risk of cesarean delivery and a 29% lower risk of preterm birth, and were 46% more likely to attend a postpartum checkup (all differences <i>P</i> < .05). <b>Conclusions.</b> Doula care is associated with improved health outcomes among Medicaid enrollees. <b>Public Health Implications.</b> Doulas have garnered increasing interest from policymakers as a strategy to address increasing trends in maternal morbidity and persistent health disparities. This study provides evidence from Medicaid enrollees across the United States that doula care can improve maternal health. (<i>Am J Public Health</i>. 2024;114(11):1275-1285. https://doi.org/10.2105/AJPH.2024.307805).