Doulas are Culturally and Inclusively Congruent for Immigrants
In the United States, people of color who are pregnant experience racism in the healthcare system. Racism is so prevalent in medicine that it contributes to the high rates of maternal death among women of color regardless of their socioeconomic status. People of color who are immigrants and are pregnant are at risk not only from racism, but also xenophobia within the health system. They have different perspectives about the birthing process, the role of medical professionals and their health literacy is often varying. Doulas are pregnancy-support professionals who can help to reduce the risks that come with being an immigrant birthing person of color in the medical system. Doulas are pregnancy-support professionals who are poised to disrupt the risks that can come with being an immigrant birthing person of color in the medical system.
Maternal health outcomes for immigrant birthing people are severely under-researched, likely because of the multitude of intersecting identities among the immigrant population. As a group, immigrant-born birthing persons have worse maternal health outcomes, and higher rates of morbidity, than U.S. born birthing persons. Immigrant birthing people also have varying levels of access to health insurance due to exclusionary health coverage policies and therefore experience additional barriers to accessing and utilizing prenatal and postpartum care, both of which are essential to managing risk factors for maternal morbidity.
The immigrant experience is not a monolith. Immigrant birthing persons have a variety of legal statuses, cultural and racial identities, and socioeconomic class. All of these factors can influence their willingness and ability to receive the necessary prenatal and afterpartum care. A newly arrived immigrant who lacks economic resources may have a very different birthing experience than a newly-arrived immigrant who has significant economic resources. Similarly, a birthing person who is undocumented or has family members without legal status may have fears associated with the threat of deportation or incarceration, and consequently be hesitant to seek out health care or interact truthfully with people they perceive to be in positions of authority, including medical providers.
Doulas are equipped to provide services that not only improve maternal health outcomes but also meet specific needs for pregnant immigrants across intersectional identities. Doulas, who are non-medical, preventive health professionals, provide emotional, physical, and informational support to birthing people throughout their pregnancy. They do this by visiting them at home for the duration of pregnancy and postpartum, and supporting them during labor and delivery. Doulas often establish a trusting relationship with their clients and their families because of their role. Doulas can be strong advocates for clients, ensuring that medical information, communication, and resources are used. Doulas have a similar role to promotoras, but they are different. Promotoras, who are community health workers trained to provide basic health information and support for Spanish-speaking immigrant communities, are promotoras. Just as promotoras can help their immigrant clients navigate the health care system, so too can doulas help their immigrant clients navigate their perinatal experience.
Doulas, especially community-based doulas, can often share cultural and language traits of the clients they serve, something that can particularly benefit immigrant birthing people. Some immigrants who give birth may come from cultures and countries that place a high value on family involvement in prenatal and postpartum health care. Some immigrant birthing women may not have the usual support system due to factors such as legal status or geographical separation. Doulas are able to play a supportive role by easing feelings of grief and isolation during a pregnancy. Some doula organizations, like Doulas Tear and the Allegheny Health Network’s Center for Inclusion Health, have tailored their training to serve immigrant communities. Doulas who are specifically trained to serve immigrant communities connect their clients and families to social services that provide them with additional support for housing, food, or preparation for the baby. The U.S. healthcare system has not been able to legitimize traditional forms of medicine like Ayurvedic, traditional Chinese, or the hot-cold theories. In the U.S., medicine is based primarily on treating symptoms as isolated phenomena and not as products of a holistic imbalance. Immigrant birthing people may have a different understanding of illness and treatment based on their cultural background. They may need more context and explanations to understand illness and treatments through a Western medical perspective. Doulas that share cultural congruence with their immigrant clients can be better equipped to provide those clients with critical understanding and information about Western medicine and practices.
Doulas are especially well positioned to establish trusting relationships with immigrant birthing people, and meet their language, cultural, and health literacy needs. Doulas can provide immigrant birthing people with necessary supportive and culturally congruent care to improve their health outcomes, and allow them the best shot at a healthy birthing experience for themselves, their future children, and their families.
This blog post is part of an occasional series by the National Health Law Program’s Doula Medicaid Project, on how doula care can benefit different communities.
Here is the complete list of posts from this series:
Kavisha Prajapati was a legal intern at the National Health Law Program in summer 2024.
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