To make that concept more than words and good intentions, we’ve designed the California PTBi (PTBi- CA) as a sustained, multipronged research effort that’s grounded in community-academic partnership and committed to a “place-based” approach that incorporates an understanding of how racism plays out in local communities. A place-based approach also drives policy change because it allows us to catalyze alignments among non-health sectors that can impact social determinants.

 California Medicaid Coverage of Doula Care

In the U.S., more women die of pregnancy-related complications than any other developed country, with women of color the most affected.

Racism and racial biases in health care have helped contribute to what is now understood to be a national crisis of maternal deaths, in particular for Black women, Latinas, and indigenous/Native American women. 

These statistics are shocking:

  • Black women are 3 - 4 times more likely as white women to die during labor and the maternal period.
  • Black infants are 2.3 times more likely to die within the first year.
  • These racial disparities exist across all levels of income, age, and education, which means a wealthy Black woman with a PhD is more likely to suffer these negative birth outcomes compared to all other women. 

What is a Birth Doula?


Individuals who provide information and non-medical support and advocacy for pregnant people before, during, and after childbirth. Doulas help pregnant women experience birthing care that is safe, healthy, equitable, and person-centered.

Racial Disparities In Birth Outcomes


The World Health Organization defines "maternal death" as "the death of a woman while pregnant or within 42 days of termination of pregnancy."

Source: Centers for Disease Control and Prevention

Credit: Alyson Hurt/NPR

Numerous studies have demonstrated that doulas can help reduce the impacts of racism on pregnant women of color by helping to provide culturally appropriate, patient-centered care. Doula care would seem to be a natural fit for underserved populations such as women of color, immigrant women, and low-income women, who experience among the worst maternal health and birth outcomes. Yet these women can ill afford to pay out of pocket for doula care. Private insurance rarely covers doula care, and presently only two states, Minnesota and Oregon, provide doula care for their Medicaid enrollees.

AB 2258 establishes a three year Medi-Cal pilot program in 14 California counties, including San Bernardino County, to provide doula care. As AB 2258 makes its way to the Health Committee for review and approval, it’s important that policymakers understand how full-spectrum doula care can improve birth outcomes, as well as understand what birth outcomes might look like in absence of full-spectrum doula care.

Research on Impact of Doula Care

Evidence of Improved Outcomes

Cost Analysis

Consumer Demand

Culturally Responsive Care

Disparities in Outcomes and Patient Experience

Community-Based Doula Models

California Birth Data

Doula Standards and Workforce

Hospital System Readiness

Theoretical and Conceptual Frameworks


Programmatic Implementation

State Pilots