Date of Award

Winter 1-7-2022

Degree Type

Capstone Project

Degree Name

Master of Public Health (MPH)


Public Health

First Advisor

Elizabeth Mosley, PhD, MPH

Second Advisor

Sarah McCool, PhD, MPH. MHA


Introduction: Poor birth outcomes are more prevalent for Black birthing people and their babies. Strong evidence shows that doula care, during labor and delivery, improves maternal and child health outcomes. Yet little is documented about racial differences, discrimination, and equity in doula care.

Methods: Between November 2020 and January 2021, 17 surveys and in-depth interviews were conducted with doulas in Georgia as part of the community-based participatory Georgia Doula Study, co-led by Healthy Mothers, Healthy Babies Coalition of Georgia and academic researchers. The study objective was to describe the challenges and facilitators of providing doula care in Georgia. In the fall of 2021, additional measures on racism and discrimination in doula care were added to the survey and interview guide and previous participants were re-contacted.

Results: Doula participants were diverse in age (41% 25-35, 35% 36-45, and 24% 46+) and race/ethnicity (53% white, 41% Black, 6% Latinx). Six of the seven (86%) Black doulas reported that more than 85% of their clientele is Black, while all of the eight white doulas reported that 50% or less of their clientele is Black. Three (18%) of the doulas indicated more than 10% of their clientele is Latinx, while only two (12%) indicated more than 10% of their clientele is Asian-American or Pacific Islander. Discrimination scores were 51.5 for Black doulas (standard deviation 7.55) 46.7 for white doulas (standard deviation 7.48). Doulas noted that the alarming maternal mortality rate for Black women and not always being listened to causes Black clients to be less trusting of medical staff, leaving them in need of advocates. Black doulas were passionate about serving and advocating with Black clients. Doulas also described how language and cultural barriers, particularly for Asian and Latinx birthing people, reduce clients’ ability to advocate for themselves, increasing the need for doulas.

Conclusion: Black doulas are an essential tool for improving birth outcomes for Black women. Increasing access to doula care for Asian and Latinx communities could address language and cultural barriers that can negatively impact their maternal and child health outcomes.


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