Doula Training to Reduce Maternal Mortality Among African American Women in Georgia

The Georgia Department of Public Health and the Georgia Board of Public Health are charged with safeguarding the health of all residents, yet maternal mortality among African American women in Georgia remains a persistent and preventable crisis. According to data from the Centers for Disease Control and Prevention, Black women in the United States are approximately 2.6 to 3 times more likely to die from pregnancy-related causes than white women. In Georgia, the disparity is even more alarming. Reports from the Georgia Maternal Mortality Review Committee indicate that Black women account for a disproportionate share of pregnancy-related deaths, and over 60% of these deaths are deemed preventable. These statistics highlight an urgent need for targeted, evidence-based interventions that address both clinical and systemic contributors to maternal mortality.

One of the most effective strategies to improve maternal outcomes is the integration of doulas into the perinatal care system. Doulas provide continuous emotional, physical, and informational support throughout pregnancy, labor, and postpartum recovery. A landmark review by Cochrane Collaboration found that individuals who received continuous labor support, including from doulas, were 25% less likely to have a cesarean birth, 31% less likely to report dissatisfaction with their birth experience, and had shorter labor durations. These improved outcomes are critical, as cesarean deliveries and unmanaged complications are significant contributors to maternal morbidity and mortality.

The need for doula support is especially critical for African American women, who often face systemic barriers within healthcare settings. Studies have shown that Black women are more likely to experience delayed diagnoses, have their symptoms dismissed, and receive lower-quality care due to implicit bias. Doulas can serve as advocates, helping ensure that clients’ concerns are heard and addressed promptly. This advocacy is not trivial—delays in treatment and lack of responsiveness are key factors identified in maternal death reviews. By providing continuous support, doulas can help reduce these risks and improve communication between patients and providers.

In addition to improving health outcomes, doula programs are cost-effective. Research suggests that widespread doula support could reduce preterm births and cesarean rates enough to save millions in healthcare costs annually. Medicaid, which finances nearly half of all births in Georgia, would particularly benefit from these savings. States that have begun covering doula services under Medicaid have demonstrated both improved outcomes and reduced expenditures, signaling a viable model for Georgia to follow.

Importantly, a state-funded doula training program would allow Georgia to build a culturally competent workforce drawn from the communities most affected by maternal mortality. Training African American doulas to serve African American mothers can significantly improve trust, communication, and patient satisfaction. Cultural concordance between provider and patient has been linked to better adherence to medical advice and more positive health experiences, which are essential factors in reducing disparities.

Despite the clear evidence, access to doula services remains limited, particularly for low-income and marginalized populations. Without state investment, many of the women who could benefit most from doula support are unable to afford it. By funding and implementing a statewide doula training and certification program, the Georgia Department of Public Health and the Georgia Board of Public Health can directly address this gap in care.

The data is unequivocal: maternal mortality among African American women is both disproportionately high and largely preventable. Doulas offer a proven, cost-effective intervention that addresses many of the root causes of this crisis, including lack of advocacy, poor communication, and systemic bias. Georgia has the opportunity—and the responsibility—to act. Investing in a doula training program is not only a public health imperative, but a necessary step toward achieving equity, saving lives, and strengthening families across the state.