Nonprofit addresses racial, economic disparities in pregnancy-related deaths with free doula services

Black women among the most vulnerable population to benefit from doula-assisted births


Ten little toes wiggled on Jeanetra Deshotel’s lap while she sat in the living room of her Point Loma home.

“Can we get a smile to show your dimples?” Deshotel said to her newborn son, Ze’Kerion.

Eight days after Deshotel gave birth to a 6-pound, 11-ounce baby boy, Venice Cotton, a doula with the nonprofit For the Village, stopped by for the mother’s first postpartum visit.

Sitting in the living room, Cotton asked Deshotel questions as she held Ze’Kerion.

“Have you been eating?…Do you have a plan for when your family is gone?…Are you having trouble breastfeeding?…Are you resting?” Cotton asked.

A postpartum visit within the first few weeks of childbirth is routine, Cotton said, adding “mom gets lost because she’s so concerned with taking care of everything else that she forgets to take care of herself.”

Cotton is a full-spectrum doula with For the Village. Doulas are non-medically trained individuals who support, advocate and provide information before, during and after birth.

When the nonprofit started in April 2018, it had six doulas, including founder and Executive Director Sabia Wade. Today, the organization has 43 doulas who have collectively assisted more than 60 clients since July 2018.

The organization’s growth, Wade said, is a direct result of the nonprofit addressing a “resource that was needed” among black and low-income families in San Diego County. Wade said most clients hear of the nonprofit by word of mouth.

Doulas with the nonprofit are known as “full-spectrum doulas” because they also support women during miscarriages, abortions, still births and more.

The nonprofit provides free doula services to populations at higher risk of pregnancy-related deaths and minority populations lacking access to adequate medical care.

Federal statistics show that black women are two to three times more likely to die from pregnancy-related cases then white women.

In San Diego County, African American mortality rates were 26.2 per 100,000 live births compared to a rate of 6.6 per 100,000 live births for white mothers from 2000 to 2018, according to data from the county Health and Human Services Agency.

A study conducted by the Centers for Disease Control and Prevention in September found that the disparities are likely related to access to quality care and implicit racial bias in the health care system. It also said racial and ethnic disparities have been persistent over the last decade.

However, a growing amount of research suggests that the use of doulas can improve both birth and breastfeeding outcomes, especially among minorities.

“Our work is focused specifically on giving access and free care to black people, black immigrants, to be able to change the disparity,” Wade said.

In San Diego County, there were 4.5 infant deaths per 1,000 live births in 2018, compared to 3.7 in 2017, according to county data. Records show the mortality rate for African American infants was 8.1 per 1,000 live births in the county compared to a rate of 3.7 per 1,000 live births for white infants.

When Alana Pearson, who is African American, discovered she was pregnant with her third child, she worried about the growing infant mortality rates for black babies, she said.

She was also hesitant to give birth in a hospital because she felt that nurses dismissed her concerns during her last pregnancy.

“In the hospital, it just felt like you are going through an assembly line,” Pearson said.

Doulas say that feeling is common, especially among black and immigrant moms.

Doula Meisha Johnson said navigating conversations with doctors is sometimes what helps moms the most, being able to ask questions about procedures that doctors want to do or why they are suggesting feeding the baby formula over breastfeeding.

Johnson said being a doula is about “being able to educate, support and show (moms) different options.”

Wade trains and certifies the doulas who work with the nonprofit but they are not medically licensed. She said doula work can be controversial but some doctors and even hospitals have embraced it.

Forty percent of the mothers served by For the Village doulas are Haitian immigrants living in San Diego. Fifteen percent of the mothers are active members of the military. Most of the women are African American.

Wade said there is a disparity in the way that both African American moms and black immigrants are treated in the medical world but there are differences in the needs of both groups. The Haitian immigrant mothers lack basic needs, but the African American mothers face the racial disparity.

“We have doulas from every background and they are all aware of what people of color are facing,” Wade said, adding that in total the doulas speak 12 different languages.

For the Village partners with Project Concern International and Birth Roots Maternity Center in Chula Vista. Doulas are paid by the nonprofit and earn about $400 per client.

Published by Sabia Wade

I am a Radical Doula, Certified Doula Business Coach and Reproductive Justice Advocate!

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