Maternity Care in Rural Areas Is in Crisis. Can More Doulas Help?

Birth in Color's doulas are filling the maternity care gap as rural labor and delivery rooms close, disproportionately impacting people of color. Doulas provide physical, emotional and informational support before, during and after childbirth, and advocate on the mother’s behalf. Doula care leads to improved birth outcomes and lower rates of C-sections, and in April 2022 doula services were added under the state’s Medicaid program.

The Abiye Project registered over 20,000 pregnant women using a community-based model to ensure they receive proper healthcare. The program connected women with trained health rangers who served as liaisons with traditional birth attendants (TBAs). When TBAs’ resistance stalled the program, the government introduced financial incentives, paying them for each patient referral, leading to more hospital births and a reduced child and maternal mortality rate.

Reachout Center Trust is addressing gaps in maternal healthcare with mobile outreach to connect pregnant women with clinics for full-service care up to delivery. The program has served over 200 women since forming and research shows its intervention has led to healthier babies and reduced stigma in seeking hospital care.

Doulas are becoming a more widely used resource among pregnant people, particularly Black women who historically face racial inequities during pregnancy and childbirth. Groups like The Doula Network and the Southern Birth Justice Network are working to expand doula services by training and connecting pregnant women with certified doulas. Doula care is more holistic and studies show that women using doulas have about a 65% reduction in their odds of developing postpartum depression or anxiety when a doula is present during labor and delivery.

In 2017, residents of Kabuga Aisami in Kano built their own maternal and child health hospital to address maternal mortality rates and improve access to care. Led by the Kabuga Aisami Community Initiative (KACI), community members pooled resources to construct the facility, which includes two labor rooms, three wards with 40 beds, four laboratories, a pharmacy, 25 toilets, and three self-contained flats for doctors to enable 24-hour care. Patient volume has since increased by over 250%, and the hospital has expanded to serve 10 surrounding communities, as well.

Jacquelyn Alvarado, a certified nurse midwife with the Texas A&M Rural and Community Health Institute, travels across Texas to teach rural hospital staff how to deliver babies. Using a mannequin, she runs simulations covering both routine and complicated deliveries for ER nurses, paramedics, and other non-obstetrical staff who may be the only help available when a rural patient goes into labor.

The Bauchi State Impact Project aims to improve maternal and newborn health by training 100 people to become skilled birth attendants. Despite infrastructure challenges, the Project not only provides work and purpose to those trained, but also helps make childbirth safer by providing much-needed care.

In an effort to address maternal mortality rates and overall maternal health conditions, groups of midwives are hosting community dialogue sessions that serve as educational opportunities for preventing danger. Maternal and infant mortality rates have already begun to decrease, and midwives also provide support beyond education, giving mothers food and other supplies as needed.

The Mamacare Foundation has trained over 860 traditional birth attendants (TBAs) in hygiene, safe delivery practices, danger-sign recognition, and timely referral systems over the past decade to improve maternal care in the region. The program pairs each TBA with a supervising midwife, creating a collaborative bridge between traditional and modern maternal care. The training has increased referrals from TBAs to clinics by 40%, and district hospitals report fewer emergency cases arriving in critical condition since the Foundation has formed.

Women volunteers with PHC Kara are going into the community to share important healthcare information with pregnant women, in an effort to improve maternal and infant mortality rates and health outcomes. The group has also received support and recognition from UNICEF’S Mama2Mama healthcare initiative and Rural Health Mission Nigeria, providing them with clean birth kits and other supplies to distribute to women.