Improving doula care for those who are incarcerated

When a mother gives birth in jail or prison, sometimes there is no one present except a guard. On top of that, there is usually little time for a mother to bond with a baby before the child is taken out of the prison environment.

Halimah Washington, a mother of four in New York City, understands the lack of support that exists well. As an advocate for women and non-binary individuals facing incarceration, Halimah received training to become a doula, in order to support the needs of those in the prison system. From her experience, she knows the impact doula support can have on maternal health.

“It would make it a smoother process if they had someone to process it with,” Halimah said, noting that the postpartum aspects of a doula are crucial. “They will not be in prison forever and they will have something to look forward to when they come home.”

Halimah received training from The Ladies of Hope Ministries (The LOHM), in partnership with Commonsense Childbirth and UnitedHealthcare, which launched a doula training program for women and non-binary individuals to support those who face incarceration. UnitedHealthcare has invested $250,000 to support The LOHM’s doula training program as part of a larger commitment to help address the nation’s maternal health crisis, which includes more than $1 million in grants to community-based organizations.

With the assistance of UnitedHealthcare, 120 participants like Halimah will be awarded scholarships by LOHM this year to attend the doula training program, which focuses on reproductive justice and birth equity. The program hopes to provide the skills to offer doula support at each stage of pregnancy for incarcerated women, as well as community members. The virtual program will also include education on how to establish, operate and market a successful doula business.

The need for maternal health support is great. The United States has the highest maternal mortality rate of all developed countries. This is especially true for Black women, who are 3-4 times more likely than white women to die during childbirth, or due to childbirth related causes. This may be due to a number of factors, including variation of quality and access to health care.

These barriers to care are even furthered with a justice involved population — with the imprisonment rate for women of color higher than that of white women. In fact, an estimated 58,000 pregnant women are admitted into jails and prisons every year. And research shows that when a pregnant individual or their partner is incarcerated in the year before birth, they are more likely to have inadequate prenatal care that can lead to low birth weight and preterm birth, as well as infant mortality. For example, only about a third of prisons and jails in a recent survey had policies written down for lactation. This could mean inconsistent practices and support for breastfeeding, which has health benefits for both infants and mothers.

Doulas have been shown to help reduce some of these disparities. During labor and delivery, they can provide comfort and coaching, and serve as patient advocates when issues such as pain management or other interventions are raised. More states are beginning to pursue doulas for Medicaid reimbursement, as a part of the maternal health experience.

“Elevating birthing people’s voices in their care journey and offering a trusted source of educational, social and emotional support is essential in achieving better maternal health outcomes” said Andy McMahon, Vice President of Health and Human Services Policy for UnitedHealthcare Community & State. “UnitedHealthcare’s investment to The LOHM highlights our commitment to reducing racial health disparities and increasing access to care.”

The LOHM hopes to eventually have diversion programs for pregnant individuals in the hopes of avoiding incarceration in the first place. This may include assistance with housing, substance abuse or mental health treatment — with doulas a supportive link for those giving birth in this environment.

For Halimah, she hopes her work helps inspire others to see the impact it can make.

“You have to be called to do it,” she said. “This has to be something that’s in you. You have to do your own personal work before you start to do work or training. I’m glad they’re leading the charge to help people to become birth workers, particularly in prisons.”

If you would like more information on how you can support the work of the LOHM Doula Initiative, please reach out to Tonja Honsey, Director of Health Equity, at Tonja@thelohm.org.