Communities Deserve Access to Inclusive and Climate-Conscious Doula Care

Communities Deserve Access to Inclusive and Climate-Conscious Doula Care
Communities Deserve Access to Inclusive and Climate-Conscious Doula Care

By: Shweta Karmakar and

*NHeLP 2026 Summer Legal Intern

Doula care can drastically improve the quality of care and birth experience for pregnant people facing the climate crisis’s increasing incidences of hurricanes, flooding, and extreme heat. The changing climate directly affects pregnancy health through discrete environmental disasters (such as wildfires, extreme heat, hurricanes, flooding, and droughts) and indirectly through long-term changes in the natural and social environment (such as air quality and forced migration). Environmental disasters can cause psychological distress for pregnant and post-pregnant people due to financial and personal loss, as well as the disruption of infrastructure that they rely on such as housing, health care, work, communication, and transportation. Potential adverse pregnancy outcomes include low birthweight, preterm birth, miscarriage, and neonatal mortality.

The climate crisis also disproportionately impacts low-income individuals and racial/ethnic minorities, especially Black pregnant and post-pregnant people. Societal practices such as redlining and environmental racism have led to the construction of highways, landfills, and industrial plants in places where historically underserved communities live, which in turn has resulted in poor air quality and a higher risk of heatstroke and other heat-related illnesses in historically redlined districts.

Doulas are birth workers who provide emotional, physical, and informational support in different aspects of reproductive health. Doulas can provide support in fertility, pregnancy, abortion, miscarriage, labor and delivery, and postpartum care. Doulas’ advocacy role makes them uniquely qualified to help pregnant and birthing people impacted by health care access disparities and health inequities. Doulas can also help their clients navigate health systems and medical institutions that do not always provide care tailored to patients’ unique needs.

During natural disasters, doulas can provide tailored climate-conscious support for their clients. For example, some clients may need to evacuate from their homes, and others may need to strategize how to stay safe during severe weather incidents. Doulas can help their clients assess the need for and timing of potential evacuations, or provide suggestions and support for clients preparing for extreme heat or hurricanes. In an article in Yes! Magazine, a doula in Eugene, Oregon, shared that navigating wildfire smoke, air pollution, and risk of evacuation—and understanding how it can affect her clients and their families—has become an integral part of her doula work.

Doulas can also provide education on climate and preparedness topics that are tailored to the communities they serve. For example, the same article describes how another doula in Michigan educated new mothers on breastfeeding or using bottled water with formula to keep their children safe during the ongoing Flint water crisis. One program in Florida has developed a training program for doulas to help them assess their clients’ preparedness in case of climate disaster and help them prepare for situations such as extreme heat or hurricanes. Another program in Oregon trains doulas to help their clients consider their wildfire risk and access resources, such as using Medicaid to pay for air conditioners and air purifiers. By educating their clients and communities on staying safe during natural disasters and how the climate crisis uniquely impacts them, doulas can be a critical resource in keeping pregnant and birthing people safe during the climate crisis.

At present, only 27 states, Guam, and Washington D.C. provide Medicaid coverage for doula care. Coverage should be expanded nationwide, so that more pregnant and post-pregnant people living in regions experiencing climate impacts can benefit from the support of a doula. Also, doulas and community-based organizations can form partnerships to create more doula training programs for climate health risks and preparedness, such as the programs in Florida and Oregon. Lawmakers should pass legislation to support doulas’ work in addressing climate change and maternal health. For example, Protecting Moms and Babies Against Climate Change Act, introduced in 2021, would have established grants to address health risks associated with climate change for vulnerable populations, including training for doulas and health care workers on climate health risks to vulnerable individuals. A combination of expanding Medicaid coverage for doula care with comprehensive doula training programs on climate health risks may transform the quality of care and birthing experience of pregnant and birthing people affected by the climate crisis.

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This blog post is part of an occasional series by the National Health Law Program’s Doula Medicaid Project, on how doula care can benefit different communities.

Here is the complete list of posts from this series:

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