Birthing people of color in the United States experience racism in the health care system. Racism in medicine is so pervasive that it contributes to high rates of maternal mortality among women of color, regardless of their socioeconomic class. Birthing people of color who are also immigrants are vulnerable not only to racism but also xenophobia in the health system. They often come with different perspectives on the birthing process and the role of medical professionals, as well as varied levels of health literacy in Western medicine. These circumstances, coupled with varying levels of English language proficiency, can make it difficult for birthing people of color who are also immigrants to advocate for themselves during the birthing process. Doulas are pregnancy-support professionals who are poised to disrupt the risks that can come with being an immigrant birthing person of color in the medical system.
Maternal health outcomes for immigrant birthing people are severely under-researched, likely because of the multitude of intersecting identities among the immigrant population. However, as a whole, immigrant birthing people have poorer maternal health outcomes and higher rates of maternal morbidity than U.S.-born birthing people. Immigrant birthing people also have varying levels of access to health insurance due to exclusionary health coverage policies and therefore experience additional barriers to accessing and utilizing prenatal and postpartum care, both of which are essential to managing risk factors for maternal morbidity.
The immigrant experience is not a monolith. Immigrant birthing people have varied legal statuses, racial and cultural identities, and socioeconomic classes. All of these are factors that can inform their ability and willingness to receive necessary prenatal and postpartum care and resources. For example, the birthing experience for a newly arrived immigrant without economic resources will be very different from that of a newly arrived immigrant with significant economic resources. Similarly, a birthing person who is undocumented or has family members without legal status may have fears associated with the threat of deportation or incarceration, and consequently be hesitant to seek out health care or interact truthfully with people they perceive to be in positions of authority, including medical providers.
Doulas are equipped to provide services that not only improve maternal health outcomes but also meet specific needs for pregnant immigrants across intersectional identities. Doulas are trained, preventive, non-medical health professionals and birthing companions who support birthing people emotionally, physically, and informationally throughout their pregnancy, typically by doing home visits for the duration of a birthing person’s pregnancy and postpartum period, as well as supporting them through labor and delivery. Because of their role, doulas are often able to establish a relationship of trust with the birthing client and their family. In this way, doulas are able to be strong advocates for their clients and ensure that medical information is understood, communication is streamlined, and available resources are utilized. The role that doulas play is similar to, though distinct from, the role played by promotoras. Promotoras are community health workers that are trained to provide basic health education and support, particularly for Spanish speaking immigrant communities. Just as promotoras can help their immigrant clients navigate the health care system, so too can doulas help their immigrant clients navigate their perinatal experience.
Doulas, especially community-based doulas, can often share cultural and language traits of the clients they serve, something that can particularly benefit immigrant birthing people. Some immigrant birthing people may come from countries and cultures that emphasize family-involved prenatal and postpartum care. However, factors like legal status and geographical separation, can leave some immigrant birthing people without their typical support structure. Doulas can step in to embrace a supportive role in easing feelings of isolation and grief during someone’s pregnancy. Indeed, some doula organizations have tailored their training and work to provide care to immigrant communities, such as Doulas Telar and the Allegheny Health Network (AHN) Center for Inclusion Health. Doulas specifically trained to serve immigrant populations connect their clients and families with social services that can provide them additional support in housing, food, and preparation for the baby.
In addition, health cultures in non-Western countries, specifically across Asia and Latin America, may emphasize spiritual or natural treatments, in addition to medicine, that tailor to holistic, whole-body healing. The U.S. health care system has been limited in legitimizing traditional forms of medicine such as Ayurvedic medicine, traditional Chinese medicine, and the hot-cold theory. Instead, medicine as practiced in the U.S. is largely based on treating symptoms as isolated phenomena rather than products of holistic imbalance. Meanwhile, an immigrant birthing person may conceptualize illness and treatment through traditional concepts relative to their home country, and thus may require more context and explanation to understand illness and treatment through a Western medical lens. Doulas that share cultural congruence with their immigrant clients can be better equipped to provide those clients with critical understanding and information about Western medicine and practices.
Doulas are especially well positioned to establish trusting relationships with immigrant birthing people, and meet their language, cultural, and health literacy needs. Doulas can provide immigrant birthing people with necessary supportive and culturally congruent care to improve their health outcomes, and allow them the best shot at a healthy birthing experience for themselves, their future children, and their families.
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:
- May 9, 2023: The LGBTQ+ Community Deserves Access to Inclusive and Affirming Doula Care by Alexis Robles-Fradet
- May 2, 2024: The Disability Community Deserves Inclusive and Accessible Doula Care by Alexis Robles-Fradet
- XXX: The Immigrant Community Deserve Access to Inclusive and Culturally Congruent Doula Care by Kavisha Prajapati
[1] Kavisha Prajapati was a legal intern at the National Health Law Program in summer 2024.
