Category: Public Health/Global Health
Poster Session IV
This qualitative study explored doulas’ perceptions of: 1) their influence on the perinatal physical and mental wellness of (particularly low-income) families, 2) health disparities and maternal morbidities, and 3) their experiences with and perceptions of Medicaid reimbursement for doula services.
Study Design: 5 in-depth interviews and 6 focus groups were conducted virtually with doulas serving in Florida (n=28). Unitized transcriptions and memos were coded post-inter-coder agreement calculation. An inductive approach to thematic analysis was used to generate primary findings.
Results: 1) Doulas reported seeing their influence on perinatal physical and mental wellness through a lens of promoting a client’s self-advocacy, whereby birthers foster skills to voice their own needs. 2) Participants overwhelmingly associated maternal morbidity and health disparities with black women. Racial disparities were attributed to systemic racism and limited prenatal care and education. 3) To address health disparities in vulnerable populations, most participants reported wanting to participate in Medicaid reimbursement, but not doing so because of a complicated reimbursement structure. Doulas that do work with Medicaid patients reflected on their frustration with insurers and the financial impact of not receiving reimbursements for months. Doulas reported being unable to help the most at-risk families, citing African Americans as those most often left behind by systemic inequities.
Conclusion: The current Medicaid reimbursement process is not easily navigable for most doulas and, therefore, the majority interviewed felt they could not take on Medicaid clients. Many shared a desire to work with underserved families, but do not due to frustration with low reimbursement rates, complex processes with insurers, and their inability to earn livable wages. Doulas have been shown to improve rates of maternal wellness, but structural barriers hinder the ability for low-income women to receive such care in Florida, creating further health disparities.
Janelle Applequist, PhD, MA (she/her/hers)
Associate Professor
University of South Florida
Tampa, Florida, United States
Ronee Wilson, PhD (she/her/hers)
Assistant Professor
University of South Florida
Tampa, Florida, United States
Megan Perkins, BA
University of South Florida
Tampa, Florida, United States
Richard Powis, PhD
University of South Florida
Tampa, Florida, United States
Charlette Williams, BS
University of Florida
Gainesville, Florida, United States
Ria Joglekar, BS
University of South Florida
Tampa, Florida, United States
Adetola Louis-Jacques, MD
Assistant Professor
University of South Florida Morsani College of Medicine
Tampa, Florida, United States