Res 0205-2022

Whereas, According to DONA International, a doula is a trained professional who provides continuous physical, emotional, and informational support to a pregnant person and the family before, during, and shortly after childbirth; and Whereas, Doulas have proven to be beneficial to pregnant people and their health; and Whereas, Doulas act as important advocates, facilitating communication between providers and patients, providing culturally-competent and language-appropriate care to immigrant communities and communities of color they serve; and Whereas, According to the New York City Department of Health and Mental Hygiene's (DOHMH's) report The State of Doula Care in NYC 2019 ("doula report"), doula care has been associated with lower rates of Cesarean birth, preterm birth, low birthweight, and postpartum depression, as well as with increased rates of breastfeeding, and greater patient satisfaction with maternity care; and Whereas, A 2017 report published by Cochrane reveals that people who had doula support were 39 percent less likely to have a caesarean section and 15 percent more likely to give birth without needing drugs or labor-inducing techniques; and Whereas, According to Choices in Childbirth, a survey regarding doula care in New York City reveals that 72 percent of people reported that their doula helped them communicate their preferences and needs, while 80 percent of those surveyed reported that their doula helped them feel more empowered; and Whereas, 83 percent of survey respondents reported having a doula made their labor and birth experience "much better" than if they had not used a doula, and it made them more relaxed before, during, and after birth; and Whereas, 88 percent of this cohort reported that cost was an issue when opting to work with a doula; and Whereas, According to DOHMH's doula report, the average cost of birth-doula services was $1,550 per client among doulas surveyed for the report, with a range of $225 to $5,000; and Whereas, Doula services are generally not covered by Medicaid or private insurance; and Whereas, Doula care should be more accessible, especially given the maternal mortality and morbidity rates in New York City as well as the inequitable health outcomes for people of color and infants of color, specifically those who are Black; and Whereas, Of the 21 pregnancy-related deaths in New York City in 2017, 11 were of people who were Black and six were of people who were Latina, accounting for nearly every pregnancy-related death; and Whereas, In New York City in 2017, the rate of severe maternal morbidity was highest among Black people (457.2 per 10,000 births), followed by people of other or multiple race(s) (399.6), people who are Latina (313.7), Asian/Pacific Islander (225.4), and, last, people who are white (187.9); and Whereas, By expanding access to doulas, New York City could better tackle these insidious inequities; and Whereas, Doulas face barriers providing care to all those who need it; and Whereas, According to DOHMH's doula report, among doulas surveyed, 9 of every 10 have turned clients away, for reasons including clients' living outside their coverage area (47 percent), being already booked with other families (43 percent), and clients' being unable to afford their fee (37 percent); and Whereas, New York State considered legislation to include doula services in Medicaid coverage; and Whereas, In April 2018, New York State announced the launch of a Medicaid pilot program to cover doula services; and Whereas, This legislation and pilot were extremely controversial in the doula community for numerous reasons; and Whereas, The Medicaid pilot program was discontinued in Brooklyn because of lack of doula participation due to many flaws with the program; and Whereas, One of the crucial flaws in the program was the inadequate reimbursement rate for doula services; and Whereas, For a Medicaid doula program to operate and become sustainable, reimbursement rates must be sufficient to allow doulas to support themselves and their families and to increase doula participation in the program; and Whereas, DOHMH's doula report on doula care provides numerous recommendations for stakeholders to improve access to doulas; and Whereas, Recommendations fall within four key components, including increasing access for underserved communities, making hospital environments more welcoming of doulas, amplifying community voices to help expand access to doula services, and improving data collection; and Whereas, The New York State Legislature should consider these recommendations, and should develop legislation, in collaboration with doulas and people with lived experience, in order to best understand the most effective and significant ways to expand access to doula services; now, therefore, be it, Resolved, The Council of the City of New York calls on the New York State Legislature to pass, and the Governor to sign, legislation making doulas more accessible to individuals with Medicaid and those without health insurance Session 12 LS 8087 EB/VM 5/26/2022 Session 11 LS 13225 EB Res. 1239-2020