Last week, the Colorado Legislature’s Senate Health and Human Services Committee passed Senate Bill 24-175, which aims to improve perinatal health outcomes, especially in Black and historically marginalized communities by requiring large employer health benefit plans to cover doula services in alignment with Medicaid. The bill would also instruct hospitals that provide labor and delivery or neonatal care services to participate in at least one maternal or infant health quality improvement initiative.

“No Black woman should lose their life, or come close to losing their life, in an attempt to birth their child,” said Sen. Janet Buckner (D-Aurora), a co-sponsor of the bill, in a news release. “While maternal mortality rates around the world fell 44 percent, maternal mortality rates in the United States increased by 16.7 percent during that same period of time. It’s unacceptable. Working to solve our maternal health crisis – especially for Black and historically marginalized communities – will lead to better economic, health, and social outcomes while saving lives.”

According to a 2021 Centers for Disease Control (CDC) study on maternal mortality rates, “the maternal mortality rate for non-Hispanic Black (subsequently, Black) women was 69.9 deaths per 100,000 live births, 2.6 times the rate for non-Hispanic White (subsequently, White) women (26.6). Rates for Black women were significantly higher than rates for White and Hispanic women.”

Photo courtesy CDC.

The CDC also notes that multiple factors contribute to these disparities, such as variation in quality health care, underlying chronic conditions, structural racism, and implicit bias. The bill’s sponsors say SB24-175 intends to address systemic racism in health care and develop better care for historically marginalized communities.

Doulas, professionals trained in childbirth, provide additional care services that include offering continuous emotional support to mothers through childbirth. A 2016 study in the Journal of the American Board of Family Medicine found that Doulas can mitigate preventive causes of maternal death. Doulas can uniquely provide trauma-informed care to mothers, as trauma-related health conditions, including PTSD, sexual assault, substance use and postpartum depression are increasingly common occurrences amongst childbearing people and may be associated with nearly 1 out of 5 maternal deaths, according to a 2020 study in the journal Midwifery.

Community-based doulas, integrated within communities they serve, can provide culturally and linguistically congruent care that supports communication between mothers and their health care team. This is a factor identified by Black women’s health organizations as an essential aspect of the birthing experience in a 2020 study published in the Journal of Health Care for the Poor and Underserved.

A 2023 report from Drexel University College of Medicine noted that both health outcomes and cost-effectiveness data have shown that the use of doulas presents a promising strategy for reducing maternal mortality disparities in the U.S. The statewide trials of doula insurance coverage through Medicaid are a step toward increasing access to doulas for the populations most at risk. New York, Nebraska, Minnesota, Oregon, and Indiana have implemented strategies to provide doula service reimbursement through Medicaid. Both Minnesota and Oregon funded doula reimbursements through Medicaid and outlined requirements for doula qualification, which include undergoing licensing and training through a choice of government-approved organizations. According to Drexel’s report, the resulting cost-saving potential of doula care, reimbursed through Medicaid at an average of approximately $1,000, results from reduced rates of Cesarean sections and preterm births. This demonstrates an overall potential cost savings of $58.4 million.

The bill would require the Department of Public Health and Environment (CDPHE) to contract with a Colorado perinatal care quality program to provide maternal and infant health equity improvement initiatives to hospitals; track disparity and health outcome data; and address disparate outcomes, particularly among American Indian, Native Alaskan, and Black birthing populations. Under SB24-175, CDPHE would create a program that provides financial support to hospitals in rural areas, hospitals serving a higher percentage of Medicaid and uninsured patients, or hospitals with lower-acuity maternal and neonatal care. The bill would also require coverage of over-the-counter and prescribed choline supplements for pregnant people. Choline is a nutrient that helps the liver and brain function correctly. A choline supplement may help reduce the risk of fatty liver disease, and choline deficiency during pregnancy can cause birth defects.

“The United States has the highest maternal mortality rate of any rich country and significant disparities in outcomes – and the crisis will continue to worsen unless we act,” said co-sponsor Sen. Rhonda Fields (D-Aurora) in a news release. “This legislation is incredibly important as it addresses gaps in coverage and holds hospitals accountable for ensuring equitable care for all people, and I’m proud to see it move forward.”