City health department takes baby steps toward Mayor Eric Adams campaign promise provide coaches known as doulas to all first-time birth parents.
He has spoken with maternal care providers about his plans to spend $2 million a year to enlist up to 10 organizations to provide doulas in neighborhoods with high health needs.
Adams made his promise in the shadow of tragedy.
The childbirth deaths of Amber Rose Isaac and Sha-asia Washington, two 26-year-old black women who died in childbirth in the Bronx and Brooklyn in 2020, have galvanized rallies and spurred scrutiny of the sharp crisis of black maternal mortality in the city.
In one design document released last month which serves as a program model, the Ministry of Health and Mental Hygiene has planned three home visits before birth and three after, as well as support before, during and after labor and childbirth. It follows a previous municipal program and a more recent state-sponsored experiment to provide doulas with the goal of improving maternal and child health and reducing maternal mortality.
An explicit goal of Adams’ new effort: to reduce “inequities in infant outcomes,” including breastfeeding, preterm birth, low birth weight, and infant mortality. Reducing maternal mortality is also a goal, tackling what has become a crisis for black women, who in New York City are eight times more likely to die from pregnancy complications than white women.
Another stated goal is to expand the ranks of doulas, “through recruiting, training, and certifying residents.”
Birthing justice advocates greet these efforts with a mixture of excitement and distrust. They are happy to see that the government takes the benefits of assisted childbirth seriously, but also wonder how large-scale government-sponsored programs will intersect with the very personal work.
Katy Cecen, a Brooklyn midwife and former NICU nurse, said she was uncomfortable with the “commercialization” of doula services and would rather keep the government out of the room. ‘childbirth.
“If we have $10 million to spend on labor support, let’s give it to people giving birth and let them choose how to use it to better support themselves in labor,” she said. The goal, she said, should be to ‘make sure people have the resources so they have the support they need and are with people they trust’. .
Kelly Davis, Executive Director of New voices for reproductive justicea national non-profit organization, applauded the “life-saving” initiative, but urged expectant mothers to make the very personal decision of who to hire as a doula.
“Voice and choice are the only ways to truly support better birth outcomes for black people,” said Davis, who previously led DOHMH’s Birth Justice Equity Initiatives. “Having a support system through the process and being able to choose that person is sometimes the only choice and the only consistency the person giving birth would get.”
The Bronx has the highest rate of serious maternal health complications of the five boroughs, with a rate of 337.1 per 10,000 live births, followed by Brooklyn, according to a 2019 report by the city’s health department, based on 2016 data, the most recent made public.
A December 2020 study from the city’s Department of Health and Mental Hygiene found this hemorrhage was the leading cause of maternal deaths in New York. The working group behind this study has published a set of recommendations that same month. Among them: “Raise awareness of programs that provide free or low-cost doulas.”
The program is modeled on the Birthing support program By my sidea pilot project launched in 2018 by the state for Medicaid-eligible families in central Brooklyn and Buffalo.
“That was the genesis of one of the first public health departments to have a doula program, period,” Davis said, adding that the program provides “vital services to black women and pregnant women who are on Medicaid. “.
“There’s been a long history of black women and advocacy related to maternal and child reproductive health, really in the borough of Brooklyn, that has really influenced the national conversation about black maternal health,” Davis said, citing also the work of the Brooklyn Health Action Centers launched by the city in 2017.
A DOHMH spokesperson did not respond to requests for comment on the upcoming program or how it might tie into Adams’ campaign speech, where he propose that doulas could help educate mothers about infant health and well-being.
A postpartum support program championed by former First Lady Chirlane McCray was canceled in 2020 due to a lack of funding, THE CITY reported at the time. A request for proposals for the new Adams Initiative could be released as early as summer, according to the concept paper released last month, closing in the fall with an award decision released next winter.
The health department expects it will issue between four and 10 contracts for an estimated $2 million a year for nine years, “subject to the availability of funds.”
A spokesman for the mayor did not respond to repeated requests for comment.