A public doula program improved maternal health outcomes for Black and Latino recipients and cost the city very little to do it, according to a new audit from the city comptroller’s office.
New York’s Citywide Doula Initiative, which provides free doula services to low-income residents, was launched to reduce disparities in maternal mortality among people of color, who are more likely to die or have an adverse pregnancy outcome than white people. The audit, released Friday by Comptroller Brad Lander, who is running for mayor, found that Black and Hispanic recipients of the service had lower rates of C-section, premature birth and low birthweight.
The program served 2,200 people with at least one visit from a doula during the audit period, from 2022 to 2024, according to the report. But it only cost $4 million, including for the retraining of 283 doulas, out of the Department of Health and Mental Hygiene’s more than $2 billion annual budget.
Despite the successes, barriers to access still exist for participants living in shelters either because doulas were denied entry or had to go through a caseworker to speak with their clients, according to surveys of doulas and clients. City-contracted providers also reported a need for more non-English-speaking doulas.
Black and Hispanic people accounted for 3 out of 4 pregnancy related deaths, according to Health Department data cited in the report. Most of them, approximately 40%, are among Black non-Hispanic individuals, despite making up just 18% of births in the city.
The Citywide Doula Initiative was established in 2022 by a law spearheaded by members of the City Council and implemented by the Health Department under Mayor Eric Adams. It required the city to launch a doula training and service program for marginalized communities and report on maternal health outcomes. The city provides the service for free to Medicaid-eligible residents, or people living in designated underserved areas, shelters and foster homes.
From March 2022 to June 2024, C-sections, a contributing factor in pregnancy-associated death, fell between 5 and 7 percentage points among Black, Hispanic and White participants in the program compared to citywide rates, the audit found.
About 34% of Black participants in the program had C-sections, higher than the overall citywide rate of 33%.
C-section rates rose among Asian-American and Pacific Islander participants by more than 4 percentage points. That output could be the result of less available data due to lower participation rates, according to the comptroller’s report.
Preterm births and low birthweight babies followed the same pattern.
