As of 2022, Indiana has the third highest maternal mortality rate among all reporting states in the United States, with 44 deaths per 100,000 live births (1). Maternal mortality pertains to the tragic loss of a mother's life during pregnancy or within one year postpartum, resulting from causes associated with pregnancy or the deterioration of a pre-existing condition exacerbated by pregnancy (2). Pregnancy-related deaths are defined by the Indiana Maternal Mortality Review Committee (MMRC) as those that have been determined to directly stem from pregnancy complications, a sequence of events triggered by pregnancy, or the exacerbation of a pre-existing condition due to the psychological impact of pregnancy (3).

In 2020, the state pregnancy-related mortality ratio for women was approximately 23 deaths per 100,000 live births. This marked a notable rise from the rate of 12 per 100,000 observed in 2018. The maternal mortality ratio for Black women in Indiana (Hoosier women) was 208 deaths per 100,000 live births in 2020. In comparison, the ratio was 108 deaths per 100,000 live births for white women and 71 deaths per 100,000 live births for Latinx women. These disparities highlight significant differences in maternal mortality rates based on racial and ethnic backgrounds (4).

Racialized experiences play a crucial role in shaping individuals' access to healthcare, their experiences within the healthcare system, and their responses to it. These experiences can influence whether and how people seek healthcare services, the quality of care they receive, and their overall healthcare outcomes. It is important to recognize and address the impact of racialized experiences on healthcare access, delivery, and patient responses to ensure equitable and inclusive healthcare for all individuals.

Supporting the training, mentoring and compensation for Black doulas in Indiana will create a more diverse and inclusive health care environment, can result in improved patient-provider communication, overall patient experience and quality of care, and a culture shift toward achieving equity. In addition, addressing these racialized experiences and working towards equitable healthcare will contribute to creating a safer environment for all patients in Indiana. By addressing disparities and promoting inclusivity, trust in the healthcare system can be strengthened, leading to improved health outcomes. It is crucial to prioritize community trust and foster a healthcare system that values doulas and serves all individuals with fairness and effectiveness.

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1. National Public Radio. (2017). U.S. Has the Worst Rate of Maternal Deaths in the Developed World. https://www.npr.org/2017/05/12/528098789/u-s-has-the-worst-rate-of-maternal-deaths-in-the-developed-world

2.  Indiana University Health. (2022). Addressing Indiana's Maternal Mortality Rate. https://iuhealth.org/thrive/addressing-indianas- maternal-mortality-rate 

3.  Indiana Department of Health. (2022). Indiana Maternal Mortality Review Committee 2022 Annual Report. https://www.in.gov/health/ cfr/files/Maternal-Mortality-Annual-Report-2022.pdf

4. Indiana Department of Health. (2022). Indiana Maternal Mortality Review Committee 2022 Annual Report. https://www.in.gov/health/ cfr/files/Maternal-Mortality-Annual-Report-2022.pdf

We collected stories from doulas across the state including Indianapolis, Bloomington, South Bend, Fort Wayne, and Clarksville in Southern Indiana. Each interview invited doulas to share their doula journey as well as their experiences with health inequities including obstetric racism. Some of our key findings include: 

• Doula work is a calling. Many women talked about doing the work of a doula long before hearing the word or officially training as a doula. They described the intimate care work of a doula as part of their ancestral and cultural traditions.

• Doulas see their work as one part of a larger solution to address health inequities for Black birthing people; there is recognition that systemic and institutional problems cannot be solved by doulas alone, however, doula work is making a difference and can be healing for both birthing people and the doulas themselves. 

• Doulas expressed an interest in more education on the role of doulas for their communities and within clinical settings. They were also interested in state-wide doula organizing that centers the voices of Black doulas and especially the need for additional support, including scholarships and mentoring, to increase the number of Black doulas currently practicing and to strengthen those currently working in this field.