Doula Care and Health Equity for Low-Income Mothers: A Scoping Review

Background: Income-based disparities in maternal and child health (MCH) outcomes persist in the United States, manifesting in adverse birth outcomes such as preterm birth, low birthweight, and cesarean section rates. Doula care has been associated with improved MCH outcomes. However, substantial variation exists in how doula care is defined across the studies, complicating efforts to assess its impact. This scoping review examines the role of doula care in serving low-income mothers and identifies common features of doula programs associated with positive MCH outcomes.

Methods: After consultation with a research librarian, this scoping review used Web of Science, PubMed, and CINAHL. Search terms included Boolean operators such as (doula*) AND (health) AND (disparit* OR low-income). Eligible studies were peer-reviewed, published between January 1, 2000 and January 1, 2025, available in English, and examined interventions conducted within the United States involving continuous labor support forlow-income women and MCH outcomes. The authors reviewed the articles using PRISMA guidelines. Articles meeting inclusion criteria were reviewed for MCH outcomes, and those with sufficient detail on the components of doula care were coded to identify common features of doula care.

Results: The search identified 659 articles. After duplicate removal, screening, and full-text review, sixteen articles met the inclusion criteria. In most studies, the findings indicate that doula care is associated with positive MCH outcomes for low-income women. Reported outcomes included lower rates of preterm birth, epidural use, low birth weight, and cesarean sections, along with higher rates of breastfeeding initiation and longer breastfeeding duration. Fourteen articles provided in-depth information about the nature of doula care received, revealing substantial variation. Program design ranged from interventions that only provided continuous labor support to programs that also included included pre- and postnatal support, resource referral and connection, childbirth and newborn care education, and lactation consultation. Programs that complement continuous labor support with additionalapproaches to care suggested patterns consistent with improved MCH outcomes.

Implications: Findings indicate that doula care can lead to positive MCH outcomes for low-income women, especially in community-based programs that provide additional supports. This study highlights the importance of addressing social determinants of health in addition to practices within clinical settings. Doula care remains financially inaccessible for many low-income people, and policymakers should consider funding mechanisms and community workforce development opportunities to increase access to doula care. Future research should focus on identifying the relative contributions of specific doula care program components in reducing health inequities.