How expanding doula access is helping Michigan improve birth outcomes – MLive.com

Report on Michigan’s Doula Initiative and its Alignment with Sustainable Development Goals

Introduction: Advancing Maternal Health through Strategic Policy

The state of Michigan has implemented a comprehensive doula initiative aimed at improving maternal and infant health outcomes. This report analyzes the program’s components and successes through the lens of the United Nations Sustainable Development Goals (SDGs). Doulas, who provide non-clinical support during the perinatal period, are central to this strategy. The initiative directly contributes to SDG 3 (Good Health and Well-being), SDG 10 (Reduced Inequalities), and SDG 5 (Gender Equality) by expanding access to care, addressing systemic disparities, and empowering birthing individuals.

Program Components and SDG Framework Alignment

Michigan’s strategy is built on several key pillars that align with global development targets:

• Medicaid Coverage Expansion: In January, the state established Medicaid coverage for doula services, later expanding covered visits and increasing reimbursement rates. This action directly supports SDG 1 (No Poverty) and SDG 3 by removing financial barriers to essential health support for low-income families.
• MDHHS Doula Registry: The creation of a statewide registry facilitates access to care, connecting families with qualified doulas, including Medicaid-enrolled providers. This infrastructure development is crucial for achieving the universal health coverage targets within SDG 3.
• Doula Training Scholarship Program: A scholarship of up to $3,000 is offered to individuals with insufficient financial resources to cover training costs. This promotes SDG 8 (Decent Work and Economic Growth) by creating a skilled workforce and supports SDG 10 by diversifying the perinatal health field.
• Collaborative Governance: The state actively involves the Doula Advisory Council in policy-making, reflecting a commitment to SDG 17 (Partnerships for the Goals) by ensuring that policies are shaped by experienced professionals.

Progress Toward SDG 3: Good Health and Well-being

The primary objective of the initiative is to improve health outcomes for mothers and newborns, a core target of SDG 3. Evidence indicates significant progress in this area.

1. Improved Birth Outcomes: Doula-assisted childbirth is associated with a reduced likelihood of complications, including low birth weight, fewer C-sections, and shorter labor.
2. Record-Low Infant Mortality: In 2023, Michigan recorded its lowest infant mortality rate, with 6.1 deaths per 1,000 live births. While multiple factors contribute, expanded access to supportive care like doulas is a key component of the state’s “Advancing Healthy Births” plan.
3. Enhanced Prenatal and Postnatal Care: Doulas encourage healthy behaviors, provide emotional support, and reduce maternal stress. Evidence shows that their involvement increases attendance at prenatal visits and the likelihood of carrying a pregnancy to full term.

Addressing SDG 10: Reduced Inequalities

A significant focus of the doula initiative is to mitigate the stark racial disparities in maternal and infant mortality, a critical aspect of SDG 10.

• Disparity Statistics: In Michigan, Black infants are three times more likely to die before their first birthday than white infants. Similarly, Black women were 2.8 times more likely to die from pregnancy-related causes than white women between 2015 and 2019.
• The Role of Doula Advocacy: Doulas serve as crucial advocates for birthing individuals, ensuring their voices are heard and their choices are respected within the healthcare system. This is particularly vital for Black and Indigenous families who face systemic biases.
• Targeted Impact: By intentionally focusing on improving outcomes for marginalized communities, the initiative aims to create a “wave of safety and dignity” that elevates the standard of care for all, directly tackling the inequality at the heart of the problem.

Conclusion: A Model for Sustainable Health Policy

Michigan’s doula initiative serves as a national model for integrating health policy with the Sustainable Development Goals. The state has exceeded its initial targets, with the Doula Registry growing to over 1,000 members—doubling its five-year goal in under one year—including 700 Medicaid-enrolled doulas across all 83 counties. By investing in doulas, Michigan is not only improving immediate health outcomes but also building stronger, healthier, and more equitable communities, making a measurable contribution to achieving SDG 3, SDG 5, and SDG 10.

Analysis of Sustainable Development Goals in the Article

1. Which SDGs are addressed or connected to the issues highlighted in the article?

• SDG 3: Good Health and Well-being

  The article’s primary focus is on improving maternal and infant health outcomes. It discusses how doula-assisted childbirths lead to “fewer complications for mothers and their newborns” and reduce the likelihood of “low birth weight.” The entire initiative by the state of Michigan, including expanding the doula network and Medicaid coverage, is aimed at promoting “safe, healthy and positive birth experiences” and achieving “healthier parents, healthier babies.” This directly aligns with the goal of ensuring healthy lives and promoting well-being for all at all ages.

• SDG 10: Reduced Inequalities

  The article explicitly highlights significant racial disparities in health outcomes. It states that “Black infants are three times more likely to die before their first birthday than white infants” and “Black women were 2.8 times more likely to die from pregnancy-related causes than white women.” The initiative’s intentional focus on “improving outcomes of Black and Indigenous families” is a direct effort to reduce these inequalities and ensure that all individuals, regardless of race, have an equal opportunity for positive health outcomes.

• SDG 1: No Poverty

  The article addresses the economic barriers to healthcare. It mentions that an “inability to pay for services” and the “stress of poverty” are barriers to infant care. Michigan’s policy of establishing and expanding “Medicaid coverage for doula services” is a social protection measure aimed at ensuring that low-income families can access these vital services without financial hardship. The creation of a scholarship program for doula training for individuals with “insufficient financial resources” also addresses the poverty-related barriers to entering the profession.

2. What specific targets under those SDGs can be identified based on the article’s content?

1. SDG 3: Good Health and Well-being

   • Target 3.1: By 2030, reduce the global maternal mortality ratio. The article addresses this by focusing on reducing “complications involving the mother” and highlighting the higher death rates for Black women from “pregnancy-related causes,” which the doula initiative aims to mitigate.
   • Target 3.2: By 2030, end preventable deaths of newborns and children under 5 years of age. The article directly relates to this target by discussing Michigan’s infant mortality rate (6.1 deaths per 1,000 live births) and the leading causes of infant death, such as “preterm birth and low birth weight,” which doula support helps to reduce.
   • Target 3.8: Achieve universal health coverage, including financial risk protection and access to quality essential health-care services. The state’s initiative to provide and expand “Medicaid coverage for doula services” across all 83 counties is a clear action towards achieving universal health coverage for pregnant individuals, protecting them from financial hardship and ensuring access to quality care.

2. SDG 10: Reduced Inequalities

   • Target 10.2: By 2030, empower and promote the social, economic and political inclusion of all, irrespective of race. The article’s focus on the stark racial disparities in maternal and infant mortality and the stated goal of “intentionally focusing on improving outcomes of Black and Indigenous families” directly supports this target by aiming to eliminate health outcome inequalities based on race.
   • Target 10.3: Ensure equal opportunity and reduce inequalities of outcome. The policy of expanding Medicaid for doulas is a specific action taken by the state of Michigan to reduce the inequality of health outcomes between different racial and economic groups, ensuring that more families have the support needed for a healthy birth.

3. SDG 1: No Poverty

   • Target 1.3: Implement nationally appropriate social protection systems and measures for all. Medicaid is a key social protection system in the United States. The article describes how Michigan is strengthening this system by expanding its coverage to include doula services, thereby increasing the support available to poor and vulnerable populations.

3. Are there any indicators mentioned or implied in the article that can be used to measure progress towards the identified targets?

Yes, the article mentions several direct and implied indicators:

• Maternal Mortality Ratio (Indicator 3.1.1): The article provides a comparative statistic: “Black women were 2.8 times more likely to die from pregnancy-related causes than white women.” This serves as a baseline indicator for measuring progress in reducing maternal mortality and racial disparities.
• Infant Mortality Rate (Indicator 3.2.2): A specific rate is given: “6.1 deaths per 1,000 live births,” which is noted as the “lowest point on record” for Michigan. The article also provides a disparity indicator: “Black infants are three times more likely to die before their first birthday than white infants.”
• Proportion of births attended by skilled health personnel (related to Indicator 3.1.2): While doulas are non-clinical, the increase in their numbers and integration into the care team contributes to the overall support system. The indicator is the number of registered doulas, which has surpassed 1,000, including “700 Medicaid enrolled doulas.”
• Proportion of population covered by essential health services (related to Indicator 3.8.1): The expansion of Medicaid to cover doula services across all 83 counties implies an increase in coverage. The number of Medicaid-enrolled doulas (700) is a direct measure of the increased capacity to provide this service to the covered population.
• Incidence of low birth weight: The article mentions that doula assistance is “found to reduce the likelihood of low birth weight,” implying that tracking the rate of low birth weight infants is a key indicator of the program’s success.

4. SDGs, Targets, and Indicators Summary

Source: mlive.com