Alvarez Spark Innovation Award Recipient Hali Ledet participated in The Changemaker Institute and works with local organizations like Birthmark Doula Collective, Sista Midwife Productions, and the New Orleans Maternal Child Health Coalition to explore ideas for how doulas can address the racial disparities of birth outcomes among New Orleans families. She is pursuing her Master’s in Public Health in Maternal Child Health. 

Last year, Louisiana ranked 49^th out of the 50 states in women and children’s health. A big reason for this are the stark racial disparities of our reproductive outcomes. We know that four Black mothers in Louisiana die for every one white mother in Louisiana due to pregnancy related causes. Local data tells a similar story of inequity. In New Orleans, Black infants die three times as often as white infants. Evidence shows us that racism, not race, is the cause. Our social environment is dangerous, and it has been dangerous for a long time.

Improving our future starts with improving health and wellness outcomes for infants and the people who give birth to them. But we can’t begin to do this until we recognize the root causes of where we are now and reckon with how we got here in the first place. New Orleans’ history as a port city during slavery is responsible for the sheer number of Black people we have here, but more importantly, it is a direct cause of our current maternal child health conditions. Chattel slavery was an institution literally founded on the policy of denying Black people the power to decide when, where, how, and for whom they gave birth. That legacy of stripping Black people of control over their bodies and reproduction still permeates our current political, economic, medical, and social systems today.

Black people often get blamed for their own poor health outcomes, with medical professionals being quick to place blame on the factors of Black patients being predisposed to illness, uneducated, obese, noncompliant with care, old, or poor. Science doesn’t support this. Though the aforementioned determinants do matter and definitely impact health, research shows us that even when we control for them, we still see different outcomes. That is to say, Black birthing people who have a family history of illness, lower educational attainment, and/or higher BMIs still have poorer outcomes than White birthing people of identical statuses. Black birthing people who are older or low-income still fare worse than White birthing people who are older or low-income. In fact, even when Black people “should” be doing better health-wise, they are still worse off. The infants of Black women with doctorate and professional degrees die at higher rates than those of White women who never finished high school.

The chronic stress that Black people of all incomes, educational levels, and health statuses, face from daily racism (both interpersonal and systemic) has consistently been associated with poor birth outcomes. This racism even comes from medical personnel who often (unconsciously or not) provide poorer quality care to their Black patients because of implicit biases they hold. It’s not about the differences of people themselves, it’s about how people are treated differently.

Often in public health, I’ve found that there is a tendency to seek grand-scale, complex solutions for grand-scale, complex problems. And the issues of racial health inequity, and more broadly, racism within our institutions are certainly gargantuan problems. But I would argue that we can start tackling these problems in very tangible and significant ways by simply treating people…right. Treating them with kindness. Treating them with respect. Treating them with a recognition for their humanity. It doesn’t have to be complicated. And this, I think, is where doulas can come in. This was the starting point of my idea for Birthlight, a company that would explicitly center the needs of Black families to provide them with support in their periods of growth—to treat them how they deserve to be treated.

I believe that if members of Black communities are equipped with support that can act as a buffer to the social determinants that are risk factors, the external social forces that take a toll on mental and physical health, and the negative interactions between patients and providers, the cycles in which they are currently trapped may be reversed. Community doulas can be that buffer. Doulas are not medical providers, but professionals trained to provide physical, mental, educational, and emotional support to a pregnant person throughout the perinatal year (prenatally, at birth, and immediately postpartum). This support comes in many forms, such as education on sex and conception, prenatal health, childbirth, and infant care; the provision of skills for self-advocacy, self-care, and pain management; guidance through labor; the connection to resources such as social services or lactation support; the formulation and implementation of a birth plan; and listening. Since community doulas are not members of the healthcare systems in which clients feel intimidated and ignored, but of the communities in which clients feel comfortable and understood, they have the power to catalyze radical change in improving outcomes. They are knowledgeable about issues relevant to social determinants of health and work with community partners to address those issues primarily during the perinatal year and early childhood years of families. They address health and wellness holistically to empower the person they work for so that their choices are respected. In the process, they ultimately increase knowledge, self-autonomy, and self-efficacy in their communities. In short, community doulas treat people right.

After training as a doula with Sista Midwife Productions, I knew that doing birthwork was how I wanted to create a more socially just world. The question was how to do birthwork in a way that centered the people who needed support the most, in a way that was accessible and impactful. The first step in doing this (I thought) was essentially market research. When I applied to the Alvarez Spark award, I was initially requesting funding to aid in the development of marketing and information dissemination. I wanted to know that my company image, mission, vision, and principles spoke to and resonated with my target audience, and that my services were wanted. Then I applied to the Changemaker Institute and everything, well, changed. Read Part 2 of my blog to find out about lessons I’ve learned since then, and where Birthlight and I are now!