Improving Black maternal health by training doulas and promoting culturally competent care
Overview
After losing her mother to preventable breast cancer and enduring pre-term births despite taking every precaution, Shantay R. Davies-Balch felt compelled to advocate for Black maternal health and community wellness. In 2005, while still working in a corporate role, Davies-Balch became a birth assistant and later formalized her training as a doula. She launched Fresno’s first Black Maternal Health Week, a national effort led by the Black Mamas Matter Alliance and started planning BLACK Wellness and Prosperity Center (BWPC) in 2017 to address critical health disparities for Black women and families, including infant mortality, preterm birth, and maternal mortality prevention.
When the pandemic hit, Davies-Balch led a rapid response, creating the African American Coalition (AAC) to address health equity gaps, offer testing, and provide vaccinations, a program that now provides ongoing community care. In 2021, Davies-Balch launched the Black Doula Network (BDN) to expand doula care among Black women by training new doulas – who provide support and guidance to mothers throughout the birthing process – and advocating for systemic changes. She developed a comprehensive, equity-centered curriculum and has trained ten doulas to date, more than tripling the number of Black doulas serving Fresno County.
“Every woman deserves culturally competent support during birth—because healthier mothers mean healthier communities.”
SHANTAY R. DAVIES-BALCH
Primary Regions Served
Challenge
- Black women in the United States are nearly three times more likely to die from pregnancy-related complications than white women, with a mortality rate of 70 per 100,000 live births.[1] Black infant mortality rates are also higher, with about 1.2% of Black babies dying compared to 0.45% of white infants. [2]
- An estimated 80% of pregnancy-related deaths are preventable by addressing the implicit bias, underlying health conditions, and lack of access to quality care many Black women face.[3]Doulas can provide culturally competent guidance and advocacy for mothers before, during, and after birth that improve maternal and infant outcomes.
- Doula services were added to Medi-Cal coverage in 2023, with the potential to benefit 40% of California births (169,000 births) annually. However, with only around 500 registered doulas in the state, the current workforce can serve just a fraction of these patients.
Innovation
- BWPC’s Black Doula Network (BDN), trains aspiring doulas through a comprehensive program that requires 125 hours of study and observation. The 400-page curriculum includes scientific illustrations of Black women through the stages of pregnancy commissioned by the organization.
- The organization created a birthing simulator – including a life-size, interactive Black birthing doll – which provides a realistic training environment for aspiring doulas and healthcare professionals.
- BWPC offers pregnancy and parenting classes, doula offices, and a free shop with baby and maternity clothes and gear, all housed within the organization’s historic building in downtown Fresno.
- African American Coalition (AAC), BWPC’s first project organized in the pandemic, employs community health workers to address equity gaps, coordinate care, and improve the overall well-being of Fresno’s Black community.
Impact
- The Black Doula Network has trained 10 doulas operating in Fresno, more than tripling the number of Black Doulas serving the county.
- Davies-Balch has increased the Central Valley’s valuation of doulas in labor care, securing hospital privileges for BDN at half of Fresno area hospitals. She also obtained approval to be an official service provider for three major insurance systems, expanding access to doula services for thousands.
- BWPC has provided free travel cribs to more than 100 parents who have completed their safe sleep course and distributed over 100 free car seats and safe installation training to families.
- AAC administered more than 13,000 COVID-19 vaccines, inoculating 39% of the Black community in Fresno County. Fresno Public Health Department representatives credit the AAC for accelerating vaccination access among African American residents.
Opportunity
- California Surgeon General Ramos released the California Maternal Health Blueprint in 2024, which aims to reduce California’s maternal mortality rate by 50% by 2026. Strategies include increasing access to doula services and culturally competent care, highlighting the need for Davies-Balch’s leadership and programming.
- Davies-Balch aims to ensure all birthing people in the Central Valley have access to a doula by 2030, which will require 200 full-time doulas in the region, including 30 Black doulas.
- To address the growing need for doulas, Davies-Balch is coordinating with educational institutions to license BDN’s curriculum and offer it statewide.
- Davies-Balch aims to build a birthing center at the BWPC facility and transition clinical rooms originally established to provide COVID-related care into a prenatal care room and birth clinic.
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