Feeling maternal: Nonprofit institute aims to address racial, socioeconomic disparities in health care, including providing doulas to underserved moms

Colleen Nelson knows her nonprofit’s work is a small piece of an intimidatingly large puzzle.

Just as well-known is that, when it comes to the challenges of Black women and women of color navigating pregnancy and childbirth in the Garden State … the state needs all the help it can get.

“In New Jersey, we were sitting at the 47th-worst in terms of maternal health outcomes,” Nelson said. “And, (although we’ve moved into 29th place), we shouldn’t be that low. New Jersey is full of resources and some of the greatest hospitals.”

Among those answering the call is an offshoot of the state’s larger nonprofit provider of in-home health care, VNA Health Group. Through its Children & Family Health Institute, it’s committed to addressing racial and socioeconomic disparities in maternal health.

Nelson, vice president of clinical operations for the organization, said it serves 800 families navigating the birth and parenting process across mostly Essex, Middlesex and Ocean counties.

One of the niches it’s filling to overcome gaps in health outcomes is increasing access underserved Jerseyans have to doulas, trained childbirth professionals who, until a budgetary change made in 2021, weren’t supported through public health insurance programs.

“But, in New Jersey, doulas weren’t until recently reimbursed through Medicaid, even though they can be a valuable part of the care team in many countries,” Nelson said.

New Jersey is the third state to include doulas under Medicaid coverage. The impetus for a change was first lady Tammy Murphy’s NurtureNJ effort, a statewide push to eliminate racial disparities in birth outcomes and reduce maternal mortality in New Jersey by half over five years.

Access to doulas have been made an integral part of that initiative. In late 2023, the first lady visited University Hospital in Newark for a roundtable discussion and to herald the introduction of a bill (A5739) that would ensure pregnant mothers can be accompanied by their doulas in hospitals and birthing centers across the state. That legislation made its way through the Assembly Health Committee in December.

The presence during labor of a doula significantly decreases the need for an epidural and the possibility of cesarean delivery, according to a May 2023 survey titled “The Effect of Doulas on Maternal and Birth Outcomes” on PubMed Central.

Nelson’s group has zeroed in on a particular issue with doula accessibility in the Garden State.

“Many of the local doulas were Caucasian, and also didn’t speak languages representative of the population in New Jersey, particularly the lower-income populations,” she said.

In support of the state’s goals in closing racial maternal health gaps, Children & Family Health Institute has started training multicultural doulas who can speak a number of languages to better serve all of the state, Nelson said.

So far, it has about a dozen doulas who have gone through its program.

“That initiative has been wildly successful, and we want to expand it,” she said. “That’s something we’re seeking funding for.”

The state’s budget has included more funding in recent fiscal years to continue the training of community doulas throughout the state.

Nelson feels as though there’s much more to do in this area to have a “well-rounded system” and the sort of results the state is looking for on public health.

That’s true for a lot of areas Children & Family Health Institute has involvement with, which also includes child care initiatives and school-based health and nutrition programs.

“We’re really trying to strategically advance programs when we’ve identified gaps in equity,” she said. “We’re looking forward to working together with larger organizations to keep doing that.”