Disrupting the Pathways of Social Determinants of Health: Doula Support during Pregnancy and Childbirth

Abstract

Purpose: The goal of this study was to assess perspectives of racially/ethnically diverse, low-income pregnant women on how doula services (nonmedical maternal support) may influence the outcomes of pregnancy and childbirth. Methods: We conducted 4 in-depth focus group discussions with low-income pregnant women. We used a selective coding scheme based on 5 themes (agency, personal security, connectedness, respect, and knowledge) identified in the Good Birth framework, and we analyzed salient themes in the context of the Gelberg-Anderson behavioral model and the social determinants of health. Results: Participants identified the role doulas played in mitigating the effects of social determinants. The 5 themes of the Good Birth framework characterized the means by which nonmedical support from doulas influenced the pathways between social determinants of health and birth outcomes. By addressing health literacy and social support needs, pregnant women noted that doulas affect access to and the quality of health care services received during pregnancy and birth. Conclusions: Access to doula services for pregnant women who are at risk of poor birth outcomes may help to disrupt the pervasive influence of social determinants as predisposing factors for health during pregnancy and childbirth.