Ranglin-Vassell bill would require insurance, Medicaid coverage for doula services

Legislation aims to improve health outcomes, particularly for black women

STATE HOUSE – Rep. Marcia Ranglin-Vassell has submitted legislation to make doula services eligible for reimbursement through private insurance and Medicaid programs. The bill is backed by the Coalition for Reproductive Freedom, which held a State House event today to promote it.

The purpose of the bill is to achieve healthier outcomes for women and babies, particularly for black women, who experience significantly higher rates of death or injury during childbirth than white women do.

“Doulas have been shown to make real, measurable improvements in the health outcomes for women and babies during pregnancy and childbirth, preventing complications, reducing the cesarean and preterm rates. They are cost-effective, ultimately saving medical dollars because patients using them require less medical intervention overall,” said Representative Ranglin-Vassell (D-Dist. 5, Providence). “All women, but particularly women of color, who are three to four times more likely to die for pregnancy-related reasons than white women, should be encouraged to use a doula during pregnancy and childbirth.”

Doulas are trained professionals who provide continuous physical, emotional and informational support to women during pregnancy, childbirth and the first few postpartum weeks. They assist in making women as comfortable as possible during birth, providing help with breathing techniques, massage and advice, and can help advocate for the woman during the birth. Births assisted by doulas have significantly lower rates of cesarean section, with one study showing a 39 percent reduction.

At 23.8 per 100,000 live births in 2014, the United States has the highest maternal mortality rate in the developed world, and, along with Serbia, is one of only two developed nations whose rate has been rising, having increased 26.6 percent between 2000 and 2014.

In Rhode Island, the maternal mortality rate between 2013 and 2017 was 11.2 per 100,000 live births.

Nationally, maternal mortality is far higher for black women than white women. According to the Centers for Disease Control, from 2011 to 2014, the mortality rate for black women was 40 per 100,000 births, compared to 12.4 per 100,000 for white women.Studieshave suggested that racial bias and unequal treatment of black women exist in the health care system, often resulting in inadequate treatment.

Representative Ranglin-Vassell said the use of a doula, whose primary focus is on the mother’s wellbeing and comfort, would better ensure that women of color have their needs met during childbirth.

Under the bill (2019-H 5609), services from a trained, qualified doula would be eligible for coverage through private insurance and Medicaid, including the state medical assistance program, for up to $1,500 per pregnancy. The bill, which would take effect July 1, 2020, would also set industry standards and create a statewide registry of doulas to assist women in connecting with qualified professionals, while simultaneously helping to assure that doulas are fairly compensated for their work.

Members of the Rhode Island Coalition for Reproductive Freedom, Doulas of Rhode Island, Representative Ranglin-Vassell, Sen. Ana B. Quezada (D-Dist. 2, Providence), and Providence City Councilwoman Nirva LaFortune took part in today’s event to present the legislation.

“Planned Parenthood of Southern New England believes that carrying a pregnancy to term should not put women’s lives at risk. As a member of the Rhode Island Coalition for Reproductive Freedom, we will fight to ensure black women receive the high-quality care they deserve, and perinatal doulas are fairly compensated for the care they provide. Maternal mortality in the United States is a public health crisis and its severe impact on black women is unacceptable,” said Kavelle Christie, Public Policy and Organizing Specialist of Planned Parenthood of Southern New England. “In partnership with SisterSong, leaders in the reproductive justice movement, and Rhode Island social justice and health care organizations with a long history of advocating on behalf of their communities, the Rhode Island Coalition for Reproductive Freedom will work to ensure women of color are seen, heard, and provided the high-quality health care they deserve.”

Currently, Oregon and Minnesota permit Medicaid coverage for doula services and New York City has launched a pilot program.

The National Partnership for Women and Families, which has advocated for coverage of doula services for improved health outcomes, estimates the reduction in cesarean births that could result from public and private coverage nationwide could save Medicaid at least $646 million per year, and about $1.73 billion for private insurers.

The legislation was introduced Feb. 27 and has been assigned to the House Finance Committee. It is cosponsored by Rep. Rebecca Kislak (D-Dist. 4, Providence), Rep. John W. Lyle Jr. (R-Dist. 46, Lincoln, Pawtucket), Rep. Anastasia P. Williams (D-Dist. 9, Providence), and Rep. Christopher R. Blazejewski (D-Dist. 2, Providence).