More than half of states now cover doula services through Medicaid, and a new paper from Farhad V. Farahani, a PhD candidate in economics at the University of South Florida, finds indications of healthier birth outcomes in those states, particularly among Black women. Spotlight spoke with Farahani about the paper recently; the transcript of that conversation has been lightly edited for length and clarity.
Many people may not be aware that Medicaid covers doula services. Why don’t we start there and then get into how you got interested in this research.
This is part of my PhD research in economics at the University of South Florida. I was looking for policies that could actually help mothers and babies, especially families who have the most to gain. I noticed that some states had started paying for doula care through Medicaid, and others hadn’t. That gave me a natural way to compare states and ask a simple question: when a state starts covering doulas, do babies end up healthier?
So, Medicaid only covers doulas in some states?
Yes, and it really depends on the state. In some states, doulas have to go through certification, Medicaid enrollment, and billing rules, and many find the paperwork and the low pay hard to manage. Other states have made the process much easier. Minnesota and Oregon started first, around 2014. New Jersey followed in 2021, and after that a lot of states joined within just a few years. Because states started at different times, it works almost like a natural experiment.
And roughly how many states have that coverage now?
Right now, it’s 28 states plus Washington, D.C. Several more have passed laws and are still setting up their programs, so that number is going to keep growing.
And for the states that do cover it, what did you find?
I used birth records for more than 32 million babies born between 2016 and 2024. I compared how birth outcomes changed in states after they began covering doulas with states that didn’t. Looking at all mothers together, I don’t find a clear effect on low birth weight. But Black mothers are a different story. In the states that have had coverage the longest, low birth weight among babies born to Black mothers dropped by about half a percentage point. That’s roughly a 5 percent reduction.
This matters because Medicaid pays for about 4 in 10 births in the U.S., and the share is even higher for Black mothers. But I’d call these results promising early evidence rather than a final answer. Only a handful of states have had coverage long enough to study. Most states started in 2024 or 2025, so we’ll know a lot more as newer birth data comes out.
And for people who may not be familiar with doulas, how do you define their role?
Doulas are trained, non-medical support people. They help a mother emotionally and physically during pregnancy, during labor, and after the baby is born. They don’t replace doctors or midwives; they work alongside them. Studies of women who had continuous support during labor show real benefits, like fewer C-sections and better birth experiences. That’s why so many states see doula coverage as a good investment in moms and babies.
Do you have any sense of how many women take advantage of this benefit in states that allow it?
That’s one of the biggest gaps right now. Most states don’t publish data on how many Medicaid patients actually use a doula, and the early numbers we do have are small. What I can measure is the doula workforce. Using the national provider registry, I found that the number of registered doulas grew much faster in states that started covering them. By 2024, those states had roughly twice as many doulas per birth as states without coverage. So coverage seems to be bringing more doulas into the field, but getting the benefit to the mothers who need it is still a work in progress.