Delivering Change: The Diffusion of Doula Awareness in Black American Communities.

Abstract

Black American mothers face disproportionately high maternal mortality rates. Despite evidence showing that doulas can reduce these adverse outcomes, a majority of Black mothers remain unaware of doula services. Through interviews with 22 participants in the Northeastern United States, this study identified key barriers to awareness, including institutional practices that intersect with racial, economic, and social factors affecting access to maternal health information. Findings reveal a dichotomy between "alternative seekers," who actively question traditional healthcare systems, and "unquestioning conformers," who accept standard medical care without exploring alternatives. Alternative seekers typically discovered doula services through community networks and social media, while conformers remained limited by institutional and socioeconomic constraints. Recommendations to close this gap include developing institutional "push/pull" strategies: healthcare providers can incorporate basic doula information into their standard communications. Community doula organizations can also improve outreach through social media testimonials and strategic partnerships. The study also highlights how postpartum care provided by doulas fosters mutually beneficial relationships with healthcare institutions.