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COVID-19 has killed , , and . It鈥檚 also worsened the U.S. . The rate of people who died during pregnancy or within the first six weeks after delivery increased by 40% in 2021, according to a Centers for Disease Control and Prevention . 

While that increase impacts people across lines of race and ethnicity, maternal mortality s. Black people continue to suffer disproportionately, dying at more than twice the rate that white people do. About a quarter of deaths in 2020 and 2021 were directly related to the birthing person having COVID. Pregnant people and those who have recently given birth are , and risks for certain pregnancy complications, such as preeclampsia, increase when someone who is expecting has the virus. 

Latona Giwa, co-founder of and the New Orleans Breastfeeding Center, offers a fuller picture of the maternal mortality and morbidity spike in Louisiana, the state where she lives and works. 鈥淲e had the height of the pandemic, and then we had Hurricane Ida on top of that in 2021 that was really devastating for pregnant and birthing families,鈥� Giwa says. 鈥淭hen we had and . I think the last couple of years have really laid bare that we are in a state of constant and overlapping crises, and that birthing families are bearing a lot of the brunt of that.鈥� 

Even before the pandemic, many pregnant and postpartum people in the United States were suffering. Deaths occurring during pregnancy or in the weeks and months following birth have been steadily , making the country an outlier in maternal mortality compared with its high-income peer countries. Pregnant and postpartum people in the U.S. of people in countries such as , , and . Families in those countries can rely on , , and , who offer more personalized care and fewer interventions than the obstetricians commonly relied upon in the U.S.

Efforts to reform health care in the U.S. are underway, as are efforts to . But as pregnant people prepare to give birth in a broken system, doulas can offer the support families need to stay safe. Doulas assist with nonmedical needs throughout pregnancy, birth, and the postpartum period. They can between the birthing person and clinician, , and offer counsel for . They also provide an extra set of hands, tending to the many tasks new parents face.

While doula care was once seen as a , it鈥檚 now widely accepted as an intervention that can keep a pregnancy on track. 鈥淲e see ourselves as frontline workers. We see ourselves as emergency responders,鈥� Giwa says. 鈥淔amilies are coming to us with so many layers of trauma, and we鈥檙e taking that on.鈥� This has meant building new infrastructure into the doula practice, including the creation of a perinatal emergency preparedness program.

鈥淲e can鈥檛 just keep conceptualizing emergencies as this far-off thing you plan for,鈥� Giwa says. Instead, an ethic of preparedness is now embedded into all doula interactions with families, some of whom live in where they must travel more than an hour to receive basic support. 鈥淲e talk to them knowing that homelessness could be a reality for someone. Natural disaster could be a reality. A traumatic birth experience could be a reality.鈥�

This critical work requires resources. Over the years, Birthmark has funded its work through a combination of sliding fees, donations, contracts, and grants. Reimbursement from insurance鈥攊ncluding Medicaid, which covers 鈥攊s another potential revenue stream. were the first states to pass legislation that expands access to doulas through Medicaid coverage.

Advocates and elected officials are trying to bring such solutions to scale at the federal level. , a package of bills that addresses pregnancy-related deaths and dramatically expands maternity care, has been introduced in Congress three times since March 2020. Taken as a whole, it has not been successful, though passed in late 2021. The Biden administration has and last year called on states to expand Medicaid coverage to one year for postpartum parents. Funding for some programs that received additional funding through a spending bill Congress passed in late 2022.

State and federal funds to address the maternal health crisis are just one piece of the puzzle. 鈥淚t鈥檚 hugely important,鈥� Giwa says. 鈥淏ut at the same time, we have to build our own reality of the future we want to see in our communities and on the local level.鈥� Giwa is a nurse and a community organizer, so she understands the broader landscape of how change is made. 鈥淚f you look at Black women organizing on any issue, that鈥檚 what we do,鈥� she says. 鈥淲e鈥檙e working all the possibilities.鈥� 

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Dani McClain reports on race, parenting and reproductive health. McClain鈥檚 writing has appeared in outlets including The New York Times, TIME, The Atlantic, Harper鈥檚 BAZAAR and Colorlines. Her work has been recognized by the National Lesbian and Gay Journalists Association, the National Association of Black Journalists, Planned Parenthood Federation of America, and she鈥檚 received a James Aronson Award for Social Justice Journalism. McClain is a contributing writer at The Nation. She was a staff reporter at the Milwaukee Journal Sentinel and has worked as a strategist with organizations including Color of Change and Drug Policy Alliance. Her book, We Live for the We: The Political Power of Black Motherhood, was published in 2019 by Bold Type Books and was shortlisted in 2020 for a Hurston/Wright Legacy Award. She was the Cincinnati public library鈥檚 Writer-in-Residence in 2020 and 2021. She is based in Ohio and speaks English.

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