Resources

Native women experience disproportionately high rates of maternal mortality and pregnancy complications¹, disparities often rooted in systemic inequalities, geographic isolation, and lack of access to culturally appropriate care. In efforts to close these gaps, doulas are reemerging as a vital resource, providing ongoing, non-medical support throughout pregnancy, childbirth, and the postpartum period. 

Many Tribal communities have unique birthing traditions and practices that center ceremony, community, and the sacred role of motherhood – knowledge that is often overlooked or misunderstood within mainstream healthcare systems. This disconnect can leave Native mothers feeling unseen or unsupported in clinical settings. Doulas, particularly those who are culturally grounded, can help bridge this gap by advocating for the inclusion of traditional perinatal practices and supporting families in exercising their cultural rights. In this way, doulas help restore a sense of cultural dignity within birthing and postpartum spaces.

In addition, doulas provide emotional support, physical comfort, and advocacy, which not only improve maternal health outcomes but also help to improve the overall safety for the mother and child. Their support can help to decrease isolation and develop trust,  which supports the ability to identify safety concerns, such as providing a safe space for Native women to disclose domestic and family violence. This trust is especially critical given the historical and ongoing impacts of policies that have led to the forced removal of Native children from their families, contributing to mistrust of institutional systems and the need for culturally safe care. Statistically, pregnancy can be a time when domestic violence escalates, making consistent and trusted support even more crucial. Doulas may be among the few individuals who have regular contact with expectant and postpartum mothers, positioning them to recognize warning signs, provide nonjudgmental support, and connect families to resources. By fostering safety, trust, and continuity of care, doulas can play a critical role in interrupting cycles of violence and helping protect both the mother and child during a particularly vulnerable time.

Increased Access: Expansions in Medicaid Coverage for Doulas

State-level policy initiatives are recognizing the importance of doula support and adopting policies to ensure access to doula care regardless of income. As of March, 2026, 26 states and Washington, D.C., have Medicaid reimbursement coverage for doula services, providing low-barrier access to prenatal, birth, and postpartum support, representing meaningful progress toward health equity

Gaps for American Indian/Alaska Native Mothers

In spite of these policy advancements, Native mothers continue to face significant challenges. Tribal communities often have limited access to trained doulas, face complex reimbursement procedures, and struggle to access prenatal healthcare. 

In addition, progress at the state level does not automatically equate to access at the Tribal level. Expanding doula access in these communities is essential to addressing high rates of violence against Native women, restoring balance to childbirth, and aiding families in a culturally grounded manner. Without targeted investment in Native communities and Native parents, our communities will continue to be left behind.

By honoring practices and traditions surrounding birth and supporting families in ways that are culturally tailored and community-led, doula access in Native communities is not only a healthcare intervention, but a restoration of Tribal sovereignty. We recognize Native mothers as lifegivers, caregivers, and knowledge keepers and support their inherent right to birth and child-rearing with dignity, safety, and respect. 

The following list identifies each state that offers Medicaid reimbursement for doula services²:

• California
• Minnesota
• Oregon
• Maryland
• Nevada
• New Jersey
• Rhode Island
• Virginia
• Michigan
• Oklahoma
• Colorado
• Kansas
• Massachusetts
• New York
• Missouri
• Illinois
• Arizona
• Connecticut
• New Hampshire
• New Mexico
• Ohio
• Washington
• South Dakota
• Tennessee
• Delaware
• Washington, D.C.

1. “Disparities and Resilience among American Indian and Alaska Native Women Who Are Pregnant or Postpartum,” Centers for Disease Control and Prevention, accessed May 6, 2026, https://www.cdc.gov/hearher/aian/disparities.html#:~:text=American%20Indian%20and%20Alaska%20Native%20women%20are,Longer%20distances%20to%2quality%20health%20care%20services.

2.  Hasan, Anoosha. National Academy for State Health Policy. State Medicaid Approaches to Doula Service Benefits. nashp.org, 31 March 2026, https://nashp.org/state-tracker/state-medicaid-approaches-to-doula-service-benefits/#:~:text=As%20o….