Three Years Post-Roe: Black Birth Workers Are Holding the Line

By Lakeesha Harris - Executive Director of Chicago Volunteer Doulas

It has been three years since the fall of Roe v. Wade, and the landscape of reproductive health in America has been reshaped by crisis after crisis, resistance, and rebirth. In the wake of sweeping bans and rising maternal mortality rates—particularly among Black women—a quiet but powerful movement is expanding: the resurgence and recognition of Black birth workers.

Black Doulas and midwives are not new. They have long existed as pillars of our communities, offering culturally grounded, respectful, and lifesaving care when the healthcare system has failed to do so. What has changed is the growing recognition of our power—and the increasing number of Black women turning to and becoming birth workers, not out of trend, but out of necessity. We see every crisis and desire a better world.

This shift is not accidental. It is a direct response to harm. Many Black women feel unheard, disrespected, or even endangered within hospital walls. With maternal mortality continuing to rise and trust in the medical system eroding, more and more birthing people are seeking Doulas and midwives who reflect their lived experiences and affirm their humanity.

Shared identity in care isn’t just about comfort—it’s about survival. Studies have shown that outcomes improve when Black patients are cared for by Black healthcare providers. It means not having to explain your pain, justify your choices, or brace yourself for bias in one of the most vulnerable moments of your life.

And the data backs this up.

Women supported by Doulas are 53% less likely to require C-sections and 58% less likely to experience postpartum depression and anxiety (Falconi et al., 2022). Those aren’t just numbers—they are lives changed, trauma avoided, and families preserved. This is not just anecdotal support. This is evidence-based intervention.

Recognizing the benefits, 31 states and D.C. proposed legislation by mid-2022 to provide Medicaid reimbursement for Doula services. But by 2024, only 12 states and D.C. had implemented it (Peters & Robles-Fradet, 2025; Gaddy, 2024). And while states like Rhode Island and Louisiana have mandated private insurance coverage, many others are falling behind. Even where policies exist, they often fall short. A 2024 study revealed that when setting reimbursement rates, policymakers ignored at least half of the actual services Doulas provide—including time spent on-call, traveling, coordinating care, and offering emotional support (Doula Data Consortium, 2024).

This disconnect has real consequences. Doulas—many of them Black women—are underpaid, undervalued, and overworked. In Oklahoma, where Medicaid began reimbursing Doulas in July 2023, some are still struggling to make ends meet (Beasley, 2025). The labor they offer is not only deeply skilled but also deeply emotional. And yet, the financial recognition often doesn't follow. Many do this work out of passion, but passion does not pay rent. Still, in Illinois, where Chicago Volunteer Doulas provide services, most Doulas aren’t clear on how to jump through the hoops of state systems in order to get reimbursed by Medicaid. We are not just organizations, we are people serving people.

Worse still, legal and political threats are creating hostile environments for birth workers, particularly in conservative states. Some midwives and Doulas have even faced criminalization for services that were once legal. The work that once filled healthcare gaps is now under siege.

And yet, despite all this, Black women continue to rise. Many are called to this work by their own birth stories—stories marked by disrespect, trauma, or silence. They are determined to ensure that future generations don’t have to suffer the same. That’s why moments like the launch of the first HBCU-based Doula certification program at Virginia Union University in April 2025 matter so deeply (Virginia Union University, 2025). They are not just milestones—they are manifestations of a broader fight for equity and access.

Still, becoming a birth worker remains out of reach for too many. The cost of certification, the lack of support, and limited training programs—especially at institutions serving Black students—are significant barriers. Since January of 2024, Chicago Volunteer Doulas has been training Doulas in Chicago and Louisiana, free of charge. We know that until we invest in making these paths more accessible, we will continue to lock out the very people most capable of closing the care gap.

The reality is, one in six Black babies in the U.S. is born in a maternity care desert—places with no OB-GYNs or birthing facilities at all. As hospitals shut their doors and rural care disappears, Doulas and midwives are stepping in where systems have abandoned people. They are not a luxury. They are essential.

But while birth workers are stepping up, state and federal policies continue to fall short—or actively work against them. In some states, legislation that once quietly enabled midwives or Doulas to practice has been repealed or restricted under the guise of medical regulation or abortion-related fearmongering. Suddenly, offering non-clinical labor support can be misconstrued as providing unauthorized medical care, especially in politically charged climates. In Texas, for instance, some Doulas have reported being harassed or excluded from hospital settings due to shifting liability concerns and unclear legal boundaries (Doulas for Justice, 2024).

At the same time, grassroots networks are finding creative ways to resist. In cities like Atlanta, New Orleans, and Chicago, Black birth collectives are training Doulas outside of traditional systems, offering scholarships, and coordinating volunteer care teams for families in need. These efforts may be informal, but they are powerful—relying on mutual aid, ancestral wisdom, and community trust. They reflect the truth many already know: that safety in birth doesn’t come from top-down institutions alone. It comes from people showing up, again and again, to protect one another.

To ignore these realities is to accept the status quo. However, to truly support them—to back the labor, leadership, and lived experiences of Black birth workers—is to move toward justice. It’s not charity. It’s a repair.

The legacy of racism in medicine—from forced sterilizations to today’s biased treatment—is not ancient history. It’s still playing out in delivery rooms every day. But Black birth workers are offering something different: care rooted in love, autonomy, community, and justice.

To move forward, federal and state investment is not just helpful—it’s urgent. We need to increase Medicaid and private insurance coverage for Doula and midwifery services. We must fund training programs—especially at community-rooted and based education programs. And above all, we must pay birth workers what they’re worth.

Three years post-Roe, reproductive justice in America hangs in the balance. But Black birth workers are holding the line—fighting for safe, joyful, empowered births against all odds. If we’re serious about maternal health equity, it’s time we stood with them.

Not just in words. In policy. In funding. And in action.