I vividly remember “The Greatest Canadian”, a 13-part competitive series produced by CBC in 2004. Each week, a biographical documentary on individuals who have made a great contribution to Canada aired, including Terry Fox, David Suzuki, and Tommy Douglas. Viewers got to vote on who the greatest Canadian of all time was. Tommy Douglas, recognized as the father of publicly funded health care in Canada, emerged victorious.
Douglas’ win says a lot about the value we attach to our healthcare system and the national pride we take in making sure that every Canadian has access to the care they need. We often look to our American neighbours with pity when we hear about $700+ a month insurance plans ($2000+ for a family plan) or families going into debt or going bankrupt to pay for life-saving treatment. But if the Canadian healthcare system is so superior to that of the US, why is publicly-funded doula access expanding by leaps and bounds in the US, while progress on the same front has been stagnant in Canada?
Over the last few years, an increasing number of jurisdictions in the US have made doula care payable via Medicaid. Medicaid is public health insurance for people who are unable to access private coverage. 11 States that have introduced Medicaid-funded doula care programs include New York, California, and Michigan. California cites familiar research as the rationale for its decision: “doula care was associated with positive delivery outcomes including a reduction in cesarean sections, epidural use, length of labor, low-birthweight and premature deliveries. Additionally, the emotional support provided by doulas lowered stress and anxiety during the labor period”.
One reason why advocates for publicly funded doula care have gained more traction in the US is that the US collects race-based healthcare data, along with information on many other social determinants of health. This data has demonstrated significant disparities in perinatal outcomes based on race, income, and other factors. The Black maternal and neonatal mortality crisis has emerged as a system disaster that requires urgent solutions. Combined with a growing body of health research demonstrating that doulas are an effective intervention that improves outcomes for Black birthers and babies, this has made a strong case for access to doula care for Black and other at-risk communities.
In Canada, we have the same research to show that doulas solve a problem, but we don’t have the same amount of data to show that there’s a problem to solve. That being said, while our race-based data collection needs to improve, we do collect data on other topics. In 2023 OBGYN researchers at McMaster University published findings on operative deliveries and 3rd and 4th-degree tears in Canada. They found that “among high-income countries, Canada has the highest rate of maternal trauma after births in which tools like forceps and vacuums are used”. Sadly, their research only compares operative deliveries (forceps/vacuum) to surgical deliveries (cesarean sections). They do not take into account the ample evidence that California and other US jurisdictions considered showing that support from a birth doula reduces the likelihood of any of these interventions.
Not only do we need to collect data that demonstrates the impact of the social determinants of health, we need to put the research we do have into action. This action needs to encompass the role that all care providers play in improving conditions and outcomes for birthing people. This includes ensuring that all birthers can access the reduction in medical interventions and related increases in good birth outcomes and satisfaction that skilled doula support can achieve.
Keira Grant (she/her) Inclusion and Engagement Lead – Racialized Communities
Keira brings a wealth of experience to the Online Community Moderator role. She is a Queer, Black woman with a twenty-year track record in Equity, Diversity, and Inclusion (EDI) education, projects, and community building initiatives.