Walmart is offering a new benefit to associates enrolled in their healthcare plan and living in Louisiana, Indiana, or Illinois: doula services.
A doula is a non-medical professional who supports a pregnant person during pregnancy, delivery, and for a short period after birth. After a pilot program started last year in Georgia, Walmart is now offering its associates in three more states up to $1,000 for doula services.
The company isn’t offering the service as a fancy perk to retain their employees in a competitive job market. Rather, it is hoping to help lower the risk of pregnancy and delivery. Walmart’s rationale for choosing the four pilot states is that they suffer from an especially high rate of maternal mortality and morbidity even in the context of the already poor maternal health outcomes in the US.
A private bandaid on a public wound
Maternal mortality in the US (officially about 17 deaths per 100,000 live births, although likely much higher) is several times that of comparable countries. But some states have even higher rates. Louisiana’s mortality rate is 77 per 100,000 (pdf)—higher than low-middle income countries such as Morocco , or Libya—and Black mothers have four times the likelihood of dying or experiencing severe illness related to childbirth than white ones. Indiana has a troubling lack of ob-gyn services, while in Illinois, where 83% of maternal deaths could be avoided, Black mothers carry six times the risk of death of their white counterparts.
For Walmart’s associate workforce, which is 55% women and 47% people of color, this data is particularly relevant. In the absence of a systemic solution, doulas can have significant impact on maternity outcomes. Research has found that the involvement of doulas in a pregnant person’s birthing plan reduces the risk of complications by up to 50%, and babies whose mothers were assisted by doulas had a fourth of the chance of having low birthweight. Breastfeeding, too, was far more common among women who hired doulas. Giving birth with a doula present is associated with lower risk of c-section and over-medication, as well as shorter labor time and overall better health and lower stress during pregnancy.
There are about 9,000 doulas in the US, and while there isn’t a formal certification process, there are several established training institutions. This role has been central to the movement for natural childbirth in America since the 1960s, and has grown in popularity in recent years, alongside the push for increased use of midwives in the country.
Sometimes, doula services are covered by insurance policies. Minnesota, New Jersey, and Oregon have included them in Medicaid-covered services, and other programs, such as New York City’s plan to offer a doula to all new mothers, are in the works. Yet overwhelmingly doulas are paid out-of-pocket—typically between $500 and $2,500—which has kept doulas a privilege.
Walmart, which provides paid maternal leave up to 16 weeks to its full-time hourly associates (in combination with whatever mandatory leave is provided by individual states), will pay for doulas registered through two of the leading doula associations, DONA and National Black Doulas Association. The benefit will be available to about 70,000 associates in the four states who have worked for the company full time for at least three months.