Article Critique - Quasheba Bey
Objective Summary
Over the past few years much attention has been given to the disparities in the
treatment of Black, Indigenous, People of Color (BIPOC) in hospitals and healthcare
facilities all over the United States. The intersection of key social determinants, provider
biases and their effect on healthcare and birth outcomes is a major issue in our society.
The study, “Disparities in Birth Outcomes: A Qualitative Study. Journal of Midwifery &
Women’s Health”, seeks to take a deeper look at the disparities in healthcare through
the lens of doulas of color.
The objective of this article is to examine the perspectives of doulas of color, their
experiences and the care disparities taking place in the United States. This study
utilized a sample of eight doulas, aged 21 to 47, who all identify as Black or African
American. They were recruited from across the United States and were all college
educated or college students. Methods utilized include in person or video interviews that
were transcribed verbatim.
The 4 themes that emerged from their interviews are: “relationship with the
medical system, role of identity in the doulas’ work, role of class, and divisions within the
natural birth movement” (Kathawa & Arora & Zielinski, & Low, 2020, p.1). The majority
of participants shared that identity strongly influenced their work. Many intentionally
chose this field due to a desire to alleviate health disparities and make a difference with
birth outcomes for women of color. Several shared feelings of alienation from both the
health care system and the mainstream natural birth community.
Article Critique
Though this study has a great number of strengths, it does have its limitations
The article shares that the benefit of doula presence has been previously documented.
Because of this, the study focuses on uniquely documenting the perspectives of doulas
of color, which has not been explored before. For me this was a surprise considering
that there are multiple pieces of legislation currently in the works regarding Medicare,
doula reimbursement, and access to doula care for pregnant and postpartum women.
The fact that a study analyzing race, class and doula care, especially where federal
funds were concerned, had not been done sooner was alarming to me.
I feel that this article utilizes the critical race theory lens of Intersectionality,
pioneered by Kimberly Crenshaw. Taking race, gender and class into account has
become a part of common knowledge where this is incorporated almost automatically
into the lens in which a larger part of society utilizes. This was not the case just a few
decades ago and such a perspective should not be taken for granted and referenced at
some point.
There is a key moment in the interviews that reference a “transfer of trust” that
takes place between doulas, their clients and health professionals (Kathawa & Arora &
Zielinski, & Low, 2020, p. 33). These types of liaisons are super important because they
point to blind spots in the health field in regards to historical and cultural traumas like
slavery, segregation as well as violated medical trust from instances like the Tuskegee
Syphilis Study, or the involuntary sterilization of Latina, Native American and African
American women. A study such as this one can help to validify the need for cultural
sensitivity training, a point the authors incorporate into their conclusion.
Personally, I was also glad to hear my voice reflected in the study. There is
something empowering and inclusive about shining the spotlight of voices on first line
doulas of color. Previous surveys had completely homogenized the birth field. Even
though this study admits to not asking direct questions on practice models “the majority
worked as both fee for service and volunteer doulas based on their answers to interview
questions” (Kathawa & Arora & Zielinski, & Low, 2020, p. 33). This one aspect is just a
testament to the range of diversity that can be found even amongst the same ethnicity.
The most notable limitation of this study is the fact that it uses a very small
sample pool of 8 doulas. A larger sample size would help to eliminate the risk of
confirming a false premise as truth. It would also help to identify outliers that could skew
the data. Also this particular study did focus on doulas who identify as primarily black or
African American. I would like to hear the experiences from doulas who are from other
minority groups as well, a sentiment echoed in the authors’ conclusion. An interesting
trend emerged where it seems that doulas are also more educated to some degree.
These participants were all college educated or at the least current college students. I
would be interested in seeing a future study that also analyzes education and possibly
class amongst doulas of color as well.
Another notable limitation was that religion and spirituality were not referenced or
included in the questions asked within the study. Faith is a vital factor that influences the
birthing world and not examining its implications on birthwork is a missed opportunity. I
have been a doula for over 8 years and most of my clients prefer home births due to
indigenous rituals, spiritual practices and/or religious beliefs that they feel will not be
honored in hospital settings by insensitive or poorly trained staff. Religion and spirituality
has played such a major role in the African Diaspora, as well as in civil rights
movements of the 50’s and 60’s and this feels like an oversight on the authors’ part.
I believe that this study would benefit from an explanation of the natural birth
movement. Readers with no cultural or social context may feel a little lost when reading
this study. The article would benefit from a simple explanation of what the movement is,
why does this movement even exist, and what are its goals. I think this would give a bit
more clarity and context for the interviews that are deeming this exclusionary and
classist. Many issues were touched on in the interviews, including doula costs, provider
discrimination, and cultural appropriation.
I believe that this research, especially as it is revisited and strengthened, will add
a lot to the discipline of midwifery to help decision makers and practitioners push for
cultural sensitivity training and doula inclusion in their practices and facilities. In the
studies conclusion, cultural sensitivity training was suggested for white doulas as well
as for doulas of color who may be coming from different backgrounds. The benefits of
exploring doula experiences within varying communities of color or even among
different sexual or gender minorities was referenced. The authors are aware that there
is more work to be done. Culture varies across race and that needs to be considered.
Also more hospitals can train or bring on in-house doulas to service their clients similar
to how many hospitals have incorporated lactation consultants. Doulas are important
allies in the fight against health disparities across the spectrum of race, class and
beyond. Doulas are a great pool of future midwives who have real world experience and
cultural awareness who have so much to offer midwifery.
Citation (APA Style)
Kathawa, C. A., Arora, K. S., Zielinski, R., & Low, L. K. (2021). Perspectives of Doulas
of Color on their Role in Alleviating Racial Disparities in Birth Outcomes: A Qualitative
Study. Journal of Midwifery & Women’s Health, 67(1), 31–38.
https://doi.org/10.1111/jmwh.13305