(O-1) Perinatal mental illness: a policy analysis of doula services as an intervention

Childbirth is the most common reason for hospitalization in the United States and perinatal mental illness is the most common complication of the birthing process. While psychotherapy medication can be effective, they are significantly underutilized, especially in African American women. Doulas are an underutilized source of mental health support for perinatal Black women. This policy analysis provides an overview of legislation pertaining to doulas. Using the Critical Policy Analysis (CPA) Framework, 319 enacted pieces of legislation were assessed to provide a landscape of doula services and provide recommendations for doula services as culturally responsive mental health support. Key word searches were conducted using a legislative tracking and engagement platform to compile legislation enacted over a five-year period across the United States. There were 39 states enacting 319 pieces of legislation. A thematic analysis yielded five primary themes related to the provision of doula services. Then, the CPA framework was used to assess the legislation. Doulas can be an underutilized, yet culturally responsive, mental health resource for Black perinatal women. States are creating legislation to increase access, standardize education and certification, and create awareness. This Critical Policy Analysis demonstrates that legislation must incorporate the voices of Black doulas throughout the process, should be founded on data, addresses barriers to implementation, explore issues of equity, and ensure sustainable culturally congruent care even during changing power dynamics.