The Citywide Doula Initiative Improves Maternal Health Outcomes for Black & Hispanic Mothers and Babies, Comptroller Lander’s Audit Finds 

New York, NY — Ahead of Mother’s Day, New York City Comptroller Brad Lander unveiled a new audit of the NYC Department of Health and Mental Hygiene’s (DOHMH) Citywide Doula Initiative (CDI), which revealed that the program successfully improves birth and health outcomes for Black and Hispanic women and birthgivers.  

The CDI program was launched to address longstanding inequities—including socioeconomic barriers, structural racism, and bias in healthcare services—that drive high rates of maternal mortality and adverse birth outcomes in communities of color. The audit underscores that doula services, long championed by reproductive justice advocates, can narrow racial disparities. Black and Hispanic participants in the program saw lower rates of C-sections, pre-term births, and low birth weights, compared to the general population of births in New York City. 

“The Citywide Doula Initiative is working,” said Comptroller Brad Lander. “By providing doula services at no-to-low costs, the city is making progress toward closing the racial gap in maternal health outcomes and on its way to eliminating maternal mortality. Providing equitable care access for all is the first step toward building a thriving and healthier city to start and raise a family.” 

Rates of maternal mortality and health complications are dramatically higher amount Black and Hispanic women. According to DOHMH, Black non-Hispanic women and birth givers accounted for 17.7% of all live births in the city, but a staggering 39.7% of all pregnancy-associated deaths. Black and Hispanic women and birthgivers made up over 3-out of-4 deaths, despite accounting for less than half of all live births across the five boroughs.  

To address these disparities, New York City has increased access to doulas in recent years, leading to passage of Local Law 85 of 2022, sponsored by New York City Councilmember Jennifer Gutiérrez, establishing a pilot program to train doulas and provide free doula services to resident of marginalized neighborhoods. Doulas provide non-medical physical, emotional, and informational support to pregnant individuals and families before, during, and after childbirth. Throughout pregnancy, doulas also advocate for clients’ health decisions and help them navigate the challenges of childbirth.  

Auditors from the NYC Comptroller’s office used citywide birth outcome data from 2022 (published in the most recent Annual Summary of Vital Statistics) and birth outcome data for the period of March 2022 through June 2024 for CDI clients, and also surveyed CDI participants and doulas. Auditors identified meaningful improvements in health outcomes for women and birthgivers.  

Key Findings from the Audit: 

• Increased doula access: DOHMH’s efforts are increasing doula access and support in underserved neighborhoods. Prenatal visit, doula-attended births, and post-partum visits all increased significantly, with over 2,000 clients receiving services through the CDI program. 

• Improved maternal health outcomes: Black and Hispanic CDI clients saw significantly better maternal health outcomes, including lower rates of C-sections, preterm births, and low birth weights, compared to citywide averages. No pregnancy-associated deaths were reported for CDI clients, indicating that doula support may help reduce maternal mortality. 

• Strong client satisfaction: Participants expressed satisfaction with the program, with 77% rating their pregnancy/birthing experience with a doula as good or excellent. One respondent stated “having a doula was life changing and more clinics/hospitals should offer it to all patients.”  

Areas for Improvement: 

The audit also identifies areas for improvement, including expanding access in shelters, advancing doula-friendly hospital policies, and increasing non-English speaking doula provider capacity. 

• Hospital barriers: Doulas reported that some hospitals prevented them from providing comfort measures, such as assisting their clients in using the restroom (17% of respondents), supporting mobility out of bed (25% of respondents), and staying with their clients during delivery (13% of respondents). During a Doula-Friendliness meeting attended by auditors, CDIs encouraged hospitals to promote policies that would better enable doulas to provide care.  

• Shelter access: Shelter residents faced inconsistent doula access due to delays in caseworker approvals or outright denials by shelter staff. Doulas experienced difficulties gaining access to clients living in shelters, with 33 (49%) of the 68 doula respondents saying that their clients were difficult to access or inaccessible.  

• Language gaps: While six of the seven CDI vendors stated they could provide services in Spanish, less than half of the vendors could provide services in other languages; only 3-out of-7 CDI vendors offer services in Haitian Creole, 2 in French, and 1 each in Cantonese and Mandarin—limiting access for non-English speakers. 

To address the findings and continue to improve this successful program, the auditors propose that DOHMH: 

• Improve data collection to ensure more timely and efficient data reporting to identify the effectiveness of doula services on the reduction of negative birth outcomes and maternal mortality. 

• Increase the number of non-English-speaking doulas. 

• Continue to work with DHS to increase doula access to clients in shelters. 

• Continue to promote doula-friendly policies in hospitals and expand doula incorporation into hospital birthing teams. 

• Incorporate client satisfaction surveys into their data collection procedures and evaluate satisfaction by vendor, analyzing differences in practice that may affect satisfaction. 

“My family has seen firsthand the challenges of fertility, pregnancy, and birthing care, and I know the inadequacies in our maternal health system and the need for supportive assistance. As this new audit details, doula services are a vital part of culturally responsive, individual-centered maternal care, and the Citywide Doula Initiative has successfully provided these knowledgeable caring professionals to many. Just as my recent report on birthing centers revealed, the audit makes clear that more can be done to expand access to these services and integrate them with our hospitals. I thank the Comptroller and all of the elected officials, families, and advocates who have helped us combat inequities in maternal health, and proudly join in the birthing justice work ahead,” said Public Advocate Jumaane Williams.

“I take great pride in the fact that one of the first laws I passed as a Council Member was to address the Black maternal mortality crisis. Local Law 86 expanded access to information about doula care and midwifery for anyone giving birth in New York City, in direct response to the alarming reality that Black mothers are eight times more likely than their white counterparts to die during childbirth,” said Council Member Crystal Hudson, Co-Chair of the Black, Latino, and Asian Caucus.“I am thankful to Comptroller Brad Lander and Council Member Jennifer Gutierrez for their audit of the Citywide Doula Initiative (CDI) run by the Department of Mental Health and Hygiene, and I am heartened to know that Black and Hispanic CDI clients experienced significantly better birthing and maternal health outcomes. As Mother’s Day approaches, my resolve to continue fighting for safe, ethical care for all birthing people is only strengthened. I look forward to continuing this work and closing the Black maternal mortality gap with partners like Comptroller Lander and Council Member Gutierrez.”

“This audit from the Comptroller confirms what so many of us already knew — the Citywide Doula Initiative is working. The pilot program I was proud to codify into law is delivering real, measurable results: healthier births, fewer complications, and greater support for Black and Brown birthing parents. When we see clear public health successes like this, we have to expand them. We have to lean in. This isn’t some trend or pilot — this is a life-saving, ancestral practice that is transforming how we care for people during and after birth. It’s not just effective, it’s essential,” said Council Member Jennifer Gutiérrez.

“I applaud Comptroller Lander and Council Member Gutierrez for shining a light on the success of the City’s Citywide Doula Initiative. This audit confirms that culturally competent, community-based care saves lives, particularly for Black and Brown birthing parents who have long been failed by our healthcare system,” said Council Member Farah N. Louis, Chair of the Committee on Women and Gender Equity. “We must continue to find solutions that center dignity, equity, and informed care in every birthing experience. I am proud to have co-sponsored Intro 472 to create the City’s doula training and no-cost services pilot program, and this Council will continue laying the foundation for a safer, more just healthcare system for every New Yorker.”

With a women-led majority, the City Council has centered maternal health and reproductive justice investments so all New Yorkers have the ability to safely choose how and if they’ll have children. The Citywide Doula Initiative has improved outcomes by supporting the highest level of care possible for all families and City leadership is demonstrating how local governments must take bold action to defend safe access and address racial disparities in our healthcare system,” said Council Member Carlina Rivera.

“As federal funding for comprehensive reproductive healthcare is rescinded and Medicaid faces mounting threats, the New York Citywide Doula Initiative (CDI) remains a lifeline for our communities. It has built a powerful workforce, delivered critical care, and offered unwavering support to birthing people, especially in the often-overlooked postpartum period. This Mother’s Day, let’s send a clear message: we value our mothers, and we stand with the community-based doulas who ensure no one is left behind. CDI isn’t just a program—it’s a frontline defense against a collapsing system and a testament to what true care looks like,” said Chanel Porchia-Albert CD, CLC, CHHC, Founder & CEO of Ancient Song Doula Services.

“We have and continue to be excited about providing community-based doula care to women in Brooklyn, who otherwise would not be able to receive and afford such services.  Birth and postpartum doula have a major impact on positive birth outcomes and birthing experiences for birthing and postpartum people.  We appreciate the city funding to be ale to do this work.” said Denise West, Brooklyn Perinatal Network Deputy Executive Director.

“Our collaboration with the Citywide Doula Initiative has strengthened our decades long efforts in addressing maternal health disparities and providing vital support to families across our community. We are grateful for this partnership that continues to improve birth outcomes for those who need it most.” said Madeleine Dorval- Moller, MSSW, MPA Executive Director of Manhattan Perinatal Partnership, Inc.

“As a doula agency deeply rooted in community care, The Mothership is proud to see the City’s investment in birth equity making a measurable impact. The Citywide Doula Initiative has provided vital, culturally competent support to families who have historically been underserved. We look forward to seeing this work expand so that every birthing person across the five boroughs can access the respectful, empowering care they deserve,” said Miranda Padilla, Founder of The Mothership.

Read the full audit: https://comptroller.nyc.gov/reports/audit-report-on-the-new-york-city-department-of-health-and-mental-hygienes-oversight-of-doula-programs-in-underserved-neighborhoods

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