Challenging Racism in Perinatal Care

How Doulas Advocate for Black Women

Bibliographic Data

ID22434752
AuthorsJuan L Salinas (0000-0003-1199-4074, University of North Florida, corresponding author), Thalia Diaz (University of North Florida), Manisha Salinas (0000-0002-6345-6385, Jacksonville College)
Year2026
Volume10
Pages24731242261466916-24731242261466916
Publication date2026-01-01
Peer ReviewedYes
Open AccessYes
TypeARTICLE
VenueHealth Equity (JOURNAL)
Journal identifiersISSN: 2473-1242 • E-ISSN: 2473-1242
PublisherSAGE Publications (PUBLISHER • US)
DOI10.1177/24731242261466916
PMID42534511
OpenAlexW7168336499
LanguageEN
References cited18

Introduction: Systemic racism continues to shape maternal health care in the United States, contributing to higher rates of adverse outcomes for Black women and other women of color. Doulas have emerged as important advocates, yet little is known about how doulas’ own racial identities influence their work in challenging inequities. Methods: This qualitative study used a phenomenological approach to explore doulas’ perspectives on racism in maternal health care. Ten doulas in Northeast Florida participated in in-depth interviews and focus groups between 2021 and 2022. Data were transcribed verbatim and analyzed thematically using established qualitative methods. Results: Four major themes were identified: (1) challenging differential racial treatment, (2) leveraging privilege, (3) anti-racist doula training, and (4) advocating for Black doula recruitment and engagement. White doulas described using their privilege to support clients of color, while Black doulas described navigating heightened scrutiny and exclusion. Across participants, there was consensus that current training inadequately prepares doulas to address racism and that greater racial diversity within the profession is essential. Discussion: Findings highlight how doulas both confront and adapt to systemic racism in maternal health care. Their accounts point to gaps in training and structural barriers to equitable practice, while also illustrating how advocacy can both protect clients and, at times, reproduce inequities through unequal access to power and privilege. Health Equity Implications: Addressing how race and privilege shape advocacy pathways, reforming training to include racial justice, expanding recruitment and support for Black doulas, and integrating doulas into perinatal care models are important strategies for advancing maternal health equity and advocating for Black racial justice in health.

Equity (law) · Focus group · Health care · Health equity · Institutional racism · Privilege (computing) · Qualitative research · Racism · Scrutiny · Cultural Competency in Health Care · Global Maternal and Child Health · Racial and Ethnic Identity Research

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