The Cook County Department of Public Health's new doula program aims to address maternal mortality and birth complications. While this goal is commendable, the implementation strategy overlooks a crucial resource: the existing network of experienced doulas serving local communities.
The stakes are high. The U.S. maternal mortality rate stood at 22.3 deaths per 100,000 live births as of 2022. In Illinois, Black individuals face a maternal morbidity rate exceeding 1 per 100 live births — more than double the rate for white individuals. Birth justice-focused, culturally competent care is literally lifesaving.
Cook County plans to spend about $1 million annually through 2027 on a contract with Prism Health Care Services to hire 10 doulas. The selection of a suburban medical equipment provider without clear expertise in birth care or serving Black and Brown communities raises concerns about program effectiveness. The training approach for new doulas remains unclear, particularly regarding cultural competency and birth justice principles, and the choice of Prism Health Care bypasses numerous established nonprofit birth justice agencies and independent doula practitioners who have spent years building trust within marginalized communities.
The timing is particularly problematic as Illinois implements statewide Medicaid coverage for doula services. Rather than aligning with this initiative, Cook County's separate program risks creating unnecessary administrative complexity and potential service gaps.
The path forward requires meaningful collaboration with established doula communities, directing resources to support existing programs and practitioners, and integration with the state Medicaid program. This program must build up, not bypass, the existing infrastructure of experience and trust in the Black birthing community.
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By partnering with established doula networks and providing sustainable funding to expand their reach, Cook County can create a more effective, culturally competent system of care that truly serves all birthing individuals equitably.
Mekazin Whitfield Alexander, co-founder and executive director of BA NIA Inc.; Star August Ali, founder and executive director of Black Midwifery Collective; Sonia Collins, co-founder and executive director of Sokana Collective
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