“My 9 to 5 Job Is Birth Work”: A Case Study of Two Compensation Approaches for Community Doula Care

Abstract

With the increased policy emphasis on promoting doula care to advance birth equity in the United States, there is a vital need to identify sustainable and equitable approaches for compensation of community doulas, who serve clients experiencing the greatest barriers to optimal pregnancy-related outcomes. This case study explores two different approaches for compensating doulas (contractor versus hourly employment with benefits) utilized by SisterWeb San Francisco Community Doula Network in San Francisco, California. We conducted qualitative interviews with SisterWeb doulas in 2020 and 2021 and organizational leaders in 2020. Overall, leaders and doulas reported that the contractor approach, in which doulas were paid a flat fee per client, did not adequately compensate doulas, who regularly attend trainings and provide additional support for their clients (e.g., referrals to promote housing and food security). Additionally, this approach did not provide doulas with healthcare benefits, which was especially concerning during the COVID-19 pandemic. As hourly, benefited employees, doulas experienced a greater sense of financial security and wellbeing from receiving consistent pay, compensation for all time worked, and benefits such as health insurance and sick leave, allowing some to dedicate themselves to birth work. Our study suggests that efforts to promote community doula care must integrate structural solutions to provide appropriate compensation and benefits to doulas, simultaneously advancing birth equity and equitable labor conditions for community doulas.

Barriers and Facilitators to the Implementation of a Community Doula Program for Black and Pacific Islander Pregnant People in San Francisco: Findings from a Partnered Process Evaluation

“…Notably, nearly all doulas worked multiple jobs to make ends meet and several were caretakers of children and family members. An in-depth examination of SisterWeb’s different compensation models has been published elsewhere (Gomez et al, 2021 ).…”

Community-based doulas for migrant and refugee women: a mixed-method systematic review and narrative synthesis

“… 73 These doulas expressed the potential benefits they received with secure employment for both themselves and their families. 73 …”

“…Eighteen papers from 12 studies were included (figure 1; online supplemental appendies 6 and 7). 38–41 60–73 Ten included studies were published in peer-review journals,38–40 60 61 63–68 70–74 one was a published book chapter41 and one a dissertation 62. The included studies were diverse in terms of study setting, methods, target population, community-based doula training and community-based doula characteristics.…”

“…The included studies were diverse in terms of study setting, methods, target population, community-based doula training and community-based doula characteristics. Studies were from four countries: Sweden (n=4),39 41 60 68–70 the USA (n=6),38 61 62 71–73 England (n=1)40 63–66 and Australia (n=1) 67. Most studies were conducted in maternity clinics and hospitals in urban settings,38 39 60 61 67–69 71–73 75 with some focusing on low-income communities in urban settings40 63–65 and others a mix of urban, rural and small towns 41 70.…”

“…This highlights that securing financial and strategic partnerships with established community or maternity organisations may be warranted, in which monetary recompense would be symbolic of the recognition and value in doulas. 62 This may include creating salaried community-based doula models 73 or exploring hospital-based doula models offering continuity of care as seen recently in Norway. 87 88 If working within a hospital-based model, migrant and refugee women must remain the foremost priority and clear boundaries of accountability and autonomy must be established.…”