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Incorporating Doula services for better maternal and child health outcomes in Medicaid populations

Narvaez, Ashley (2018) Incorporating Doula services for better maternal and child health outcomes in Medicaid populations. Master Essay, University of Pittsburgh.

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Social determinants of health (SDOH) are predisposing factors that influence health outcomes. Including factors such as socioeconomic status (SES) and level of education, the impact of SDOH is heightened for vulnerable populations, which in the context of maternal and child health, has contributed to longstanding disparities among ethnic groups. Poor outcomes of this nature not only place a burden on underrepresented communities, but they also significantly impact state Medicaid programs, which in most states cover 46% of all deliveries.
To address outcomes related to SDOH, research shows that nonmedical interventions are preferred. However, this finding is at odds with the pattern of healthcare spending in the U.S., which continues to disproportionately invest capital on health services rather than social services. Nonmedical in nature, an example of such a service is the utilization of doula care to provide continuous labor support. Though identified as having the potential to disrupt the pathway between SDOH and poor outcomes, to date, only two state Medicaid programs reimburse for doula services.
This essay aimed to conduct a review of the literature by exploring the efficacy of doula services in the context of improving maternal and child health outcomes for women enrolled in state Medicaid programs. In total, 8 studies were reviewed, which showed positive outcomes related to initiation of breastfeeding, rates of cesarean deliveries, mother’s overall satisfaction with birth experience, and low birth weight. However, this review concluded that, despite positive evidence presented, additional research with stronger study designs will be needed before causal inference can be made. In conclusion, this review seeks to put an emphasis on the importance of public health interventions on low income, underserved communities and showcase state Medicaid programs’ role in financing and providing access to them.


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Item Type: Other Thesis, Dissertation, or Long Paper (Master Essay)
Status: Unpublished
CreatorsEmailPitt UsernameORCID
Narvaez, Ashleyamn85@pitt.eduamn85
ContributionContributors NameEmailPitt UsernameORCID
Committee ChairDonohue, Juliejdonohue@pitt.edujdonohueUNSPECIFIED
Committee MemberBurke, Jessicajgburke@pitt.edujgburkeUNSPECIFIED
Date: 28 March 2018
Date Type: Completion
Number of Pages: 41
Institution: University of Pittsburgh
Schools and Programs: School of Public Health > Health Policy & Management
Degree: MHA - Master of Health Administration
Thesis Type: Master Essay
Refereed: Yes
Date Deposited: 08 Nov 2018 14:47
Last Modified: 08 Nov 2018 14:47

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