The path leading to the track at a Durham middle school was marked with signs bearing the names of Black women who died from pregnancy-related causes. 

Walkers and runners participating in a fundraiser for MAAME, or a Durham nonprofit that offers doula care, walked past the signs, reminders of the tragedies the organization is working to prevent. MAAME stands for Mobilizing African American Mothers through Empowerment. It’s also the Twi word for woman or mother. 

Laura Gonzalez Dutor arrived at the fundraiser with her partner Uriah Shaw and their 1-month-old daughter Ember to pick up baby supplies. Gonzalez Dutor had doula care during her pregnancy and said it helped reduce her anxiety. 

“She gave me a sense of peace, in a way, because she was very knowledgeable about everything,” Gonzalez Dutor said. “I knew that there was always going to be someone, in addition to my partner, that would be able to advocate for me and just help me make informed decisions.”

Women in the United States die from pregnancy-related deaths at higher rates than any other wealthy country. Black women died from pregnancy-related causes at three times the rate of white women, according to CDC data from 2024. 

In North Carolina, maternal deaths among Black women were nearly twice as high as for white women from 2018-2020, according to the North Carolina Maternal Mortality Review Committee. Nearly 80% of those deaths were considered preventable. 

Doulas offer nonmedical support before and during births. Some work with the families of newborns. Research studies have found that doula care reduces the likelihood of Cesarean sections. Low-income mothers who had doulas were four times less likely to have low-weight babies and two times less likely to experience birth complications, according to one study. 

Studies also show racism and implicit bias play a role in the higher rate of Black maternal deaths. Efforts to improve those statistics are facing new challenges. Last year, the Trump administration canceled grants studying maternal health as it sought to end diversity, equity, and inclusion efforts, Stateline reported. 

MAAME Executive Director Maya Jackson said her organization has felt the ripple effects. Soon after national grants were axed last year, $10,000 in sponsorships that would have helped MAAME meet a $15,000 fundraising goal were canceled, she said. 

Some of the money MAAME raises goes to subsidize doula care for people who can’t afford the full price. With less money, MAAME had to reduce local services, Jackson said. MAAME also works in counties beyond the Triangle as part of a UNC study looking at ways to narrow the gap between Black and white maternal death rates. MAAME received American Rescue Plan funds from Durham County a few years ago. 

That money has helped the organization survive the lean times, Jackson said. “We’re good for another year,” she said. “But if there are more decreases in funding, it will get tough.”

Private insurance does not typically cover doula care. Two of the state’s four Medicaid managed care organizations offer doula care as an extra service, though one company limits the benefit to certain counties. 

The state has been talking for years about offering doula care as a regular part of Medicaid maternity care coverage.  

Tatiana Smith is a community doula who travels between New Jersey, where Medicaid pays for doula care, and North Carolina. New Jersey’s reimbursement rates are low, Smith said, and include a flat fee for attending a birth, even though there’s no telling how many hours someone’s labor will last. 

Medicaid officials don’t understand the work, said Melanie Patrick, owner of Emerald Doulas, which operates in the Triangle. 

“Medicaid deciding how we work, who’s going to certify us, whether or not we’re certified, and then deciding how much we’re going to earn doesn’t make sense, because they don’t understand what we do,” she said.

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