We have all heard the phrase, “it takes a village,” a reminder that raising children and sustaining life has never been the responsibility of one person alone. For Black communities, this has never been a metaphor. It has been practice. It has been tradition. It has been survival.
Long before care was medicalized, childbirth was held by a collective. Mothers, grandmothers, aunts, neighbors and midwives formed a web of support that surrounded birthing people with wisdom, protection and care. Knowledge was shared across generations. Birth was understood not only as a clinical event but as a communal and spiritual experience. Care extended beyond delivery into the daily rhythms of life, where meals were prepared, children were tended to and rest was protected.
Doulas have always been a part of this broader ecosystem of care. They are not an addition to the village. They are a continuation of it. Alongside family and community, doulas provide emotional, physical and informational support. They help navigate medical systems, offer comfort through prayer, song or affirmation and remain present well beyond birth. Their work reflects a truth our communities have always known: No one brings life into the world alone.
Global Black Doula Day, held last Saturday, was an opportunity not only to celebrate and honor this work but to name what has too often been overlooked. Black women have long created and sustained systems of care that have been essential to the health of families and communities. At the same time, those contributions have been routinely undervalued, under-resourced and, at times, erased within formal health systems.
Even within this reality, it is important to hold a fuller truth. Black women are knowledge holders, innovators and caregivers whose practices have sustained life across generations. The challenge is not the absence of solutions within our communities. It is the failure of systems to recognize, invest in and follow our lead. That failure has real consequences.
In Missouri, approximately 70 women die each year during pregnancy or within the first year postpartum, and 80% of those deaths are considered preventable, according to the state’s Pregnancy-Associated Mortality Review. Black women are disproportionately impacted. These outcomes are not inevitable. They are the result of systems that too often fail to listen to, believe or adequately care for Black women.
And yet, there are signs of progress. Missouri has taken an important step by expanding Medicaid coverage to include doula care, allowing mothers to access up to 16 visits for nonclinical support. This is meaningful. It reflects a growing recognition that care extends beyond clinical interventions and that doulas play a vital role in improving outcomes. At the same time, this progress must be understood for what it is: an incremental step, not a final solution.
Expanding access without fully investing in the doulas themselves, through fair compensation, sustainable infrastructure and respect for their autonomy, risks folding this work into a system that was not designed with them in mind. If doulas are treated as another credentialed extension of the medical system, rather than as community-rooted practitioners, we risk losing the very essence of what makes their care effective.
This is where a health justice lens matters. Health justice lives in the understanding that health is shaped not only in hospitals but in homes, neighborhoods and communities. It centers the leadership and lived experience of those most impacted and calls for investment in the conditions that make healthy lives possible, including stable housing, nutritious food, economic security, child care and transportation.
Within this frame, Black doulas are not simply service providers. They are part of a broader infrastructure of care that must be resourced, protected and sustained. Their work sits at the intersection of community knowledge, cultural continuity and improved health outcomes. Integrating Black doulas into birthing plans is not a trend. It is a return to what has always worked, now supported by policy that is beginning to catch up to practice.
There is reason to be hopeful. The demand for Black doulas is growing. Policymakers are paying closer attention. Communities are organizing to reclaim and rebuild the village. Missouri is moving in the right direction, even as more work remains.
The path forward is clear. We must continue to invest in community-based models of care. We must support and compensate Black doulas in ways that honor their expertise. We must strengthen the networks of mothers, families and neighbors who make up the village. And we must hold systems accountable to the people they are meant to serve.
Each of us has a role to play in building and sustaining that village. This can look like supporting local doula collectives, advocating for policies that protect and expand this workforce, checking in on new mothers in our own circles or contributing resources to organizations doing this work on the ground. Care is not an abstract idea. It is something we practice every day.
Black women deserve to be seen, heard and believed. We deserve care that is compassionate, culturally grounded and rooted in dignity. And we deserve systems that recognize what our communities have always known: When the village is strong, families thrive.
Constance Harper is vice president of impact and innovation at the Deaconess Foundation.