"I Live in a Doula Desert": A Community-Engaged Study of Doula Care in Rural Georgia.

Background: Maternal morbidity and mortality in the United States-and disparities therein-are significant and growing public health crises. Doulas (nonclinical perinatal support professionals) could be part of the solution, but there are significant barriers to health care in rural areas. Methods: This study examines the facilitators and barriers rural communities face in accessing doulas and ideas for expanding doula work in rural communities. As part of a larger-mixed methods, community-engaged project on full-spectrum doula care in Georgia, this study surveyed and interviewed doulas in Georgia from June 2022 to January 2023. We conducted descriptive statistics and thematically analyzed the transcripts using memoing, coding, and group discussion. Results: We surveyed and interviewed 22 doulas, 17 of whom serve rural clients including 7 who reported over 20% of their clientele are rural. Our main findings included (1) significant perinatal and social service gaps in rural areas, (2) rural poverty that impedes perinatal options, including doula access, (3) long distances between doulas, rural clients, and health care, and (4) childbirth education disparities, resulting in knowledge gaps that doulas could fill. Discussion: These results are relevant to national maternal health equity efforts in rural communities and can inform policies, programs, and future research including Medicaid reimbursement, doula training, and community-engaged research with doulas.