Beyond birth support: how doulas navigate anti-racism advocacy for refugee and asylum-seeking women in UK maternity care.

Background: Asylum-seeking and refugee women face significant maternal health disparities in the UK, prompting the emergence of doula and birth companion organisations to provide advocacy and support. This study examines how these organisations train volunteers on advocating for anti-racism in maternity care settings and supporting their clients. Methods: Semi-structured interviews were conducted with representatives from 12 doula service organisations across the UK, plus two training experts. Interviews explored organisational structure, volunteer recruitment and training, and mechanisms for reporting discriminatory incidents. Data were analysed using grounded theory approaches. Results: Three key themes emerged: volunteer motivations and expertise varied significantly, with many lacking lived experiences of forced migration; organisations demonstrated inconsistent capacity to document and report racism but saw the need to implement systems; and volunteer demographics often failed to reflect client populations due to structural barriers limiting participation from marginalised communities. Conclusion: While birth companion organisations provide essential advocacy for asylum-seeking women, systemic barriers limit their full potential. Moving toward paid positions and addressing underlying healthcare racism are necessary for meaningful change. Doula service organisations should be better funded and integrated into the national health system.