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Doulas: A Formal Part of CA Health Care System – Birthing While Black Part 2
BLACK VOICE NEWS — While California boasts one of the lowest pregnancy-related mortalities in the nation, the latest available data from the California Department of Public Health (CDPH) that covers the period of 2017-2019 shows that the pregnancy-related mortality rate is 47.3 per 100,000 births for Black people compared to 11.1 for White people, 12.6 for Hispanic people and 14.0 for Asian people.
The post Doulas: A Formal Part of CA Health Care System – Birthing While Black Part 2 first appeared on BlackPressUSA.

CA acknowledges doula services as part of the solution to reduce maternal mortality
By Breanna Reeves | Black Voice News
The topics of Black maternal mortality and pregnancy-related death have become more prevalent over the last decade as the U.S. has been identified as having one of the worst maternal mortality rates among high-income countries.
A report published by the Commonwealth Fund found that the U.S. had the highest maternal mortality rate among wealthy nations: 23.8 deaths per 100,000 live births in 2020. That rate is double for Black maternal mortality: 55.3 deaths per 100,000 live births.
While California boasts one of the lowest pregnancy-related mortalities in the nation, the latest available data from the California Department of Public Health (CDPH) that covers the period of 2017-2019 shows that the pregnancy-related mortality rate is 47.3 per 100,000 births for Black people compared to 11.1 for White people, 12.6 for Hispanic people and 14.0 for Asian people.
Available data for maternal mortality rates across race/ethnicity for Riverside and San Bernardino Counties are not available for public access. According to a representative from the California Department of Public Health, the agency “does not publish pregnancy-related death counts or pregnancy-related mortality ratios (PRMR) by race/ethnicity at the county or regional level to maintain data confidentiality and ensure statistical stability,” but noted that across the state, Black birthing people “continue to have the highest PRMR.”
The disproportionate rate at which Black women and birthing people die from pregnancy-related deaths is not new to Black doulas.
Chantel Runnels has been a doula for 14 years, something she said she was “called to do.” Family history of fatal maternal health care, a desire to see public health care change and her own pregnancy experience served as catalysts for her becoming a doula. She was introduced to the Sankofa Birthworkers Collective, an Inland Empire-based organization, through a friend who is a midwife.
A midwife is an individual who is medically trained to assist with labor and delivery and provides prenatal, intrapartum and postpartum care, as well as family planning care. The Sankofa Birthworkers Collective consists of a well-rounded group of birthworkers including licensed midwives, postpartum doulas, lactation specialists, maternal mental health experts and midwives-in-training.
“To be around other Black women who may have secondary or tertiary lines of work that affect Black maternal health care or are directly in Black maternal health care was really attractive to me,” Runnels explained. “To be a part of a community of women who live across the [Inland Empire], who come from different demographics, but want to support each other and just wanted to come together was super attractive.”
Married for nearly 15 years and a mother of four, Runnels provides services to a diverse clientele, some who pay out of pocket for private services, others who receive free services through community-based programs like Sankofa or through insurance programs like the Doula Access Program.

Chantel Runnels explains her role as a doula during a panel at the Inland Empire Perinatal Equity Provider and Community Summit at Cal Baptist University in Riverside, CA on September 16, 2022 (Aryana Noroozi for Black Voice News/CatchLight Local).
Runnels explained that as the need for doulas grows, doula training is that much more important to help ensure that they are trained to meet the needs of the community and have the availability to serve clients.
“This is why compensation for doulas is important, too, because the wages that doulas are paid can’t really compensate for the availability that’s required for the job,” Runnels explained.
As the state began to recognize the invaluable services provided by doulas, legislation to implement doula services throughout the state was introduced prior to the start of the pandemic.
Elevating, expanding, standardizing and compensating doulas in CA
In February 2020, Majority Leader of the California State Assembly Eloise Gómez Reyes (D-Colton) introduced Assembly Bill 2258 which aimed to lower maternal and infant maternal mortality rates in California by launching a three-year Medi-Cal pilot program to provide doula services in 14 counties with the highest birth disparities. The bill fell through when the COVID-19 pandemic shifted priorities in March 2020.
The momentum to introduce legislation that addressed maternal mortality picked up again when Governor Gavin Newsom budgeted funding for a Medi-Cal benefit, which will allow doulas to be reimbursed for full spectrum care rendered to Medi-Cal enrollees. In order to add these services as a benefit, the Department of Health Care Services (DHCS) is required to submit a State Plan Amendment (SPA) to the Centers for Medicare and Medicaid Services (CMS) and receive federal approval — essentially an agreement between the state and federal government on how their Medicaid program will operate and assures the state will abide by federal rules.
Over the last year, DHCS has worked with stakeholders from across California including birthworkers, doulas and community organizations to develop a comprehensive SPA that specifies what doula coverage will look like under Medi-Cal, including the scope of services. Following the first draft of the SPA, a coalition of stakeholders made recommendations for an updated version of the SPA that requested the need for specific language to define doula care and services.
The letter recommended revising the definition of a doula to specify the types of services and support they offer. Part of the letter recommended that the SPA add: “The doula care provided will offer any and all aspects of full-spectrum doula care, including prenatal and postpartum or post-pregnancy doula care, continuous presence during labor and delivery, and doula support during miscarriage, stillbirth and abortion. Doula care includes physical, emotional and other nonmedical care.”
Alexis Robles-Fradet is a Health Policy Analyst at National Health Law Program (NHeLP) in Los Angeles, CA, and drafted the coalition letter in April. Alongside Amy Chen, a senior attorney at NHeLP and member of the stakeholder group, Robles-Fradet has published several reports about the components of successful doula programs and pilot doula programs in other counties as part of the Doula Medicaid Project, launched in 2018.
One of the biggest challenges with finalizing the SPA has been the reimbursement rate offered. The initial proposed rate was one of the lowest rates in the country. Upon receiving the first draft of the SPA from DHCS, the coalition noted in the letter: “We do not believe this benefit will be successful if the reimbursement rate is $450.”

After receiving and reviewing a draft of the State Amendment Plan, a coalition of stakeholders and advocates drafted a letter in response, outlining changes to the plan such as defining a doula’s role and recommending an increase to the offered reimbursement rate of $450. (Graphic by Breanna Reeves).
With the high cost of living in California and the amount of time doulas spend with their clients, Robles-Fradet explained that $450 is not a living wage and would be a barrier to getting the necessary workforce to cover Medi-Cal patients. Medi-Cal covered more than half of all births in California in 2019.
“Doulas deserve to be paid a fair wage. I know we talk about [a] living wage, but I think we should shift into thriving wages, like they’re doing great work and they’ve been doing this great work for so long,” Robles-Fradet stated. “They know how to support their communities.”
Robles-Fradet explained that listening to the doulas and making sure that the benefit will be equitable for them are important factors that will contribute to the success of the Medi-Cal benefit.
As a member of the stakeholder group, Runnels said that the group has worked “tirelessly” to demonstrate that the situation is nuanced. One of the first tasks for DHCS and the stakeholder group was to define doula services and qualifications since it isn’t defined in state law.
“The doula stakeholders did emphasize to us that the length of service in terms of time that they were spending with individuals needed to be considered since doula services typically last significantly longer than other visits with a licensed practitioner,” said René Mollow, Deputy Director of Health Care Benefits & Eligibility.
Mollow explained that doula services as a benefit will be offered through both the Medicare fee-for-service delivery system and Managed Care delivery systems, so doulas will need to be enrolled as Medi-Cal providers and will have contracts with Managed Care plans.
“The majority of covered populations in our program here in California are served through Medi-Cal managed care plans,” Mollow added. “So, that’s where we would expect to see the bulk of the services being provided.”
Following several stakeholder meetings, feedback from birthworkers and Governor Gavin Newsom’s revised 2022-23 budget, California’s current proposed reimbursement rate has increased to $1,154 with one initial visit paid at $126.31, eight perinatal visits paid at $60.48 per visit and one labor and delivery visit paid at $544.28.
“California is such a large state. We have so many births a year. The cost of living for doulas and families in San Francisco varies greatly to doulas and families that are serving Barstow,” Runnels clarified. “And so, helping them understand that the original rate…was embarrassing. Even other states do better than that. And the rate that they’ve come to now is still embarrassing.”
There are more than 400,000 births each year in California which is roughly one-eighth of all U.S. births, nearly half of which are paid for by Medi-Cal, according to the California Health Care Foundation. Comparatively, in 2020, there were 39,817 births in Oregon. In June 2022, Oregon updated its SPA to increase the doula reimbursement rate to $1,500.
“I am so grateful for the work that the State Plan Amendment workgroup is doing to really work on this,” Runnels stated. “[But] also, it still does not reflect how critical the role of a doula is in addressing maternal health care in the state of California, particularly for those most vulnerable, which are Black women.”
Stakeholder meetings are ongoing as the group continues to discuss the SPA and work on developing a Provider Manual. DHCS plans to publish a public notice and formally submit the SPA in September.
This article is the second in a series produced as a project for the USC Annenberg Center for Health Journalism’s 2022 California Fellowship.
The post Doulas: A Formal Part of CA Health Care System – Birthing While Black Part 2 appeared first on Black Voice News.
____________________________________________________________
Photo Captions:
Chantel Runnels explains her role as a doula during a panel at the Inland Empire Perinatal Equity Provider and Community Summit at Cal Baptist University in Riverside, CA on September 16, 2022 (Aryana Noroozi for Black Voice News/CatchLight Local).
After receiving and reviewing a draft of the State Amendment Plan, a coalition of stakeholders and advocates drafted a letter in response, outlining changes to the plan such as defining a doula’s role and recommending an increase to the offered reimbursement rate of $450. (Graphic by Breanna Reeves).
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The post Doulas: A Formal Part of CA Health Care System – Birthing While Black Part 2 first appeared on BlackPressUSA.
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EXCLUSIVE OP-ED: President Joe Biden Commemorating Juneteenth
BLACKPRESSUSA NEWSWIRE — “I’ve always believed that we need to be honest about our history, especially in the face of ongoing efforts to erase it. Darkness can hide much, but it erases nothing. Only with truth can come healing, justice, and repair.”

By Joseph R. Biden, Jr.
46th President of the United States: 2021—2025
The people of Galveston, Texas, have been commemorating Juneteenth since the Civil War ended. Yesterday, in honor of the 160th anniversary, I went there to join them.
You can read about the events of Juneteenth, but there’s nothing quite like going to Galveston and seeing where it all happened.
After General Robert E. Lee surrendered at Appomattox Court House on April 9, 1865, Union troops marched across the South for two months, freeing enslaved people along the way. Their final stop was Galveston, an island off the Gulf coast of Texas. There, on June 19, 1865, Union troops went to Reedy Chapel, a church founded in 1848 by enslaved people, and posted a document titled simply “General Order #3.”
“The people of Texas are informed,” it said, “that, in accordance with a Proclamation from the Executive of the United States, all slaves are free.”
We can only imagine the joy that spread through Galveston – and across the state and nation – on that day and those that followed.
Yesterday, there was once again joy in Galveston, with a parade, picnic, and fireworks. There was also great solemnity, because Juneteenth is a sacred day – a day of weight and power.
The Book of Psalms tells us: “Weeping may endure for a night, but joy cometh in the morning.” Juneteenth marks both the long, hard night of slavery and subjugation, and the promise of that joyful morning to come.
As President, I had the great honor of signing the law declaring Juneteenth a federal holiday. It was our nation’s first new federal holiday since Martin Luther King, Jr. Day was created in 1983.
Our federal holidays say a lot about who we are as a nation. We have holidays celebrating our independence… the laborers who build this nation… the servicemembers who served and died in its defense.
And now, we also have a national holiday dedicated to the emancipation of enslaved Black Americans.
Signing that law was one of my proudest acts as President.
Yet for 156 years, Juneteenth was not written about in textbooks or taught in classrooms. Still today, there are those who say it does not deserve a holiday. They don’t want to remember the moral stain of slavery and the terrible harm it did to our country.
I’ve always believed that we need to be honest about our history, especially in the face of ongoing efforts to erase it. Darkness can hide much, but it erases nothing. Only with truth can come healing, justice, and repair.
I also believe that it’s not enough to commemorate the past. We must also embrace the obligation we have to the future. As Scripture says, “Faith without works is dead.” And right now, we Americans need to keep the faith and do the work.
In honor of Juneteenth, let’s help people register to vote.
For decades, we fought to expand voting rights in America. Now we’re living in an era when relentless obstacles are being thrown in the way of people trying to vote. We can’t let those tactics defeat us. In America, the power belongs with the people. And the way we show that power is by voting.
So let’s reach out to family, friends and neighbors – especially those who have never voted before. Remind them that with voting, anything is possible. And without it, nothing is possible.
Yesterday in Galveston, we gathered in Reedy Chapel to commemorate Juneteenth, just like people have done for 160 years and counting. We prayed, sang, and read General Order #3 again. The pews were full of families. How many people must have prayed for freedom inside those walls. How many must have sent fervent thanks to God when slavery finally ended.
I remembered the words of my late friend John Lewis. He said, “Freedom is not a state. It is an act.”
Juneteenth did not mark the end of America’s work to deliver on the promise of equality. It only marked the beginning. To honor the true meaning of Juneteenth, we must continue to work toward that promise. For our freedom. For our democracy. And for America itself.
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Cities Across the U.S. Shrink or Cancel Juneteenth Events as DEI Support Wanes
BLACKPRESSUSA NEWSWIRE — Across the country, Juneteenth celebrations are being scaled back or eliminated as public funding dries up and corporations withdraw sponsorship.

By Stacy M. Brown
Black Press USA Senior National Correspondent
Across the country, Juneteenth celebrations are being scaled back or eliminated as public funding dries up and corporations withdraw sponsorship. In many communities, the once-growing recognition of the holiday is facing sharp resistance tied to the unraveling of diversity, equity, and inclusion efforts.
In Denver, Colorado, the annual Juneteenth Music Festival, one of the largest in the nation—was cut from two days to one. Organizers said more than a dozen corporate sponsors walked away from commitments, leaving them with a financial gap that almost canceled the event. Norman Harris, the festival’s executive director, said several companies “pulled back their investments or let us know they couldn’t or wouldn’t be in a position to support this year.” Harris credited grassroots donors and small businesses for stepping in when larger backers stepped aside.
In Colorado Springs, the local celebration was relocated to the Citadel Mall parking lot after support from previous sponsors disappeared. Organizers noted that where there were once dozens of corporate partners, only five remained. The downsized event was pieced together with limited resources, but community leaders said they refused to let the holiday go unacknowledged.
Scottsdale, Arizona, canceled its Juneteenth observance after the city council voted to dissolve its diversity, equity, and inclusion office in February. Without the office in place, the city offered no support for planning or funding, leaving residents without an official celebration.
In San Diego, the Cooper Family Foundation lost a $25,000 grant from the National Endowment for the Arts that had been earmarked for Juneteenth programming. Organizers said the decision forced them to personally finance key elements of the event, including cultural exhibits, performances, and youth engagement activities.
Bend, Oregon, called off its Juneteenth event entirely. Organizers cited political tensions and safety concerns, saying they could not secure the partnerships needed to proceed. A public statement from the planning committee described the current climate as “increasingly volatile,” making it difficult to host a safe and inclusive event.
West Virginia, which has recognized Juneteenth as a paid state holiday since 2017, will not sponsor any official events this year. State leaders pointed to budget constraints and recent decisions to eliminate DEI programming across agencies as the reasons for stepping away from public observance.
Austin, Texas, has also reduced its Juneteenth programming. While the city has not canceled events outright, organizers said diminished city support and fewer private contributions forced them to focus only on core activities.
“Thankfully, there was a wide range of support that came when we made the announcement that the celebration is in jeopardy,” said Harris. “But it shows how fragile that support has become.”
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Juneteenth and President Trump
BLACKPRESSUSA NEWSWIRE — Juneteenth is a day for African Americans in this nation to connect to their ancestry. It honors the end of slavery in the United States and is considered the longest-running African American holiday. The primary focus is freedom and the emancipation of enslaved people in the United States.

By April Ryan
BlackPressUSA.com Newswire Washington Bureau Chief and White House Correspondent
President Trump is set to proclaim the federal observance of Juneteenth as the White House is open for business on this holiday. The White House says the president will sign a “historic proclamation designating Juneteenth as a National Day of Observance, marking the 160th anniversary of General Order Number 3 in Galveston, Texas.” The declaration was that “all slaves are free.” This Trump proclamation, according to the White House, “will celebrate the Emancipation Proclamation, the Republican Party’s role in passing the 13th Amendment, and reaffirm the administration’s dedication to equal justice and prosperity for all.”
This proclamation comes as President Trump has denounced Diversity, Equity, Inclusion, and anything Woke. Juneteenth is a celebration of freedom from the tyranny of 250 years of slavery after the Civil War.
The Juneteenth celebration started when Union troops reached Galveston, Texas, and told the slaves that they were free on June 19, 1865, two years after the Emancipation Proclamation was created.
The Emancipation Proclamation, which is on display in the Lincoln Bedroom of the White House, was issued by President Abraham Lincoln on January 1, 1863. It established that all enslaved people in Confederate states in rebellion against the Union “shall be then, thenceforward, and forever free.”
Juneteenth is a day for African Americans in this nation to connect to their ancestry. It honors the end of slavery in the United States and is considered the longest-running African American holiday. The primary focus is freedom and the emancipation of enslaved people in the United States.
The Juneteenth federal holiday was signed into law by then-President Joe Biden on June 19, 2021. This Trump White House is in full swing today, with a press briefing by Karoline Leavitt, not taking the federal holiday off. Also, President Trump will receive an intelligence briefing in the morning and participate in a swearing-in ceremony for the U.S. Ambassador to Ireland.
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