Category: Academic Reportage

Source: The Conversation – USA – By Rachel Rebouché, Professor of Law, The University of Texas at Austin

In 2026, the biggest battles over abortion will not be at the polls.

There will be a few contested measures on state ballots. Next year, Nevada’s government will ask residents to approve constitutional protection for abortion rights for the second time, as required by state law. The same measure passed in 2024 with just over 64% of the vote.

Virginians will likely see a similar ballot initiative. In November 2025, voters there cemented a majority for Democrats in the state legislature, and the House of Delegates is expected to put forth an abortion rights ballot measure to voters in 2026.

Anti-abortion proponents in Missouri want to undo an amendment protecting abortion rights that voters passed in 2024. They’re advancing a new measure that could strip residents of the reproductive rights that are now constitutionally enshrined.

However, the most consequential questions about abortion in 2026 could be answered at the federal level, by the Trump administration or in the courts. As a scholar of reproductive health law, I’m watching how federal judges and agencies respond to conservative efforts to restrict or end people’s access to mailed abortion medication.

Medication abortion in the courts

Over 25 years ago, the Food and Drug Administration approved mifepristone – one of two drugs commonly paired together to end a pregnancy. Since that time, medication abortion has been closely regulated by the FDA and is under attack.

In 2022, the Alliance for Hippocratic Medicine, a coalition of anti-abortion physicians, sued the FDA for approving mifepristone in 2000 and for each time the agency eased a restriction on mifepristone thereafter, in 2016 and 2021. The complaint argued that the FDA failed to consider evidence establishing the harm caused by medication abortion – claims roundly rejected by decades of rigorous, peer-reviewed research.

The Supreme Court in 2024 ruled that the Alliance for Hippocratic Medicine lacked standing to sue because FDA regulation of medication abortion caused no actual injury to the doctors it represented, who do not prescribe mifepristone or perform abortions.

Yet the case lives on in lower federal courts. There is ongoing litigation, and politicians are taking up the fight over mailed medication abortion.

Kansas, Missouri and Idaho intervened in the Alliance lawsuit in 2023, seeking to establish standing, and Louisiana sued the FDA in a separate case challenging the FDA’s regulation of mifepristone.

The pending actions focus on the FDA’s decision in 2021 to lift the requirement that patients pick up mifepristone in person, which has permitted patients to receive medication abortion by mail. These states claim this development is dangerous and threatens their right to enforce their abortion bans.

In October 2025, a federal court in Hawaii came to a different conclusion. The court concluded that because mifepristone is very safe, the FDA must reconsider whether the drug necessitates any restrictions at all.

The politics of medication abortion

The dispute over medication abortion is playing out in Washington, D.C., too.

In 2025, 51 Republican senators and 22 Republican attorneys general asked the FDA to reinstate the 2021 in-person restriction and upend the transit of abortion pills.

In response to Republicans’ push to restrict or withdraw the availanlity of mifepristone, 47 Democratic senators and 20 attorneys general issued letters supporting mifepristone’s safety. The letters questioned a pledge by Health and Human Services Secretary Robert F. Kennedy Jr. and his FDA chief to commence a “review” of the drug. The Democratic senators’ letter pressed the agency to remove all remaining restrictions on mifepristone.

In early December, Bloomberg reported that the FDA had quietly postponed its planned mifepristone “review” until after the 2026 midterm elections.

The battle over telehealth abortion care

Decades of research demonstrates that medication abortion is safe and effective. When commenced before 10 weeks’ gestation, the two-drug method is effective about 98% of the time. Complications, such as infection or hemorrhage, are rare; they occur in perhaps a fraction of a percent of all medication abortions.

Yet courts and legislators cannot agree on basic facts, in part due to widespread disinformation about abortion care, and anti-abortion forces have waged a concerted national campaign to stop mailed abortion pills.

Today, no part of the medication abortion process needs to be done in person: The patient, provider and pharmacy can all interact virtually.

Mailed medication abortion is popular nationwide, particularly in states with abortion bans. Because of mailed medication abortion, the average number of abortions nationwide has actually increased since the U.S. Supreme Court in 2022 overturned Roe v. Wade, reversing abortion protections under the U.S. Constitution.

Providers in so-called “shield” states are a key reason for this. Eight U.S. states have laws that shield providers from civil, criminal and professional consequences for delivering reproductive health care to out-of-state patients.

In these shield states, doctors may prescribe abortion medication no matter where the patient lives, so long as that care is delivered by a provider licensed and located in the shield state, complying with the shield state’s laws.

These laws are the subject of legal conflicts between anti-abortion states and shield states.

Late in 2024, Texas sued a doctor in New York, a shield state, for violating Texas abortion and licensure laws. In early 2025, Louisiana indicted the same New York physician.

Texas won its case in a Texas court and then asked New York to enforce the judgment of more than $100,000 in fines and fees. A New York court has refused to do so, citing its shield law. New York also rejected Louisiana’s request to extradite the doctor to stand trial for the same reason.

On Dec. 4, 2025, Texas officially enacted the first bill in the country that explicitly targets shield laws. Passed in September 2025, HB 7 allows private citizens to file lawsuits against a person or entity for attempting or intending to mail abortion pills into the state.

Watch the courts and the FDA

Having written about shield laws extensively, I believe these interstate conflicts will land, sooner or later, before the Supreme Court. Right now, state and federal courts are deciding the issues.

If judges determine that shield laws are unconstitutional or that the FDA acted illegally, courts could substantially alter people’s ability to gain access to medication abortion.

So could the FDA. If it reimposes an unnecessary restriction on mifepristone, meaning the drug would no longer be widely available through telehealth, that decision would curb how 1 in 4 women in the U.S. receive abortion care today.

But opinion polls indicate that the majority of Americans do not think abortion should be illegal in all circumstances, and they vote accordingly.

In November 2025, Democrats won significant elections, for example, in New Jersey, Virginia and Pennsylvania. Abortion was absent from ballots in these states this year, but these races still held significance for abortion rights.

The election of a pro-choice governor and legislature in Virginia, for example, all but guarantees that abortion will continue to be legal in the last Southern state to protect broader abortion rights. Likewise, Pennsylvanians opted to keep the state supreme court’s liberal majority, which struck down the state prohibition on Medicaid payment for abortion.

In 2024, two years after the fall of Roe v. Wade, 14 states put forth ballot initiatives to enshrine abortion as a constitutional right. Eleven passed.

With little political support to pass a nationwide abortion ban, making it illegal to mail abortion pills is the most immediate way to obstruct reproductive health care in states with abortion bans.

The question for abortion in 2026, then, is: Will courts or federal forces do what democratic processes cannot?

This story was published in collaboration with Rewire News Group, a nonprofit newsroom dedicated to covering reproductive and sexual health.

Rachel Rebouché does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.

– ref. 2026’s abortion battles will be fought more in courthouses and FDA offices than at the voting booth – https://theconversation.com/2026s-abortion-battles-will-be-fought-more-in-courthouses-and-fda-offices-than-at-the-voting-booth-269328

Source: The Conversation – USA (2) – By Brian P. McCullough, Associate Professor of Sport Management, University of Michigan

If you go to a pro sports event today, there’s a good chance the stadium or arena will be powered at least in part by renewable energy. The team likely takes steps to reduce energy and waste. Some even claim to have net-zero greenhouse gas emissions, meaning any emissions they still do produce they offset by paying for projects, such as tree-planting, that reduce greenhouse gases elsewhere.

The venue upgrades have been impressive – Seattle’s hockey and basketball arena runs on 100% renewable energy, makes its rink ice from captured rainwater, and offers free public transit for ticket holders.

But how much of the teams’ offset purchases are actually doing the good that they claim?

It’s an important question, in part because fans may ultimately pay for those offsets.

The cost of carbon offsetting in sports varies by organization, with no industry standard for who pays. Some teams and leagues absorb costs through their operational budgets, treating carbon neutrality as a core responsibility. Others pass costs to consumers: Some teams add sustainability fees to ticket prices to offset each attendee’s carbon footprint. The payment model ultimately reflects whether an organization views offsetting as an institutional obligation or a shared responsibility with fans.

Carbon offsets in sports are also in the news, with scandals erupting around them in connection with sports from FIFA’s 2022 World Cup to basketball’s LA Clippers.

As sport management researchers, we have been following offset agreements and other sustainability commitments that teams and sports leagues such as FIFA have been making to see whether they translate into measurable environmental outcomes. We see lots of good intentions but also a disturbing amount of failures and outright fraud.

Where sports teams’ emissions come from

The vast majority of a sports team’s climate footprint comes from team’s and fans’ travel, which they have little control over. Leagues can reduce teams’ travel somewhat with creative scheduling, but unlike other industries, sports teams have few ways to reduce the bulk of their emissions.

What many of them do instead is offset those travel emissions by buying carbon credits.

Carbon credits are generated by projects that reduce greenhouse gases in the atmosphere or prevent greenhouse gas emissions. Many of those projects involve planting trees to remove carbon dioxide from the atmosphere; others expand clean energy to reduce fossil fuel use. Each carbon credit is supposed to represent the reduction or prevention of one metric ton of carbon dioxide.

However, carbon offset projects have come under scrutiny in recent years. Tree-planting projects, the most common type, take time to meet their promise as the trees grow, and wildfires and logging can wipe out the benefit. Studies have found that companies tend to buy cheap, low-quality carbon credits, which run a risk of exaggerating their carbon reduction claims or providing results that would have happened anyway, leaving no real climate benefit.

Unfortunately, several teams, perhaps unknowingly, have been purchasing fraudulent or low-quality credits.

Reputations at risk

FIFA brought the sports world’s carbon offset problem into the spotlight during the 2022 Qatar World Cup.

FIFA claimed the event would be carbon neutral, but that claim relied on creative accounting that understated the event’s construction and travel emissions. Organizers also used low-quality offsets. Many of those offsets were renewable energy projects with a high likelihood of being built anyway.

A year after the tournament, FIFA had completed offset purchases for less than a third of the World Cup’s estimated emissions, the nonprofit Carbon Market Watch found. And Switzerland’s advertising regulator ordered FIFA to stop claiming the World Cup had been “carbon neutral.”

The Clippers and baseball’s Boston Red Sox ran into problems when they publicly partnered with Aspiration, a now-bankrupt finance technology company and carbon credit broker, to meet their “carbon neutral” claims.

The Clippers had a US$300 million partnership with Aspiration that included paying the company at least $56 million for carbon credits in mid-2022, The New York Times reported. Both teams also had plans with Aspiration to offer fans a way to buy carbon credits to cover their own travel when purchasing tickets.

However, Aspiration officials claimed to have supported millions more tree-plantings than what had actually happened, a ProPublica investigation found. Aspiration co-founder Joe Sanberg pleaded guilty in 2025 to wire fraud involving false statements about financing to secure loans and attract investors, who lost at least $248 million.

The Aspiration partnership is also under investigation by the NBA over an endorsement deal the company made with Clippers all-star Kawhi Leonard at about the same time and questions about whether it was used to violate the league’s salary cap. Team owner Steve Ballmer, who personally invested at least $50 million in Aspiration, told ESPN he and the team did nothing wrong. “They conned me,” he said.

While the scandal focused on financial fraud and the salary cap, it also raised questions about the team’s sustainability claim.

Without verification, who knows?

In some cases, the value of offset projects is difficult to verify, even when trees are being planted nearby.

The Seattle Sounders FC declared itself the first carbon-neutral professional soccer team in North America in 2019 by cutting its waste, water and energy use and offsetting its remaining emissions through the nonprofit organization Forterra, which plants trees in the Puget Sound region.

While the effort positioned the club as a sustainability leader, the offsets lacked what’s known as third-party verification. Similar to how organic food must be certified by reputable agencies, third-party validation of carbon credits ensures credits truly represent the removal of carbon from the atmosphere or avoided emissions.

Without verification, it’s unclear whether claimed emission reductions are permanent, accurately tracked and transparently reported.

Potential legal consequences

Even the most prominent venues are susceptible to issues with unreliable credits.

Climate Pledge Arena in Seattle has been celebrated as the world’s first “zero-carbon” certified arena, with electric Zambonis, recycled materials, renewable energy and free public transit. It represents one of the most ambitious pushes to develop sustainable sport infrastructure globally.

To offset unavoidable construction emissions, the arena’s owner relied on carbon credits tied to projects meant to reduce rainforest loss in Colombia. However, an analysis by the carbon rating company Calyx Global found that while the arena’s credits may prevent some deforestation, the numbers likely overstate the benefits.

A 2023 report suggested that over 90% of rainforest carbon credits from the leading certifier of offsets lack evidence that they reduced deforestation. The certifier disputed that conclusion but is working to revise its review process.

When credits fail to offset real emissions, that erodes public trust and can expose organizations to potential legal consequences.

Delta Air Lines, for example, is facing a lawsuit over its carbon neutrality claim. The suit alleges that Delta misled passengers by describing itself as a “carbon-neutral airline” while relying on carbon offset projects that were ineffective or “junk.”

Time for some strategic reassessment

These and other failures in the carbon credit market suggest the industry needs to fundamentally reassess how sports teams achieve their climate goals.

To provide meaningful sustainability commitments, sports organizations and facilities can start at home by lowering their fossil fuel use and increasing their energy efficiency. Many arenas do this.

Leagues can design game schedules to reduce team and fan travel. Many of the Paris Olympics venues in 2022, for example, were connected by subway or bus. The 2026 FIFA World Cup, in contrast, has venues hundreds of miles apart across North America, meaning potentially higher emissions from fan travel.

Where offsets will still play a role, teams can ensure that they partner with verified carbon credit providers that deliver measurable, transparent carbon reductions.

In a field where public trust and reputation matter as much as performance, the sports industry cannot afford foul play on climate. We believe a shift toward strategies that cut emissions first, and then use only the most credible offsets, will be the difference between striking out and leading the sustainability game.

The authors do not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.

– ref. From FIFA to the LA Clippers, carbon offset scandals are exposing the gap between sports teams’ green promises and reality – https://theconversation.com/from-fifa-to-the-la-clippers-carbon-offset-scandals-are-exposing-the-gap-between-sports-teams-green-promises-and-reality-270428

Source: The Conversation – USA (2) – By Suvrat Dhanorkar, Associate Professor of Operations Management, Georgia Institute of Technology

Electronic gifts are very popular, and in recent years, retailers have been offering significant discounts on smartphones, e-readers and other electronics labeled as “pre-owned.” Research I have co-led finds that these pre-owned options are becoming increasingly viable, thanks in part to laws and policies that encourage recycling and reuse of devices that might previously have been thrown away.

Amazon, Walmart and Best Buy have dedicated pages on their websites for pre-owned devices. Manufacturers like Apple and Dell, as well as mobile service providers like AT&T and Verizon, offer their own options for customers to buy used items. Their sales rely on the availability of a large volume of used products, which are supplied by the emergence of an entire line of businesses that process used, discarded or returned electronics.

Those developments are some of the results of widespread innovations across the electronics industry that supply chain researcher Suresh Muthulingam and I have linked to California’s Electronic Waste Recycling Act, passed in 2003.

Recycling innovation

Originally intended to reduce the amount of electronic waste flowing into the state’s landfills, California’s law did far more, unleashing a wave of innovation, our analysis found.

We analyzed the patent-filing activity of hundreds of electronics firms over a 17-year time span from 1996 to 2012. We found that the passage of California’s law not only prompted electronics manufacturers to engage in sustainability-focused innovation, but it also sparked a surge in general innovation around products, processes and techniques.

Faced with new regulations, electronics manufacturers and suppliers didn’t just make small adjustments, such as tweaking their packaging to ensure compliance. They fundamentally rethought their design and manufacturing processes, to create products that use recycled materials and that are easily recyclable themselves.

For example, Samsung’s Galaxy S25 smartphone is a new product that, when released in May 2025, was made of eight different recycled materials, including aluminum, neodymium, steel, plastics and fiber.

Combined with advanced recycling technologies and processes, these materials can be recovered and reused several times in new devices and products. For example, Apple invented the Daisy Robot, which disassembles old iPhones in a matter of seconds and recovers a variety of precious metals, including copper and gold. These materials, which would otherwise have to be mined from rock, are reused in Apple’s manufacturing process for new iPhones and iPads.

How do consumers benefit?

In the past two decades, 25 U.S. states and Washington D.C. have passed laws requiring electronics recycling and refurbishing, the process of restoring a pre-owned electronic device so that it can function like new.

The establishment of industry guidelines and standards also means that all pre-owned devices are thoroughly tested for functionality and cosmetic appearance before resale.

Companies’ deeper engagement with innovation appears to have created organizational momentum that carried over into other areas of product development. For example, in our study, we found that the passage of California’s law directly resulted in a flurry of patents related to semiconductor materials, data storage and battery technology, among others. These scientific advances have made devices more durable, repairable and recyclable.

For the average consumer, the recycling laws and the resulting industry responses mean used electronics are available with similar reliability, warranties and return policies as new devices – and at prices as much as 50% lower.

Suvrat Dhanorkar does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.

– ref. New industry standards and tech advances make pre-owned electronics a viable holiday gift option – https://theconversation.com/new-industry-standards-and-tech-advances-make-pre-owned-electronics-a-viable-holiday-gift-option-270347

Source: The Conversation – USA (3) – By Anna Maria Santiago, Professor of Community Development, Michigan State University

High levels of neighborhood violence increase the risk of Latino and African American teens in Denver starting to use alcohol and tobacco, according to our recent study.

In the U.S., approximately 2 in 10 adolescents between the ages of 12 and 20 drink alcohol. About 1 in 10 smoke cigarettes. For teens living in neighborhoods with high levels of disadvantage and social disorganization, the odds are 35% to 72% higher. Disadvantaged neighborhoods generally have higher levels of economic hardship, poorer educational opportunities and limited resources. Those factors weaken the social fabric of a community.

Although alcohol and tobacco use among adolescents has declined in recent years, both remain the most commonly used and abused substances compared to cocaine or heroin. Alcohol and tobacco use have been linked to substance dependence in adulthood, sexual victimization, some cancers and premature death.

One of us – Anna Maria Santiago – studies neighborhood effects, or how where children and adolescents live affects their health and well-being. Iris Margetis is a Ph.D. candidate in economics and co-author of the study.

Why it matters

Exposure to neighborhood violence has been thought to trigger adolescent alcohol and tobacco use as a way of coping with the heightened levels of stress associated with that exposure. However, previous findings have been mixed.

Seventeen percent of survey participants started smoking as teens. The average age of first use was 15.6 years. Fifteen percent started drinking as teens when they were 16.1 years old, on average.

Greater exposure to neighborhood violence prompted teens in our study to start drinking and smoking two to eight months earlier than their peers. Girls started using both substances earlier than boys. Latino teens started earlier than African Americans.

We controlled for other potential individual, household and neighborhood risk factors such as family size, household stressors and level of neighborhood disadvantage. The risk of starting to use alcohol still increased 32% for all teens residing in neighborhoods with greater violence. The risk of tobacco use in those neighborhoods was 1.3 to 1.5 times higher for boys, Latino and African American adolescents.

How we do our work

We analyzed administrative and survey data originally gathered from a natural experiment involving a policy change in Denver for approximately 1,100 Latino and African American teens. The teens lived in 110 census tracts across metro Denver.

To measure exposure to violence, we used our survey data to create a neighborhood problems index that measured several factors. Those included the presence of people selling drugs, gang activity, homes broken into by burglars, people being robbed or mugged, people getting beaten or raped, and children and youth getting into trouble. We defined the presence of three or more of these as high exposure to neighborhood violence.

What still isn’t known

We still don’t know what community interventions work best. But research suggests that caregiver and community-level action is crucial. According to study participants, caregivers monitored their adolescents closely. They limited unsupervised time outside or with friends, especially in neighborhoods with higher exposure to violence.

Study findings suggest that neighborhood youth clubs, sports teams, community centers and parks may serve as powerful deterrents to substance use initiation among teens. Community-led, evidence-based programs such as Rise Above Colorado support efforts promoting positive youth development and fostering positive community norms as prevention and early intervention strategies.

The state of Colorado says preventing or delaying initiation of both alcohol and tobacco use remain key public health goals.

However, additional work is needed to develop programming and activities that facilitate these efforts in Latino and African American communities.

The Research Brief is a short take on interesting academic work.

Anna Maria Santiago previously received funding from the U.S. Department of Housing and Urban Development; the National Institute of Child Health and Human Development; the John D. and Catherine T. MacArthur Foundation; the Ford Foundation; the Annie E Casey Foundation and the W.K. Kellogg Foundation.

Iris Margetis does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.

– ref. Exposure to neighborhood violence leads some Denver teens to use tobacco and alcohol earlier, new study shows – https://theconversation.com/exposure-to-neighborhood-violence-leads-some-denver-teens-to-use-tobacco-and-alcohol-earlier-new-study-shows-270412

Source: The Conversation – USA (3) – By Adetola F. Louis-Jacques, Clinical Assistant Professor of Obstetrics and Gynecology, University of Florida

A growing share of Americans, especially in rural areas, are losing access to reproductive health care. At the same time, American women are dying during or after pregnancy at higher rates than in any other high-income country.

As a result, many U.S. health care providers and policymakers are looking for ways to improve maternal care.

We believe doulas – care workers who provide nonmedical support before and during pregnancy, labor, birth and the postpartum period – may be a part of the solution.

We are a physician-researcher specializing in high-risk pregnancies and breastfeeding and a Ph.D. candidate in sociology focused on reproductive health and health care disparities.

As hospitals adopt more favorable policies and states expand insurance coverage for doula services, doulas are becoming part of the mainstream U.S. maternal health system.

But there are still significant barriers to access, including awareness, costs and challenges to full partnership with doulas in hospitals.

What a doula offers

Pregnancy, birth and the postpartum period are vulnerable times, and many parents-to-be and new parents find it can be difficult to navigate. Doulas advocate for their clients, helping them voice what they need. They can also help address mistreatment and guide them to appropriate resources.

Doulas do not perform clinical tasks, such as giving medical advice, making medical decisions, providing prescriptions or delivering babies. Rather, they provide nonmedical support. This will look different depending on the type of doula parents hire.

Fertility doulas assist people who are trying to get pregnant. They offer emotional support throughout the fertility journey, complementing the medical care, diagnostics and interventions provided by fertility doctors.

During pregnancy and labor, birth doulas help their clients identify normal symptoms and those that may be urgent warning signs. They also provide labor support, such as positioning and breathing assistance, massage, words of encouragement, coaching, education, continuous presence and other forms of comfort. They offer direct emotional support through the validation of clients’ experiences and emotions.

Postpartum doulas offer extended support to new parents and infants in the immediate days, weeks or months after delivery. They educate parents and act as a bridge to mental health services and additional resources such as diapers, feeding support and housing needs. They may help with supporting a new mom’s infant feeding goals, integrating the infant into the family, sibling care and processing their births.

Full-spectrum doulas offer support throughout pregnancy, delivery and up to six months after birth. Still others offer bereavement services for parents experiencing pregnancy loss, such as abortion, miscarriage and stillbirth.

This sort of holistic care can be invaluable, even for women with access to good medical care. Several months ago, one of us (Adetola) helped a patient find a postpartum doula. She was an educated woman with insurance and access to top medical care. She was suffering the effects of postpartum depression and anxiety despite all the therapy and medical resources offered.

She later wrote that, for her, “the support of my postpartum doula was invaluable in my recovery. My doula provided me with the support I needed in caring for my baby for me to care for myself. Not only did she care for my baby for me to rest, but she helped me with breastfeeding.”

Doula training

As of August 2025, there were 2,232 registered doula businesses in the U.S. California has the highest concentration at 7.5%, while West Virginia has the lowest concentration, 0.1%. These numbers may not reflect hospital-based or nonprofit-affiliated doulas, or those not formally registered.

In the U.S., more than 100 independent organizations provide doula training. Some of the larger organizations include DONA International, Childbirth International and the Childbirth and Postpartum Professional Association. Doula training typically covers communication and advocacy skills, stages of labor and birth, and postpartum support. It also includes coursework on how to build a business as well as infection prevention and control.

Some organizations provide online or in-person courses, and doula training can also be done through apprenticeships. While certifications or licenses are not required to practice, various state Medicaid programs mandate training and certification to qualify for Medicaid reimbursement.

Better outcomes with doula support

The services that doulas offer can complement the more mainstream biomedical approach of many doctors and nurses.

Maternal health outcomes in the U.S. have been worsening for decades in comparison to other high-income countries.

But studies show that a doula-clinician partnership improves key components of maternal health care, such as better communication and patient-centered care, accountability in the health care team and continuity of support for mothers.

Having a doula present in the lead-up to delivery, at the delivery or both is associated with lower rates of cesarean deliveries and preterm births and fewer low-birthweight infants.

Doula support is also associated with improved childbirth education attendance, birth satisfaction, self-efficacy and confidence, breastfeeding experiences and outcomes, and positive infant-care behaviors.

After birth, infants born with a doula present have higher five-minute Apgar scores, an assessment of infant health taken exactly five minutes after birth. Parents who received doula support have reduced rates of postpartum depression and anxiety.

Doula support has also been shown to help close maternal outcome gaps, particularly those rooted in racial, socioeconomic and institutional barriers.

And beyond all the health benefits for parents and infants, research shows that doulas can reduce health care costs associated with having a baby.

Funding sources for doula support

Unfortunately, despite all of these benefits, many U.S. families struggle to afford doula care. Private insurance does not typically cover doula services. Clients can pay out of pocket using a flat-rate service charge, fee-for-service or monthly stipend model. They can also pay for these services using extended benefits such as flex or health savings accounts.

The cost varies by state and region, experience level and service package. Out-of-pocket costs for comprehensive birth doula services can range from US$800 to more than $3,000 across the U.S.

As of September 2025, 23 states plus Washington, D.C., were actively reimbursing Medicaid coverage for doula care.

Only two states – Rhode Island and Louisiana – currently require that private health plans cover doula care. However, Colorado, Virginia, Illinois and Delaware are in the process of implementing doula coverage in private health plans. More states are expected to continue efforts to require doula coverage for private health plans.

Some community-based organizations and nonprofits provide free or low-cost doula care through grants or donations. These programs usually prioritize low-income families. In New York City, free or low-cost doula support is available through the Citywide Doula Initiative which serves Medicaid-eligible families, teen parents and residents of priority neighborhoods.

Moreover, some hospitals and birth centers employ doulas or work with them as part of their maternal care teams.

Finding a doula

When hiring a doula, you’ll want to consider their training, certifications and experience. You will also want to know how available they are, what services they offer and their fees and payment methods.

In addition:

• Consider asking your health care provider or hospital for recommendations for doulas in the community.
• Look into doula directories, such as DONA International, DoulaMatch.net, CAPPA and the National Black Doulas Association. Also, check to see whether your state has a doula directory, like those in California, Minnesota Oregon and Michigan.
• Ask for recommendations from friends, family or local parenting groups.
• Check local community boards, birth centers and drugstores for any doula advertisements.
• You might also connect with doulas at birth or parenting classes.

Adetola F. Louis-Jacques receives funding from NIH, Direct Relief, Children’s Trust of Alachua County.

Seun Mauton Ajoseh does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.

– ref. Doulas play essential roles in reproductive health care – and more states are beginning to recognize it – https://theconversation.com/doulas-play-essential-roles-in-reproductive-health-care-and-more-states-are-beginning-to-recognize-it-253903