The Evolution of Doula Care in Arkansas

OBJECTIVE: Arkansas has significant health disparities for maternal and infant outcomes, including high rates of low birth weight, preterm birth, severe maternal morbidity, and both maternal and infant mortality. Multiple studies have identified advantages of including doulas in maternal care teams. The purpose of this article was to describe the evolution of doulas in Arkansas. METHODS: Leaders began training the workforce with only a hope of reimbursement, and doula organizations continued to evolve from informal dispersed networks into a formal statewide organization, the Doula Alliance of Arkansas. Collaborative efforts were key in driving policy change for doula reimbursement. RESULTS: The University of Arkansas for Medical Sciences and stakeholders throughout Arkansas have collaborated to expand doula workforce capacity. In 2025, Arkansas legislators passed two bills focused on Medicaid reimbursements for doulas, which Governor Sarah Huckabee Sanders signed into law (HB 1252/Act 965 and HB 1427/Act 124). CONCLUSIONS: The article documents the results of persistent stakeholder collaboration focused on improving maternal health through expanded access to doula care. This article can serve to inform other states' policies and practices by documenting Arkansas's relatively rapid progression from establishing its first doula organization to expanding the doula workforce and ultimately passing legislation for Medicaid coverage.