Black Doula Support in US Jails and Prisons: Caring for Those Confined

INTRODUCTION: As patient advocates, Black community-based doulas aim to address disparities in perinatal health care within both community and carceral settings. Yet, little is known about how they interpret their work with people who are pregnant and incarcerated. The purpose of this study was to examine Black doulas' perspectives on providing care in carceral systems and the institutional constraints of this work. METHODS: This study draws on interviews with 19 Black doulas who provided services in US jails and prisons. Using a directed content analysis and the reproductive justice framework, their care practices are examined to understand how they provide care in systems structured by punishment, surveillance, and perinatal health care disparities. RESULTS: Participants framed their work as relational and culturally grounded, which countered the punitive logics of incarceration. They described providing one-on-one support and education that people who are pregnant might not have otherwise received, given the precarious state of perinatal health care in carceral facilities. At the same time, they detailed various institutional constraints that influenced their model of care. Despite these constraints, doulas interpreted their work as a transformative intervention within carceral systems. DISCUSSION: By centering Black doulas' perspectives, this study shows how their care work resists state-sanctioned reproductive oppression and affirms alternative visions of perinatal health care that are culturally grounded and rooted in dignity and respect. As such, it demonstrates how Black doulas' insights are critical for informing institutional policies and practices and also for advancing reproductive justice.