Community-based doulas and their role in combating obstetric racism for marginalized BIPOC & migrant women: The Contigo Bilingual Doula Program

The United States has the highest maternal mortality rate among high-income nations, and the burden of that crisis is not shared equally. Black, Indigenous, and People of Color (BIPOC) and migrant women die at disproportionate rates, experience higher rates of obstetric mistreatment, and face systematic barriers to the culturally and linguistically congruent care they need and deserve. These patterns are not biological inevitabilities. They are the predictable consequences of structural racism, and they carry moral weight. This thesis takes that moral weight seriously. I argue that community-based bilingual doulas are a justice-based necessity in a maternity care system that has failed its most vulnerable patients. Using frameworks of health justice, reproductive justice, autonomy, and structural competency, I contend that the integration of community-based doulas (CBDs) into standard maternity care is required under conditions of structural injustice, not merely recommended. The thesis moves from evidence to ethics. Sections 1 and 2 establish the scope of maternal health inequities and the case for CBD care as a meaningful response, including the distinctive power of cultural and linguistic concordance and the advocacy role CBDs play in obstetric settings. Section 3 is the ethical heart of the argument, articulating what four convergent frameworks demand of healthcare systems and why the failure to act is not a neutral policy position. Section 4 grounds the argument in the Contigo bilingual doula program at Esperanza Health Center in Philadelphia, an ongoing study whose design itself reflects the commitments this thesis defends. The conclusion draws out what must follow if the argument holds.