As the country continues to grapple with rising mortality rates for African-American mothers, many communities are taking matters into their own hands by hiring doulas for women in critical need of support.

In cities like Milwaukee and Detroit, local advocacy groups like the Black Breastfeeding Mothers Association have been stepping up efforts to ensure that moms are not left to fend for themselves in today's increasingly isolating and individual-focused culture. And according to the New York Times, Michigan and Oregon have recently expanded coverage for Medicare to help offset the cost of doulas, who assist women during childbirth and in the months postpartum. Additional states like New Jersey, Vermont, and New York State have also been taking steps to increase coverage for women.

Improved outcomes for moms who have access to doulas are well-documented. According to NPR, in some communities where doulas are utilized in higher numbers, the C-section rates are lower and women are more likely to attend prenatal care visits. This is huge for marginalized groups, like African American and Native American women, who are dying at four times the rate of white women during labor or in the months after.

"This crisis is not new, but is finally getting the attention it deserves," University of Minnesota expert Carrie Neerland said recently. "Care providers and institutions must examine ways to confront their own biases and structural racism, as well as look to innovative, evidence-based solutions. These solutions include the use of midwives and community doulas, diversifying the health care workforce, and quality improvement processes and toolkits. Ultimately, we must listen to black women."

It is indeed the lack of listening to—and simply supporting of—so many women in need that has lead to the crisis in the US, which lags behind other developed countries in maternal mortality rates.

Moreover, a recent New York Times report reveals that many women of color are simply afraid to speak up about feeling unprepared for motherhood. "A lot of times women of color won't express what they're going through, or seek out help, because they don't want to be criminalized for the choices they make," Chanel Porchia-Alber, founder of Ancient Song Doula Services in New York, told the Times. She noted that black and brown women face the very real fear of losing custody of their children in a system that all too often works against them.

But with that difficult reality also comes the reality of paying for the services of a doula, which can cost thousands and is still not covered by insurance in most states. For too many women, that cost is simply not a reality. As a result, many doulas are volunteering their time, which prevents them from making a living wage or fully devoting their time to growing their craft.

"Black doulas have a bleeding heart," Lyanne Jordan, founder of Milwaukee-based reproductive justice organization Maroon Calabash told WUWM. "And so our rates are very low compared to the work that we are doing."

Worse, Jordan says the new legislation being implemented is putting doulas of color and the women they serve at a complete disadvantage. Not only because the doulas need to be certified, when many in these communities are not, but also because insurance companies often pay for coverage via a paltry reimbursement. In this environment, without the money to pay for the service up front, many women are simply still not able to get the support and assistance they need.

Still, the city's efforts are worth noting. "Some of the ideas proposed that we're pushing forward include this concept of mothering the mother and providing prenatal and continuous labor support and postnatal care provided by doulas to the tune of three or four prenatal visits and three or four postnatal visits," Becky Rowland with the Milwaukee Health Department said.

Hopefully, if their efforts are successful, more doulas and the women who need them will receive support nationwide. America has a maternal health crisis and should be doing everything possible to save these mamas' lives.

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