Ama Bidziil (Strong Mothers): Advancing American Indian Maternal Health through Community-Based Doula Support

About This Grant

American Indian (AI) women experience significant challenges in maternal morbidity and mortality, particularly in rural areas where 40% of AI women reside. This research aims to address these differences by employing AI research methodologies to explore the impact of the AI doula role. By integrating AI-specific protective factors, evidence-based practices, and doula best practices, the project seeks to evaluate the impact of doula support on comprehensive maternal health outcomes, including receipt of guideline-concordant perinatal care, perinatal mood and anxiety disorder (PMAD) symptoms, breastfeeding initiation, and characteristics of labor/delivery, among other areas. Building on a 40+ year partnership between the Johns Hopkins Center for Indigenous Health (JH CIH) and the Navajo Nation, this study will be conducted in collaboration with two rural Navajo communities: Tuba City and Fort Defiance, Arizona. These sites are key hubs for perinatal care and labor/delivery within the largest federally recognized AI nation in the United States. The research is deeply rooted in community-engaged practices, with continuous collaboration with Community Research Councils (CRCs) and community approvals integrated into all stages of the project. Community engagement is central to this study. All research activities will be guided by a CRC of 8–10 Navajo community members, including health providers, counselors, Navajo knowledge keepers, and doulas. Facilitation and ongoing communication with the CRC will be jointly led by the Principal Investigator (Dr. Richards), local JH CIH site coordinators, and study doulas. The study has received strong support from various community organizations and stakeholders, including the Diné Doula Collective, Navajo Breastfeeding Coalition, and local healthcare institutions. Utilizing a Hybrid Type I effectiveness-implementation design, the study focuses on maternal health outcomes, particularly increasing guideline-concordant postpartum engagement, a priority identified by the community. The measurement of costs will provide valuable insights for potential implementing partner organizations and future Medicaid reimbursement. To ensure broad dissemination of our findings, the study will be registered on ClinicalTrials.gov within 21 days of the trial’s start date, with regular updates and adverse event reporting. Results will be submitted to ClinicalTrials.gov within 12 months of study completion. Informed consent documents will include statements about the posting of clinical trial information. We will share our findings with community partners through co-developed lay summaries and presentations, and disseminate results via local newsletters, tribal radio programs, and newspapers. For researchers and policymakers, results will be presented at national conferences, through webinars, and published in peer- reviewed journals.