Bridging the gaps: a mixed methods study of migrant perinatal experiences and the role of doulas and home visitors in creating integrated systems of care
OA Version
Citation
Abstract
BACKGROUND: Migrant women in the United States, defined here to include immigrants, refugees, asylum seekers, and undocumented individuals, face structural, cultural, and relational barriers that compromise perinatal health and well-being, and yet, they remain underrepresented in research and policy. While home visiting and community-based doula care show promise for advancing perinatal equity, access to these services and their alignment with migrant families’ needs are not well understood. This study explored the perinatal needs of recently arrived (2018–2024) migrant women in Massachusetts, how current systems meet those needs, and opportunities for more integrated, culturally responsive community-based supports.
METHODS: This mixed-methods study investigated family experiences and system dynamics. Spanish-language focus groups with migrant women in Boston explored perinatal needs and care experiences. Interviews with local, state, and federal home visiting leaders examined system-level challenges and opportunities. A statewide doula landscape assessment documented integration options with home visiting programs.
RESULTS: Migrant families faced persistent challenges across all domains of person-centered care, including feeling dismissed in clinical encounters, navigating language and cultural dissonance, and receiving fragmented support. Fear of deportation, economic hardship, and isolation deepened emotional distress. While home visitors and community-based doulas emerged as trusted providers who offered relational, continuous, culturally affirming care, access was limited and often delayed. Migrant-serving doulas typically share racial and linguistic backgrounds with families, provide advocacy and system navigation, and operate outside formal systems, often unpaid. Only 20% of doulas reported collaboration with home visiting. Despite shared goals and similar populations served, the two workforces largely functioned in silos. Participants emphasized care models that begin earlier in pregnancy, offer sustained support and are delivered by people who reflect and respect the communities they serve. Collaboration, defined as joint planning and execution, with organizations working together to coordinate at multiple points to carry out a combined effort, emerged as the most feasible form of integration, preserving professional autonomy, flexibility, and community trust.
CONCLUSION: The study findings highlight three strategies for a more integrated, equitable, and responsive perinatal care system for migrant families. First, expand prenatal access to home visiting to all migrant families who seek it. Second, connect community-based doulas to home visiting through shared protocols and sustained workforce investments. Third, elevate both workforces as trusted, community-rooted providers. Together, these strategies can inform policy and programmatic decisions at the local, state, and federal levels.
Description
2025
License
Attribution-NonCommercial 4.0 International