The Black–White racial disparities in maternal and infant health outcomes are among the largest disparities seen in traditional perinatal health measures.^{1, 2} Black pregnant and postpartum people^** We use “people” as a gender‐inclusive term to refer to individuals with the capacity for pregnancy and childbirth, and use “woman,” “women,” “mother” and “maternal” when reporting the results of studies that used these terms.
have a pregnancy‐related mortality ratio that is three to four times that of their White counterparts, and disparities in severe maternal morbidity are similar.^3-5 Additionally, the infant mortality rate among Black neonates is more than twice that of White neonates (10.8 vs. 4.6 per 1,000 live births),^{6, 7} and the proportion of births that are preterm is more than 50% higher among Blacks than among Whites (14% vs. 9%).⁸ The reasons for these disparities are multifactorial, but have been linked to Black individuals having higher prevalence of preexisting chronic disease^{5, 9} and less access to primary and prenatal care,¹⁰ as well as to social and structural determinants of health (e.g., poor housing, food insecurity, high‐crime neighborhoods)^11-13 and to racial discrimination that results in poor patient–provider communication, disrespectful care, delayed medical intervention and lower quality of care.^14-18 As the United States battles the COVID‐19 pandemic, racial disparities in COVID‐related deaths have risen alarmingly,¹⁹ and mounting data suggest that similar increases are occurring for disparities in birth outcomes.

Providing pregnant individuals with support to mitigate the social and structural factors that are key drivers of COVID‐19–related health inequities may help ameliorate these disparities. For pregnant and birthing people, community‐based doulas are a potential source of such support. Community‐based doulas are a type of health worker who focuses on the care of pregnant people and their infants, and use of their services is associated with improved birth outcomes among low‐income and marginalized racial and ethnic populations.^{20, 21, 23} Despite evidence suggesting they can improve maternal and infant health, community‐based doulas have been deemed nonessential workers during the pandemic, and pregnant patients have often had limited access to their services in hospital labor and delivery settings. This lack of access could have serious implications for maternal and infant health outcomes and threatens to worsen the already extensive racial disparities.

In this viewpoint, we describe emerging data concerning racial disparities in birth outcomes during the pandemic (and potential mechanisms for those disparities), highlight how use of community‐based doulas can disrupt the pathways leading to racial disparities in COVID‐19–related birth outcomes, and propose strategies for integrating doulas into health care teams and ensuring recognition of their role as essential health care workers through this pandemic and beyond.

孕产妇和婴儿健康结果方面的黑人与白人种族差异是传统围产期健康措施中最大的差异之一。 ^1、2黑人孕妇和产后人士^*
*我们使用“人”作为包含性别的术语来指代具有怀孕和分娩能力的个人，并在报告使用这些术语的研究结果时使用“女人”、“女性”、“母亲”和“母亲”条款。

与怀孕相关的死亡率是白人的三到四倍，并且严重孕产妇发病率的差异相似。 ^3-5此外，黑人新生儿的婴儿死亡率是白人新生儿的两倍多（每 1,000 名活产婴儿 10.8 例 vs. 4.6 例）， ^{6, 7}黑人的早产比例高出 50% 以上高于白人（14% 对 9%）。 ⁸造成这些差异的原因是多因素的，但与黑人个体先前存在的慢性病患病率较高^{5、 9}以及获得初级和产前护理的机会较少有关， ¹⁰以及健康的社会和结构性决定因素（例如，贫困）住房、粮食不安全、高犯罪率社区） ^11-13以及导致患者与提供者沟通不畅、护理不尊重、医疗干预延迟和护理质量较低的种族歧视。 ^14-18随着美国抗击新冠病毒 (COVID-19) 大流行，与新冠病毒相关的死亡人数的种族差异惊人地上升， ¹⁹并且越来越多的数据表明，出生结果的差异也出现了类似的增长。

为孕妇提供支持，以减轻社会和结构性因素，这些因素是与 COVID-19 相关的健康不平等的关键驱动因素，可能有助于改善这些差异。对于孕妇和分娩者来说，社区导乐是此类支持的潜在来源。社区导乐师是一种专注于孕妇及其婴儿护理的卫生工作者，使用他们的服务与改善低收入和边缘化种族和民族人口的出生结果有关。 ^{20, 21, 23}尽管有证据表明社区助产士可以改善孕产妇和婴儿健康，但在大流行期间，社区助产士仍被视为非必要工作人员，而孕妇在医院待产和分娩环境中获得其服务的机会往往有限。这种机会的缺乏可能会对孕产妇和婴儿的健康结果产生严重影响，并有可能加剧本已广泛的种族差距。

从这个角度来看，我们描述了有关大流行期间出生结果种族差异的新数据（以及这些差异的潜在机制），强调了基于社区的助产士的使用如何破坏导致 COVID-19 相关出生结果种族差异的途径，并提出将助产士纳入医疗保健团队的战略，并确保在这场大流行病及以后的疫情期间，他们作为基本医疗保健工作者的作用得到认可。