I 119th CONGRESS 1st Session H. R. 2469 IN THE HOUSE OF REPRESENTATIVES March 27, 2025 Ms. Strickland (for herself and Ms. Moore of Wisconsin ) introduced the following bill; which was referred to the Committee on Energy and Commerce A BILL To direct the Secretary of Health and Human Services to evaluate the benefits of abortion doula care and coverage.

1. Short title This Act may be cited as the Abortion Data and Outreach to Unlock and Leverage Abortion Support Act or the Abortion DOULAS Act . 2. Definitions In this Act: (1) Abortion doula care The term abortion doula care means the provision of emotional, social, informational, and physical support by non-clinical, trained professionals (commonly known as abortion doulas ) to individuals before, during, and after medication and procedural abortions, including such provision of practical support, patient navigation support, patient advocacy, and postabortion care. (2) Secretary The term Secretary means the Secretary of Health and Human Services. 3. Findings Congress finds the following: (1) Abortion doulas provide critical support to patients and families before, during, and after medication and procedural abortions. Abortion doula care can encompass physical, social, and emotional support; information sharing, advocacy, and education; and personal care, such as planning meals or providing childcare. Abortion doula care may be individualized, culturally and linguistically congruent, and trauma-informed. (2) Abortion doulas work in a variety of environments, including hospitals, clinics, clients’ homes, and community spaces, and in both telehealth and in-person care settings. They may work independently, through a collective or community-based organization, as part of a local health department, or through or in close partnership with a health care system or health plan. (3) While research has shown that doula support to parents during labor, birth, and the postpartum period is associated with better birthing experiences and healthier outcomes for both parents and infants, existing evidence on doula support during other reproductive health care events, such as abortion, miscarriage, or stillbirth, is more limited. (4) A 2015 National Institutes of Health study found that nearly all the women who had doulas present during first-trimester procedural abortions reported satisfaction with the doula care they received, with many expressing support for greater involvement of abortion doulas in abortion care. (5) In a randomized controlled trial of doula support during first-trimester procedural abortions, 96 percent of women who received doula support recommended that it be incorporated into routine abortion care, and 72 percent of women who had not received doula support wished they had received it. (6) The Supreme Court’s decision in Dobbs v. Jackson Women’s Health Organization and its impact on communities across our nation have made access to abortion doula care more important than ever. (7) The Dobbs decision has had an outsized impact on people who already face barriers to health care access, particularly Black people, Indigenous people, people of color, disabled people, undocumented immigrants, low-income individuals and families, young people, people in rural communities, and people with limited English proficiency. The care that doulas provide, which often includes culturally competent patient advocacy and coordination with health care providers, can help medically marginalized patients confront heightened challenges to accessing appropriate medical care. Abortion doulas with a lived understanding of the communities in which they work can leverage local social support and connect clients and their families with community resources that best meet their needs. (8) Additionally, in the confusing legal landscape of abortion access after the Dobbs decision, abortion doulas help people navigate misinformation and combat the shame and stigma around abortion that restrictions may have exacerbated. (9) There are several barriers to accessing doula care. (10) Barriers include limited awareness of doula services among pregnant patients and their families, members of the perinatal care workforce, and other health care professionals. (11) The cost of doula care is another barrier to access, particularly for Black people, Indigenous people, people of color, people in rural communities, and low-income individuals and families. (12) Doulas themselves face challenges such as barriers to entering the field, insufficient support during the Medicaid credentialing process, and low Medicaid reimbursement rates. As a result, abortion doulas are often unpaid and operate within a volunteer infrastructure. (13) Many State Medicaid programs still do not cover doula services despite growing interest in expanding State Medicaid coverage to include doula care. Private insurance coverage of doula care is more limited. State Medicaid and private insurance plans that do include doula care often do not include support for abortion doula care. 4. Study on the benefits of abortion doula care and coverage (a) Study The Secretary of Health and Human Services, in coordination, as appropriate, with the Director of the Office of Minority Health and the Director of the Office on Women’s Health, shall conduct and complete a study on the benefits of abortion doula care and coverage. Such study shall include an assessment of the following: (1) The impact of abortion doula care on the well-being of individuals seeking abortions, including patient experience before, during, and after seeking care. (2) The potential of abortion doula care to enhance the quality of care provided before, during, and after abortions. (3) The role of abortion doulas in providing informational, logistical, and practical support to individuals in the process of seeking abortion care. (4) The availability and accessibility of abortion doula care in all States of the United States. (b) Data collection The Secretary shall collect data from a representative sample of individuals who have received abortion doula care, including the following: (1) Surveys of and interviews with individuals and their family members who have utilized abortion doula care, including those in States in which doula care for all pregnancy outcomes, including abortion, is covered under State plans (or waivers of such plans) under title XIX of the Social Security Act ( 42 U.S.C. 1396 et seq. ). (2) Surveys of and interviews with practicing abortion doulas and health care providers who work with abortion doulas, including those in States in which doula care for all pregnancy outcomes, including abortion, is covered under such plans or waivers. (3) Review of academic literature on the subject of abortion doula care. (c) Expert input The Secretary shall consult with experts in the fields of reproductive health, maternal health, mental health, and social work. The Secretary shall also consult with community-based doulas and organizations that provide abortion doula care to individuals in underserved or rural communities. (d) Patient privacy protections The data collected under subsection (b) shall be anonymized to prevent the release and misuse of sensitive personal information. 5. Report on State Medicaid approaches to abortion doula care benefits and access (a) Report Not later than 18 months after the date of enactment of this Act, the Secretary shall complete the study under section 4 and submit to the Committee on Energy and Commerce of the House of Representatives and the Committee on Health, Education, Labor, and Pensions of the Senate a report on the results of such study. (b) Topics The report under subsection (a) shall include the following: (1) An assessment of the potential benefits and challenges of integrating abortion doula care into abortion care and services. (2) Suggestions on how to increase access to abortion doula care, especially in underserved or rural areas where access to comprehensive health care may be limited. (3) Policy considerations and recommendations to States regarding the incorporation of abortion doula care into State plans (or waivers of such plans) under title XIX of the Social Security Act ( 42 U.S.C. 1396 et seq. ), with attention to Federal and State regulations, eligibility criteria for program participation, covered services, payment models and levels, and other programs features, through changes to such plans or waivers. (b) Public accessibility The report under subsection (a) shall be made publicly available on the website of the Department of Health and Human Services.