NEW YORK (AP) — Walmart, the nation’s largest private employer, is expanding nationwide its health care coverage next month for employees who want to enlist the services of a doula, a person trained to assist women during pregnancies.

The coverage was first offered to Walmart employees in Georgia in 2021, and then last year the Bentonville, Arkansas-based discounter offered the same benefit to employees in Louisiana, Indiana and Illinois. The exception is Hawaii, which has its own set of health benefits, Walmart said.

Walmart said the program, which kicks off nationwide on Nov. 1, is meant to address racial inequities in health care and improve the maternal and infant health of its workers and their babies, especially in areas where access to care may be limited. Doulas are trained experts that must receive credentials from either the National Black Doulas Association or DONA International.

“As things evolve and we’ve come out of COVID, we continue to see the gaps where maternal care is not always available or there needs to be additional support,” said Lisa Woods, Walmart’s vice president, physical and emotional well-being.

Woods declined to specify the number of Walmart employees who have taken part in the program so far, noting that the biggest challenge was educating employees on what doulas actually do. It plans to better publicize the offering and include the expanded coverage in this year’s annual health insurance enrollment materials.

The expansion of the doula benefits comes as a new collection of reports from the March of Dimes, a nonprofit organization committed to ending preventable maternal health risks and death, shows that more than 5.6 million women live in counties with limited or no access to maternity care services, pushing families to find new ways to get needed care. The loss of obstetric units in hospitals was responsible for decreased maternity care access in nearly 1 in 10 counties across the U.S, according to the report.

Black women are three times more likely to die from a pregnancy-related cause than white women, largely due to differences in the quality of health care, underlying chronic conditions and structural racism, according to the Centers for Disease Control and Prevention.

Employing a doula as a part of a birthing team decreases cesarian sections by 50%, shortens the time of labor by 25% and decreases the need for other medical interventions by more than half, according to the National Black Doulas Association.

Employees on Walmart’s medical plan can receive assistance from a doula with coverage of up to $1,000 per pregnancy. The company already has in place a “Life with Baby” program, which offers no-cost resources like one-on-one coaching from a nurse, tools to track daily progress and gifts for new babies.

Other major U.S. companies are also offering full or partial doula services for employees, including CVS Health and Microsoft.

Tracy Collins, president and founder of the National Black Doulas Association, noted that Walmart’s move to expand the program nationwide could help increase momentum for the use of doula services to help address racial inequities in maternal care.

“I am seeing major corporations take an interest in wanting to align with the (National Black Doulas Association) for the look of supporting a Black business or a Black and brown company, but they don’t follow suit,” Collins said.

Jillian Bowman, a 28-year-old mother of a now 17-month-old boy from Clarksville, Georgia, who works as an hourly optician at a nearby Walmart store in Clayton, Georgia, turned to a doula service after she was unhappy with her care at a local ob-gyn practice. Bowman had gestational diabetes and was told that she would need a C-section, which would have required a longer recovery period. Midway through her pregnancy, Bowman turned to a doula and was able to get the service covered by Walmart’s insurance plan. The doula guided her through her pregnancy.

She credited her doula for being able to have a natural birth at a local hospital.

“I wasn’t getting as much attention from the medical team there,” she said. “But having her there and having her prepare for all of that, I felt so much more confident going into the whole thing.”