One month into Iran war, some Trump objectives are unfulfilled as he looks to wind down the conflict

WASHINGTON (AP) — President Donald Trump has listed five objectives that the U.S. wants to achieve before ending its war with Iran. Now, one month into the conflict, he hassuggested the U.S. may soon be "winding down"the operation, even though some of his key aims remain undefined or unfulfilled.

Trump

Trump last weekoutlined five goalsfor the massive air campaign. That's up from four laid out by his staff since the war's start on Feb. 28 (and up from the three generally enumerated by the Pentagon and Secretary of State Marco Rubio). Though the Trump administration has said its objectives are clear and unchanging, the list of priorities has expanded and shifted as the war has taken a toll on the global economy, tested alliances and raised unanswered questions about the planning for the conflict, its justification and its aftermath.

By most accounts, the strikes by the U.S. and Israel have significantly degraded Iran's military capabilities and killed scores of senior leaders. But those tactical successes don't necessarily translate to achieving all the president's strategic aims.

Some of his objectives are difficult to achieve and if the U.S. walks away with unfinished aims and Iran's paramilitaryIslamic Revolutionary Guardin power, Trump could face political fallout at home and global repercussions about what was accomplished in his decision to launch a war of choice that upended the Middle East and roiled the global economy.

Trump and the White House have insisted the operation is going well and on track to meet its goals. "We are very close to meeting the core objectives of Operation Epic Fury, and this military mission continues unabated," press secretary Karoline Leavitt told reporters this week, saying the operation was "ahead of schedule and performing exceptionally."

Here's a look at the objectives as laid out by Trump and where they stand:

1. 'Completely degrading Iranian Missile Capability'

One of the prime objectives laid out by the president with Iran was to "destroy their missiles and raze their missile industry to the ground."

The administration says that the ability has been significantly degraded. But Iran is still launching missiles and drones, including aseries of barragesat Israel as Trump claimed that negotiations with Iran were underway.

Trump said Thursday at the White House that about 90% of Iran's missiles and launchers have been knocked out, and that drones and the factories where drones and missiles are manufactured "are way down."

2. 'Destroying Iran's Defense Industrial Base'

Before last week, the president and his administration sometimes listed this as a standalone objective, describing it as a goal to "raze their missile industry to the ground." Other times, this has fallen off the list. The Pentagon has generally lumped it into the first objective of destroying Iran's missile capability.

U.S. Central Command has said its targets for strikes in Iran have included weapons production and missile and drone manufacturing facilities. But Iranian attacks against its Gulf neighbors and Israel continue.

3. 'Eliminating their Navy and Air Force'

The U.S. and Israel quickly established air superiority in the skies above Iran, where they have flown largely unchallenged. Defense Secretary Pete Hegseth said Thursday that the U.S. has damaged or destroyed more than 150 Iranian vessels.

After a U.S. submarine torpedoed and sank an Iranian warship in early March, two other Iranian vessels — the IRIS Bushehr and IRIS Lavan —docked in Sri Lankaand India and sought assistance from the two countries. There has been no indication from the U.S. that they have since been sunk or captured.

Iran's Revolutionary Guard has its own navy that also relies on smaller vessels to do swarm attacks and drop mines. It is unclear how much of that force remains or whether it has planted any mines. But Iranian missiles continue to disrupt shipping through the Strait of Hormuz.

4. 'Never allowing Iran to get even close to Nuclear Capability'

Trump made a marked shift over the last year after declaring that the U.S. has "obliterated" Iran's nuclear programin June, only for his aides to warn that Iran was just weeks away from a bomb to justify the current operations.

Iranian state media said itsnuclear facilities were attacked Friday. A heavy water plant and a yellowcake production plant were struck and Israel later confirmed it was behind the strikes.

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Israel had previously announced strikes on other nuclear-related targets, including the killing of a top Iranian nuclear scientist.

One of the most pressing questions in the war is whether Trump will seek toseize or destroyabout970 pounds of enriched uraniumthat Tehran has that could potentially be used for a weapon.

Trump, for the first time on Monday, said the U.S. would retrieve the uranium, which is believed to be buried deep under a mountain facility. But he indicated that would occur if the U.S. struck some kind of deal with Iran to the U.S. to retrieve it. Without permission from Iran, seizing it would be a dangerous mission, experts say, and would require a sizable deployment of U.S. troops into the country.

5. 'Protecting, at the highest level, our Middle Eastern Allies'

Trump, in a recent social media post, added a fifth objective for the U.S: "Protecting, at the highest level, our Middle Eastern Allies, including Israel, Saudi Arabia, Qatar, the United Arab Emirates, Bahrain, Kuwait, and others. The Hormuz Strait will have to be guarded and policed, as necessary, by other Nations who use it — The United States does not!"

The U.S. already maintains thousands of troops on bases and other installations in the region. It's not clear how much further Trump is willing to go to protect Middle East allies from threats, and Iran is still able to attack those countries. It's also not clear how far the U.S. is willing to go to keep open the Strait of Hormuz. Trump has vacillated on whether the U.S. needs to take a role in policing it. He has again extended a deadline for Iran to reopen theStrait of Hormuzor face attacks on its power plants,now giving them until April 6.

Regime change is not officially on the list

Trump has spoken about regime change since the start of the war, encouraging the Iranian people to "take over your government" after Israel, assisted by the U.S., launched strikes that killed Iran's supreme leader and much of its upper echelon of leaders.

Trump and his administration, however, have never explicitly stated regime change as an objective in Iran, despite making it clear they want to end the repressive theocracy's 47-year reign.

Trump said Thursday at the White House that the regime is "largely decimated."

"You could really say we have regime change because they have been killed," he said in a Fox News Channel interview.

Now the U.S. claims to be holding talks with elements of the same Iranian government as it looks to bring a swift end to the conflict and reopen the Strait of Hormuz to maritime traffic. Iran, however, continues to publicly insist it is not negotiating with the White House.

And Trump's initial hopes for the Iranian people appear set to continue unfulfilled.

Also falling off the list: Cutting off support for Iranian proxy groups

Trump administration officials have offered few updates about this objective, which the president has described as ensuring that "the region's terrorist proxies can no longer destabilize the region or the world and attack our forces" and "ensuring that the Iranian regime cannot continue to arm, fund, and direct terrorist armies outside of their borders."

While the U.S. has struck Iranian-aligned militia groups in Iraq, and Israel appears to be expanding its operations against Hezbollah in Lebanon, the administration has not offered details about how it's going to permanently halt Tehran's support for the militant groups.

The White House said in a statement that ensuring that Iranian proxy groups cannot further destabilize the region remains a key goal and that "proxies are hardly putting up a fight because our United States Military is so strong and lethal."

Associated Press writer Konstantin Toropin contributed to this report.

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March 28, 2026

One month into Iran war, some Trump objectives are unfulfilled as he looks to wind down the conflict

WASHINGTON (AP) — President Donald Trump has listed five objectives that the U.S. wants to achieve before ending its war ...

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Ashlon Jackson's buzzer-beating trey lifts Duke past LSU

Ashlon Jackson's rim-circling 3-pointer as time expired gave third-seeded Duke an 87-85 win over second-seeded LSU in a roller-coaster Sweet 16 matchup on Friday in the Sacramento Region 2 nightcap.

The win sends Duke to the regional final on Sunday, when the Blue Devils will face top-seeded UCLA. The Bruins cruised past fourth-seeded Minnesota in the first Sweet 16 contest on Friday, 80-56.

Duke (27-8) led most of the night and by as many as 11 points, including a 78-67 edge in the fourth quarter after an 11-0 run.

LSU (29-6) rallied multiple times in the game. The teams exchanged the lead six times in the third quarter with their big spurt, punctuated with three consecutive converted and-one opportunities.

Facing another double-digit deficit in the final period, the Tigers chipped away again, however, holding Duke without a field goal for more than five minutes. LSU had an opportunity to take the lead with 37 seconds remaining after MiLaysia Fulwiley intercepted a pass near midcourt.

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However, with the Blue Devils' Taina Mair bearing down on her on the fastbreak, Fulwiley attempted a reverse layup going left-to-right that rimmed off. Duke regained possession, and LSU sent Jackson to the foul line -- where she missed both attempts with 19 seconds left.

After a disputed ball knocked out of bounds, LSU pulled ahead on a pair of Mikaylah Williams free throws with nine seconds to go.

Mair had an open look at a corner 3-pointer on the ensuing Duke possession and missed, but in the scrum for the loose ball, it went out off LSU to set up the game-winning inbounds play.

Jackson sank a 3-pointer from the right wing to cap a 19-point night.

Fulwiley led all scorers, finishing with 28 points for LSU. She added four assists and four rebounds. Williams scored 22 points in the loss, and Flau'jae Johnson had 13.

--Field Level Media

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Ashlon Jackson's buzzer-beating trey lifts Duke past LSU

Ashlon Jackson's rim-circling 3-pointer as time expired gave third-seeded Duke an 87-85 win over second-seeded LSU...

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Bank of America OKs $72.5M settlement in Epstein accusers' lawsuit

NEW YORK - Bank of America agreed to pay $72.5 million to settle acivil lawsuitbrought by women who accused the bank of facilitating their sexual abuse by Jeffrey Epstein, court records showed on March 27.

Lawyers for the bank and the women had told Manhattan-based U.S. District Judge Jed Rakoff this month they had reached a "settlement in principle," but terms of the deal were not disclosed at the time.

"While we stand by our prior statements made in the filings in this case, including that Bank of America did not facilitate sex trafficking crimes, this resolution allows us to put this matter behind us and provides further closure for the plaintiffs," a spokesperson for Bank of America said in a statement.

In a joint court filing, David Boies and Bradley Edwards, attorneys for the plaintiffs, said the settlement represented the best option for their clients "given that many Class Members suffered harm many years ago and are in need of financial relief now."

The plaintiffs' lawyers may seek up to 30% of the settlement, or about $21.8 million, for legal fees, according to court records.

The settlement requires Rakoff's approval. The judge scheduled a court hearing for April 2 to consider approving the deal.

The proposed class action, filed in October by a woman using the pseudonym Jane Doe, accused the second-largest U.S. bank ofignoringsuspicious financial transactions related to Epstein despite a "plethora" of information about his crimes because it valued profit over protecting victims.

Bank of America has said Doe alleged merely that it provided routine services to people who at the time had no known links to Epstein, and that any suggestion that it was more deeply involved was "threadbare and meritless."

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Rakoff ruled in January that Bank of Americamust faceDoe's claims that it knowingly benefited from Epstein's sex trafficking and obstructed enforcement of the federal Trafficking Victims Protection Act. Among the transactions Doe flagged were payments to Epstein by Apollo Global Management's billionaire co-founder, Leon Black.

Black stepped down as Apollo's chief executive in 2021 after a review by an outside law firm found he had paid Epstein $158 million for tax and estate planning.

Black has denied wrongdoing and said he was unaware of Epstein's criminal conduct.

Doe's lawyers have also sued other alleged enablers of Epstein's sex trafficking, and in 2023 reached settlements of $290 million with JPMorgan Chase and $75 million with Deutsche Bank on behalf of his accusers.

The lawyers are also appealing Rakoff's dismissal in January of a similar lawsuit they brought against Bank of New York Mellon.

Epstein died in a Manhattan jail cell in August 2019 while awaiting trial on sex trafficking charges. His death was ruled a suicide by New York City's medical examiner.

Reporting by Luc Cohen in New York; Editing by Rod Nickel

This article originally appeared on USA TODAY:Bank of America to pay $72.5M to Epstein accusers' lawsuit

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Bank of America OKs $72.5M settlement in Epstein accusers' lawsuit

NEW YORK - Bank of America agreed to pay $72.5 million to settle acivil lawsuitbrought by women who accused the bank o...

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Report card on America at its 250th birthday: How have we changed?

As the nation approaches its250th anniversary, its population is larger and significantly older, more racially and ethnically diverse and likelier to be foreign-born than it was at the time of the nation'sbicentennial, according to a report compiled by the Pew Research Center.

The U.S. population has grown to 340 million over the past 50 years, an increase of more than 120 million people, the center said. Much of that growth, it said, has been driven by immigrants, longer life spans, and an increase in Asian andHispanic Americans.

As the 1970s got underway, theBaby Boom generationwas still between 6 and 24 years old, noted Ken Johnson, a professor of sociology at the University of New Hampshire not connected to the report.

"It was the first generation where many women went to college," Johnson said. "Older generations were relatively small, having been born during the war and Great Depression. And immigration was picking up, but it had been modest for decades before."

The Baby Boom generation was the first to have many women with higher education, Johnson said. The resulting opportunities led many women to marry later and have fewer children, patterns that would endure in later generations.

That bears out in thePew analysisof U.S. Census data, which shows Americans today less likely to be married and women more likely to have college degrees.

However, economic gaps have widened, the center said, despite many people being better off financially than they were a half-century ago.

With the Baby Boom cohort now ranging from 62 to 80 years old, the share of Americans aged 65 or older has nearly doubled from 10% to 18%, the center said. While the nation's median age has risen across racial and ethnic groups, the increase is sharpest among White Americans (from 30 to 45 years old) and Black Americans (from 21 to 36 years old).

Immigrants carve out a niche

Since 1970, the center said, non-Hispanic White Americans have formed an increasingly smaller share of the U.S. population, falling from 83.5% to 56.3%. Meanwhile, Asian Americans have climbed from less than 1% to 6% today, while Hispanics, just 4.4% of the population in 1970, now comprise 20%.

The share of foreign-born people in the U.S. has more than tripled since 1970, rising from an all-time low of 4.7% to 14.8% in 2024, the center said. The numbers are highest among Asian and Hispanic Americans and most concentrated in the West and Northeast United States.

Johnson noted that White Americans are largely older and no longer having children, while many immigrants are of younger, childbearing age with above-average fertility rates.

"The diversity of the U.S. population is greatest for young children and least for the oldest part of the population," he said.

Census Bureau datareleased this week shows immigration has slowed throughout the country, with nine out of 10 U.S. counties experiencing lower immigration levels between July 2024 and July 2025 compared to the year before.

Meanwhile, the Pew Center analysis found America's population has shifted geographically as well, moving toward Southern and Western states.

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In 1970, it said, less than half of the U.S. population lived in the American South (31%) and West (17%). Today, more than six in ten people live in the Sunbelt, with White Americans comprising about half or less of the population there.

Division over diversity's benefits

The center said Americans largely view the nation's racial and ethnic diversity, and efforts to promote it in the workplace, as positive. However, it found Americans divided along racial, ethnic and party lines about its impact on American culture and about DEI efforts on a fair society.

The Pew Center gauged those sentiments late last year and released thesurvey resultsin conjunction with its half-century analysis.

Three-quarters of U.S. adults – including 86% of Democrats and 66% of Republicans – view racial and ethnic diversity as good for the country, the center said.

While 62% of the nearly 14,000 respondents surveyed in late 2025 said diversity positively American culture, they were sharply divided among party lines: Just 45% of Republicans said diversity had a positive impact, compared to 82% of Democrats.

Nearly two-thirds said it was very or somewhat important for U.S. companies and organizations to promote diversity, down from 75% in a Pew survey conducted in 2019. With the share of Democrats edging up a point to 87%, the decline was mostly among Republicans: Just 40% of Republicans said such efforts were important, compared to 61% in 2019.

Likewise, Americans were divided on whether such efforts lead to a fairer society: While 65% of Democrats say diversity efforts have made society fairer, just 18% of Republicans felt the same.

Respondents broke along racial and ethnic lines as well. Only 38% of White adults said diversity efforts in workplaces and schools have made society fairer, compared to 53% of Black adults, 48% of Asian adults and 46% of Hispanic adults.

America's altered households

The American family has changed substantially in the last half-century, the center said. Americans now marry and have children later in life than they once did, and while U.S. women averaged about three children in 1970, the number has hovered closer to two over the last several decades.

About half of American adults are married today, down from 69% in 1970, with the decline steeper for adults without a four-year college degree. While the portion of adults aged 50 and older who have never been married has risen from 7% to 10%, the share has tripled for Black adults, from 7% to 21%.

Children in the U.S. are much less likely to live with two married parents than they were a half-century ago, the center said, with the share falling from 82% to 63%. The decline has taken place across racial and ethnic groups – except for households headed by Asian adults, which fell only slightly from 87% to 83%.

Meanwhile, 22% of Americans now live in multigenerational households, the center said, compared to 13% in 1970. The increase has been highest among Black, Hispanic and Asian Americans, climbing to 30% for those groups compared to 16% for White Americans.

"A lot of Asian Americans still live in high-cost housing markets," said Melany de la Cruz-Viesca, deputy director of the Asian American Studies Center at the University of California Los Angeles. "If they live in California or New York, it's more likely they feel comfortable living together. There's a lot of stigma around risky spending, and a belief that it's better to save and not be in debt than to be on your own."

This article originally appeared on USA TODAY:Report card on America at its 250th birthday: How have we changed?

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March 28, 2026

Report card on America at its 250th birthday: How have we changed?

As the nation approaches its250th anniversary, its population is larger and significantly older, more racially and ethnic...

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World’s tallest bridge and biggest museum named ‘greatest places of 2026’

China's robot restaurant, the challenges of African airspace, plus TIME's pick of the best places to visit in 2026. Here's what's happening in Travel.

TIME's 'greatest places'

A heap of shiny new parks, museums, cruises, hotels and attractions have made it into TIME magazine's 100 "greatest places of 2026," providing a great excuse to freshen up your bucket list.

Huajiang Grand Canyon Bridge, which opened in September 2025, is the world's tallest bridge, rising some 2,050 feet above the Beipan River in southeast China. As well as cutting commuters' travel time over the canyon from two hours to two minutes, it's a tourist attraction, too, with a glass walkway, panoramic cafe and bungee jumping among the emerging treats.

TheGrand Egyptian Museumin Giza is the world's largest museum dedicated to a single civilization. It was two decades in the making, and its budget ballooned to more than $1 billion, but it finally opened in November 2025. The array of treasures on display is a huge leap forward for Egyptology.

Check out CNN's stories on some of the other selected destinations:Surf Abu Dhabiand Abu Dhabi'sZayed National Museum,Reefline Miami,Universal Epic Universein Orlando,Jumeirah Marsa Al Arabin Dubai,Six Senses Laamuin the Maldives and theMSC World Americacruise ship. The full TIME list ishere.

Destination inspiration

Samurai treasures, a hidden-gem temple and the world's youngest Communist capital: here are three CNN Travel picks of where to travel in Asia.

Haedong Yonggungsa Templehas become one of the most recognizable temples in Busan, South Korea, but beyond its beauty, there's a deep and surprising history.

Japan's stunning Seto Inland Sea is an excellent destination for island-hopping around theGeiyo archipelago. The six islands are connected by a 43-mile highway and bicycle path, making it both convenient and accessible.

Landlocked Laos gets far fewer tourists than its beach-blessed neighbors Thailand and Vietnam. However,Vientiane, which just marked 50 years as the capital of the Lao People's Republic, is an easy-going, manageable city with thriving street food and independent music scenes.

Spotlight on Africa

TheGreat Rift Valleyis an epic series of valleys and mountains carving its way 3,000 miles through East Africa and beyond. South African photographer Shem Compion has spent 20 years documenting its landscape, people and wildlife, and gathered it all in a new book, "The Rift: Scar of Africa."

InAngolain southern Africa, the National Museum of Slavery in Luanda is working to reconnect descendants of enslaved people with their family history and to preserve its collection for future generations.

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A digitized version of the archives is in the works, says museum director José António Fazenda. "We want people who are here and want to learn more to have a place where they can," he says.

African tourism is hampered by lack of connectivity in the continent's aviation sector, which is in need of more investment in infrastructure, safety oversight and a regional hub. The potential, however, is huge, andunlocking Africa's airspacecould be a multi-billion dollar opportunity.

Robots at the restaurant

Robots chop, stir, and cook more than 100 dishes in thisexperimental restaurantin China, with noodles ready in just three minutes — and no humans running the kitchen.

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World’s tallest bridge and biggest museum named ‘greatest places of 2026’

China's robot restaurant, the challenges of African airspace, plus TIME's pick of the best places to visit in 202...

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Nepal's former prime minister Oli arrested over deaths during Gen Z protests

By Gopal Sharma

Former Nepal Prime Minister and Chairman of the Communist Party of Nepal, K.P. Sharma Oli gestures while being taken to a hospital from the District Police Range after his detention by police, in Kathmandu

KATHMANDU, March 28 (Reuters) - Nepal's former prime minister, K.P. Sharma Oli, was arrested on Saturday as police investigate whether he was negligent in failing to prevent dozens of deaths in a ‌crackdown on Gen Z-led anti-corruption protests last September, officials said.

Oli's arrest, which his lawyer said was illegal ‌and sparked protests by supporters who clashed with police, followed rapper-turned-politician Balendra Shah's swearing in as prime minister on Friday and a recommendation by ​a panel investigating violence during the protests that he should be prosecuted for negligence.

His former home minister, Ramesh Lekhak, was also arrested.

Seventy-six people were killed last September during a police crackdown and arson and violent unrest during the protests, which led to Oli's resignation.

After his arrest on Saturday, supporters staged protest rallies and clashed with police who tried to stop them ‌burning tyres near the prime minister's office. ⁠Police lobbed a teargas shell and used batons to break up the protests, injuring one person, witnesses said.

Oli's Communist Party of Nepal (Unified Marxist Leninist) called his arrest illegal and said ⁠it was an act of "revenge". It demanded his immediate release and said more protests were planned for Sunday.

Shankar Pokhrel, a senior party official, told reporters that protest notes against the arrest would be handed to the government in all 77 districts of ​the country ​on Sunday.

Home Minister Sudan Gurung dismissed the criticism, saying on ​Facebook: "It is the beginning of justice. The country ‌will take a new direction now."

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ELECTION DEFEAT

Oli was prime minister four times between 2015 and 2025 but never served a full five-year term. In 2020, he published a new political map including in it a small stretch of disputed land controlled by India, giving him a popularity boost in Nepal.

His popularity did not last, and he was beaten by Shah in his home constituency in an election this month, his second defeat since the restoration of multi-party democracy in ‌1990. Anger over the deaths in September's protests helped Shah's Rastriya ​Swatantra Party win the election by a landslide.

The panel investigating last ​September's violence held Oli and Lekhak responsible for ​not taking any action to stop hours of firing on the protesters by police.

Police spokesperson Om ‌Adhikari said Oli and Lekhak would be brought ​to court on Sunday.

Oli, 74, ​who has had two kidney transplants, has been transferred to a hospital from the police office where he was first taken, witnesses said.

His lawyer, Tikaram Bhattarai, told Reuters that the arrest was unwarranted and would be challenged ​in the Supreme Court.

"They have said ‌it (the arrest) is for investigation. It is illegal and improper because there is no risk of him ​fleeing or avoiding questioning," he said.

Lekhak and his lawyer could not immediately be reached for comment.

(Reporting ​by Gopal Sharma; Editing by Edwina Gibbs and Timothy Heritage)

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Nepal's former prime minister Oli arrested over deaths during Gen Z protests

By Gopal Sharma Former Nepal Prime Minister and Chairman of the Communist Party of Nepal, K.P. Sharma Oli ...

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Once a luxury for moms, doula care is going mainstream

MEMPHIS, Tenn. (AP) — Shaquoiya Stewart held one of her 6-month-old twins on her lap while Shanille Bowens held the other. As the women caught up and thebabiesstared at each other quietly, Bowens came around to the key question she asks all themothersshe works for: "Do you think there's anything you need more support with?"

Doulas Mainstream

Bowens is adoula, a provider of physical and emotional support before, during and after birth — care that used to be seen as a luxury and was available only to those who could afford it. But doulas are becoming mainstream.

The country's once-reluctant medical establishment is increasingly welcoming the way doulas complement doctors and nurses, and with insurance coverage growing fast, parents from across the economic spectrum can now take advantage.

More than 30 states reimburse doulas through Medicaid or are in the process of implementing such coverage, up from 14 in late 2022, according to the nonprofit National Health Law Program. Private insurers are starting to do the same, with industry giant UnitedHealthcare launching a new benefit this year. Without insurance, costs vary widely but can exceed $2,000.

The changes are being driven by mounting research that shows these trained, non-medical professionals can significantly improve the health of moms and babies. Expanding doula care, experts say, is a relatively inexpensive way to help reduce maternal mortality, which killsBlack motherslike Stewart at a rate more than three times higher than white women.

"Doulas can benefit everybody," said Sierra Hill, maternal care access coordinator for Minnesota's health department. "And that's especially true for our communities that are facing a lot of inequities and health disparities."

Stewart, who has Tennessee Medicaid, said Bowens shepherded her through the jitters of early pregnancy with her twin sons, blood pressure issues during delivery, a C-section and baby blues after birth.

"I felt safe. It didn't feel like I was just by myself," said Stewart, a 35-year-old single mother of four. "She was like my homegirl."

Awareness of doulas has grown

In 2006, 3% of women in the U.S. got care from a doula during labor, according to a survey conducted for the nonprofit Childbirth Connection, now a program of the National Partnership for Women & Families. That figure has doubled or tripled since then, researchers estimate.

When Bowens was pregnant with the first of her six children more than two decades ago, a counselor recommended a doula.

"I'm like, 'A doula, what is that?'" Bowens recalled.

Bowens was so inspired by the care she received that she ultimately became one herself. In addition to answering moms' questions and connecting them to community services, Bowens helps her clients navigate the health system and advocates for them.

"Oftentimes, we become friends with our clients – lifelong friends. We help connect them with resources in the community," said Bowens, founder of Naturally Nurtured Birth Services. "We cater to them … so it looks different for each client."

That help pays off, especially for moms from underserved communities.

Research comparing two groups of socially disadvantaged mothers found that those who used doulas were four times less likely to have a baby with low birth weight, two times less likely to have a birth complication and much more likely to start breastfeeding. Another study published last year found that Medicaid recipients with doulas had a 47% lower risk of C-sections and a 29% lower risk of preterm birth and were 46% more likely to go to a postpartum checkup.

That postpartum finding is key, said April Falconi, a scientist at Carelon Research who co-authored the recent study. More than half of maternal deaths occur during the postpartum period, she said. Causes include infection and excessive bleeding.

These sorts of results led Minnesota to become one of the first states to cover doulas through Medicaid in 2014. A decade later, the state expanded coverage, allowing Medicaid recipients 18 sessions with a doula without prior authorization, more than double what was allowed before.

"The return on investment is huge," the health department's Hill said.

Rising acceptance of doulas by doctors and nurses

There are no mandatory licenses for doulas, but there are state qualification standards to receive Medicaid payments and many doulas seek certification from private entities.

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Naturally Nurtured is involved in a pilot project in Memphis in which doula services are paid for under a Tennessee Medicaid program run by UnitedHealthcare. Services are free to members.

UnitedHealthcare commercial clients with a doula benefit, on the other hand, get reimbursed for the care. Doulas are also included in a limited but growing number of other private plans.

"I see doulas becoming more and more integrated and accepted by all within the health care system," said Dr. Margaret-Mary Wilson, chief medical officer at UnitedHealth Group.

That extends to doctors and nurses in hospitals.

Dana Morrison, principal director of Doulas of Duluth in Minnesota, said there "was definitely" resistance to doulas by birth teams when she began her work 10 years ago. That was also true nationally. One point of friction was when doulas advocated for something different from what the medical professionals wanted. And since doulas weren't as integrated into care, they didn't have the time to build trust with doctors and nurses.

Today, Aspirus St. Luke's hospital contracts with Doulas of Duluth on a grant-funded program, and patients can receive a scholarship to hire a doula through the organization.

Nurse Mallory Cummings, doula coordinator at Aspirus St. Luke's, said people on the birth team accept and appreciate doulas. "What it really comes down to is everyone's knowledge of what a doula is," she said.

Doulas support moms through trying times

On a recent afternoon, Mary Bey settled into a chair in a homey room at the Memphis doula center, cradling her sleeping infant, Ca'Mya. Bowens sat beside her, taking notes on her laptop.

After discussing breastfeeding and sleep, they talked about how Bey, 39, has been crying a lot since the delivery.

"What brings it on?" Bowens asked.

"I'll be scared and I'll just be so protective and treat her like she's just glass," Bey replied.

Bey is haunted by a past loss. Before giving birth to her daughter last December, she suffered a stillbirth. Bowens helped her through.

"She was there when I had to push him out. She was there after, when I was healing. She came to the house. She brought groceries," said Bey, a single mother of four who was connected with Bowens through the same pilot program as Stewart.

When Bey got pregnant again, she texted Bowens: "Hey, can you still be my doula?"

As the pregnancy progressed, Bowens answered all of Bey's questions and kept her calm. She was there for Bey's scheduled C-section and supported her when doctors monitored Ca'Mya for jaundice and what they briefly thought was a heart problem.

Later, Bey worried her C-section scar might be infected. Bowens advised her to get it checked out. It was.

Without her doula, Bey said she would never have gotten through either pregnancy as well as she did, physically or emotionally.

"She makes you feel like she's family," Bey said. "She was a friend — my best friend — a cousin, an auntie, a sister. All of the above."

The Associated Press Health and Science Department receives support from the Howard Hughes Medical Institute's Department of Science Education and the Robert Wood Johnson Foundation. The AP is solely responsible for all content.

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March 28, 2026

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