San Francisco to Provide $1,000 Per Month to Expecting Black and Pacific Islander Moms to Combat Infant Mortality

San Francisco Mayor London N. Breed, in partnership with Expecting Justice, announced this week the  launch of the Abundant Birth Project, a pilot program that provides targeted basic income to women during pregnancy and after giving birth.

The pilot will provide an unconditional monthly income supplement of $1,000 to approximately 150 Black and Pacific Islander women in San Francisco for the duration of their pregnancy and for the first six months of their baby’s life, with a goal of eventually providing a supplement for up to two years post-pregnancy.

Expecting Justice, a collective impact initiative led by Dr. Zea Malawa at the San Francisco Department of Public Health and supported by the Hellman Foundation and the UCSF California Preterm Birth Initiative, will study the resulting health impacts of the pilot program, which is the first of its kind in the United States.

The Abundant Birth Project is a simple, yet novel, approach to achieving better maternal health and birthing outcomes: provide pregnant Black and Pacific Islander women a monthly income supplement for the duration of their pregnancy and during the postpartum period as an economic and reproductive health intervention.

Prematurity is a leading cause of infant mortality and has been linked to lifelong conditions, such as behavioral development issues, learning difficulties, and chronic disease. In San Francisco, Black infants are almost twice as likely to be born prematurely compared with White infants (13.8% versus 7.3%, from 2012-2016) and Pacific Islander infants have the second-highest preterm birth rate (10.4%).

Furthermore, Black families account for half of the maternal deaths and over 15% of infant deaths, despite representing only 4% of all births. Pacific Islander families face similar disparities.

“Providing guaranteed income support to mothers during pregnancy is an innovative and equitable approach that will ease some of the financial stress that all too often keeps women from being able to put their health first,” said Mayor Breed.

“The Abundant Birth Project is rooted in racial justice and recognizes that Black and Pacific Islander mothers suffer disparate health impacts, in part because of the persistent wealth and income gap. Thanks to the work of the many partners involved, we are taking real action to end these disparities and are empowering mothers with the resources they need to have healthy pregnancies and births.”

The project is a fully funded public-private partnership designed under the collaborative change model, a process which directly involves all impacted and interested parties in decision-making.

The Abundant Birth Project entered its design phase after receiving a Hellman Collaborative Change Initiative grant from the Hellman Foundation, and has since gone on to also receive an award of $1.1 million from Jack Dorsey’s #startsmall campaign, $200,000 from Genentech, and $200,000 from the San Francisco Department of Public Health.

Additional funders include California Preterm Birth Initiative at UCSF, WKKF (Kellogg Foundation), San Francisco Health Plan, Tipping Point, Economic Security Project, Walter and Elise Haas, San Francisco Foundation, and Friedman Family Foundation.

“Structural racism, which has left Black and Pacific Islander communities particularly exposed to COVID-19, also threatens the lives of Black and PI mothers and babies,” said Dr. Zea Malawa.

“Providing direct, unconditional cash aid is a restorative step that not only demonstrates trust in women to make the right choices for themselves and their families, but could also decrease the underlying stress of financial insecurity that may be contributing to the high rates of premature birth in these communities. It is exciting to be in a city that not only calls out racism as a problem, but also takes steps to heal the wounds left by decades of injustice and anti-Black sentiment.”

“San Francisco has seen lasting health disparities in the Black and Pacific Islander communities, which we cannot allow to continue,” said Dr. Grant Colfax, Director of the San Francisco Department of Public Health. “The Abundant Birth Project addresses those disparities in a positive and active way, to directly benefit expecting mothers and their babies in those communities.”

One theory for these unacceptable disparities is the growing racial wealth gap in San Francisco. Even before the pandemic, Black and Pacific Islander families faced some of the greatest degrees of income inequality in San Francisco. The median annual household income for Black and Pacific Islander families in San Francisco is close to $30,000 and $67,000 respectively, compared with over $104,000 citywide.

The Abundant Birth Project will work with local prenatal care providers and the City’s own network of pregnancy support services to identify and enroll eligible clients over the next two years. The project will target low-income and middle-income pregnant people with the income supplement given the high cost of living in San Francisco.

The community itself was involved at every phase of development of the Abundant Birth Project program. Black and Pacific Islander mothers were part of the design team and have been recruited and trained as community researchers to engage pregnant mothers and women with children to obtain accurate on-the-ground data about the actual needs of potential participants.