San Francisco, CA — Mayor London N. Breed, in partnership with Expecting Justice, today announced 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.

“The Abundant Birth Project is exactly the kind of innovative, community-driven social policy solution that the Hellman Collaborative Change Initiative was designed to support,” said Susan Hirsch, Executive Director of the Hellman Foundation. “When we made the first grant to this project a year ago, we did so cognizant of the fact that Black and Pacific Islander mothers have long faced structural racism that impacts the ability to have healthy birth outcomes, and that for too long those concerns went unaddressed by those in power. What we never could have imagined was how the current pandemic would rip open a chasm within our society and make clear exactly why we all must listen to those with lived experiences — the very people who have been sounding the alarm and providing cogent and restorative solutions all along. It is our responsibility not just as a donor community but as human beings to listen to one another, to encourage others to do the same, and to partner with local government to address seemingly intractable problems that are the consequences of years of inequality.”

“Despite decades of research and investment in clinical and behavioral interventions, the racial inequities in preterm birth persist, with Black and PI pregnant people the most affected in San Francisco,” said Dr. Larry Rand, Principal Investigator of the UCSF Preterm Birth Initiative, funded by Marc and Lynne Benioff. “So, it’s crucial that we focus our efforts on developing more upstream interventions like the Abundant Birth Project to really turn the curve on the preterm birth epidemic. We feel very fortunate to be a partner in this truly innovative project and in a city that is supportive of research that is rooted community wisdom and racial justice. By improving outcomes for those who experience the worst outcomes, we can improve outcomes for all pregnant people.”

“Two years ago as Supervisor, I helped launch a citywide doula program in partnership with Expecting Justice and DPH,” said Malia Cohen, member of the California State Board of Equalization and San Francisco Police Commissioner. “This work left a tremendous impact on my personal life. I recently gave birth outside of a hospital with support from a dedicated team of midwives and doulas. The Abundant Birth Project is a smart, groundbreaking proposal that will enrich childbirth for so many, helping pregnant women and new mothers navigate an extremely delicate moment in life. I’m so proud of the hard work and collaboration that brought us to this point and I am hopeful that this caring approach to benefits distribution will substantively reduce the financial burden associated with birth and help us to increase positive birth outcomes for mother and baby.”

Led by Expecting Justice, a Black-led Birth Justice initiative based in the San Francisco Department of Public Health grounded in the principles of collective impact, the Abundant Birth Project is a collaboration between the Department of Public Health, the California Preterm Birth Initiative at UCSF, UC Berkeley School of Social Welfare, the San Francisco Human Rights Commission, the San Francisco Treasurer’s Office, the San Francisco Human Services Agency, and First 5 San Francisco.

Expecting Justice

Expecting Justice is taking an innovative, multicomponent approach to reduce the astonishing rates of preterm birth and infant mortality among Black and Pacific Islander communities. Using a racial equity framework, the approach includes a focus on increasing access to community doula care, increasing economic access in Black and Pacific communities, and anti-racism promotion within San Francisco’s programs, services and institutions.

Hellman Foundation’s Collaborative Change Initiative

The Collaborative Change Initiative was created to honor legendary philanthropist Warren Hellman. His tenacious, pragmatic and creative approach to collaborative change brought diverse stakeholders together to roll up their sleeves and tackle tough local challenges. The initiative also reflects the priorities of the current Hellman Foundation leaders, who are driven by an agenda for fairness and justice for Bay Area communities and believe in the power of collaboration as a strategy to impact these goals. ​Since 2014, the Hellman Collaborative Change Initiative has awarded close to $5.5M to enable collaborations in Alameda and San Francisco Counties to scale exciting solutions and impact systems, tackling disparities in health, education and opportunity.

UCSF California Preterm Birth Initiative (PTBI)

The UCSF California Preterm Birth Initiative (PTBI) is a research enterprise whose mission is to eliminate racial disparities in preterm birth and improve health outcomes for babies born too soon through research, partnerships and education grounded in community wisdom. PTBI conducts and funds transdisciplinary research to identify promising interventions that can turn the curve on the preterm birth epidemic and create positive change for Black and brown families. Funded by Lynne and Marc Benioff, PTBI asserts structural and interpersonal racism along with other key social determinants are important drivers of an epidemic that disproportionately affects women of color in our state, and nationally.

#STARTSMALL

#startsmall is Jack Dorsey’s philanthropic initiative to fund global COVID-19 relief, girls’ health and education, and efforts towards Universal Basic Income. Dorsey transferred $1 billion (28% of his wealth) to #startsmall in 2020.

###