The city of San Francisco wants to test a novel approach to get at the decades-long, pernicious problem of Black and brown women dying at far higher rates than whites in pregnancy and childbirth: Give them money.
On Monday, Mayor London Breed announced the launch of the Abundant Birth Project, a pilot program that would give about 150 low- and middle-income Black and Pacific Islander expectant parents $1,000 per month throughout their pregnancies and for at least six months after the birth of their children — no conditions attached.
The idea of the project, led by Dr. Zea Malawa at the San Francisco Department of Public Health, is to ease one of the biggest factors adversely affecting pregnant people’s health — and particularly the health of pregnant Black and brown women: stress.
“We’re trying to address the racism directly and instead of trying to change Black women — because there isn’t anything wrong with them — we’re trying to change the environment so it doesn’t have to be so stressful,” Malawa said.
In an expensive city like San Francisco, the monthly stipend would go a long way toward covering necessary expenses for a healthy pregnancy, like transportation to health appointments, secure housing and food in the fridge.
Nationwide, Black women are three times more likely to die from pregnancy-related complications than whites. Black families represent only 4% of births in San Francisco, but half of the city’s maternal deaths are those of Black women and 15% of infant deaths are those of Black babies, while Pacific Islander babies are the second most likely group to die at birth, the mayor’s office says. The two groups also have the highest preterm birth rates in San Francisco.
Meanwhile, Black and Pacific Islander families are at the bottom of a stark racial wealth gap in the city, with median household income around $30,000 for Black families and around $67,000 for Pacific Islander families, compared to over $104,000 for residents of the city at large.
The study will look at how participants’ health is affected and could expand to other counties if it’s found to be successful. The project will be the first of its kind in the U.S., Malawa said, to test if an income supplement for pregnant people reduces maternal mortality, low birth weight and premature babies — and specifically whether it helps close the racial gap in those outcomes.
“For a very long time, Black mothers and other mothers of color have been in crisis, and this country has not done anything to support or help them from the manifestations of our racism,” Malawa said. “My goal is that, in the U.S, no matter your race, you can have a healthy pregnancy. That’s all I want. Unfortunately, that feels huge.”
The project — which is a public-private partnership, funded so far with about $200,000 from the San Francisco Department of Public Health and over $1 million in philanthropic funds — will enroll its 150 or so participants over the next two years.
The idea of a basic income, or free money with no conditions, to improve economic and other outcomes for low-income people is not new. It’s been tested at significant scale in countries such as Kenya and India with positive results like improved nutrition, and in Finland, where preliminary results showed improved health and well-being. And basic income became a popular topic in the Democratic presidential primary when candidate Andrew Yang pushed it.
Here in the U.S., the young mayor of Stockton, California, is currently running a pilot program giving $500 to 125 residents, and so far, recipients have spent it largely on food and utility bills. And a small-scale program in Mississippi gave $1,000 per month to Black moms, who said it made a difference.
But these programs haven’t focused specifically on pregnant women and their health outcomes.
A larger-scale, more similar initiative in the Canadian province of Manitoba gave about $60 per month, no strings attached, to thousands of low-income pregnant people, starting in 2001, and there were positive results in lowering the rates of pre-term and low birth weight babies, according to a 2018 study.
However, free money isn’t the only way to help close the racial disparities in health outcomes for pregnant people, Malawa cautioned. “Racism has many different manifestations and economic alienation is only one,” she said. Her initiative at the San Francisco Department of Public Health, Expecting Justice, also has a program to provide Black pregnant people access to doulas, who can provide support pre- and post-partum and help advocate for their patients’ care.
Malawa is optimistic about the outcomes of providing cash support to Black and Pacific Islander expectant parents, particularly in San Francisco — a city that prides itself on its liberal politics but where years of gentrification have pushed out families of color to the point that “there are more Black Lives Matter signs than Black people,” she said.
“I feel like people want to address anti-Black racism and just don’t know what to do, especially at a government level,” Malawa said. “What feels exciting about this project, in this moment, is we are demonstrating what it looks like to address racism in health equities, because rather than trying to change moms, we’re trying to change the system.”