The Abundant Birth Project

There are longstanding racial inequities in birth outcomes in the US, which medical interventions have failed to eliminate. Chronic and acute stress are important drivers of these inequities. Economic stress may be particularly acute during pregnancy, when income is volatile, and families can experience shifts in housing, employment, and healthcare and childcare costs. The racial wealth gap that has resulted from a history of exclusion of Black families from economic opportunity means that Black families are more vulnerable to this economic stress during pregnancy, putting them at greater risk of preterm birth, especially during the COVID-19 pandemic. Expecting Justice is piloting the first pregnancy income supplement program in the US. The Abundant Birth Project (ABP) will provide guaranteed income of $1000 per month for 12 months during pregnancy and after birth to 150 Black and Pacific Islander (PI) pregnant women in San Francisco—two groups that experience disproportionately high rates of adverse birth outcomes. Led by community researchers and using a human-centered design process, ABP will be designed to meet the needs of the communities who will benefit from the program.

This innovative project will provide an opportunity to contribute to the growing national conversation surrounding basic income as a COVID relief, poverty remediation, and resilience strategy for health equity. It will also allow the communities most affected by adverse maternal and child outcomes to have an active voice in shaping the solution because the project will integrate community members throughout the entire process. ABP focuses on economic relief as a mechanism to buffer the effects of centuries of economic exclusion of Black and Pacific Islander communities—all the more important with the health and financial impacts of COVID-19 for these communities. Interventions that provide income during pregnancy may impact maternal and infant health through several pathways, including reductions in stress associated with financial insecurity and increases in material resources such as housing, nutrition, healthcare access, and transportation. If we achieve our aims, ABP will reduce economic stress, improve maternal mental health, and reduce racial inequities in adverse birth outcomes for Black and Pacific Islander communities in San Francisco. ABP will be evaluated by our research partners at UCSF and UC-Berkeley, ensuring that our learnings can be translated to future policy and program development. Using racial equity as a framework, the pregnancy income supplement program will address the upstream impacts of racism by mitigating financial insecurity and associated stress. Based on deep engagement with community and other stakeholders, we believe this program is imperative to ensure safe and healthy childbirth in our city.

Vision

Basic Income for Healthy Births

ABP is the first pregnancy income supplement program in the US. ABP is crucial for Black and Pacific Islander families, two groups that have been excluded from wealth-building opportunities and most affected by COVID-19. As racism takes a great toll on the health of Black and PI pregnant people, ABP has an opportunity to meaningfully buffer against stress caused by economic inequities.

Expecting Justice

Model and Strategy

Impact

Leadership

Zea Malawa, MD, MPH