In the United States, racial disparities in birth outcomes continue to persist with income inequality being one of the key contributors. Structural interventions that reduce the racial-wealth gap are urgently needed and have the promise to narrow longstanding inequities. In a community-academic partnership, Expecting Justice piloted the first pregnancy income supplement program in the US, the Abundant Birth Project (ABP). ABP will provide unconditional cash supplements to Black and Pacific Islander mothers as a strategy to reduce preterm birth and improve economic outcomes for our communities. ABP is an opportunity to transform San Francisco into a city where all children have a healthy start at life.

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.

The pilot was a fully-funded public-private partnership designed under the collaborative change model, a process that 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.

Since the summer of 2021, the Abundant Birth Project has given $1,000 per month to nearly 150 pregnant and postpartum people residing in San Francisco. It was announced in December 2022, that the program will receive $6.5 million in city and state funding and will expand its services Alameda, Contra Costa, Los Angeles, and Riverside counties.