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Guaranteed income in pregnancy has the potential to improve racial inequities in the health of infants and birthing people by mitigating financial stress. Racial inequities in pregnancy outcomes persist despite interventions to promote access to prenatal care, healthy behaviors and stress reduction. There is a growing consensus that to remedy these inequities, racism must be addressed as a root cause. San Francisco is home to a shrinking Black and Pacific Islander population, with significant disparities in preterm birth (13.8% and 10.4%, respectively, compared to 7.3% among white women), and extreme income inequality. Evidence points to economic inequality as a key contributor to birth disparities, but there is limited research exploring economic interventions as a health equity strategy. Building on evidence from Earned Income Tax Credit and international cash transfer evaluations, the Abundant Birth Project (ABP) is a pregnancy income supplement pilot program targeted towards Black and Pacific Islander pregnant people in San Francisco. This presentation will describe the community-centered design process and implementation of the ABP pilot.
Methods
Using a community-based participatory research approach, four community researchers were trained in qualitative methods and conducted in-depth interviews with 21 currently or recently pregnant San Franciscans to investigate financial needs and stress during pregnancy, experience with service programs, and health concerns. Findings from these interviews along with two human-centered design sprints, allowed community members to collaboratively design the ABP program.
Results
All participants experienced stress during their pregnancies, mostly related to the high cost-of-living in San Francisco during their pregnancies. Participants were overwhelmingly supportive of an unconditional income supplement during pregnancy, given that many had incomes that were currently too low to meet the cost of living in San Francisco but too high for benefits through social services. Participants’ past experiences with social services were positive overall, but many cited the recertification processes as administratively burdensome. Despite support for the income supplement, many participants’ narratives reflected internalized stigma that translated into concerns that the people would “take advantage” of the program and suggestions for restrictions to prevent possible “misuse” of the supplement funds.
From the interviews, design sprints, and continuous discussions with community, ABP was designed to provide $1000 a month for one year to Black and Pacific Islander pregnant San Franciscans, beginning during their pregnancy. The unconditional funds will be delivered through a debit card, and participants will be offered optional case management and financial empowerment services. Anticipating a greater demand for this program than funding will allow, an “Abundance Drawing” will randomly select recipients of the supplement from the pool of eligible applicants. The program is set to launch in mid-2021.
Conclusions and Implications
It is feasible to implement community-centered design of a guaranteed income program for pregnant Black and Pacific Islander people, including training community members as qualitative researchers and human-centered design facilitators. This presentation will reflect on lessons learned from the program design process and launch, including the implications of conducting this work during the COVID-19 pandemic.