Background: There is growing national momentum for basic income as a poverty reduction and equity-generating strategy. Here, we build the case for basic income as a structural intervention to reduce racial inequities in family health. We will discuss 1) a review of the literature on cash transfers and family health and 2) preliminary evidence or potential impact of unrestricted cash as a narrative disrupter on our notions of who is deserving/undeserving by race and gender.

Methods: We conducted a critical review of evidence from published literature and ongoing basic income studies. We also have extensive expertise in narrative change and have studied how unconditional cash can move people’s thinking on who is seen as fully human and deserving of living a life with dignity and choice and who does not.

Results: Evidence from international contexts as well as natural experiments of income policies reveals income supplementation as a promising intervention to reduce racial inequities in family health. We will present findings from our racial and gender economic justice narrative change work.

Conclusions: This session will cover the preliminary evidence from your program/policy perspective here], as well as policy recommendations for sustainability. We will present the state of the evidence for income supplements/basic income as a public health intervention for family health.

Background: Racial disparities 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 inequalities. Evidence points to SES as a key contributor to Black-White birth outcome disparities, but there is limited research exploring economic interventions as public health solutions. Building on evidence from earned income tax credit and international cash transfer evaluations, the Abundant Birth Project is a pregnancy income supplement targeted towards Black and PI communities.

Methods: Using human centered design and CBPR methods, community researchers conducted formative research, including in-depth interviews to assess financial needs and stress during pregnancy, experience with service programs, and health concerns. These results are being used to collaboratively design the first pregnancy income supplement program in the US to address the upstream impacts of racism by reducing poverty and associated stress.

Results: Our interviews with stakeholders indicate that pregnant people face significant barriers to financial stability. We will present themes from qualitative research, including how financial needs, experiences and stress may impact birth equity. We will present our implementation strategy and lessons learned while building this initiative.

Conclusion: Addressing birth disparities requires robust community engagement and innovative upstream approaches that addresses structural racism as a root cause.

Our study aims to understand if there is an association between neighborhood police exposure and preterm birth for white and black women living in Minneapolis who gave birth in 2016 at the largest hospital system in Minnesota.

Our data came from the administrative and medical records of the Fairview Health System, one of the largest maternity care providers in the Minneapolis-St. Paul area. Our analytical sample included Black and White women who gave birth to live singletons from January 1st to December 31st, 2016 and lived in one of the 116 census tracts that make up the City of Minneapolis plus the 15 bordering census tracts. The final sample included 745 White, 121 US-born Black and 193 foreign-born Black women. The dependent variable for this study is PTB. Independent variable is neighborhood police exposure measured at the census tract level. Police incident data were extracted from the City of Minneapolis Police Incident Report from 2012 to 2016.

When neighborhood police exposure, census tract population estimate, and the woman’s racial group were regressed on PTB, we observed an 83% increase in the odds of PTB among those who resided in the neighborhood with high police exposure relative to those in the low exposure neighborhood (OR=1.83, CI: 1.01-3.32). When maternal and census tract median household income were controlled for, we observed a slightly larger magnitude of our association of interest (OR=1.99, CI: 1.00-3.96). Results suggest that high level of neighborhood police exposure increases the risk of PTB among women of all racial groups.

Preterm birth, and its complications, is the leading cause of death for children under five years of age. Babies born before 37 weeks face a number of health concerns, including cerebral palsy, intellectual disabilities and lung and vision problems. In California, the preterm birth (PTB) rate has risen for the 4th year in a row, is at a 10-year high, and racial disparities continue to persist. In Los Angeles County, the PTB rate is 9.0, while the rate for Black women is 12.8-- 66 percent higher than the rate for White women. Black women are disproportionately impacted by adverse maternity outcomes irrespective of education attainment, insurance coverage and health behaviors.

March of Dimes conducted a qualitative study to better understand the patient experiences of Black mothers, barriers to quality prenatal care, and strategies to improve equity in access to quality perinatal and maternity care.

In-person and virtual focus groups and key informant interviews were conducted with 43 participants including, Black mothers with a prior preterm birth, Community-based organizations serving Black families, and clinicians. Mothers reported experiencing high levels of stress during pregnancy, chaotic and unresponsive prenatal/maternity care, and needing more support when transitioning home from the NICU. Clinicians reported a lack of resources and institutional support to develop trusting patient rapport and adequately address patient concerns. Study findings will inform prevention strategies, policy priorities, and collaborative activities to improve maternal and infant health and advance birth equity

Background: Structural racism is associated with adverse birth outcomes among Black women. Despite advancements with this work, current measures and interventions aimed at capturing and addressing structural racism have not reduced the Black-white inequity gap. We hypothesize that this is due to Black women traditionally being excluded from the research process. In response, we partnered with Black women to develop and prioritize policy recommendations to address structural racism to improve pregnancy experiences and outcomes.

Methods: We convened Black women (N=32) across the reproductive lifespan who resided in Oakland and Fresno, California (March 2018-June 2019) to develop a conceptual framework containing nine domains of structural racism (e.g., negative societal views; housing; medical care; law enforcement; community infrastructure) and policy recommendations to address them. We used the Franck et al. (2018) Research Prioritization by Affected Communities Strategy to develop and prioritize policy recommendations (May-June 2019); and to create infographics, flyers, and postcards for women to advocate for themselves in their communities.

Results: Black women prioritized 2-5 recommendations for each domain. The most salient domains for Black women in Oakland and Fresno were medical care (e.g., mandated holistic postpartum information-sharing and resources before hospital discharge) and community infrastructure (e.g., local policies preventing higher gasoline prices in low-income communities of color), respectively.

Conclusions: In order to address and dismantle structural racism, Black women must be centered in research, interventions, and policy. Findings from our study show that Black women are the experts and know what is needed to improve pregnancy experiences and outcomes.