The San Francisco Pregnancy Family Village: A New Model of Perinatal and Family Care Delivery

The U.S. has the highest maternal mortality rate among high income countries, with stark inequities in this and other critical perinatal outcomes including severe maternal morbidity, preterm birth, and infant death. In 2017, members of the SF Respect Initiative (SFRi) embarked on a one year Human-Centered Design process to better understand, and build around, the experiences of San Francisco residents who face the most severe inequities in pregnancy care and outcomes: individuals insured by Medicaid and particularly those who identify as Black. Results confirmed extensive evidence demonstrating that current U.S. care delivery structures, built within a culture of white supremacy, have resulted in care that is difficult to access, does not meet the stated needs of individuals, and does not support autonomy and dignity of Black pregnant people. Recognizing the current system of care delivery as a root cause of inequities in healthcare access, experience, and outcomes, the team is utilizing the Precede-Proceed framework to develop, implement, and evaluate a novel model of care that they hypothesize will reduce barriers to care stemming from systemic and institutional racism and eliminate racist and discriminatory encounters during care access, which will improve the overall health and well-being of Black birthing individuals.

Accessibility of health and social services, mental wellbeing, person-centered care, and experience of racial discrimination

The team is employing a pre-test post-test non-equivalent control group design nested within an explanatory sequential mixed methods design to answer the study questions. Two separate analyses will be conducted – one will focus on the intervention group changes between baseline and endline and across different iterative time points. The second analysis will compare differences between the intervention and control group, which will inform sample size calculations for the next phase of The San Francisco Pregnancy Family Village evaluation. The primary study population consists of people who are pregnant (of any gestation), are within one year of pregnancy, or are parents of young children up to five years old living in San Francisco who identify as Black or members of other racial and ethnic minority groups.