SAN FRANCISCO HAS THE WORST birth disparities by race of any city in California, according to Supervisor Myrna Melgar. A new initiative that launched this week aims to end that neglect.
At the center of the new initiative announced by Mayor Daniel Lurie are the health care and other needs of pregnant women, as well as people, moms, newborns, infants and toddlers in the city’s most underserved populations, particularly residents who are Black, Native and Indigenous, and Asian and Pacific Islander.
Lurie announced the creation of the Strong Starts program Tuesday at a press conference inside City Hall with Melgar and Supervisor Shamann Walton, both of whom alternatively called the disproportionate outcomes “shameful” and “deplorable.”
Strong Starts will expand and draw upon the training and expertise of doulas who have been working with mothers neglected by the health care system for years through the nonprofit organization SisterWeb and other community organizations. Doulas are trained caregivers who support women through their pregnancies.
The initiative will bring new coordination between city departments and within the city’s health care system, improve data collection, and create accountability criteria and benchmarks.
According to the city’s Department of Public Health, Black babies make up about one out of every five infant deaths in San Francisco, despite Black births only comprising 4% of the live births in the city.
Premature birth is the largest contributing factor to infant death and serious health issues.
Rates of very premature births of Black babies, which are those born at 32 weeks or before, increased in San Francisco by about 71% between 2016 and 2024, rising from 2.1% of births to 3.6%. Rates of Black births that were premature, meaning those before 37 weeks, rose from 13% to 16%, an increase of about 23%, during that period.
The right to begin life with dignity should not depend on race.
Marlee-I Mystic, SisterWeb co-executive director
There were smaller increases in rates for Latino and Asian premature births over that period, but very premature births also increased for Asian births. Rates stayed steady for Latino births in that time, but those were nearly twice the rate of premature birth rates for whites.
Rates fell in both categories for white women giving birth in the city during that time. The rate of very premature Black births was more than five times higher than white very premature births from 2022-2024.
A human rights issue
Representatives from SisterWeb and at least one former client of the organization appeared at City Hall on Tuesday to champion the new program’s launch.
Marlee-I Mystic, SisterWeb co-executive director, said the disparities in outcomes are not just a problem created by health care providers, but are representative of a systemic neglect that is maintained through “fragmented funding, siloed departments, misaligned priorities and a lack of accountability.”
She said the issue was one of human rights.
“The right to begin life with dignity should not depend on race,” Mystic said. “Every family deserves the right to a safe pregnancy, a supportive birth, and a healthy body, without the gaps based on race.”
Mystic said the urgency is to eliminate the gaps in outcomes, not merely reduce them.
The program’s main goals are to improve connections to early clinical care, invest more in infant child care and increase resources for family caregivers, and to expand wraparound services that address other issues that impact health such as food security and behavioral health.
Community organizations will be engaged on an ongoing basis, including through a partnership with a doula training program at City College of San Francisco.
“If we want to be a city where every child can thrive, we must support our kids and parents at every stage of life,” said Lurie.
Melgar said that city leaders have known about the poor state of health care for non-white mothers and babies in the city for decades but have made little progress.
Walton said it was time for the city to confront the issue with more urgency.
“The maternal health data in San Francisco is unacceptable, especially for preterm births for Black mothers,” he said. “These disparities are not accidental, they are the result of long-standing inequities that we must address with urgency and accountability.”
Besides clear and persistent racial disparities, the Department of Public Health also identified health insurance coverage, access to health care, and even ZIP codes as determining factors in the health, life and deaths of the city’s mothers and babies.