A one-stop shop to reduce pregnancy care-related inequities in San Francisco

Systemic, institutional, and interpersonal racism are root causes of disparities in pregnancy care in the US. Communities facing these inequities need comprehensive services beyond what healthcare settings typically offer, such as support accessing health insurance, housing, healthy food, and other necessities.

Accessing available services is often burdensome. Cities like San Francisco offer health care, public health, and wraparound services in silos, making it hard for people with limited job security, childcare, and transportation. Pregnant people of color experience racism and discrimination when receiving services, posing yet another barrier to access.

people holding up signs that say "you're doing a great job, Mom" and "Hey Mom, you are not alone" at the Family Pregnancy Pop-Up VillageTo achieve health equity in pregnancy and childbirth, we need new models to reduce barriers and improve people’s experiences. With this goal in mind, a team of leaders went through a yearlong human-centered design process centered on pregnant people insured by Medicaid in San Francisco, with a focus on Black community members, who face the deepest inequities.

This process surfaced three foundational needs: easier access to services, better interactions with providers, and institutional efforts to earn the trust of historically harmed communities. This led to the development of a pregnancy village model—a community-based, community-institutional co-led model of providing social, public health, clinical, and wraparound services as a one-stop shop, in an intentionally-designed, celebratory, and uplifting environment.

In a new paper, the team documents their process and offers lessons that can inform similar efforts. Given the extensive evidence of the role of systemic and institutional racism in creating disparate health outcomes, achieving health equity requires identifying problematic features within existing care delivery systems and designing alternative approaches. Deep collaboration between communities and institutions is essential to the process. People with lived experience hold key insights into existing problems and potential solutions. Institutions are well-positioned to move systems toward these solutions and create sustainable structural change.

Implementation of San Francisco’s Family and Pregnancy Pop-Up Village demonstrated the ability to bring together cross-sector organizations around a unified vision based on antiracism principles. The model disrupts siloed systems that disproportionately burden people facing structural barriers by delivering services in a one-stop shop, building in mechanisms for community feedback, and creating processes for responsive change. The model acknowledges that communities of color may feel unsafe in historically harmful built environments and creates an alternative dignified and uplifting care environment.