Pregnancy and childbirth should be a time of care, compassion, and joy. Yet Black and other minoritized people in the United States often confront racism and barriers to care, leading to stark inequities in the outcomes of their pregnancies. The most recent maternal mortality figures show that Black people were nearly 3 times more likely to die than white people. Black infants are twice as likely as white infants to die before age one.
Racism is a key driver of these inequities, with people facing discrimination and a lack of care that centers their needs and preferences. Black and other minoritized people are more likely to face economic barriers and challenges like limited transportation, childcare, and time off work.
The San Francisco Pregnancy Family Village provides an innovative model (Pregnancy Village- PV) that aims to tackle these gaps and barriers experienced during pregnancy and beyond. It’s a cross-sector collaboration designed to address inequities, including a monthly community-based one-stop-shop event for care and resources in a celebratory and uplifting environment for Black families. Through work done inside and outside of events, the model is deeply rooted in person-centered and antiracism principles and develops authentic and sustainable partnerships between community and institutions.
The events take place in San Francisco’s Bayview neighborhood, home to 35,000 residents and known as the city’s “most isolated” neighborhood, with significant inequities in access to care, experience, and outcomes. Most of the pregnant and birthing people in the area use Medicaid insurance, and 93% are from racial or ethnic minority groups.
The Village is organized into different focus areas ranging from Health & Wellness services to Arts & Culture, each representing essential elements to support comprehensive wellness within communities. There are vibrant colors, shaded areas, live music, and a variety of seating arrangements, with onsite services such as clinical consultation with a midwife or doctor, social services from City organizations, and holistic well-being services such as massage and sharing/learning circles.
Evaluation using surveys and in-depth interviews reveals that PV presents a promising model for addressing access to care and racism in healthcare and other service settings, aiming to improve health outcomes.
Most people who attended found the Village to be accessible and acceptable. Spanish speakers, people without medical insurance, and those who had experienced discrimination during prenatal care reported lower scores. While most people reported minimal burden accessing services, some noted challenges related to language access, navigation, and lack of provider follow-up. Survey respondents described the Village as inviting and resource-rich, felt confident accessing services during and after events, and perceived the offerings—ranging from wellness care to prenatal education—as useful and effective.
Favorable responses reflected in participants’ positive feelings about the Village’s vibrant, welcoming, and healing atmosphere. The outdoor setting, vibrant design, and diverse activities and services likely contributed to a restorative feeling.
Many Black people report feelings of dismissal, judgment, and lack of autonomy in their interactions with health care providers, which disrupts a collaborative, trust-based relationship, undermining a key element of positive care. Evaluation of the PV model found that people perceived it as person-centered—reflecting their needs, values, and preferences. Elements like dignified and respectful care, communication and autonomy, and responsive and supportive care were integral to shaping these perceptions. They also valued provider attentiveness, warm handoffs, and inclusivity.
These findings demonstrate that the PV model to provide services as a community-based one-stop shop is not only possible but can be done in a person-centered manner that prioritizes people’s needs, values, and preferences. One key area for improvement identified in the evaluation was improving provider follow-up. Neglecting to follow up can lead to people feeling abandoned and frustrated, with a diminished sense of control over one’s health and well-being. Another critical piece is ensuring visitors have access to help and resources in their preferred language.
Another key piece of the success of the PV model is building trust. Historical injustice, systemic racism, unequal health care access, and provider bias have fostered mistrust in health care institutions. Authentic and sustainable community-institutional partnerships could be a critical path to building trust.
The evaluation found that trust in health systems and community-based organizations was shaped by experiences of person-centered care and familiarity with the organizations. Trust in organizations was influenced by emphasis on holistic care, relatability, and responsiveness to community needs.
Trust in the Village was generally high. The high levels of trust are likely linked to the cross-sector collaborative approach to care delivery, which includes known, trusted sources such as community-based organizations. These collaborations often result in services that are more relevant, culturally affirming, and responsive to community needs, fostering greater trust.
The findings from these evaluations show support for the SF Pregnancy Family Village model, offering a pathway to improve the experiences of Black and other minoritized pregnant and postpartum people and their families. These findings underscore the need for ongoing partnerships between community organizations and healthcare institutions to ensure alignment with evolving community priorities. The model can help bridge historical divides between community members and health systems. The Pregnancy Village’s innovative model may also serve as an avenue to mitigate the lack of access and negative care experiences that continue to contribute to health disparities and worse health outcomes for parents and babies. Policy efforts that commit funding to sustain community-institutional partnered care delivery efforts will help ensure models like PV thrive and evolve.