As a parent, you imagine a world where birth is safe, sacred, loving, and a celebration for you and your family. You might picture a doula comforting you through the experience and expecting a sense of safety in a birth center.

Unfortunately, in the United States, this isn’t the birth reality for many women, especially those with Black and indigenous backgrounds, due to long-standing systemic racism in U.S. health care and social systems.

The San Diego Foundation Early Childhood Initiative is raising awareness of and addressing birth equity to improve the lives of women of color and their families in San Diego County.

San Diego County

It’s natural for an expecting parent to seek the best healthcare experience for a healthy pregnancy and baby. However, in the United States, Black and Native American women and their babies are not treated equally in our healthcare system.

In fact, according to the County of San Diego and Black Legacy Now, Black infants in San Diego are:

  • Nearly three times more likely to die during their first year
  • Nearly 60% more likely to be born prematurely
  • Nearly two times more likely to be born with low birth weight


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Building Community Power

San Diego County’s Black Infant Health Program (BIH), which is contracted to Neighborhood House Association (NHA), also partners with Black Legacy Now through their Perinatal Equity Initiative, to provide social support, stress management, and empowerment through prenatal/postpartum groups and one-on-one sessions to help women of color in San Diego to understand their risks and try to reduce them.

Together, these programs help Black women have healthy babies and become empowered to make positive choices for themselves and their families.

While it is important to continue this focus in San Diego, here’s a look at how birth equity is being addressed in California and throughout the United States.

California & the United States

In California, and in much of the U.S., Black and Native American mothers experience the highest rates of discrimination and serious maternal complications, including death.

According to California Health Care Foundation, Black women are three to four times more likely to die from a pregnancy-related cause and twice as likely to suffer serious pregnancy complications. Native Americans and Asian Americans/Pacific Islanders also experience high rates of maternal mortality and morbidity. These variations cannot be simply explained by factors such as age, income, educational level and health insurance status; there is evidence that points to implicit bias and racism, as key causes of disparities in maternity care and maternal outcomes for Black mothers.

The California Health Care Foundation also shares findings from the Listening to Black Mothers in California survey, which shows on average, more than 10 percent of Black mothers reported they were treated unfairly, experiencing rude and threatening language during their hospital stay because of their race and/or ethnicity, whereas one percent of white women said the same.

For Native American women in California, KQED News states Native American babies die at a rate more than double the state average. In 2021, Gov. Gavin Newsom signed Senate Bill 65, also known as the California Momnibus Act, into law with plans to improve racial disparities of maternal and infant health for Black and Native American people and their babies. Collecting more data regarding pregnancy-related deaths would help recommend other ways to reduce the racial gap, build a more racially and ethnically diverse midwifery workforce, and expand access to doulas and midwives, whose presence can drive better care.

While implementing laws and initiatives is a step forward toward reducing racial disparities, and improving birth outcomes and maternal mortality, it is important for organizations to work together to make a difference in the community.

Making a difference locally

In March 2023, SDF committed $500,000 in grant funding to 10 local nonprofit organizations to improve access to quality care, including child care, mental and behavioral services, parent education and health care, for mothers, babies and young children. These Early Childhood Initiative Responsive grants engage regional partners to strengthen families, increase health equity, bolster the regional workforce and support economic growth.

The SDF Early Childhood Initiative builds upon a regional vision that supports both immediate impact initiatives and systems-level change in early education and care. Since 2018, the SDF Early Childhood Initiative has impacted the lives of more than 19,000 young children, ages 0 to 5, by awarding more than $8 million to uplift children, families and childcare providers by providing over 100 grants to 40-plus community-based organizations in San Diego County.

Learn more about the Early Childhood Initiative and consider making a donation to help give all children and their families access to the early care, education and resources needed to thrive.