The Abundant Birth Project California Evaluation: Understanding the Role of Guaranteed Income in Promoting Birth Equity

Pregnancy is a critical period of development: stress during pregnancy can lead to adverse birth and long-term health outcomes. In the U.S. racial inequities in pregnancy and birth outcomes are stark and persistent signaling the need for novel interventions that address the social determinants of health. The Abundant Birth Project (ABP) California (CA) Expansion is a guaranteed income program for pregnant people at greatest risk of birth inequities (Black/African American pregnant people) in five California counties (San Francisco Alameda Contra Costa Riverside and Los Angeles) funded by the State of California municipal governments and philanthropic funding. ABP will provide unconditional monthly income supplements during pregnancy and postpartum to 725 randomly selected participants with the goal of curbing financial stress and promoting healthy pregnancy outcomes. This project is an evaluation of the ABP CA Expansion and aligns with multiple MCHB Strategic Research Issues including focus on birth inequities; involving families in research; supporting research that pose new questions test hypotheses and challenges existing paradigms; and supporting diverse MCH researchers.

Goals and objectives:

The goal of the ABP CA Expansion Evaluation is to use a quasi-experimental community-driven mixed-methods approach to evaluate whether providing unconditional income to Black pregnant people can advance perinatal health equity through the reduction of adverse pregnancy outcomes stress and adverse mental health outcomes. The study objectives are to determine the impact of income supplementation during pregnancy on: (1) perinatal health as measured by composite measures of adverse pregnancy outcomes (preterm birth low birth weight small-for-gestational age gestational hypertension preeclampsia and gestational diabetes); and (2) stress and perinatal mental health (depression and anxiety). Proposed data sets and target population(s): The five county sites will recruit applicants to the ABP program (eligibility: 1st or 2nd trimester of pregnancy reside in a participating county identify as Black/African American and household income less than the county threshold). Eligible applicants to the ABP program who are older than 16 will be invited to participant in the evaluation prior to entering the program lottery (called the Abundance Drawing). We will recruit participants at a 1:1.5 ratio of ABP program:control group for an expected samples size of N=1450. Data collection methods include three interviewer-administered surveys abstraction of medical records and two in-depth interviews among a subsample (N=50).

Products:

We will produce at least 3 peer-reviewed publications and engage in public-facing dissemination activities with our community partners.

Evaluation:

In Objective 1 we will examine differences in the composite adverse pregnancy outcomes measure between ABP and control group participants. We will examine models comparing the ABP group to the control group adjusted for covariates using logistic mixed models with clustering by program site. For Objective 2 we will conduct intention to treat analyses to compare changes between the ABP and control groups in stress depression and anxiety scores from baseline to the third trimester of pregnancy and from baseline to postpartum.