3 ways the Philly Joy Bank program can impact health disparities

By Gabriela Marmolejos

­In recent years, the United States has seen a "stunning" increase in maternal mortality rates amid a longstanding decline in birth rates. While this shift can be attributed to several factors, financial pressures have played a significant role.

According to a report by the First Five Year Fund, the cost of raising a child has increased by 220% over the last three decades, with the average annual cost of raising a child under the age of six rising to roughly $10,000. ­

Meanwhile, the United States is faring far worse than its peers regarding infant and maternal mortality, with 5.4 infant deaths per 1,000 births and 23.8 maternal deaths per 100,000 births every year.

Among the ten most populated U.S. cities, Philadelphia has the highest rate of infant mortality, with an overall average 1.5 times higher than the national average. According to PDPH, disparities in birth outcomes by race and ethnicity are "large and alarming."

For example, more than 15% of infants born to non-Hispanic Black mothers in Philadelphia had low birthweights — roughly 40% higher than the city's average — and nearly 15% of infants born to non-Hispanic Black women were premature — roughly 30% higher than the city's average. Black infants in the city are more than four times as likely to die before their first birthday than white infants, PDPH said.

The Philly Joy Bank program aims to address both health disparities and financial challenges associated with pregnancy and postpartum in the communities with the worst outcomes. Under the program, participants could see a big impact in three major ways.

1. This could help address economic inequalities among pregnant people of color

We have written about the root causes of maternal health disparities and the impact poverty has on pregnant people's ability to afford key social goods, including maternity care, transportation, safe housing, and healthy food.

While programs like WIC and SNAP are available to low-income families, there are several barriers to access, including work requirements, tedious application processes, and language barriers. It is also important to acknowledge that WIC and SNAP provide an average value of just $57 and $121 in food per month, respectively.

The Philly Joy Bank could greatly improve access to healthy foods and other needs beyond what is currently offered by other social assistance programs. 

2. This could improve maternal health and birth outcomes among participants

According to CDC, over half of pregnancy-related deaths in the United States occur postpartum. This program could significantly reduce the risk of maternal mortality among participants by alleviating financial stressors 12 months postpartum. 

Philadelphia is not the first city to launch this type of program. The Philly Joy Bank mirrors similar programs in other cities, which led to fewer reported low birth weights, fewer preterm births, and increased adherence to childhood immunizations. 

Philadelphia' program mirrors a pilot study, the Abundant Birth Project, in California that offers unconditional $1,000/month cash supplements to Black and Pacific Islander mothers with a household income of less than $100,000 per year. The evaluation of this pilot is underway, but we've seen results from Canada's Healthy Baby Prenatal Benefit program, which reported fewer low birth weight and preterm births as well as increased adherence to childhood immunizations. 

3. This could better participants lives beyond the pregnancy period

In recent months, several leaders of health plans and health systems shared with my team their strategies to improve maternal health outcomes in their communities. Many of these strategies occur pre- and post- partum. For example, some employers are adding family-building benefits and many health systems now offer postpartum home blood pressure monitoring services. 

The determinants of maternal health extend beyond the pregnancy period, with roots in intergenerational and systemic racism. To address this, I encourage all organizations to investigate the root causes of maternal mortality and morbidity in their communities and consider the opportunities to improve the health of women and other birthing people outside the pregnancy period. (Shaheen, Daily Mail, 1/16)