Ensuring every San Franciscan can experience a joyful, autonomous birth supported by respectful perinatal care
Strong Starts is a mayoral initiative to reexamine how San Francisco funds and delivers perinatal and infant care, and to hold City departments accountable for improving health outcomes. The initiative co-chairs are the Department of Early Childhood, the Department of Public Health, and the Agency for Human Rights (Department on the Status of Women and the Human Rights Commission). San Francisco has among the worst perinatal and infant health disparities in California for Black, American Indian, and Pacific Islander families. These disparities are not accidental – they reflect long-standing, systemic and structural inequities that demand an urgent, coordinated response.Sign up for updatesEngagement
Strong Starts survey
Take the San Francisco Pregnancy and Postpartum Experience Survey. Tell us what is working and what needs to change - at the hospital, in the clinic, and in how our city supports new and expectant parents.
Community advisory panel
Are you a San Franciscan who is pregnant or has given birth? Apply to join the advisory panel by Monday, September 14, 2026.
Care team advisory panel
Are you a clinician, birthworker, or service provider who provides care to pregnant or postpartum people or newborns? Apply to join the advisory panel by Monday September 14, 2026.
About Strong Starts
North star goals
- Every San Franciscan experiences joyful, autonomous births supported by respectful, dignified, and non-burdensome perinatal care
- Equitable health experiences and outcomes, with a focus on:
- Positive perinatal care experiences
- Healthy, full-term births
- Maternal health, including postpartum experiences in the first year after delivery
- Infant wellness, focused on first year of life
Overarching strategies for FY 2026-27
Engage in meaningful community engagement to inform program decisions
- Working with community to provide input and feedback into decision points and design choices within ongoing initiatives
- Exploring other areas of focus in partnership with community and adding new workstreams for implementation as identified
- Quarterly updates from the Mayor’s Office to the Human Rights Commission Equity Advisory Council – Maternal Health Subcommittee
- Launching a process to identify community members and a panel of care team experts to join monthly meetings with the Strong Starts cross-departmental working group, targeting a start in October 2026
- Community panel: People who are currently pregnant or who have recently experienced pregnancy or birth in San Francisco: https://digital.forms.sf.gov/strong-starts-community-panel
- Care team panel: Professionals from each of the following disciplines: OB-GYN; family medicine or pediatrics; nurse-midwife; licensed midwife; prenatal/postpartum or labor and delivery nurse; public health nurse; lactation consultant or counselor; doula; perinatal mental health specialist; health educator or community health worker: https://digital.forms.sf.gov/strong-starts-care-panel
Create a more coordinated and culturally respectful clinical care system
- Strengthening infrastructure at the Maternal, Child, and Adolescent Health Division (MCAH) of the Department of Public Health to ensure sustainable funding, fiscal accountability, and effective program operations that support the implementation of interventions that address disparities in maternal and infant health outcomes
- Prioritizing the timely filling of open Black Infant Health Program and MCAH leadership positions to avoid disruptions in care, sustain grant-funded staffing capacity, and ensure full utilization of state funds allocated to these programs
- Working to influence standard practices at all San Francisco hospitals and health systems, beginning with San Francisco General, where the City has the greatest oversight
- Exploring models to better coordinate prenatal care, by integrating clinical prenatal care with wraparound community services
- Developing a postpartum midwifery care program and developing an Associate’s Degree midwifery education program for certified professional midwives
Strengthen wraparound supports that address social determinants of health
- Housing: Allocating new hotel and rapid rehousing vouchers for pregnant and postpartum birthing people, alongside efforts to assess the current continuum of care for women
- Guaranteed income: Launching new financial supports for high-risk pregnant and postpartum birthing people
Advocate for policy and legislation that creates the conditions for healthy births
- Exploring policy changes to improve enforcement against pregnancy discrimination
Improve our use of research and data to ensure investments drive outcomes
- Examining past research and conducting new analyses to inform strategies and program design
- Advancing a scoping review of existing data and information from past community engagement efforts
- Conducting a chart review and holding case conferences of preterm births of communities impacted by disparities in maternal and infant health outcomes
Resources
Updates
Equity Advisory Council - Maternal Health Subcommittee
Upcoming meetings of the Maternal Health Subcommittee of the Human Rights Commission Equity Advisory Council. Includes quarterly updates on Strong Starts initiatives
February 2026 Strong Starts Launch
Announcement from Mayor Lurie on Strong Starts launch
August 2026 Strong Starts Update
Letter to the Equity Advisory Committee, including an outline of Strong Starts strategies, initiatives, and budget