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Black mothers in California and across the U.S. deserve a health care system that supports them through safe, healthy pregnancies and births. Yet the persistence of systemic racism and medical discrimination continue to produce stark disparities in maternal health outcomes.
Data from the U.S. Centers for Disease Control and Prevention show that the maternal mortality rate for Black women in 2024, while slightly lower than in the previous year, remained significantly higher than for all non-Black and non-Indigenous groups. California’s data are consistent: Black mothers die at three to four times the rate of White, Hispanic, or Asian mothers. This gap is driven by systemic racism, implicit bias, and social drivers of health rather than just biological factors.
Giving Black mothers and babies a fair start was a top priority for CHCF when it launched the Pulse of Change initiative, supporting projects that improve the clinical quality of care for Black Californians. Among the eight organizations awarded Pulse of Change grants was the Solid Start Initiative at Zuckerberg San Francisco General Hospital, a program dedicated to addressing Black maternal health inequities.
Family Navigation Services
Since 2015, Solid Start has taken a multidisciplinary approach to developing, implementing, and evaluating innovative clinical and psychosocial care models. The initiative uses evidence-based practices, such as doula services, mental health services, and access to racially concordant providers, to address disparities in maternal and child health outcomes for Black-identified individuals and families. “The people are not broken, but our system is broken,” said the program’s director, Melanie Thomas, MD. “By bringing all the services under one roof, we will make a difference in the lives of our families.”
Solid Start’s Pulse of Change project, “Birth Equity Begins Before Birth: Addressing Anti-Racism in Prenatal Care,” aims to improve the clinical care experience and perinatal mental health outcomes for Black people receiving prenatal care at the hospital. The project centers on a model of psychosocial needs assessment and rapid referral to community services provided by Solid Start’s family navigation services team. This process runs in parallel with the clinical care intake pathway.
While Solid Start had built a strong foundation of prenatal care services, coordination and linkage remained a challenge. Pulse of Change resources allowed the program to invest in increasing racially concordant screening and linkage to care across medical providers, mental health services, and community-based doula organizations.
The Power of Racially Concordant Care
In its project, Solid Start focused on offering Black patients psychosocial needs assessments and mental health screening with Black family navigators; referrals to Black community-based doulas; perinatal mental health support from Black therapists; and team-based care from Black-identified clinical providers through pregnancy and into the postpartum phase.
Deundra Hundon, who directs San Francisco Pregnancy Family Village, one of Solid Start’s community partner organizations, emphasized the impact of this approach. She said that it’s important to have providers who appreciate and understand where their patients come from. Racially concordant providers can build trust in a way that helps patients open up and share more.
Schyneida Williams, community engagement coordinator for Solid Start, got into this work after looking for that kind of care during her own pregnancies. She didn’t find it.
“When you show up and the person that’s there to talk to you has a structure or curriculum based on how they hear you and how they approach your specific needs, but they’ve never been through anything that you’ve been through and can’t relate,” Williams said, “it’s hard to confide in those people. It’s hard to trust, it’s hard to build a rapport.”
Progress Funded by Pulse of Change
Pulse of Change funding allowed Solid Start staff and its doula organization partners to provide stronger, more integrated care coordination for Black mothers and pregnant people in San Francisco. The funding also supported regular case discussion among partner organizations to ensure consistent and cohesive follow-up on referrals and linkage to care.
Project funding also made it possible for the Solid Start team to establish a new internal care coordination meeting series with the hospital’s pediatrics and family medicine clinics that serve Black patients and their children, creating a safety net that helps keep patients from falling through the gap between childbirth and the start of postpartum care.
Initial Outcomes
In 2025, Solid Start’s navigation services team provided psychosocial intake appointments for 58 Black mothers and pregnant individuals, conducting prenatal mental health screenings, discussing hospital and community mental health and social supports, and making referrals. Over 80% of these appointments were conducted by a racially concordant patient navigator, and every patient who requested a racially concordant navigator received one.
Randi Tanksley, the program’s director of family navigation services, is a Black woman who leads care coordination for Black patients seeking care from Black providers in the hospital where she had her first child. “I didn’t have a Black provider when I had my first child at San Francisco General Hospital at age 17,” Tanksley said. “My daughter had my granddaughter in the same hospital, and she actually did have a Black provider. She was always super excited about her appointments because she got to meet with somebody she could relate to, who she felt comfortable with.”
Tanksley’s own experience shapes how she works with patients. One Solid Start patient involved in the Pulse of Change project initially refused all services, so Tanksley struck a balance between persisting and giving the patient space and grace. She shared her phone number and invited the patient to reach out if she needed anything or changed her mind about services. A few days later, the patient contacted her and opened up about the financial concerns that led her to refuse services.
Tanksley then coordinated several services for which the patient was eligible, such as racially concordant group prenatal care through Black Centering Pregnancy; mental health support through San Francisco’s Black Birthing Health Initiative; and San Francisco Health Plan’s Enhanced Care Management program, a Medi-Cal benefit that provides a lead care manager to coordinate servoces for members in specific populations of focus, including pregnant and postpartum people.
After building that relationship and addressing the patient’s concerns, Tanksley invited her for an in-person prenatal visit instead of a telehealth appointment.
While every pregnancy and postpartum journey is unique, Solid Start’s dedication to connecting patients to the resources they need to thrive is a constant.
This is the fourth in a series of reports on how Pulse of Change grantee organizations are working to help providers deliver culturally responsive health care to Black patients.
