No strings attached: a mixed methods evaluation of the acceptability of the San Francisco Abundant Birth Project, a perinatal guaranteed income program

Economic insecurity during pregnancy is a critical social determinant of maternal and infant health. Traditional public assistance programs often fail to meet the needs of marginalized communities, particularly Black and Pacific Islander (Pasifika) pregnant women and people. Guaranteed income (GI)–unconditional cash transfers for specific populations–has emerged as a potential solution, but little is known about the experiences of participants accessing perinatal GI programs. The current study describes the implementation and acceptability of the San Francisco Abundant Birth Project (ABP), the first perinatal GI pilot program in the U.S. ABP provided $1,000 per month for up to 14 months to 151 Black and Pasifika pregnant individuals in San Francisco, CA, between 2021 and 2024. We conducted a mixed-methods participatory evaluation with a subset of program participants (116 survey and 21 interview participants), and asked about program satisfaction, trust, and experience. Community researchers co-led the study design, data collection, and analysis. Participants reported being very satisfied (95.7%) with ABP and felt very respected by the staff (95.7%). A majority (77.5%) trusted ABP to act in their best interest, compared to 9.0% who trusted the government to do the same. While some participants initially doubted that the funds from ABP were unconditional, trust grew over time. Qualitative findings emphasized the importance of ABP’s community-centered design and culturally aligned staff in building trust. Findings highlight the value of community-rooted GI programs in fostering trust, dignity, and reimagined models of pregnancy support.