June 21, 2024
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Philly Joy Bank, a guaranteed income program meant to support pregnant women in neighborhoods where infant mortality rates have been the highest, will give 250 women $1,000 monthly with no restrictions for 18 months, including the first year after their children are born.
An experimental program soon will give 250 pregnant women in Philadelphia monthly payments of $1,000 – with no strings attached – in hopes of improving the city's infant mortality rate, which is the worst in the United States, and reducing racial disparities.
Philly Joy Bank, announced last year, builds on growing research into how guaranteed income — sometimes called universal basic income — can improve health and well-being when there are no restrictions on how the money is used. The city's health department has partnered with multiple philanthropic organizations to pay for the $6.3 million program.
On Monday, the city will begin accepting online applications from pregnant women in three neighborhoods — Strawberry Mansion and Nicetown-Tioga in North Philly, and Cobbs Creek in West Philly — that were chosen because of their high rates of poverty and infant mortality.
"If you don't have enough cash during pregnancy and you need it, that's incredibly stressful. And just by alleviating stress, we know that stress can affect the body and pregnancy in birth outcomes in real ways," said Stacey Kallem, director of the health department's division of maternal, family and child health.
Philadelphia's infant mortality rate is nearly 40% higher than the national average — about 8.4 deaths per 1,000 live births compared to 5.8 nationally. Low birth weight and pre-term birth, which often are linked, also are higher in Philadelphia than in other parts of the country. The data consistently reflect racial and socioeconomic disparities that current assistance programs aren't tailored to combat during the stresses of pregnancy and early motherhood, health officials said.
The 250 women who are selected for the program will receive payments for 18 months, beginning with the second trimester of pregnancy and ending a year after they give birth.
"Part of the whole ethos of guaranteed income is that it's unrestricted, so you're not requiring hoops to jump through," Kallem said. "We imagine that it will be used flexibly to address what we call the social determinants of health. It's really everything outside of what the doctor does that affects someone's health, whether that is buying more nutritious foods, using the money for transportation to go to appointments, housing — really anything."
To be eligible, residents must be between 12 and 24 weeks pregnant, over 18 years old and have an annual household income of less than $100,000. The relatively high income threshold was determined based on community feedback during the planning process. Most households in the neighborhoods covered by Philly Joy Bank earn $20,000 to $30,000 per year, which falls within the federal poverty guidelines in 2024.
"There are so many public benefits programs that use the federal poverty line or the same cutoff, but really there's a gap between not qualifying for those programs but still not making enough to thrive," Kallem said.
After applications have been vetted, women will be chosen using a rolling lottery held every other week. Participants will then speak to a program navigator and start getting monthly payments within two weeks of entering Philly Joy Bank.
The purpose of the program is not only to improve health outcomes among infants, but to empower mothers to plan their futures in ways that will support the development of their kids.
"We want them to use this to advance their own lives in whatever ways they think is best," Kallem said. "Having a baby with this extra income, that can mean, 'Now I can stay home with my baby.' If someone has this extra income and decides to use it to cut down from working three jobs to working two jobs and that makes their life better, that's also great. If they can go back to school to advance their own life to have a different job, that's also great."
Black babies in Philadelphia have an infant mortality rate more than three times higher than white infants. Low birth weights — babies born at less than 5 1/2 pounds — and pre-term births also are significantly more common among Black infants than other races and ethnicities, according to health department statistics.
Between 2005 and 2020, public health programs helped Philadelphia reduce the annual number of infant deaths from nearly 300 to 130, but high-risk pregnancy particularly remains a serious concern among Black mothers and their infants. From 2013 to 2018, Black women accounted for 43% of births in the city but 73% of pregnancy-related infant and maternal deaths.
Pre-term birth and low birth weight are associated with higher rates of sleep-related deaths and developmental delays, potentially resulting in disadvantages that are compounded by financial strain, health experts say. Poor outcomes in pregnancy often are influenced by the health of mothers and the chronic stress they experience, sometimes as a result of discrimination that affects their financial security.
"Pregnancy and having a newborn are these big financial, stressful times," Kallem said. "You might be working less, or might not be feeling well or there's discrimination against pregnant people when it comes to work sometimes. A baby is expensive."
Philly Joy Bank was developed by the the Philly Maternal and Infant Health Community Action Network, a broad coalition of institutions and leaders in health care, government, social services and education.
"There was a really rigorous strategic planning process around infant mortality in Philadelphia and how we can reduce racial health disparities. ... Financial stress really rose to the forefront as something impacting infant mortality," Kallem said. "So looking at the literature on what to do when there's financial stress, it's very simple. You alleviate the financial stress. Money."
The program is inspired by the success of Canada's Healthy Baby Prenatal Benefit, which has provided pregnant women in Manitoba guaranteed income for more than 20 years. That program gives low-income mothers payments of up to $81 per month, which has been enough to deliver promising results. Among nearly 14,600 pairs of mothers and newborns, low birth weights declined by 21% and preterm births went down 17.5% from 2003 to 2010.
Philadelphia is among several U.S. cities that have formed the Mother Infant Cash Coalition to experiment with guaranteed income for pregnant women.
In San Francisco, the Abundant Birth Project has given $1,000 per month to nearly 150 pregnant and postpartum women. The New York-based Bridge Project is giving $1,000 monthly payments to women throughout the country for periods of up to three years in hopes of breaking generational cycles of poverty. And in Flint, Michigan, the citywide RX Kids program offers all pregnant moms cash payments of $1,500 during pregnancy and $500 monthly through the baby's first year of life, regardless of income.
Kallem said the goal of Philly Joy Bank is to rethink how existing assistance programs work. That includes taking another look at earned income tax credits and child tax credits, and evaluating whether large federal grant programs that restrict direct payments are working as effectively as they could.
"How can evidence of guaranteed income in pregnancy be used to make existing cash transfer programs more like a guaranteed income?" Kallem said. "How can we tap into existing funds that are already out there to support maternal and child health, and use them for guaranteed income?"
Philly Joy Bank will be monitored by researchers at Drexel University for a study that looks at how the money is used, the effects the program has on birth outcomes and parenting, and how the mothers assess the impact the money has on their lives.
During the the program, women will have voluntary access to a variety of services. That could include visits from a case manager, doulas, lactation support, sleep education and financial counseling.
Philly Joy Bank will be Philadelphia's second guaranteed income program. Last year, the city became one of several municipalities to join a federally-funded program that gives $500 monthly payments to low-income parents with no strings attached. That program aims to better understand the effects of offering guaranteed income to needy families that already qualify for public assistance.
Kallen said the two studies will help gather evidence about the relationships between financial stress, parenting and infant and maternal health. Research continues to suggest they are intertwined in ways that can be long-lasting and repeating.
"It's not a coincidence," Kallem said.
For now, Philly Joy Bank is funded for a single group of 250 women. The program received funding from the William Penn Foundation, Spring Point Partners, Philadelphia Health Partnership, Vanguard, the Barra Foundation, the Jewish Healthcare Foundation and Pew Charitable Trusts. City funds will be used to cover program staffing and evaluation.
Kallem said the hope is that the findings of Philly Joy Bank will open new funding opportunities and help lead to a shift in thinking around how to address high rates of infant mortality.
"If it goes well, we would like to expand and do it again," she said.
