Zea Malawa is a Black mother and a paediatrician working in San Francisco, California. She runs the Abundant Birth Project, a guaranteed income pilot project for Black pregnant people experiencing marginalisation. We caught up with Zea at the 22nd Basic Income Guarantee Conference in San Francisco, California to discuss the racism inside America’s health disparities and what monetary support can do to narrow the gap.
Neil Howard (BTS): What does a guaranteed income mean for pregnant people of colour?
Zea Malawa: On a technical level, a guaranteed income means providing cash in an ongoing, predictable and regular way for folks to use however they see fit. It’s about recognising that poverty is not a monolith and that low-income folks have a variety of different needs. This includes the most basic needs, such as shelter, food and health care.
They should be able to meet their needs and those of their kids on their own terms, and with dignity and flexibility, so they have what they need to thrive.
Underpinning our project, is the recognition that Black women in the US die at a significantly higher rate than anybody else during pregnancy because of racism. And Black babies are born smaller and earlier, again, because of racism.
We can't fix racism with a magic wand, but we can try to protect and buffer Black mamas against stress during this critical period in their and their babies’ lives. We hope that we can give the next generation a healthier start, and we can give these families a new way to interact in our economic world.
Neil: Could you tell us more about the project?
Zea: We launched in June 2021 in San Francisco, with an initial feasibility pilot of 150 mums. And we continued from there. Now, we want to generate statistically significant evidence around whether providing mamas with cash during pregnancy can actually improve outcomes.
We’re reaching 1,000 mums across California with the same intervention, along with a robust research plan to really understand what it will take to turn the corner on health disparity in the US.
Our programme provides other types of support apart from cash, because we recognise that cash isn’t the entire solution. A huge part of what we also do is called ‘abundance coaching’. It’s optional coaching provided to the mamas to help them identify and achieve their goals. And that’s actually been one of the things our recipients have been the most positive about.
We aim to make sure all our coaches are also doulas, and we train them in lactation education so they can serve as an important, multi-faceted resource for mamas during this critical moment in their lives.
Neil: Can you tell us about the involvement of community members in the planning stages?
Zea: One of the things I am most excited about with the Abundant Birth Project is the way that community members – the very people who will be using the programme – were involved in designing it.
So often in the US, politicians, policy makers and programme directors don't represent the communities they're serving. They're pretty disconnected from the real needs of families as a result. We’re really trying to heal that relationship with government by turning the keys over to the mamas in our community, so that they can tell us how they want this to go.
If we want to undermine racism in birth, we need to undermine it in all dimensions of the programme as well
We asked our community members questions like: how much money should we give? How do you want it to be distributed? What kinds of additional services do you want? How long should we give the money for? What should we do if a parent loses their child? What should we do if a parent becomes incarcerated during pregnancy? All these questions and more were answered by the very mamas that we're hoping to serve in the programme.
And that feels important to me, because even though our team is mainly made up of Black mums and other mothers of colour, we recognise that we couldn’t represent the entire complexity of the Black maternal experience in California. We needed the collective wisdom of our community to help us make the most functional programme possible.
Neil: The approach you’re describing is a really democratic one. How does this fit into your values as a project?
Zea: Power sharing is so fundamental to the Abundant Birth Project. We recognise that, as academics, physicians, programme directors and public health practitioners, we bring a certain amount of expertise to the work. But that expertise is not the be all and end all.
This is especially important when we consider that only certain kinds of knowledge are valued in our societies. This has all been constructed with a white supremacist lens. So to decide that folks with a university education have more expertise in designing a programme like this than folks with lived experiences is fundamentally very racist.
If we want to undermine racism in birth, we need to undermine it in all dimensions of the programme as well. One component of that is making sure that authentic decision-making power is handed over to folks who identify as what we call community experts.
Neil: What impacts have you seen so far?
Zea: There’s a few things I want to say. When we first launched the programme, I remember I was coming back from my clinic and entered the office where we meet the mamas. I walked in on a Thursday afternoon and there were four pregnant Black mamas in the waiting room, all looking so happy. And that is just not something you would ever see at the Department of Public Health.
This was a really special moment – to have seen a need and to have met it with something that actually works. Not just giving someone a leaflet to read, or telling them to go stand in an hours-long line for public benefits that may not serve them. But being able to say, here is actual cash and we trust you to do what you want with it. That was huge.
The power of cash is so much larger than just the impact on a single baby's birth
I'll also mention something that I really didn't expect. About eight months after we launched the programme, I ran into one of my paediatrician colleagues. She sat me down with tears in her eyes because she wanted to tell me about a mum and a kid she was supporting. The mum had broken down to my colleague – she was so upset because she was pregnant with twins and they didn’t have a place to live.
My colleague said to her, “I know what we're going to do. Let me refer you to this programme.” So the mum was referred and accepted into the programme, and she started receiving $1,000 a month, four months into her pregnancy. Entering the Abundant Birth Project not only transformed her and her kids’ experiences, but also this paediatrician's experience of working with marginalised communities.
I didn’t expect that outcome, but it makes sense. For providers in safety net settings who are always up against very intense burnout, that cash is making a difference in our lives too. Because we get the satisfaction of seeing our clients and our patients thrive. We don’t have to fight for resources, or watch our patients suffer because they’re living in poverty.
The impact of this kind of support actually goes even further than that. It reaches the small businesses where the mamas go to spend the money. It reaches the community. Because now moms don't have to work two jobs to support themselves, they can show up in parent teacher alliances. They can show up in civic engagement. They can show up for their communities. The power of cash is so much larger than just the impact on a single baby's birth.
Neil: Hearing you speak, three words jumped out to me: dignity, power and hope.
Zea: Dignity, power and hope are so important to us. We actually have a measurement in our evaluation that assesses hope and well-being. We want to make sure that when we report our results, we're not just showing how we can save the government money by preventing preterm birth.
We want to also show that we’re helping our future, which is what birth is all about. We want to show people thriving and feeling hopeful. And for a community like the Black community in the US, hope has always been in short supply. I feel so honoured to be able to serve that up in the form of guaranteed income.
Neil: It seems like using direct cash payments to mitigate racial health inequalities is the core vision for the project. Can you tell us more about your goals?
Zea: I have two main visions for this programme. First, I want to show that we can use cash as a public health intervention. We have many long-standing, racial health disparities in this country that we have not made progress on narrowing, even though we recognised their existence in public health over 40 years ago.
I think one reason why we got stuck is that, as a country, we have been unwilling to address the racism at the root of these disparities. With the Abundant Birth Project we are trying to address one disparity in the clearest terms possible. Providing financial and economic opportunity to pregnant folks who have been historically excluded because of racism is a clear anti-racist step.
My second goal is to think about how we can leverage public funds to provide a guaranteed income for mothers in general. The US spends a ton of money on ensuring healthy pregnancies, but disparities still exist. That means we need to have a different approach. I would really like to see public funds being used for a guaranteed income during pregnancy, like it has been in both Canada and Mexico.
The opposition in this country against Black families thriving is very, very strong
Neil: Do you see a guaranteed income as being part of reparations for racial injustices in the US?
Zea: In my opinion, the Abundant Birth Project is a really critical, foundational step towards making Black families whole in the US. But the Abundant Birth Project is not reparations. Reparations come with an apology and an acknowledgement of past harms, as well as an acknowledgement of the harms that continue in the present.
We can't have reparations if we don't, for instance, have divestment from the prison industrial complex in this country. Reparations are a much larger series of steps that acknowledge how policy in this country has been actively formed to harm Black folks, indigenous folks and other folks of colour. Reparations involve an active and good faith effort to apologise for and repair those harms.
What we are doing is a kind of stopgap measure in the interim. The question we’re asking with this programme is, while extreme racism continues, how can we protect this most vulnerable group within this critical time period?
Neil: Thank you for sharing these powerful reflections. My last question is about positionality. What does this work mean to you and how do you reflect on your position within it?
Zea: I don’t think I’d be doing this work if I didn't also identify as a black mum, and if I hadn't been raised by a single black mum in a very low income household. These experiences absolutely influenced the work I do with the Abundant Birth project.
And at the same time, I’ve faced many challenges doing this work as a Black woman. This has happened especially during conversations about fundraising with established institutions. I regularly get asked questions such as, “how can we trust that you are going to make sure these Black mums spend the money in the right way?” There’s so much racism underlying that question, and I suspect that my white colleagues don't face that same type of scrutiny.
Growing up, we had a sign in our kitchen that said, ‘we stand so tall because we stand on the shoulders of our ancestors’. I was told it was a West African proverb. In our family, it meant that we owe a debt to those who came before us, and we need to pay it forward.
When I face hurdles, or opposition, it’s so hard not to take it personally, because this is not just a job to me. This is not just an opportunity to expand my career. This is really deep heart work, ancestral work, work that I can't totally separate from emotionally. I think this is both a strength and a vulnerability, because the opposition in this country against Black families thriving is very, very strong.
Explore the rest of the series
This series looks at the specific challenges that campaigners face when arguing for universal basic income in highly individualised and neoliberal contexts like the United States and the United Kingdom, and how they work to overcome them.
Part 1 | Getting on with it
- UBI in the US ‘not just an idea’ – it’s achievable
Shafeka Hasash, Economic Security Project - 'Hope goes a long way': BI as a lifeline for ex-prisoners
Kevin Scott, Community Spring - Could a guaranteed income pave the way for racial justice?
Rachel Pyon, Deon Hodrick and Matthew Harvey, Equity and Transformation - Direct cash transfers 'could halve child poverty' in Oregon
Antonio Gisbert, Oregon Rebate - What can end the suffering of Black mothers and children in the US?Zea Malawa, University of California, Berkeley Public Health
Part 2 | Widening the politically possible
- UBI could mean justice for everyone. How do we get there?
Philippe Van Parijs, UCLouvain - Basic income ‘won’t stop people working’: lessons from CanadaBen Earle and Sheila Regehr, Basic Income Canada Network
- Basic income could put food banks out of businessDavid Beck, University of Salford and UBILab Food
- Basic income: why we need to start talking about moneyCleo Goodman, Autonomy and the Basic Income Conversation
- Can cities do what national governments won’t on basic income?
Leandro Ferreira, Brazilian Basic Income Network
Part 3 | Getting the policy mix right
- It's time for a welfare revolution in the UK
Vibhor Mathur, University of Bath - Put the whole government to work rebuilding Britain
Matthew Johnson, Elliot Johnson and Kate Pickett, Northumbria University and University of York - Does Labour dare to renew the welfare state?
Cleo Goodman, Autonomy - Will Scotland be the first to guarantee a minimum income?
Ruth Boyle and David Eyre, Poverty Alliance - Sustainable welfare for a sustainable planet
Nicholas Langridge and Milena Büchs, University of Bath and University of Leeds - From dogma to data: a centrist case for pragmatic welfare reform
David Westlake, Cardiff University
