Maternal, Child & Adolescent Health Division

Perinatal Equity Initiative2019-2024 Results

Background

The California Perinatal Equity Initiative (PEI) is a community-driven and implemented initiative designed to address racial disparities in infant mortality by providing meaningful support and resources to Black families. Through this initiative, each funded local health jurisdiction (LHJ) is required to establish a community advisory board, develop a public awareness campaign and fund community-based organizations to implement at least two interventions thought to improve health outcomes.¹

The Maternal, Child and Adolescent Health (MCAH) Division follows the progress of local PEI public health interventions using the Results-Based Accountability (RBA) framework.² This framework aids local health jurisdictions (LHJs) and communities in identifying desired health outcomes and determining the strategies needed to achieve them. PEI launched in California in fiscal year (FY) 2019-2020. PEI services are financed by State General Funds.

Using a collaborative approach, LHJ PEI coordinators worked together at the launch of the initiative to identify common performance measures for each of the interventions, with technical assistance from the MCAH Division and an RBA contractor. The PEI performance measures (PMs) are intended to keep the focus on what LHJs are accountable for: the people they serve. Measures fall into three categories that RBA outlines to identify what matters most:

How much did we do? These measures inform us about how much of an activity was conducted, the frequency of activities, or how many people participated.
How well did we do it? These measures inform us about quality: was the activity conducted at the level of quality expected and aimed for?
Is anyone better off? These measures inform us if the activity made a difference in someone's life. These measures should relate to impacts that can result directly from delivering services as intended: Are our services having the desired impact on participants?

Given there is evidence supporting that some of the PEI interventions can impact perinatal health outcomes such as rates of c-sections, preterm births and low birth weights, consensus was achieved on utilizing these outcomes as “Is Anyone Better Off?” measures. We also acknowledge that these are complex health outcomes with multifactorial causes,³ and intervention impacts on participants for an individual local program might be influenced by environmental factors beyond the intervention.

The data presented here cover July 1, 2019 to June 30, 2024 (state fiscal years 2019-2020 through 2023-2024). Each LHJ was responsible for working with their subcontractors to collect participant data and submit aggregated data quarterly to MCAH for each of the performance measures. The information presented here is a fiscal year aggregation of all the LHJ data reported to MCAH. Refer to the About the Data document on each page for more technical details about the measures.

What Does the Data Say?

As you explore the data you will learn about how each PEI intervention progressed over the reporting years (2019-2024), the number of people they enrolled, the number of services provided, and other activities conducted. Explore the “Is Anyone Better Off?” measures to learn how the interventions are delivering their intended benefits for the community. Overall, PEI implementation and outcomes are moving in the right direction.

Limitations of the Data and its Interpretation

When exploring the data in these visualizations, please note that the completeness of the data for each measure was dependent on multiple factors.

Notably, PEI launched during the COVID-19 pandemic, which impacted timelines and service providers' availability in earlier years.

Otherwise, if data were not reported for a given period(s), there may have been various reasons including:

LHJs were in the process of subcontracting with community-based organizations to provide services.
LHJs reached expiration of a contract with a provider.
Local capacity building was needed prior to subcontracting for service delivery (i.e., training community-based doulas; design of innovative and community-centered fatherhood programs). In this case, data related to PMs were not available; LHJs did report qualitative information to MCAH (not shown).
Interventions that were initially selected were later phased out based on local community input. This flexibility aligns with the community-driven nature of the initiative.

Community-defined impacts of the PEI intervention are displayed by the “Is Anyone Better Off?” performance measures. The availability of data for these measures was based on completion rates of surveys by participants which differed depending on the LHJ/intervention combination. Positive impacts were seen for the most part among those that completed surveys.

The nature of the PEI legislation calls for each LHJ to choose and implement their own interventions (ranging from evidence-based to innovative practices) and LHJs are fully responsible for data ownership including developing their own processes for data collection, management, and analysis.¹ LHJs aggregated their own data for each intervention and reported to MCAH on a quarterly basis. Given this, PEI's positive impacts on communities should be considered examples of developing contextual and experiential evidence as opposed to research evidence.⁴ This aligns with a shifting paradigm in the importance of community-defined evidence as it relates to public health decision making.⁵

It is important to acknowledge that health outcomes (such as preterm birth, infant mortality, or c-section rates) are the result of complex systems and public health programs like PEI and Black Infant Health contribute to change in targeted ways.³ As always, a multipronged approach is needed to continue addressing the root causes of health disparities.

References

California Assembly Bill 1701, 2023. Accessed February 4, 2026. Bill Text: CA AB1701 | 2023-2024 | Regular Session | Chaptered | LegiScan
RBA was created by Mark Friedman who has the intellectual property of the concepts and information about RBA, including the book Trying Hard Is Not Good Enough: How to produce measurable improvements for clients and communities (2005, 2015) and the website www.raguide.org.
Braveman P, Dominguez TP, Burke W, et al. Explaining the Black-White Disparity in Preterm Birth: A Consensus Statement from a Multi-Disciplinary Scientific Work Group Convened by the March of Dimes. Front Reprod Health. 2021 Sep 2; 3:684207. doi: 10.3389/frph.2021.684207.
Vasquez, N.I., Powis, L. Uplifting Community Expertise in Evidence for MCH. November 7, 2023. Accessed on February 4, 2026. https://amchp.org/wp-content/uploads/2023/12/AMCHP_Community-Expertise-in-Evidence_Nov-2023-Partnership-Mtg.pdf
Powis, L., Ramirez, G. G., Krisowaty, L., and Kaufman, B. Shifting Power in Practice: The Importance of Contextual and Experiential Evidence in Guiding MCH Decision Making. Matern Child Health J. 2022, 26(Suppl 1), 204–209. https://doi.org/10.1007/s10995-022-03457-8.