San Francisco launches ‘Strong Starts’ to align agencies and reduce preterm births and infant deaths

A citywide push to narrow stark gaps in birth outcomes

San Francisco officials have launched a new initiative designed to reduce preterm births and infant mortality, with a particular focus on communities that experience the city’s largest disparities in maternal and infant health. The effort, called Strong Starts, was announced at City Hall on February 24, 2026, by Mayor Daniel Lurie alongside Supervisors Myrna Melgar and Shamann Walton.

City leaders said San Francisco spends more than $20 million each year on maternal and infant care, yet outcomes remain uneven across racial and ethnic groups. In public remarks at the launch, Lurie said Black infants in San Francisco are born preterm at nearly twice the city average and account for about one in five infant deaths despite representing roughly 4% of births.

What Strong Starts is designed to change

Strong Starts is structured as a coordination and accountability effort spanning multiple city departments rather than a single new clinical program. The initiative’s stated purpose is to align goals, clarify responsibilities, and improve how the city tracks spending and outcomes across existing maternal and infant health services.

Officials described a framework that combines health care coordination with attention to non-medical factors that can affect pregnancy and a child’s first year, including housing instability and food security. The city has also signaled that seeking additional state and federal funding will be part of the strategy as it faces ongoing budget constraints.

• Reduce preterm birth and infant mortality rates citywide, with a focus on the largest inequities.
• Set shared benchmarks across city departments and within the local health care system.
• Strengthen data collection to show how programs are delivered, funded, and used.
• Expand coordination and support services tied to health outcomes, including wraparound needs.

Why preterm birth is central to infant mortality

Preterm birth—birth before 37 weeks of pregnancy—is widely recognized as a major driver of infant illness and death. Local health data and public health program descriptions in San Francisco identify low birth weight related to prematurity as a leading contributor to infant deaths in the city, alongside sudden unexpected infant death and birth-related complications.

San Francisco public health materials also describe persistent disparities in preterm birth by socioeconomic conditions and access to care, including higher risks associated with inadequate prenatal care and unstable housing conditions.

The role of doulas and community-based support

As part of the initiative, city leaders said Strong Starts will expand and draw on the training and expertise of doulas working through community organizations, including SisterWeb. Doulas provide non-clinical support during pregnancy, childbirth, and postpartum periods and are often used to strengthen continuity of care and patient advocacy.

Officials and community representatives at the launch framed Strong Starts as an effort to improve coordination, transparency, and accountability across systems that influence pregnancy and early childhood outcomes.

What to watch next

The city has described Strong Starts as a process-driven program with performance benchmarks and stronger tracking of outcomes. Key next steps include how departments define measurable targets, how data will be shared and reported, and whether additional state and federal resources are secured to sustain expanded services amid budget pressure.

Any assessment of impact will depend on whether the initiative produces measurable changes in preterm birth rates and infant mortality over time, particularly in populations that have experienced the greatest gaps in outcomes.