Title
Authorize Acceptance of the Black Infant Health and the Perinatal Equity Initiative Allocations from the California Department of Public Health (Districts: All)
Body
Overview
The San Diego County Board of Supervisors (Board) has supported improving birth outcomes and reducing infant mortality for over three decades through the approval of the California Department of Public Health (CDPH) Maternal, Child, and Adolescent Health Division Title V Maternal and Child Health Block Grant (Title V MCH Block Grant) funding. Most recently, on October 21, 2025 (10), the Board authorized allocation agreements to accept MCH funding.
The Title V MCH Block Grant funding addresses health and birth equity through a number of initiatives including the Black Infant Health (BIH) program in San Diego County, which was established over 35 years ago. The 2018-19 California State Budget Act established the California Perinatal Equity Initiative (PEI) to expand the BIH program to improve birth outcomes and reduce mortality in Black infants through evidence-based interventions. Counties that implemented BIH programs were eligible to receive PEI State General Funds (SGF). On June 28, 2022 (2), the Board approved the acceptance of the BIH allocation in the amount of $1,345,415 for the period of July 1, 2022, through June 30, 2023. In addition, on January 24, 2023 (8), the Board approved the acceptance of the BIH expansion allocation in the cumulative amount of $3,425,400 through June 30, 2026. On October 21, 2025 (10), the Board approved the acceptance of the PEI allocation in the amount of $484,310 for the period of July 1, 2025, through June 30, 2026.
Today’s action requests the Board authorize the acceptance of BIH Title V and SGF allocations from CDPH for the period of July 1, 2026 through June 30, 2027 in the amount of $1,828,350, the acceptance of PEI SGF allocation in the amount of $484,310, and subsequent annual allocations of $1,828,350 and $484,310 for the period of July 1, 2027 through June 30, 2029 and to apply for additional funding opportunities to help improve health equity for San Diego County residents. This funding supports State-mandated Maternal, Child, and Family Health Services programs designed to improve the health of mothers, infants, children, adolescents, and their families.
Today’s action supports the County vision of a just, sustainable, and resilient future for all, specifically those communities and populations in San Diego County that have been historically left behind, as well as our ongoing commitment to the regional Live Well San Diego
vision of healthy, safe, and thriving communities. This will be accomplished by improving access to quality healthcare for mothers, infants, children, adolescents, and families.
Recommendation by the Chief Administrative Officer:
1) Waive Board Policy B-29, Fees, Grants, and Revenue Contracts-Department Responsibility for Cost Recovery, which requires prior approval of grant applications and full-cost recovery of grants.
2) Authorize the acceptance of $1,828,350 in allocation funds from the California Department of Public Health, Maternal, Child, and Adolescent Health Division for the period of July 1, 2026 through June 30, 2027, and subsequent annual allocations of $1,828,350 for the period of July 1, 2027 through June 30, 2029 for the Black Infant Health (BIH) program, and authorize the Chief Administrative Officer, or designee, to execute all required allocation documents, upon receipt, including any extensions, amendments, and/or revisions thereto that do not materially impact or alter the services or funding level.
3) Authorize the acceptance of $484,310 in allocation funds from the California Department of Public Health, Maternal, Child, and Adolescent Health Division for the period of July 1, 2026 through June 30, 2027, and subsequent annual allocations of $484,310 for the period of July 1, 2027 through June 30, 2029 for the Perinatal Equity Initiative (PEI) program, and authorize the Chief Administrative Officer, or designee, to execute all required allocation documents, upon receipt, including any extensions, amendments, and/or revisions thereto that do not materially impact or alter the services or funding level.
4) Authorize the Chief Administrative Officer, or designee, to apply for any additional funding opportunity announcements, if available, to address preventive health care and early intervention and treatment programs for at-risk women, infants, children, and families in San Diego County for both BIH and PEI programs.
Equity Impact Statement
In 2024, 8.8% of infants born in San Diego County were born prematurely. Despite the overall improvements in birth rates, significant disparities persist, with African-American infants more than 60% more likely to be born preterm than White infants (11.8% compared to 7.2%, averaging 2022-2024). Similarly, 7.1% of infants in San Diego County were born with low birthweight in 2024, yet African-American infants were about twice as likely as White infants to be born with low birthweight (10.9% versus 5.3%, averaging 2022-2024). These disparities highlight the ongoing need for targeted, culturally responsive maternal and infant health interventions.
The County of San Diego HHSA Public Health Services administers the Black Infant Health (BIH) program and the Perinatal Equity Initiative (PEI) to reduce perinatal morbidity and mortality among disadvantaged populations. Both programs work to address longstanding inequities in maternal and infant health by expanding access to quality prenatal and postpartum care, and community resources. . Through the joint BIH-PEI Community Advisory Board, stakeholders and community members provide critical guidance to ensure services reflect community needs and lived experiences.
Sustainability Impact Statement
Today’s proposed action supports the County of San Diego Sustainability Goal #1 to engage the community; Sustainability Goal #2 to provide just and equitable access; and Sustainability Goal #4 to protect the health and well-being of everyone in the region. This will be accomplished by ensuring that those eligible are provided access to services offered through the Black Infant Health (BIH) program, and partners of program participants are eligible to receive services through the Perinatal Equity Initiative (PEI) Fathers First program. Community engagement and input will continue to be supported through the BIH-PEI Community Advisory Board and the Family Support Connection collaborative.
Fiscal Impact
Recommendation #2: Accept Black Infant Health Title V and State General Funds Grant
Funds for this request are included in the Fiscal Year (FY) 2026-28 Operational Plan in the Health and Human Services Agency. If approved, today’s actions will result in estimated costs of $3,065,487 and revenue of $2,638,665 in FY 2026-27, and estimated costs of $3,004,380 and revenue of $2,619,790 in FY 2027-28. The funding sources are Title V, State General Funds, and Title XIX. A waiver of Board Policy B-29 is requested because the funding does not offset all costs. These unrecovered costs are estimated at $426,822 in FY 2026-27 and $384,590 in FY 2027-28, for a total of $1,196,002 through FY 2028-29, which includes the matching requirement, the Title XIX component. The funding source for these costs will be existing Realignment. The public benefit for providing these services far outweighs the B-29 unrecoverable costs. There will be no change in net General Fund costs and no additional staff years.
Recommendation #3: Accept Perinatal Equity Initiative State General Funds Grant
Funds for this request are included in the FY 2026-28 Operational Plan in the Health and Human Services Agency. If approved, today’s actions will result in estimated costs of $1,064,001 and revenue of $662,578 in FY 2026-27, estimated cost of $1,109,487 and revenue of $685,355 in FY 2027-28. The funding sources are the Perinatal Equity Initiative State General Funds Grant from the California Department of Public Health and Title XIX. A waiver of Board Policy B-29 is requested because the funding does not offset all costs. These unrecovered costs are estimated to be $401,422 in FY 2026-27 and $424,132 in FY 2027-28, for a total of $1,271,960 through FY 2028-29, which includes the matching requirement, the Title XIX component. The funding source for these costs will be existing Realignment, General Fund, and Tobacco Settlement funds. The public benefit for providing these services far outweighs the B-29 unrecoverable costs. There will be no change in net General Fund costs and no additional staff years.
Business Impact Statement
N/A
Details
Advisory Board Statement
The Health Services Advisory Board received a presentation on this item at its meeting on August 4, 2026.
Background
Social and economic inequities, such as in the availability of quality health care and supportive built environments, are serious public health concerns. This is because they lead to disparities in health outcomes and increased healthcare costs. As it is influenced by social determinants of health, infant mortality is an important indicator of the overall health of a society. According to the Centers for Disease Control and Prevention (CDC), African-American infants are more than twice as likely as White infants to die before reaching their first birthday (2020-2022 average). In the same period, CDPH data analyzed by the County show that, in San Diego County, African-American infant mortality rates are about six times higher than the rate among Whites. Although disparities continue to exist, progress has been made over the years. For example, averaging three years, the African-American infant mortality rate decreased by over 30%, from 14.3 to 9.6 deaths per 1,000 live births between 2000-2002 and 2020-2022. Nationwide, the African-American rate is 10.6, compared to 8.7 in the County (2020-2022, according to CDC).
The County Health and Human Services Agency, Public Health Services (PHS), delivers maternal and infant health programs through its Maternal, Child, and Family Health Services Branch to improve health outcomes, reduce morbidity and mortality, and address related inequities. Since 1991, the Black Infant Health (BIH) program has improved birth outcomes for African-American infants by offering client‑centered case management that helps pregnant women build on their strengths, enhance life skills, reduce stress, and strengthen social support. In 2010, BIH expanded its approach by introducing weekly group sessions-ten prenatal and ten postpartum to further support clients in building social connections, reinforcing personal strengths, and setting health‑promoting goals for themselves and their babies. One‑on‑one case management continues to reinforce these skills and connects clients with essential community and social services. In 2018, BIH added a case‑management‑only model for clients who prefer or require individualized services. Partners of BIH clients are eligible for services through the Perinatal Equity Initiative (PEI) Fatherhood program.
The 2018-19 State of California Budget Act legislation established the Perinatal Equity Initiative (PEI) program to identify best practices to address disparities in infant mortality. Establishment of PEI, a community-driven initiative, expanded the BIH program by promoting the use of specific interventions designed to fill gaps in health departments to promote leadership and coordination for widespread and lasting change in public awareness, public health, and clinical practice. Counties that implemented a BIH program were eligible to receive PEI funding allocation. San Diego County PEI services include a fatherhood intervention for expectant fathers, trainings for healthcare providers and medical staff, maintenance of a community advisory board, and public awareness campaigns.
Additionally, the County’s BIH and PEI programs have made significant progress in reducing disparities related to infant mortality and improving health outcomes for African-American infants and families. Key BIH program outcomes for Fiscal Year (FY) 2024-25 and FY 2025-26 include:
• 621 participating clients (representing 643 pregnancies).
• 98.3% (467 of 475) of new participants received education about safe sleep/SIDS prevention.
• 92.1% (211 of 229) of singleton infants (non-multiple births) were of normal birthweight (2,500 grams or more; includes only infants of prenatally enrolled clients with birthweight information).
• 91.8% (214 of 233) of infants-initiated breastfeeding, and 68.8% (110 of 160) of 3-month-old infants sustained breastfeeding (includes only infants of prenatally enrolled clients with breastfeeding information and no medical contraindications to it).
PEI program outcomes for FY 2024-25 and FY 2025-26:
• Enrolled 54 new and expectant fathers in an evidence-informed fatherhood program designed to strengthen support for women during pregnancy and childbearing (February 2025 - November 2025).
• Coordinated with the Office of Nursing Excellence to implement the Diversity Science - Implicit Bias training and exam for a cohort of 99 Public Health Nurses in FY 2024-2025.
• Led Community Advisory Board, which includes approximately 50 active members and 262 community partners who provide guidance on program services and receive birth equity resources to support BIH and PEI activities.
• Developed and launched the Black Legacy Now Public Awareness Campaign in September 2020, featuring a website, social media content, transit posters, and advertisements. The campaign has generated 104,361 clicks, reflecting strong community engagement.
On June 28, 2022 (2), the San Diego County Board of Supervisors (Board) approved the acceptance of the BIH allocation in the amount of $1,345,415 for the period of July 1, 2022, through June 30, 2023. In addition, on January 24, 2023 (8), the Board approved the acceptance of the BIH expansion allocation in the cumulative amount of $3,425,400 through June 30, 2026. On October 21, 2025 (10), the Board approved the acceptance of the PEI allocation in the amount of $484,310 for the period of July 1, 2025, through June 30, 2026. Today’s action requests the Board to approve and authorize acceptance of BIH and PEI Title V and State General funding of $1,828,350 and $484,310 in allocation funds from CDPH, for the period of July 1, 2026, through June 30, 2027, and subsequent annual allocations of $1,828,350 and $484,310 for the period of July 1, 2027, through June 30, 2029.
The total cost to implement the BIH program is $3,065,487 and includes an estimated $426,822 in unrecoverable B-29 costs for FY 2026-27. The funding source for the unrecovered costs is existing Realignment. Additionally, the BIH funding includes a Title XIX matching component. For the County to qualify for this match, a local contribution is required. In this case, the unrecovered B-29 costs support the local contribution. A waiver of Board Policy B-29 is requested because the funding does not offset all costs.
The total cost to implement the PEI program is $1,064,001 and includes an estimated $401,422 in unrecoverable B-29 costs for FY 2026-27. The funding source for the unrecovered costs is existing Realignment, General fund, and Tobacco Settlement funding. Additionally, the PEI funding includes a Title XIX matching component. For the County to qualify for this match, a local contribution is required. In this case, the unrecovered B-29 costs support the local contribution. A waiver of Board Policy B-29 is requested because the funding does not offset all costs. The public benefit for providing these services far outweighs these costs by providing culturally appropriate support services and resources throughout the county to address health disparities and improve birth outcomes.
Linkage To The County Of San Diego Strategic Plan
Today’s proposed action supports the Equity (Health) and Community (Quality of Life) Initiatives in the County of San Diego 2026-2031 Strategic Plan, as well as our commitment to the regional Live Well San Diego vision of healthy, safe, and thriving communities. This will be accomplished by ensuring that San Diego County has fully optimized its health service delivery system for mothers, children, and families.
Respectfully submitted,
ebony n. shelton
Chief Administrative Officer
Attachment(s)
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