County officials present AIM strategy: doulas, guaranteed income pilot and community governance to cut Black birth disparities

County public-health officials briefed the Los Angeles City Health Commission on Nov. 10 about the African American Infant and Maternal Mortality Prevention Initiative (AIM), a multi-pronged, community-led effort to reduce disproportionately high Black infant and maternal deaths.

"The goal of the initiative is not simply to end or address the disparity. The goal of the initiative is to foster abundant, beautiful, joyous births for Black folks in LA County," said Melissa Franklin, director of Maternal, Child and Adolescent Health for the Los Angeles County Department of Public Health.

Key data and drivers: Franklin said county-level figures show infant mortality for Black infants in LA County of 7.1 per 1,000 live births in 2021, 9.6 in 2022 and 8.9 in 2023. Presenters emphasized that premature birth is the leading driver of infant mortality and that disparities persist after adjusting for conventional protective factors such as education and income; presenters pointed to structural racism, generational trauma and chronic stress ("weathering") as key, research-backed contributors.

Programs and partnerships: AIM encompasses a community doula program, community action teams, a Motherboard (community governance body), a Medi-Cal doula hub to support doulas becoming Medi-Cal providers, and partnerships with local organizations including Charles R. Drew University, Black Maternal Health Center of Excellence and Black Women for Wellness. "We offer free doula services to African American women to be provided by African American women," said Adwa/Adja Jones, AIM birth equity unit lead.

Abundant Birth pilot: The County launched a guaranteed-income pilot called the Abundant Birth Project in January 2024. Presenters said LA enrolled 410 women and provided a stipend of $807 per month for 18 months, plus optional coaching (about 75% opted into coaching), and linked participants to other AIM services and referrals.

Equity and scale: Franklin described "Project 8,000," an effort to reach 8,000 Black births with affirming supports through managed-care contracts and community partners; contracts were being finalized at the time of the presentation. Presenters also described a Motherboard of community members who inform governance and a "doula hub" that helps doulas become Medi-Cal providers in the post-SB-65 policy landscape.

Commissioner questions and follow-up: Commissioners asked for more disaggregated data at the council-district or census-tract level and raised clinical questions (BMI, hypertension, gestational diabetes) and program-evaluation rigor. Presenters said state dashboards are improving, the County is working on census-tract analysis and that more granular reports could be shared when confidentiality and statistical robustness allow. On housing, presenters said homelessness is a major barrier: roughly 30% of Abundant Birth participants were unhoused or housing insecure, and AIM staff said they are developing housing-focused work groups and partnerships.

Why it matters: The AIM initiative ties community leadership, clinical supports (including doulas), social-determinant interventions (guaranteed income) and managed-care partnerships to address a persistent racial gap in birth outcomes. Presenters stressed that many evidence-informed interventions—doulas, group prenatal care, mental-health supports and guaranteed income—work together to reduce stressors and improve outcomes.

Sources and attribution: All program descriptions, data points and pilot numbers are from remarks by Melissa Franklin, Adwa/Adja Jones and AIM staff during the Nov. 10 Los Angeles City Health Commission meeting (transcript segments SEG 1278'SEG 2890).