NOURISHING PREGNANCY PROJECT

• Sponsoring Institution: National Institute of Food and Agriculture
• Project Status: ACTIVE
• Funding Source: OTHER GRANTS
• Reporting Frequency: Annual
• Accession No.: 1028696
• Grant No.: 2022-33800-37537
• Cumulative Award Amt.: $363,791.60
• Proposal No.: 2022-01873
• Project Start Date: Jul 1, 2022
• Project End Date: Jun 30, 2026
• Grant Year: 2022
• Program Code: [LN.C]- Community Foods

Recipient Organization
18 REASONS
3674 18TH ST
SAN FRANCISCO,CA 941101532

Performing Department
(N/A)

Non Technical Summary
The Nourishing Pregnancy Program will provide free weekly grocery delivery, free weekly cooking classes, and free peer support over the course of four months to low-income pregnant Black and Latinx people and their families in San Francisco. 23% of pregnant people in these communities currently experience food insecurity. By sourcing local food, creating a convenient way for families to access it, and incorporating food skills education, Nourishing Pregnancy helps achieve the USDA's goal to "provide all Americans access to a safe, nutritious and secure food supply"Over the four years of the grant period, our project will evolve to include community meal preparation and delivery that will support families in the early postpartum days while providing job opportunities for community residents. 18 Reasons will also connect participants with additional services including federal food benefits and local produce incentive programs.Over the four years of the program, nearly 2,000 graduates of Nourishing Pregnancy will report positive behavior changes including eating more fruits and vegetables, cooking more meals at home, and stretching their food budgets farther. Graduates will report more full-term births and healthy birth weights (at least 90%) than the average Black or Latinx mother in San Francisco (86%). We are interested to learn how our program affects other pregnancy complications and birth outcomes such as gestational diabetes, preeclampsia, breastfeeding success, and peripartum mood disorders; we will work with partner organizations, external evaluators, and participating families to determine how to best measure these outcomes.

Animal Health Component

(N/A)

Research Effort Categories

Basic

(N/A)

Applied

(N/A)

Developmental

(N/A)

Classification

Knowledge Area (KA)	Subject of Investigation (SOI)	Field of Science (FOS)	Percent
703	6020	1010	100%

Knowledge Area
703 - Nutrition Education and Behavior;

Subject Of Investigation
6020 - The family and its members;

Field Of Science
1010 - Nutrition and metabolism;

Keywords

pregnancy

equity

food access

food security

maternal health

peer education

Goals / Objectives
The Nourishing Pregnancy Program will provide free weekly grocery delivery, free weekly cooking classes, and free peer support over the course of four months to low-income pregnant Black and Latinx people and their families in San Francisco. 23% of pregnant people in these communities currently experience food insecurity. By sourcing local food, creating a convenient way for families to access it, and incorporating food skills education, Nourishing Pregnancy helps achieve the USDA's goal to "provide all Americans access to a safe, nutritious and secure food supply"Over the four years of the grant period, our project will evolve to include community meal preparation and delivery that will support families in the early postpartum days while providing job opportunities for community residents. 18 Reasons will also connect participants with additional services including federal food benefits and local produce incentive programs.Over the four years of the program, nearly 2,000 graduates of Nourishing Pregnancy will report positive behavior changes including eating more fruits and vegetables, cooking more meals at home, and stretching their food budgets farther. Graduates will report more full-term births and healthy birth weights (at least 90%) than the average Black or Latinx mother in San Francisco (86%). We are interested to learn how our program affects other pregnancy complications and birth outcomes such as gestational diabetes, preeclampsia, breastfeeding success, and peripartum mood disorders; we will work with partner organizations, external evaluators, and participating families to determine how to best measure these outcomes.

Project Methods
This project is designed to "meet the food needs of low-income individuals through food distribution [and] improving access to food as part of a comprehensive service." By sourcing local food, creating a convenient way for families to access it, and incorporating food skills education, Nourishing Pregnancy helps achieve the USDA's goal to "provide all Americans access to a safe, nutritious and secure food supply" and to create "nutrition education programs for at-risk populations to enhance food purchasing and food-preparation skills and to heighten awareness of the connection between diet and health."By building strong peer education networks and creating economic opportunities in partnership with community members, the project also "increase[s] the self-reliance of communities in providing for the food needs of the communities." While racial health disparities are not mentioned in the Program Objectives, addressing them is a key element in ensuring that a healthy diet is accessible to all.Graduates of our program will report increased food security, increased positive health behaviors such as eating more fruits and vegetables, and increased cooking confidence. We will track birth outcomes, and track positive changes in gestational age, birth weight, and pregnancy and birth complications as a result of Nourishing Pregnancy. We will also track referrals to and enrollment in other wraparound services that can provide long-term support for families.We will evaluate the success of Nourishing Pregnancy using a matched pre- and post-series survey that tracks behavior changes as well as pregnancy outcomes. Participants will take the same survey we administer in Cooking Matters classes, as well as an additional survey that tracks birth outcomes. In our most recent data from 2021, our Cooking Matters graduates report increased consumption of healthy foods, with 74% of graduates eating more vegetables, 78% eating more fruit, and 63% eating more whole grains. Graduates report a 15% decrease in consumption of sugar-sweetened beverages. Graduates are able to access more healthy food by learning to stretch their food dollars; 52% plan meals ahead of time more often, 48% compare prices before buying food more often, 61% shop with a grocery list more often, 97% use the "nutrition facts" label more often, and 52% think about healthy food choices more often. Food insecurity in the Bay Area drops by 1% each year as the wealth in our area grows; 18 Reasons is able to reduce food insecurity among our participants by 12% in just 6 weeks because of the food resource management skills we teach. We anticipate similar results from Nourishing Pregnancy graduates.We ask graduates to report the gestational age and birth weight of their babies, as well as any pregnancy, birth, or postpartum complications such as preeclampsia, gestational diabetes, etc. In 2021, 39 of our 41 graduates (95%) gave birth to full-term, healthy weight infants. (Baseline for this population is 86%.) We did not collect information about other complications. Starting in 2022, we will be working with the local consulting firm Reimi + Associates to develop a more robust evaluation tool that protects client information while gathering data about pregnancy and birth outcomes.We will track program participation and quantities of food distributed to ensure we are meeting output goals. We will also gather qualitative data from program participants and peer educators using interviews and focus groups with doulas, peer health educators, and program participants (tools which we also used to develop the program in 2020-2021). Qualitative feedback has the potential to capture the full experience and impact of the program.

Progress 07/01/24 to 06/30/25

Outputs
Target Audience:Over the past year, 18 Reasons reached 251 pregnant women and their families through the Nourishing Pregnancy program. Changes/Problems:No major changes. What opportunities for training and professional development has the project provided?We have trained two peer health educators to teach Nourishing Pregnancy classes, and have provided professional development to staff members in newborn care through a certification program. How have the results been disseminated to communities of interest?We share our results in an annual report with all program participants, guest instructors, and community partners. What do you plan to do during the next reporting period to accomplish the goals?During the next reporting period, which is the final year of the grant, we plan to focus on: 1. Program evaluation: we will conduct a thorough evaluation of the program and results. We hope to partner with a local research institution to study our program. 2. Expanding the meal delivery program: we recently received a contract from a local health department to fund meal delivery to post-partum mothers in one of the counties we work in. We will scale up our meal delivery program through this contract. 3. Expanding our work with Medicaidthrough a statewide initiative that allows Medicaid to pay for food supports like ours: we have designed a curriculum and outreach materials to enroll Medicaid members in our program. We can get reimbursed for the cost of the food we deliver as well as for our nutrition education services. This will help support the long term sustainability of the program.

Impacts
What was accomplished under these goals? This year, 18 Reasons reached 251 pregnant women through the Nourishing Pregnancy program. 91% of participants gave birth to a full-term, healthy birthweight baby (baseline is 86% for this population). Of the 251 participants, 25% had previously given birth to a preterm or low birth weight baby; during our program, none of these women experienced a preterm birth or gave birth to alow birth weight baby. Our food security and social support program helped support healthy, positive birth outcomes for women enrolled in the program. We worked with a local chef to design and launch a meal preparation service that delivers meals to women enrolled in Nourishing Pregnancy during the first four weeks postpartum. During the rest of the 16 week series, they receive bags of groceries, but receiving prepared meals in the early postpartum days helps them rest and recover without having to cook for themselves. By participants' request, after the first four weeks we begin delivering groceries again. We are working closely with the chef to expand this program.

Publications

Progress 07/01/23 to 06/30/24

Outputs
Target Audience:During this reporting period, we offered 22 sixteen-week cohorts and reached a total of 473 individuals (goal was 24 cohorts/450 individuals). 61% of participants identified as Latine, 32% identified as Black, and 7% identified as mixed race or other. Changes/Problems:We did not make any major changes to our original Nourishing Pregnancy program. We did add and modify some lessons based on community feedback from participants and instructors. We created a modified curriculum tailored to pregnant people with diabetes as part of our work with Medicaid managed care plans. This curriculum includes diabetes-specific nutrition education and recipes. The partnership with the Perinatal Equity Initiative to deliver meals to postpartum birthing people was an unexpected opportunity that we were able to seize because of the work we had done through this project and the partnerships we had formed. We will have more to report next year. What opportunities for training and professional development has the project provided?We trained six new doulas as community health workers in our program. We also provided training opportunities for staff members through a partnership with Trauma Transformed, which included a six-part training on trauma-informed community work. How have the results been disseminated to communities of interest?We disseminated our evaluation report to Nourishing Pregnancy participants, graduates, community partners, and instructors, as well as to our funders and donors. What do you plan to do during the next reporting period to accomplish the goals?During the next reporting period, we will: 1. Expand the Nourishing Pregnancy program to add more cohorts and reach more people. 2. Expand our work with Medicaid to reach more pregnant Medicaid recipients and grow our fee-for-service program. 3. Launch an expanded meal preparation and delivery program in partnership with The Foodie Doula and the Perinatal Equity Initiative.

Impacts
What was accomplished under these goals? The Nourishing Pregnancy program successfully reached 473 indivuals during the reporting period with free, home-delivered groceries and free online cooking, nutrition, and prenatal/postpartum education. 93% of graduates reported experiencing a full-term birth (baseline for this population is 87%; our goal is 90%). 77% of graduates reported eating more fruits and vegetables as a result of the program. Graduates reported an average 51% increase in cooking confidence. Graduates also shared qualitative outcomes like experiencing greater social support and enjoying learning new recipes and techniques. In April, 2024, we launched a Nourishing Pregnancy cohort specifically serving pregnant people with gestational diabetes or type 2 diabetes, in partnership with the Contra Costa Regional Medical Center. We have successfully reached 22 people through this program. We contracted with Contra Costa Health, the Medicaid managed care plan in Contra Costa County, to be able to bill Medicaid for the groceries we deliver to these individuals, through a Medicaid waiver program called CalAIM (California Advancing and Innovating Medicaid). We will expand this program in the new fiscal year to reach more individuals. We also hope to contract with managed care plans in additional counties, but this process has been extremely slow due to the managed care plans' lagging timelines for new contracts. Contracting with Medicaid is part of our long-term sustainability strategy. In May, 2024, we were awarded a contract with the Contra Costa County Perinatal Equity Initiative to deliver meals to Black birthing people for 12 weeks postpartum. This contract is still in negotiation, but we hope to launch this service by the end of the year and expand our offerings. We are partnering with The Foodie Doula, a local Black-owned/woman-owned business, who is working with 18 Reasons to design and cook the meals that we will deliver. The Foodie Doula will use the 18 Reasons kitchen to prepare the meals. We will be able to report more about this part of the project in our next REEport.

Publications

Progress 07/01/22 to 06/30/23

Outputs
Target Audience:The target audience for our project is Black and Latinx pregnant people in the San Francisco Bay Area. Changes/Problems:We have not reached as many people as we hoped in year one, and are working hard to increase our reach by adding new partners. One of our original visions for the program was to integrate it with the healthcare system, so that pregnant people who were food insecure could easily be referred to Nourishing Pregnancy. We quickly learned that there is no easy way for medical providers to refer people to social services, and that in fact many providers don't know how to screen patients for food insecurity. We have spoken with dozens of doctors, midwives, and social workers over the past year, and have learned a tremendous amout about the gaps in the healthcare system that keep patients from receiving social services. Luckily, two innovations are currently being launched in California that will help 18 Reasons and other service providers connect more seamlessly with healthcare. First, the Unite Us platform will create a central database of social services, and healthcare organizations that opt to use it (which currently include the San Francisco Health Plan and Kaiser Permanente) will be able to easily refer patients to needed services. Second, in 2021 California launched the statewide CalAIM initiative(California Advancing and Innovating Medi-Cal),a multiyear plan to transform California's Medi-Cal program and to integrate it more seamlessly with other social services. 18 Reasons became a community supports provider in 2022, and we are currently being reimbursed by Medi-Cal for some of our services. Nourishing Pregnancy is not part of this work yet, but we are hopeful that it will intersect with CalAIM in 2024, and that we will eventually be able to be reimbursed by Medi-Cal for our services. What opportunities for training and professional development has the project provided?18 Reasons provided professional development opportunities for both staff and independent contractors. The Nourishing Pregnancy team worked on developing their skills in evaluation and program development by working with an external consultant. 18 Reasons also offered training and professional development to peer health educators who teach with the Nourishing Pregnancy program. We have trained 12 peer health educators in the curriculum so far.We are currently working with them to develop lessons specifically tailored to gestational diabetes, in anticipation of launching a cohort specifically for people with gestational diabetes. We anticipate more opportunites for peer health educators to receive training and to be employed by 18 Reasonsin the coming year. How have the results been disseminated to communities of interest?We share program results in our annual report, in our newsletters, on our website, and in monthly newslettters to program participants. What do you plan to do during the next reporting period to accomplish the goals?In the next reporting period we are focused on five goals: 1. Program expansion: we are building partnerships with healthcare partners and community-based organizations to increase program participation. A new platform called Unite Us will make it easier for healthcare providers to refer patients to social services and programs like Nourishing Pregnancy; we have created our Unite Us profile and we are working with healthcare providers to raise awareness about our program and how to refer patients to it. 2. Expanding our meal delivery pilot to more participants, and refining the meal preparation and delivery model. 3. Completing our evaluation project and launching new evaluation tools: we are working with our evaluation consultant through January, 2024, and will launch a revised evaluation instrument at that time. 4. Launching a cohort specifically for people with gestational diabetes: we are working with the Contra Costa Regional Medical Center to develop a program specifically tailored for people with gestational diabetes, and hope to launch by January, 2024. Through a new initiative called CalAIM, which aims to transform Medicaid (called Medi-Cal in California) by reimbursing providers of food and housing with Medicaid funds, eventually we may be able to bill Medi-Cal for our services. 5. Peer health educator training and employment: we are exploring further opportunities to train and employ peer health educators. We are exploring the option of having our training program certified by the state of California as a Community Health Worker training program, which would open up new job opportunities for our educators.

Impacts
What was accomplished under these goals? In the first year of the project, 18 Reasons provided free weekly grocery delivery, free weekly cooking classes, and free peer support to 246 Black and Latinx low-income community residents. 87% of our program participants reported a full-term, healthy weight birth, and the average participant increased their food security by 14%. Graduates reported cooking more at home, eating more fruits and vegetables, and saving money while grocery shopping.?18 Reasons developed a resource guide thatreferred participants to a variety of local, state, and federal programs, including SNAP, WIC, local produce incentive programs, free doula services, and a local universal basic income program for pregnant Black people. We began working with an external evaluator to refine our evaluation instruments, and started planning focus groups that will improve the program design over the next year. We piloted adding meal delivery to the postpartum food deliveries, and collected feedback from participants, who were enthusiastic about the meal component of the program, especially in the early postpartum days when cooking is a challenge. We partnered with a local nonprofit community kitchen and job training program to prepare the meals.

Publications