April 7, 2025

By Ali Groves, PhD, MHS, and Elizabeth Valdez, PhD, MPH

This UHC Policy Core blog series highlights important topics in urban policy that have implications for health and health equity.

Despite its rich history and vibrant culture, Philadelphia faces a heartbreaking truth: one in every 152 infants born in the city will not survive the time before their first birthday. Moreover, these deaths are not evenly distributed. Black infants are nearly twice as likely to die as White infants. This excess risk is driven in part by poverty. In Philadelphia, 1 in 4 Philadelphians (and 3 in 10 Black Philadelphians) live in poverty, and poverty is consistently associated with poor health. Given this broader context, it is not surprising that a recent survey found that almost half of all parents reported significant financial stress (such as losing a job or having to move) in the 12 months before giving birth. To counter this financial stress and improve birth outcomes, Philadelphia is piloting an innovative new financial support program: the Philadelphia Joy Bank.  

What Is The Program? 

The Philly Joy Bank provides $1,000 of monthly guaranteed income, defined as regular cash payments with no restrictions on how it is spent, and no work requirements. Pregnant individuals who are eligible for and selected to take part in the Philly Joy Bank receive 18 payments monthly, starting in the second trimester and lasting until 12 months postpartum. By providing cash to be used by participants as they choose, the Philly Joy Bank aims to center the dignity, power, and autonomy of participants. 

Why Might This Program Work? 

Financial stress during pregnancy can increase depression and lead to low birth weight.  On the other hand, individuals who are not experiencing financial hardship during and after pregnancy are better positioned to attend prenatal care, maintain their housing, and purchase healthy food for themselves and their family. Alleviating financial stress can have real, positive impacts on birth outcomes and has also improved recipient’s mental health and well-being. And there is a simple way to do this: give families money – enough money so that they can meet a meaningful line item in their monthly budget for an extended period, such as housing or childcare. This is the Joy Bank approach: $1,000 per month for the three months before birth and up to a full year after.  

Is This Program Unique To Philadelphia? 

No! A growing number of cities across the country are implementing guaranteed income programs for families during and after pregnancy. But Philadelphia’s infant mortality rate ranks among the worst in the nation's ten most populous cities, making it an important city in testing the impacts of these programs. In partnership with community members and key stakeholders at the Philadelphia Department of Public Health, researchers at Drexel are using surveys and storytelling methods to understand whether and how extra cash during and after pregnancy impacts parents and their infants. We hope that the results from this evaluation can be used to expand the program to other families in Philly and beyond. 

Why Are These Programs Important Right Now? 

Local policy solutions offer critical opportunities to preserve and advance population health and health equity. Such solutions are more important now than ever, given the federal governments’ scaling back of public health programs and the public health workforce.  Providing direct cash to families during and after pregnancy is an administratively efficient way to combat perinatal poverty. Moreover, scale up of these programs is possible, as illustrated in cities like Flint, Michigan, where Rx Kids draws on existing government grant dollars to provide a universal cash benefit to all families during and after pregnancy. By providing financial stability during a critical life transition, these programs can help babies and families flourish, not just at birth, but for years to come.