By Megan Smith, Hilary Hahn, Becky Wasserman, and Treasurer Mike Pieciak | January 2026
Nearly a thousand women die each year in the United States from preventable pregnancy-related causes, and Black and Indigenous mothers die at nearly three times the rate of white mothers. These deaths are not solely explained by biomedical reasons and the quality of healthcare received. Instead, they reflect the broader conditions in which mothers live.
Research shows that 80% of our health is determined by factors outside of the healthcare system including the neighborhoods we live in, our access to basic material needs, livable wages, social support, and educational and economic opportunities. Inequities in maternal mortality and morbidity are the result of deep structural forces — rooted in racism and economic inequality –that have shaped health outcomes across generations.
While income is an important driver of health and specifically maternal health, wealth plays an even more powerful role in a woman’s overall health, even beyond income. Wealth provides stability, buffers economic shocks, and allows for investments in a family’s future. Building wealth through programs such as Baby Bonds is a promising approach to promoting maternal and child health across generations.
Baby Bonds programs can directly address what researchers describe as economic “weathering” or the cumulative toll of chronic exposure to poverty and limited access to opportunities such as education and home ownership. For families with low wealth, these disadvantages compound over time, shaping health well before pregnancy begins and continuing into the next generation. By providing a financial asset at birth that grows over time, Baby Bonds have the potential to interrupt this cycle and support long-term positive economic and health outcomes.
The periods of pregnancy, infancy, and adolescence are particularly critical for brain development and overall health. Baby Bonds programs that prioritize enrollment of pregnant people and infants can be considered as a central strategy to the promotion of optimal brain development of infants and toddlers, health in pregnancy, and positive birth outcomes. Put simply, Baby Bonds programs that focus on building wealth across generations have strong potential to build healthy brains and bodies across the lifecourse.
While a life course approach to maternal and child health is an important concept for policymakers and health researchers, it does not address the immediacy of the economic hardship many families experience during pregnancy and early parenthood. Long-term wealth building programs do not address the immense daily stress from financial instability: the anxiety of mounting bills, the struggle to provide basic necessities like food, diapers, housing, and healthcare, and the heartbreak mothers feel when their resources fall short. Mothers have described how these pressures contribute to chronic stress, social isolation, and a feeling of being trapped.
Too often, mothers are overlooked as experts on their own needs in conversations with policy makers about economic opportunity. When interviewed, over 40% of lower income mothers with infants and young children report experiencing diaper insecurity. Mothers describe that the experience of diaper insecurity often means they cannot go to work or school because they do not have enough diapers to provide the required amount to leave their child at childcare. Mothers with diaper insecurity describe missing out on social and bonding experiences with their children. When given the flexibility of direct cash assistance, many families use those funds to buy diapers.
Listening and responding to mothers means addressing both the structural drivers of maternal health—such as income and wealth—and the most immediate, basic needs like diapers, stress, and the cash required to pay for transportation to the pediatrician’s office or buy the baby shampoo. Addressing long-term economic outcomes while meeting immediate needs leaves families supported during the most critical moments of pregnancy and early parenting.
Responding to the current maternal health crisis demands listening to mothers and putting forth a bold solution. This approach must address the upstream economic forces driving inequities in maternal health while simultaneously validating and responding to mothers’ immediate needs. We call this integrated approach the Superbundle™ of proven, yet brilliantly simple programs targeting the three large upstream drivers of inequities in maternal health while simultaneously validating the immediate needs of mothers.
The Superbundle brings together three proven and complementary strategies: (1) reducing maternal stress by meeting basic material needs like diapers in partnership with diaper banks, and strengthening mental health skills through a group-based, brief mental health program, the MOMS Partnership®; (2) providing income supports through cash transfers to help families navigate economic shocks in the pregnancy and postpartum period, and (3) undertaking wealth building through baby bonds to help build long term prosperity, positioning families to weather future economic challenges and provide future generations with assets and increased financial freedom. Together these strategies are designed to improve maternal and child health outcomes across generations.
In Vermont, the National Diaper Bank Network, The State of Vermont Office of the Treasurer, and the MOMS Partnership based at the Yale Child Study Center, are launching a three-year Superbundle called First Steps Forward. Beginning in late 2026, the pilot will be implemented in three counties in Vermont’s rural Northeast Kingdom. Data examining over ten years of maternal deaths in Vermont shows that poverty directly impacts maternal mortality. At the time of birth, 88% of mothers who died in Vermont in pregnancy or the postpartum period had Medicaid as primary insurance and 69% were utilizing the Women Infant Children (WIC) program. An estimated 90% of maternal deaths in Vermont occurred among people with a diagnosis of a mental health disorder.
The Vermont Superbundle, First Steps Forward, pilot will be used to evaluate the impact, effectiveness, and operational necessities for a statewide expansion of the program. Changes in maternal morbidity and longer-term economic outcomes will be tracked, as well as shorter term outcomes that could be measured in the next 1-3 years. These include maternal and infant mental health indicators, social isolation, employment, and healthcare utilization. Beyond generating evidence, the pilot aims to raise public awareness and inform state policy solutions to better support families.
At its core, the Vermont Superbundle First Steps Forward program reflects a commitment to systemic and long-lasting change. By addressing immediate needs while building long-term economic security, the Superbundle offers a model for sustainable and inclusive policy innovation—one that centers mothers’ lived experiences and supports the health and wellbeing of children and their families.
Megan Smith, DrPH, MPH, is Chief of Innovation and Impact at the National Diaper Bank Network.
Hilary Hahn is Executive Director of Elevate Policy Lab at Yale, where she leads the dissemination of evidence-based, trauma-informed programs, including the MOMS Partnership, to improve maternal mental health and support family economic mobility.
Becky Wasserman is Director of Economic Empowerment in the Vermont State Treasurer’s Office, where she leads asset- and wealth-building initiatives across the life course, including Vermont Saves, an automatic enrollment Roth IRA savings vehicle for employees who do not currently have access to a workplace savings plan.
Mike Pieciak is Vermont’s 31st State Treasurer, where he focuses on making smart public investments that strengthen economic security and expand opportunity, including advancing innovative approaches to maternal health, wealth-building, and financial stability.