San Francisco has one of the worst rates of Black maternal and infant mortality in the entire state of California. Let that sink in for a city that spends over $14 billion a year, operates its own universal health care program, and never misses an opportunity to trumpet its progressive credentials.

Supervisor Myrna Melgar put it plainly: "That is a damn shame. A damn shame in a city that has universal health care and has as many resources as we do."

She's right. And the fact that a city supervisor has to say it out loud in 2025 should tell you everything about the gap between San Francisco's self-image and its actual results.

Here's the uncomfortable truth that cuts across ideological lines: this isn't a funding problem. San Francisco's Department of Public Health has an enormous budget. The city has clinics, outreach programs, and layers upon layers of bureaucratic infrastructure supposedly designed to address exactly these kinds of disparities. And yet Black mothers and infants are dying at rates that should be unconscionable for any major American city, let alone one that fancies itself the capital of compassion.

Recent research published in the New England Journal of Medicine found that violence and drug overdose are leading causes of maternal death nationally — a grim reality that intersects with the city's ongoing struggles with public safety and the fentanyl crisis. Meanwhile, one Black woman in San Francisco described the lived experience bluntly: "You practically have to beg doctors to listen to you, and even when they do they're rarely motivated to find solutions."

City leaders recently held a panel discussion at City Hall on identifying solutions. As one local resident pointedly asked, "What were the solutions discussed? That seems like the most important part of the gathering." It's a fair question. San Francisco excels at convening panels. It's less impressive at producing outcomes.

What mothers actually need isn't another task force or awareness campaign — it's a health system that delivers results proportional to what taxpayers are putting in. That means accountability metrics, transparent reporting on where dollars go, and honest conversations about why a city this rich keeps producing outcomes this poor.

Stop measuring compassion by how much we spend. Start measuring it by who survives.