Maternal mortality is a public health emergency. More than 80 percent of pregnancy-related deaths are considered preventable. Yet, the United States remains the most dangerous place to give birth among high-income nations. Each year, hundreds of women die during pregnancy or within one year postpartum. In 2022, there were roughly 22 maternal deaths per 100,000 live births, a rate more than double and in some cases triple that of peer countries with comparable wealth, which have managed to drive this measurement of the maternal death rate down to single digits.

What we are witnessing is not inevitability. It is failure in policy design, implementation, and accountability. This gap reflects choices about access, coverage, workforce investment, and social supports—and the burden of those policy decisions falls unevenly.

Maternal mortality is a public health emergency. More than 80 percent of pregnancy-related deaths are considered preventable.

The Inequities We See

Black women in the United States are three to four times more likely to die from pregnancy-related causes than White women. These disparities persist across income and education levels, underscoring that the issue cannot be reduced to individual behavior or socioeconomic status. Even at the highest level of education and income, a Black woman still faces a higher risk of maternal death compared to women of other races. This is a crisis of inequity: Such outcomes are the result of systemic injustice, a lack of fairness, and biased policies.

Too often, maternal deaths are treated as isolated clinical failures. In reality, they follow predictable patterns tied to policy gaps. Structural racism, uneven access to quality care, and provider bias are causing harm.

Nearly two-thirds of maternal deaths occur in the postpartum period, yet the United States has historically failed to guarantee comprehensive care during the full year after birth. Many women lose insurance coverage just weeks after delivery, cutting off access to follow-up care when complications such as cardiomyopathy, hypertension, and mental health conditions are most likely to emerge. Postpartum insurance coverage—especially Medicaid—typically ends due to strict postpartum eligibility limits that are designed around childbirth as an end point. This reflects a failure of policy to provide the conditions needed to address a medical necessity.

Geography compounds these risks. Large swaths of the country are now considered maternity care deserts, where hospitals have closed obstetric units and providers are scarce. In these areas, women must travel long distances for prenatal visits or deliver without adequate medical support. The result is delayed care, missed warning signs, and preventable emergencies that escalate into fatalities.

Even when care is available, quality is inconsistent. Studies and patient reports repeatedly show that Black women’s symptoms are more likely to be dismissed or minimized by providers. These failures to listen and respond in a timely manner are not abstract concerns; they are direct contributors to preventable deaths. This concept of “failure to rescue,” widely used in other areas of medicine, is only beginning to be applied to maternal health despite clear evidence that earlier intervention could save lives.

Moving from Policy Failure to Flourishing in Maternal Care

If maternal mortality is a policy failure, then solutions for repair must be policy-driven and measurable. There is no shortage of evidence pointing to what works:

• Continuous coverage matters. States that have extended Medicaid coverage to a full year postpartum are beginning to close dangerous gaps in care. Ensuring that every mother has uninterrupted access to physical and mental health services throughout pregnancy and the postpartum period is one of the most immediate ways to reduce mortality.
• The maternal health workforce must be expanded and diversified. The United States has fewer midwives per capita than many peer nations, despite evidence that midwife-led care improves outcomes and patient satisfaction. Investing in midwives, doulas, and community-based providers can bridge gaps in both access and trust, particularly in communities that have historically experienced discrimination in the healthcare system.
• Data transparency and accountability need to be strengthened. Maternal mortality review committees exist in many states, but their findings are not always translated into enforceable policy changes. Better data collection, including on near misses and complications, would allow policymakers to identify patterns earlier and intervene before deaths occur. Without consistent reporting, failures remain invisible and therefore unaddressed.
• Implicit bias training and hospital quality improvement initiatives must move beyond check-the-box exercises. For example, the Urban Institute has recommended that healthcare institutions incorporate implicit bias training to avoid culturally incompetent care. Black mothers have shared that they’re “not taken seriously” and their pain is downplayed in serious crises.

Hospitals should be required to implement standardized safety protocols for common complications such as hemorrhage and hypertension. These protocols have already been shown to reduce mortality when applied consistently. The problem is uneven policy adoption and enforcement.

• Social determinants of health cannot be separated from maternal outcomes. Stable housing, paid family leave, nutrition support, and protection from environmental hazards all play a role in whether a pregnancy is safe. The United States stands out among peer nations for its lack of guaranteed paid leave and home visiting supports, both of which are associated with better maternal outcomes. Addressing maternal mortality requires policy that extends beyond the healthcare system.
• Community-based organizations must be treated as essential partners, not afterthoughts. Groups led by Black women and other marginalized communities have long been on the front lines of this crisis, providing culturally competent care and advocacy. Yet they remain underfunded relative to large healthcare institutions. Sustained investment in these organizations is critical to reaching those most at risk.

Political Will and the Courage to Invest in What Works

The persistence of maternal mortality in the United States reflects a broader truth about how the country values care work and reproductive health. A system that allows preventable deaths to continue year after year—despite clear evidence of how they can be reduced—signals a lack of political will, not a lack of solutions.

This issue is deeply personal to me: I am a mom who has experienced the shortcomings in our maternal health care system, a doula who has worked to support other mothers, a midwife training to care for our communities, and an advocate fighting for change as the national director for maternal justice at MomsRising.

Reframing maternal mortality as a policy failure is about generating the urgency necessary to take action. Every statistic on maternal mortality represents a life lost and a family forever changed. We have the capacity to make pregnancy, childbirth, and the postpartum period safer for all women. Policymakers have the tools to prevent most of these deaths. The question is whether they will choose to use them.

What if we were explicit about caring for all people, more than corporations or profit?The last 10 years of American politics seem uniquely horrible. We increasingly tolerate brutal policies that deny people basic dignity. Income inequity has risen beyond any imaginable logic, while policies that would feed and house all people are demonized as dangerous or risky. Political influence is being used to further hoard resources and advantages for billionaires, leaving more people to suffer than to benefit. By design, today’s politics are focused on turning people against one another to impede solidarity and maintain the status quo of a system that is massively widening inequality.

This raises a question: What might happen across our country if those working to make life better for our neighbors—policymakers, philanthropists, nonprofits, universities, thought leaders—embraced the politics of “loving kindness”? That is, what if they combated the fearmongering of manufactured scarcity with a vision that ensures all of us can thrive? What if we were explicit about caring for all people more than corporations or profit for a few?

In 2021, I led a team of researchers, advocates, and mothers to launch the Abundant Birth Project: a guaranteed-income program built to advance birth equity by providing unconditional monthly cash transfers to birth-givers facing the highest risk of adverse outcomes. Through this work, I have learned that loving kindness is foundational to birth equity because it centers care, respect, and human dignity; it expands our imagination for what’s possible by directly supporting population health and wellbeing. As I reflect on this work, it is clear that loving kindness is not only necessary for the welfare of new parents and babies, but also essential to building the conditions in which our communities can flourish.

Nearly half of US families do not earn enough income to meet their basic needs.

Here, I offer insights and a guiding framework to invite more people into a movement that starts and ends with something everyone finds irresistible: love. With loving kindness as our compass, we can collectively work to provide unconditional care for others while actively transforming the structures that drive inequity and suffering.

Income Inequality, Health Risk, and the Policies That Shape Them

Parents are increasingly bearing the hefty burdens imposed by our current regime of brutal policies. According to a 2024 report from the US Surgeon General, nearly 50 percent of parents say their stress is completely overwhelming on most days. This level of stress is partly driven by structural factors such as income inequality, which fuels adverse birth outcomes.

With loving kindness as our compass, we can collectively work to provide unconditional care for others while actively transforming the structures that drive inequity and suffering.

Raising a child is becoming overwhelmingly expensive in the United States, a primary reason many people are deciding not to have children. Nearly half of US families do not earn enough income to meet their basic needs. And as the various provisions of Trump’s so-called Big Beautiful Bill begin to take effect this year, families are experiencing even more pressure. This legislation calls for federal funding reductions, increased share of cost for states, and increased administrative hurdles for programs like Medicaid and SNAP food assistance. This will likely mean that states will drop optional Medicaid services, reduce access to food assistance, and cut other crucial services that have been keeping American families afloat.

The United States has by far the worst birth outcomes of all high-income countries and these policy shifts have a direct impact on mothers and their babies. Over the past 20 years, researchers have conclusively established a link between socioeconomic disadvantage and birth complications. As a pediatrician, I see firsthand what happens when mothers cannot afford fundamentals like rent, food, or utilities: Babies are born too small and too early, mothers feel the impact on their physical and mental health, and children don’t have what they need to grow up healthy.

Living in poverty disproportionately exposes pregnant people to stressors like housing insecurity, pollution, poor nutrition, and crime. The stress of these circumstances is toxic to pregnancies; chronic stress can lead to nearly twofold increased risk of delivering an infant with low birth weight.

Reimagining Birth Equity with Loving Kindness

After years of pediatric practice serving low-income communities, I found myself looking upstream in search of systemic solutions that would transform the circumstances for my patient families to support their wellbeing. This led to launching the Abundant Birth Project, where we worked to discover what providing recurring, unconditional cash to pregnant people during the critical period before and after birth could do. We sought to lead with a framework rooted in loving kindness, where our measures of success are health, happiness, and opportunity for the average family.

And, it turns out, big-hearted programs like these are not just ensuring that pregnant people and new babies have enough to eat. Investing in families with a monthly income boost also has significant health benefits for mothers and infants.

So far, studies have found cash supplements are associated with positive impacts on birth weight, fewer early-term births, fewer NICU admissions, a greater uptick of prenatal care for parents, improved maternal mental health, decreased food insecurity, and could produce millions in annual healthcare savings due to the reduction of premature and low–birth weight babies and maternal health complications. We’re also seeing indicators that money invested into the community has compounding economic returns. Recent data from a maternal guaranteed income program in Michigan show programs raising per capita income by more than double the program’s costs, meaning direct cash is not only investing in families with infants but also strengthening the local economy.

When we provide mothers with regular infusions of money, we are providing protection to two generations. Guaranteed income lets pregnant people breathe easier, knowing that they can afford the essentials. It provides flexibility that lets mothers decide how to best meet their family’s needs. And it provides pregnant people with dignity and autonomy during a high-stakes moment in their lives.

A Framework for Action: Four Principles Grounded in Loving Kindness

The Abundant Birth Project has now served over 1,000 mothers across California, distributing more than $11 million through public-private partnerships. What began as a pilot project in San Francisco has become a coalition of 30 programs, serving as a model for mother/infant cash programs across 20 states.

This level of progress would not be possible without being in deep community with—and led by—mothers who had experienced birth complications. Our work together made me want to be audacious, to be led by what was needed rather than what was feasible.

In retrospect, I can say that we held ourselves accountable to four principles, which I offer here with hope that they help guide the social sector for how we might show up for one another during this crucial moment in history.

Principle 1: Become stewards (instead of destroyers) of the future.

“Anticipating and collectively envisioning healthy futures takes time, care, and cooperation. We, individually and collectively, have to fall in love with the futures we want to emerge.” This statement comes from a recent report by the Robert Wood Johnson Foundation, based on convening over a dozen futurists, artists, and leaders, calling for love as a key tenet to bringing about a more sustainable future.

Our work to create conditions for all to thrive takes time, and when so much of the work in the social sector has become about responding to crises, the immediacy of that orientation leaves little room for anything but the problem right in front of us. Still, I encourage us all to stay the course.

The Abundant Birth Project was the culmination of a yearlong process during which we listened and learned from the people most impacted by the issue we want to resolve. We trained mothers to be community researchers, interviewed people who gave birth to understand what was needed for healthy pregnancies, and held design-thinking workshops with mothers as subject matter experts to guide the details of the program. Finally, we formed a community governance council to provide ongoing guidance and accountability during implementation.

Together, with the communities we serve, we can create healthier futures by investing in and building something new and lovable.

Questions to reflect on:

• What does a future you can fall in love with look like and what voices are helping to co-create this vision?
• In what ways are you laying the groundwork for that better future to emerge?
• How are you practicing accountability to future generations?

Principle 2: Trust people.

When the COVID-19 pandemic hit, US policymakers, funders, and nonprofits mobilized quickly to connect people with the resources needed to stay healthy, housed, and fed. People showed up for each other, and the government showed how possible it is to mobilize funds and advance policy change when the moment demands it.

For Medicaid, pandemic-era policy changes did more than stopgap emergencies; they improved care and protected state budgets. These improvements came down to whether states were required to regularly verify applicants’ eligibility. However, in 2023, the government decided to suspend the continuous eligibility policies that had improved user churn so significantly. This decision came at a tremendous cost. Uninterrupted insurance coverage is associated with fewer hospitalizations, fewer ER visits, and better outcomes. Data from the Commonwealth Fund estimate that, had continuous eligibility continued, people in the United States would have spent $1.8 billion less on healthcare in 2024. Further, analysis of government reports from 2023 found that fraudulently receiving Medicaid was a negligibly rare occurrence. Unfortunately, by the end of 2026, the Big Beautiful Bill will require even more frequent eligibility verifications, and not just for Medicaid but also for SNAP benefits.

This is a stark example of the tremendous progress that can be made when we trust the neighbors we are serving and work to remove barriers rather than uphold systemic practices that impede access to supports meant for their wellbeing.

Questions to reflect on:

• How are you trusting the people closest to the issues you work on to be decision-makers in your work?
• How might you operationalize trust internally and externally, throughout your work?

Principle 3: Put human outcomes over corporate outcomes.

“Forever chemicals,” or PFAS, are toxic, industrial chemicals that are used in a variety of consumer products. The health risks of these chemicals were first noted by the industries producing them more than 50 years ago, but they kept it secret. Despite having conclusive evidence about the harms of forever chemicals for more than 25 years, the EPA allowed companies to contaminate our water and soil for decades. Now half of all US residents have forever chemicals in their water. Why? Producing PFAS chemicals is cheap, but disposing of them properly is costly.

In 2024, after years of advocacy, the EPA finally adopted PFAS drinking water regulations to curtail the rampant dumping of these toxins into communities. But it shouldn’t have taken so long. And—one year later—in 2025, we’ve regressed, as the Trump administration’s EPA decided to weaken the 2024 PFAS drinking water protections, putting all our water at risk again for the sake of corporate profits.

Water is a basic human necessity and critical component of good health. Corporate priorities should not matter more than our collective safety.

Questions to reflect on:

• In your sector, how are corporate priorities harming our neighbors and our communities?
• In what ways are corporate interests diluting the impact of your work? How might you push back?

Principle 4: Nothing—and no one—is apolitical.

The American Medical Association (AMA)—a nearly two-century-old professional organization for physicians—has recently started standing up for science and taking a stance on vaccines, and speaking out on gun violence, racism, and reproductive healthcare access, among other politicized health topics.

The AMA is now facing blowback in Republican circles, where it once enjoyed special status. But the way forward is not to retreat. Instead, organizations in the social service sector should join them and become political together.

Choosing to be silent or apolitical in the face of violent and illogical policy decisions is in itself a political act, one which affirms those in power. In the face of bullying at school, we ask kids to join with other bystanders to show their disapproval. Organizations across the social sector can take this lesson. To overcome brutality and restore compassion, our organizations should become politically engaged.

Legal restrictions are often posed to scare organizations from political advocacy, so know this: It is legal for nonprofits to educate legislators and for their staff to educate the public on political topics, challenge unjust laws in court, register and mobilize voters, and take a position on proposed legislation. Bolder Advocacy is a wonderful resource to help 501c3s understand their rights and restrictions when it comes to political activity.

Questions to reflect on:

• Will the work you are doing now address the underlying systems and structures that are driving the adverse outcomes in our communities?
• Who benefits when social services are silent on political issues?
• Fifty years from now, when people are looking back at this period in history, what do you want to be able to say about how you responded?

From Abstraction to Actuality

The Seventh Generation Principle is a Haudenosaunee (Iroquois) philosophy that suggests, when making decisions, it is not enough to consider the impact on oneself, one’s family, or even one’s larger community—the impact on seven generations into the future must also be front of mind. Many dimensions of our government that we think of as essentially American were actually adopted from the Haudenosaunee’s Great Law of Peace. In fact, the Iroquois Confederacy influenced the US Constitution and Bill of Rights. In 1988, the US House passed a resolution to acknowledge the “Iroquois and other Indian nations [for their role] in the formation and development of the United States.”

However, it seems their Seventh Generation wisdom has been left behind. I urge us to return to this wisdom and steward a future where everyone—including      future generations—can thrive.

We can start the campaign for loving kindness now by reweaving the fabric of our society with compassion and gathering it close again. Philanthropy, nonprofits, universities, and advocates can align around these four big-hearted principles. We can determine how our organizations, together, can influence policy and take action.

It’s up to us to bring about change. The same alchemy is involved, whether birthing babies or kinder futures: When love is the seed, the blossom will inevitably be magnificent.

This story is republished with permission from Stateline.

MIAMI — Midwife Sheila Simms Watson leaned to gently press on the pregnant woman’s belly. Me’Asia Taylor lay on a bed fitted with tie-dyed purple printed sheets in the corner of the RV.

Far from a typical camper, this RV houses a mobile midwifery clinic for prenatal, postpartum and women’s general health care.

“Roll when you’re getting up, and we can help you. You can sit there for a moment, all right, so you’re not lightheaded, not dizzy,” said Watson, whom patients and doulas call “Mama Sheila.”

Calm and slow, led by Watson’s soothing and attentive demeanor, the appointments are unrushed.

Run by the Southern Birth Justice Network, the mobile midwifery clinic brings care to majority-Black and Latino neighborhoods across Miami-Dade County several times a month. The clinic aims to offer a more relaxed setting, where women are comfortable and heard, their cultures are integrated, and they can connect with doulas from diverse backgrounds.

On the half-moon bench inside the RV, Watson, a doula and a midwife in training sit with patients. They take blood pressures and draw blood. They ask the women about their lives: How is their mental health and sleep? Do they have support at home? Do they want to give birth at a hospital or birth center with a midwife?

Taylor said pre-eclampsia, a dangerous pregnancy condition, runs in her family. She wanted to make sure she had space and time to express her concerns about her first pregnancy.

Taylor said she wants a midwife for her delivery. Many women of color have reported feeling marginalized or dismissed in medical settings. “I’ve just seen too many people have bad experiences,” Taylor told Watson.

The U.S. has markedly higher maternal mortality and infant mortality rates compared with other high-income countries, and women and babies of color fare the worst. Black women’s maternal death rates are three times higher than those of white women, and American Indian and Alaska Native women’s rates are twice that of white women. Researchers point to implicit bias, less regular access to prenatal care and higher rates of poverty.

OB-GYN shortages and labor and delivery units closing continue to make getting care harder. Last year, more than two dozen hospital labor and delivery units across the nation closed, including some in South Florida. And pregnant patients living miles away, or feeling uneasy about going to the doctor, may even forgo care.

Midwives can help fill gaps, maternal health equity advocates say, and mobile clinics can meet patients where they are.

“It really helps to disrupt this idea that patients must navigate these complex systems to receive care — and instead, (mobile midwifery) reimagines care as something that should be responsive to the needs of patients and should be community-centered,” said Tufts University professor and maternal health scholar Ndidiamaka Amutah-Onukagha.

But mobile units are not as common for midwifery as they are for other areas of care, such as dentistry or family medicine, the American College of Nurse-Midwives told Stateline. Other prenatal mobile outreach efforts in the state include an OB-GYN-run mobile unit by the University of Florida that serves areas around north-central Alachua County and an operation called The Midwife Bus in Central Florida.

To increase access to care, maternal health advocates are also pushing states to change regulations that restrict midwifery. The American College of Nurse-Midwives recently filed a lawsuit against Mississippi for requiring nurse-midwives to have agreements with physicians in order to practice. This week, Jamarah Amani, a midwife and the executive director of the Southern Birth Justice Network, joined other plaintiffs in filing a lawsuit against Georgia over its restrictions. But supporters of the rules say they are meant to protect patients and foster communication between clinicians.

Offering culturally centered prenatal care that women are more inclined to use can help address inequities in maternal health, Amani said. The group trains doulas, offers telehealth, provides referrals such as to mental health therapists, and advocates for equitable policies across the South.

Most of the mobile clinic’s clients — about 70% — are on Medicaid or uninsured, and the clinic is funded through federal and university grants, as well as donations.

“(Midwifery) presents like a luxury concierge-type of service,” Amani said. “Our goal is to really change that and to bring it back to the community in a very grassroots way.”

Preserving Tradition

The Southern Birth Justice Network keeps a small drum on a table at a nearby booth. It represents the heartbeat, and ancestral reverence, Amani said. Drums are a universal language, and the instrument is meant to symbolize culture.

For doulas and many midwives like Amani and Watson, bringing their profession to communities today is the continuation of a significant part of Black American heritage.

Throughout history, Black midwives were venerated in their communities. Many practices were rooted in West African traditions. These midwives were the keepers of Black ancestral records, and delivered many white women’s babies. Enslaved women who were midwives traveled for deliveries. Some routes, long and traversed by foot, were dangerous in the deep rural South. During the Jim Crow era, Black Americans were denied care at hospitals or given inferior care.

“They only had protection if someone would send a carriage for them if they were going to deliver a white woman’s baby. But to care for the Black families, they often had to go in the middle of the night, alone,” Amani said. “We talk about the legacy of Black midwives as health care providers, but also as social pillars, as community leaders, as resistors of oppression.”

In the 20th century, medical institutions began to oppose midwifery, sometimes using racist and sexist campaigns to target the practice. They argued it was unhygienic and lobbied across states to dismantle midwifery. At the same time, while developing the field of obstetrics, doctors conducted gynecological experiments on Black women. The American College of Obstetricians and Gynecologists has acknowledged this history and said it’s committed to fighting racism and inequities.

Dr. Jamila Perritt, an OB-GYN and president and CEO of Physicians for Reproductive Health, said that in order to address structural barriers and close gaps, policies have to prioritize access to care, such as allowing midwives to expand their practices. Throughout the South especially, states still restrict midwives from practicing independently, despite widespread maternal health care deserts. She also pointed to research showing midwifery is associated with fewer C-sections, less preterm labor and better patient satisfaction.

“Expanding access to midwifery care, and expanding collaborations between physicians and midwives, only improves outcomes,” Perritt said.

Cultivating Trust

On a recent breezy and brisk Saturday morning, the Southern Birth Justice Network’s midwives and doulas were stationed in the parking lot of the Freedom Lab, a local community center that hosts food and clothing distribution and a free urgent care center.

At the booth by the mobile clinic, under the shade of a royal-purple awning, meditation music, low-key and mellow, reverberated from a small speaker. There was a cooler filled with oranges, water and other snacks for the clinic’s pregnant patients.

“I’m going to keep giving you food. You need to eat enough,” one doula told a patient, handing her an orange and a liter of spring water.

Staff had surveys to help assess a new patient’s needs, and Florida-specific pamphlets on pregnant patients’ rights. The group is working on other state-specific guides for Louisiana, Massachusetts, Tennessee and Texas.

The table also held a portrait of the late midwife Ada “Becky” Sprouse, who started the mobile midwife clinic around 2008. She’d drive it to the city of Homestead, an agricultural hub in Miami-Dade County. There, she offered free midwifery care to migrant farmworkers, many of whom couldn’t afford care throughout their pregnancies.

Sprouse passed the clinic on to Amani, who relaunched the mobile unit and broadened the scope of the Southern Birth Justice Network.

Patients told Stateline trust was one of the main reasons they sought out the clinic. One patient said she spent 2 1/2 hours on public transit that day so that she could see the team.

For now, deliveries take place at hospitals or neighboring birth centers, where some of the group’s midwives also work. But the organization recently bought a building to open its own freestanding birth center, aiming for next year, along with a larger RV.

One patient, Isis Daaga, turned to Amani to deliver her other children after her first birth at a hospital. Despite the pressure she felt and her need to push during labor, Daaga recalled, hospital staff prevented her from delivering.

“They literally held my knees together,” Daaga said. “They were like, ‘the doctor’s not here yet,’ and the nurses were scared to deliver the baby.” In many hospitals, protocol is to wait for the doctor in case an emergency occurs.

By the time the doctor came, Daaga had a severe perineal tear, and she delivered the baby in one push. She had been in labor for 15 hours.

“I was in pain, I was upset,” said Daaga, a mental health therapist who is 35 weeks pregnant.

At the mobile clinic and with the midwives, Daaga said she feels supported.

“They make me feel the way I try to make my clients feel, like, it’s a safe space. You’re not judged here. I have a lot going on,” she said. “If I’m MIA or something, most of them will call and text me and (say), ‘Girl, you need to come in.’”

Welcome back to NPQ’s fundraising advice column, Ask Rhea. Rhea Wong is a fundraising expert and professional coach, exuberant author of Get That Money, Honey! host of the Nonprofit Lowdown podcast, and an unfailingly encouraging voice in a sometimes-bleak landscape. Rhea wants you to succeed, and she’s here to answer your questions.

Have a fundraising question? Send it to this submission form and choose “Fundraising” from the drop-down menu.

Dear Rhea,

I finally worked up the nerve to make a major gift ask last month. I did the visit, named the number, stopped talking. And then…silence.

I panicked and started explaining myself before the donor even opened her mouth. She ended up giving a much smaller gift than I asked for, and I can’t stop thinking I negotiated against myself. How do I learn to just sit there?

Sincerely,

Frozen After the Ask in Philadelphia

Dear Frozen,

We’ve all been there.

Every fundraiser I know has a version of this story.

You’ve done the cultivation. You’ve had the visits, sent the notes, brought them on the site tour. The moment arrives. You make the ask.

And then the donor goes quiet.

Unable to sit with 10 seconds of silence, you fill it. You start walking back the number. You start explaining yourself. You say something like, “Of course, we understand if that’s not the right fit right now,” before they’ve even had a chance to breathe.

It is as you said: You negotiated against yourself.

Real talk: The ask is not the hard part. The silence after is. And the reason most fundraisers blow it starts long before they ever make the ask.

The Pitch Is the Problem

Most fundraisers learned to pitch. We practice the case for support. We memorized the statistics. We rehearsed the impact story. We built a tight, polished argument for why the donor should give and delivered it like we were proud of ourselves.

Most of the time, this turns out to be more akin to a monologue, and monologues do not raise major gifts.

Real talk: The ask is not the hard part. The silence after is.

Here is what a pitch does to the person sitting across from you. The moment a donor realizes they are being presented at rather than talked with, their brain shifts posture. The brain regions involved in assessing intentionality and trustworthiness transmit signals of safety or danger to the amygdala, which shapes whether a person moves toward you or away.

A pitch, however polished, reads as a threat signal. It says: I have prepared something to change your mind. The donor’s defenses go up. They stop exploring and start evaluating whether they are being manipulated.

The pitch also assumes you already know what the donor cares about. It treats them as a target to be convinced rather than a person to be understood. And it guarantees that when you finally go quiet and wait for a response, you have no idea what is actually happening on the other side of the table. You are waiting for a verdict on your performance. No wonder the silence feels like rejection.

FBI hostage negotiators do not walk into hostage negotiations with a pitch. The FBI trains negotiators to listen. To ask. To let the other person feel so thoroughly heard that the path forward becomes something they arrive at themselves. People do not commit because they were persuaded. They commit because they came to their own conclusion. Your job is to create the conditions for that conclusion. Not to deliver it pre-packaged.

What Happens in the Silence

When you ditch the pitch and approach it as a genuine conversation rather than a transaction, something different lands after the ask. The donor goes quiet. And that quiet is not rejection. It is biology.

Behind every decision is a tug-of-war between two brain regions: the prefrontal cortex, which handles rational thinking and planning; and the amygdala, which processes the situation emotionally. The outcome of that neuronal debate determines the final choice.

Silence is when that debate happens. The donor is pulling on memory, emotion, identity, values. This is not stalling. This is the brain doing exactly what it needs to do to make a consequential decision.

The problem is that your brain is doing something too. Even a four-second gap can feel like social rejection. The amygdala lights up, scanning for danger. That is why people rush to fill the air. It is not weakness. It is wiring.

Both of you are in your amygdalae. The donor is deciding. You are panicking. The one who speaks first loses.

The Move

The FBI calls it a calibrated question. It’s an open-ended question starting with “what” or “how.”

“What would make this feel right for you?”

“How are you thinking about the timing?”

These hand the conversation back to the donor. They also tell you what is actually standing between this person and the gift. That information is worth more than anything you would have said to fill the pause.

Make the ask. Name the number. Say what the gift does. Then stop talking.

If you need to name what you are sensing before you ask, do that. “It seems like you’re weighing a few things.” Not a push. An invitation. It signals that you are still listening, not waiting to pounce.

Then hear what comes next without defending or fixing. A donor who expresses hesitation is telling you something true. That is data. Work with it.

Ditch the Pitch. Do the Discovery. Sit in the Silence.

The fundraiser who panics in the silence never did the work before the ask. If you do not know what motivates this donor, if you have not spent real time understanding their story and their reasons, then the silence is terrifying because you have no idea what is happening across the table.

Learn who the donors are and why they give before you ever name a number. Then when the quiet comes, you are not waiting for a verdict. You are waiting with someone you know, while they find their way to yes.

Make the ask. Name the number. Say what the gift does. Then stop talking.

The silence is doing its job. Let it.

Warmly,

Rhea

For More on This Topic:

Using AI for Fundraising Still Requires Human Strategy

Does Personal Investment Hurt Fundraising?

Power and Possibility: The Role of Donor Organizing

This article is republished from The Conversation under a Creative Commons license. Read the original article.

2026 kicked off with thought leaders across the sector releasing a flurry of reports on the year’s predictions and trends, naming the forces actively reshaping our field: democratic fragility, escalating government overreach, rising political violence, cuts to federal funding, the erosion of DEI protections, the operational strain of donor-advised funds (DAFs), and unprecedented pressure on nonprofits to reorganize or merge.

From funders to advocates, dozens of leaders’ perspectives rightly identified turbulence ahead. Yet among the various recommendations of drivers for change, something was missing from these reports: the naming of movement-rooted philanthropic intermediaries as a necessary part of future solutions. That absence is neither intentional nor reflective of how intermediaries are expansively moving resources across the field, it spotlights a visibility gap that risks reinforcing the inequities that philanthropic investments aim to dismantle.

The Untapped Power of Movement-Rooted Intermediaries

Collaborative funds collectively move between $4 and $7 billion annually across more than 500 funds globally. A recent Philanthropy Together study found that these funds consistently rank in the top 15 percent of all funders nationwide for field impact, advancement of knowledge, and contributions to public policy—and in the top 10 percent for understanding the populations served and the political and socioeconomic conditions shaping grantee work. And yet, that $4 to 7 billion in global investments represents a fraction of the estimated $103.5 billion in annual US foundation giving.

Our sector has developed a shared understanding that community-driven solutions are key to advancing equity. As former Ford Foundation President Darren Walker has noted: “As we continue to address the major challenges of this moment—be it inequality, climate change, or the refugee crisis—we need to get out of our comfort zones, listen to communities, and develop unlikely, unconventional partnerships. We need to tap into relationships and resources that we don’t normally consider.”

Meeting this moment will require a deliberate alignment among funding priorities, data transparency, and the voices of those most impacted.

And community-rooted intermediaries, grounded in the social movements they serve, are a powerful vehicle for ensuring that community voices guide decisions. The infrastructure is proven. The rationale is clear. Yet the investment is not proportionate.

Aligning Priorities to Create a Beautiful Future Together

Today, funders have both the charge and opportunity to close this gap through investments in movement-rooted infrastructure—that is, the community-centered systems and supportive networks that grow directly out of the social movements themselves.

Forecast reports from the Chronicle of Philanthropy to Inside Philanthropy warn that our sector is facing and will increasingly be defined by our ability to respond to:

• Authoritarian pressure and attacks on civic freedom;
• Shrinking social safety nets and widening inequality;
• Narrative manipulation and disinformation;
• Unsustainable nonprofit operating models, including mergers driven by existential distress; and
• A growing expectation that philanthropy must “move together,” “spend more boldly,” and “center people, not institutions.”

Meeting this moment will require a deliberate alignment among funding priorities, data transparency, and the voices of those most impacted by the social, economic, and environmental challenges being addressed. Sitting at the intersection of institutional philanthropy and grassroots movements, community-rooted philanthropic intermediaries make alignment possible, and—by inviting simultaneously diverse opinions and experiences through collaborative positioning—offer iterative possibilities to collectively imagine and create a more promising, beautiful future.

Whether the threat is authoritarianism, disinformation, polarization, or fraying democratic trust, this connective function is exactly what philanthropy must safeguard.

Building Bridges for Impactful Change

Fortunately, there is a rising understanding of the power of collaborative funds at the field level. A recent Bridgespan Group report, Releasing the Potential of Philanthropic Collaborations, outlines the unique role of collaboratives, including the pursuit of systemic change through “building fields and movements.” Robert Wood Johnson’s report, Working With Intermediaries Strategically, makes clear the sector’s “growing desire for more reciprocity among philanthropic, intermediary, and community partners.” Philanthropy Together’s report, The Collaborative Effect: Grantee Perspectives on How Collaborative Funds Work Best, summarizes: “The question is no longer whether philanthropy can pursue transformative change, but how it can do so while staying grounded in the experiences of those most affected.”

As two former institutional foundation staff members who now lead programming at Borealis Philanthropy—a movement-rooted intermediary—we have seen the approaches and impact of collaborative funds up close. We know firsthand that, when rooted in community values, collaborative funding can transform not only how resources flow, but how change is imagined, shaped, and sustained.

Movement-rooted intermediaries are transformative because they:

• Translate pluralist values into practice

They bridge philanthropic institutions and donors to grassroots communities and resource a future where many kinds of leaders, communities, and strategies can shape the public good.

• Share responsibility and lighten the frontline administrative burden

They pool funds to distribute philanthropic burden so frontline organizations aren’t forced to absorb it alone.

• Bridge movements and resources to amplify the power of intersectional collaboration

They distribute investments across multiracial, intersectional movements, and serve as a connective tissue between rural and urban movements, between cultural work and civic work, between narrative change and material support.

• Protect and sustain movements through flexible, rapid funding

They steward flexible, multiyear commitments, ensuring movements’ long-term sustainability, and distribute money quickly, ensuring survival in times of crisis.

• Leverage community-rooted networks as insights to spot opportunities and risks

They ensure staff, grantee, and donor networks are rooted in communities that are directly impacted by the social, political, and economic shifts being addressed. Through these connections and learnings, they serve as an aggregator of field knowledge, identifying early threats and opportunities.

Insights from Our Collaborative Fund Journey

To be community-rooted is also to be movement-responsive. This has informed Borealis’s decision-making since our inception a decade ago—and it remains the case today. In 2025, for example, as we witnessed communities increasingly targeted—and federal and philanthropic resources waning—we knew what our people needed. To ensure additional resources to help frontline organizations meet emergency needs, Borealis launched the Security, Action, and Freedom for Everyone (SAFE) Initiative. Based on what we heard from community partners, the fund was established to route dollars to six key areas of rising concern: adaptive and operational, safety and security, rest and healing, facilities, tech and digital, and legal.

This initiative created a new opportunity for the sector to pool and mobilize dollars to frontline organizations’ self-identified needs, including increasingly vital program work—from narrative change to community safety and civic engagement—and growing organizational needs—from physical and digital security to legal defense and staff hazard pay. Our unique infrastructure allowed us to move with the alignment and urgency that our partners required. Grants were flexible and distributed within two weeks of receiving an application, ensuring that our partners received money when needed, to use however they determined best.

To be community-rooted is also to be movement-responsive.

The creation of SAFE allowed for responsiveness and experimentation. For example, we were able to route additional rapid dollars to Minneapolis-based organizations as ICE operations intensified there—including our grantee partner Sahan Journal, a nonprofit newsroom dedicated to covering immigrants and communities of color in Minnesota, following the arrests of law-abiding journalists in the state. We were also able to distribute dollars to targeted, hyperlocal organizing efforts via a partnership with Oregon-based funder Meyer Memorial Trust—a collaboration that facilitated rapid grantmaking at significant volume and linked statewide trends to national themes. This produced insights that are not always available to a local funder and will further sharpen our responsiveness in the critical years ahead.

From Underutilization to Greater Courage and Coordination

So why, then, are intermediaries underutilized across our sector? One answer is that some funders prefer to direct grantmaking dollars themselves. Others simply may not see the outsized impact of intermediaries or understand their unique role in the philanthropic sector. As sector commentator Vu Le pointed out, likening intermediaries to mycelium: intermediaries “are often invisible, we frequently take them for granted.”

Yet, from Hungary to Turkey, we’ve learned that obscuring or ignoring infrastructure is how systems fail. If philanthropy is serious about stopping our slide into authoritarianism, then intermediaries aren’t optional. They are a necessary infrastructure to protect democracy, offering the sector proximity to the people who are defending and building it.

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Nonprofit work is demanding. Limited resources, high expectations, staff burnout, economic uncertainty, rising community needs, and deep emotional investment place constant strain on organizations and the people who lead them. When problems surface, the conversation often narrows quickly to a familiar question: Is the issue with the system or with the people? When the problem is systemic, the path forward is often clearer: Identify what isn’t working, fix it, and reset. The situation becomes far more complicated when the issue involves people. Emotion, pressure, lived experience, and biases all come into play. In those moments, “identify, fix, and reset” is no longer a simple formula.

This challenge is present in all sectors but is magnified in the nonprofit world. Because nonprofits are mission-driven, organizational culture is often infused with emotion. When tensions rise, that emotional investment can cause conflict to escalate quickly and become personal.

When the conflict is between boards and staff leadership, the effects are highly visible and ripple across the organization: tense board meetings, micromanagement, passive‑aggressive communication, personal disagreements, and high turnover. Like a cough signaling a deeper illness, these behaviors are symptoms rather than the problem itself. Often, the underlying causes are power dynamics, biases, and role confusion—sometimes all at once.

Even when conflict is emotionally charged, nonprofits can approach these challenges with clarity and intention by slowing down, analyzing what’s truly happening, addressing what needs to change, and resetting in ways that strengthen both relationships and the organization.

Analyze the Root Cause

Boards of directors occupy a unique position in nonprofit organizations. Made up of people charged with stewarding the mission and ensuring alignment with community needs, boards play a critical oversight role. Yet this very structure can invite tension. When board members and staff leadership are both tasked with guiding a single organization—each from a different perspective and with different responsibilities—power struggles can emerge.

These dynamics are further complicated by who typically serves in each role. Board members are usually volunteers with the time and financial resources to give, while staff members tend to be more economically and demographically diverse and depend on the organization for their livelihood. The nonprofit governance model is almost designed to create power imbalances, especially if left unexamined.

Because nonprofits are mission-driven, organizational culture is often infused with emotion. When tensions rise, that emotional investment can cause conflict to escalate quickly and become personal.

Those power imbalances do not exist in a vacuum. They are shaped and often deepened by the biases each of us brings into the room. There is a common assumption that because of the values nonprofits espouse, discrimination or bias does not exist within these spaces. Yet biases exist wherever there are people, and they can deeply shape decision-making, relationships, and power dynamics. When they go unrecognized, they become a source of conflict.

Our country has a long history of undervaluing the contributions of people from marginalized communities, and that history does not check itself at the door when someone joins a nonprofit board. Even the most well-intentioned board members carry assumptions shaped by that history. When those assumptions go unexamined, they can quietly erode the trust and credibility of staff leadership—not necessarily because of malice, but due to blind spots that no one has been asked to examine. It is also worth noting that bias runs in both directions. When staff carry unexamined assumptions about board members, it can undermine respect for the board’s role and erode the governance structure that the organization depends on. Ultimately, it is the board’s responsibility to ensure that biases do not take root in the organization’s culture or undermine its mission.

Alongside power dynamics and bias, role confusion emerges as an equally damaging force. Though it is often attributed to unclear responsibilities, it is more frequently the result of power and bias reshaping how roles are interpreted and exercised.

The board’s role is governance and oversight: setting direction, ensuring legal and ethical compliance, and stewarding resources responsibly. Staff bring the operational expertise that carries the mission forward day-to-day. These are distinct and complementary responsibilities, and when both sides understand and respect this, the relationship works. And when they don’t, it doesn’t. When boards begin doing staff work, they neglect their own governance responsibilities, leaving staff feeling unsupported and mistrusted. When staff dismiss the board’s oversight role, they undermine the very structure that protects the organization.

Focusing on symptoms without understanding their cause will not lead to a lasting fix. Smoothing over tension in meetings or adjusting communication styles may reduce friction in the short term, but if the underlying issue is a power imbalance, an unexamined bias, or a lack of role clarity, the conflict will resurface—often worse than before. Over-the-counter medicine may dull the symptoms, but if you need an antibiotic, cough medicine alone will only delay and ultimately worsen the illness as it goes longer without proper treatment.

Fix What Is Broken

Once the source of the tension is clear, the real work begins—work that must address both the structural problems and the human dynamics that allowed the conflict to take hold.

It is easy to focus on the personalities involved, but personality clashes only become organizational conflict when structures and culture create the conditions for them to take root. By examining tension within the broader context of organizational design, leadership can identify root causes without getting swept into emotion and therefore build solutions that last. The question is not, “Who is causing this?” but rather, “What is allowing this?”

A diversity and equity statement that sits on the “About” page of a website accomplishes little. Embedding such a statement in board orientation, staff onboarding, and governance policy becomes part of the organization’s DNA.

That said, no fix is effective if we don’t first acknowledge and address the emotional impact of the conflict. This is not about dwelling in feelings; it is about clearing enough space for people to engage in solutions rather than grievances. Acknowledge the emotion, then move into the work.

That work is most effective when done collectively. Bringing all voices into the room creates clarity and shared ownership. But collaborative problem-solving must be handled carefully; coming together to resolve conflict can blur the chain of command if the process is not structured well. Teamwork is essential. It cannot, however, replace management structure.

When dealing with power imbalances and biases, this phase requires intentionality. Recognizing the expertise and experience that staff bring—and building that recognition into how the organization operates—is not a courtesy. It is a governance responsibility. Clear role delineation, board meeting procedures that ensure all voices are heard, and explicit norms around decision-making can help level a playing field that is rarely level by default.

When bias has played a role in the conflict, the temptation is to avoid naming it directly in order to preserve relationships. But avoidance does not resolve bias; it protects it. The board’s responsibility is not to manage discomfort. It is to protect the governance system. That means establishing clear diversity commitments and treating equity as a design principle embedded in how the organization operates.

When organizations rely on relationships and goodwill to manage conflict, they are one difficult conversation away from crisis. When they rely on systems, they have something that holds regardless of who is in the room. The goal of the fix is not just to resolve the current conflict. It is to replace the conditions that allowed it to develop with structures strong enough to prevent the next one.

Reset the Organization

Once a fix has been identified, the final step is ensuring that the conflict—or something like it—doesn’t resurface. It’s tempting to declare the issue resolved and move on, but without intentional safeguards, any fix will be temporary. A reset is forward‑looking. It allows an organization to move on from the past while ensuring its lessons are not lost.

That future focus matters because today’s leaders will not be the only ones to guide the organization. Board members will turn over. Staff will change. Executive directors will come and go. If an organization’s culture, values, and governance structures exist only in the minds of its current leaders, they will not survive that transition. A reset creates the opportunity to embed them more durably.

The process begins by addressing what emerged in the analysis and fix phases. Role confusion is resolved by clearly defining—in writing—where board responsibility ends and staff responsibility begins. Power imbalances and invisible biases are countered through transparent, consistently applied decision‑making processes. When culture has allowed bias or inequity to go unchallenged, we must document values, equity commitments, and codes of conduct as enforceable standards.

It’s important to note here that commitment to diversity, equity, and inclusion must live beyond a public statement. It should function as a working document that shapes how decisions are made, how conflict is addressed, and how new leaders are brought into the organization’s culture. A diversity and equity statement that sits on the “About” page of a website accomplishes little. Embedding such a statement in board orientation, staff onboarding, and governance policy becomes part of the organization’s DNA.

This work also underscores why succession planning is not optional; it is a core stewardship responsibility. Intentional transitions ensure that outgoing board members actively pass the culture forward rather than simply vacating a seat. Organizations that skip this step are often just one difficult board class away from undoing everything the reset was meant to protect.

A meaningful reset also requires a hard look at who has a seat at the table. Ensuring that underrepresented voices are present in the boardroom is not symbolic; it is structural. Boards that reflect the diversity of the communities they serve are better equipped to recognize bias, navigate power dynamics, and make decisions that advance the mission equitably.

Trust grows from clarity. Structure creates that clarity and resilience that outlasts any individual leader. Systems that rely on personalities will not protect leaders who experience bias. When bias undermines a leader’s authority and no structural safeguards exist, the board has failed in its stewardship responsibility—not just to that leader, but to the mission itself.

Conflict in nonprofits rarely begins as personal. But when there is no structure to guide resolution, problems are ignored until they become personal—and, by then, they are much more difficult to repair. Approaching future conflict with a clear road map and with the mindset that problems are rooted in systems, culture, and unexamined biases allows nonprofits to weather challenges without losing sight of why they exist.

Stewardship is a core responsibility of the board, and that responsibility extends beyond finances and donor relationships. The board-staff relationship deserves the same intentional care. When boards treat that relationship as a core stewardship responsibility, conflict becomes something to address quickly rather than something to endure at the expense of the mission. The organizations that survive are not the ones without conflict. They are the ones built so that conflict cannot destroy them.

For More on This Topic:

Reimagining Nonprofit Boards: A Three-Part Series

The Board Is Not the Boss—and More Thoughts on Its Role

Seat at the Table, No Vote in the Box: Finding the Governance “Sweet Spot”

New York positions itself as a bastion of inclusion amid federal rollbacks. The latest example is Mayor Zohran Mamdani announcing the creation of the city’s first Office of LGBTQIA+ Affairs, appointing lawyer and activist Taylor Brown as its director. Brown becomes the first openly trans person to lead a municipal agency in New York.

The initiative comes against the backdrop of sweeping federal cuts introduced by Donald Trump upon returning to the presidency in January 2025. Among his administration’s first measures was the elimination of more than 270 National Institutes of Health grants, worth over $125 million, dedicated to LGBTQIA+ health research. These funds had supported HIV prevention programs, mental health studies, and precision medicine projects.

“I think New York City has been a sanctuary city for immigrants for a while, and its proposal to make it a sanctuary city for the LGBTQ community is really important,” said Lorelei Crean, lead organizer at NYC Youth 4 Trans Rights, in conversation with NPQ.

Crean added that many queer people are currently fleeing states with hostile legislation—they cited Kansas’s new ID law, which invalidated the driver’s licenses of hundreds of trans people in the state—and emphasized that New York aims to position itself as a safe place to migrate and live. Crean noted that the state has one of the strongest legislative frameworks in the country on trans issues and highlighted the role of New York State Attorney General Letitia James, who has been leading legal efforts against the administration’s restrictions on transgender healthcare.

Mamdani framed the new office as a local counterweight to these rollbacks. “New York City is proud of its LGBTQIA+ community and will refuse to deny healthcare, safety or dignity to anyone on the basis of their identity,” he declared in a statement.

Three Central Commitments

The Office of LGBTQIA+ Affairs extends the work of the NYC Unity Project, created under Bill de Blasio, and adds a sanctuary component for queer and trans people fleeing persecution in other states. While Mamdani avoided specifying the budget allocation, the office is tasked with ensuring that no municipal agency discriminates on the basis of sexual orientation or gender identity.

Taylor Brown brings a strong legal background to the role. She worked in the New York Attorney General’s office, contributing to lawsuits against Nassau County’s ban on trans women in sports, and at Lambda Legal and the ACLU, where she helped secure a landmark ruling allowing trans people to amend their birth certificates in West Virginia.

“We want the same things as everyone else, and we deserve the same things as everyone else. We are people,” Brown said upon taking office.

Brown’s appointment responds to longstanding demands from local organizations that had called for a dedicated municipal structure to systematically protect LGBTQIA+ rights. The move comes in a climate where, according to data from the city’s Human Rights Commission, 23 percent of transgender residents reported experiencing housing discrimination in 2024.

The new office is designed to address these issues comprehensively, coordinating efforts across municipal agencies to ensure that protections are not fragmented but embedded throughout the city’s governance.

Mamdani’s campaign platform went beyond the creation of the office. He pledged three central commitments: to make New York a sanctuary city for queer and trans people, to establish the Office of LGBTQIA+ Affairs, and to invest $65 million in gender-affirming care. According to the plan, $57 million would go to public hospitals, community clinics, and nonprofits, while $8 million would fund telemedicine and expanded access programs.

Yet the preliminary 2027 budget does not explicitly reflect this allocation, raising concerns about the office’s operational capacity. The office has been created, but it cannot function fully because the entire state budget is still being negotiated. Nothing—related to LGBTQIA+ care or otherwise—has been funded yet.

Precariousness of LGBTQIA+ Healthcare

The announcement of New York’s new Office of LGBTQIA+ Affairs also coincided with the closure of gender-affirming care services for minors at NYU Langone Health. The hospital cited federal funding threats and regulatory pressure under the Trump administration—including risks to Medicare and Medicaid reimbursements—as well as the departure of the program’s medical director.

Legislation becomes ineffective when it is disconnected from the communities it is intended to support.

Families of patients under 18 were notified that gender-related care would no longer be available, leaving many without alternatives in the city. This decision followed earlier restrictions in 2025, when NYU Langone stopped accepting new patients under 19 needing gender-affirming care after an executive order targeting providers.

The latest closure could foreshadow broader limitations, even for adult patients, underscoring the precariousness of LGBTQIA+ healthcare under current federal policy. Local politicians condemned the move as part of a nationwide rollback of rights and protections, framing Mamdani’s initiative as a deliberate counterweight to this climate of retrenchment.

“The office should prioritize funding community-based, LGBTQIA+-led organizations that understand seniors’ needs firsthand and already work within the community,” Sean Ebony Coleman, founder and CEO of Destination Tomorrow, a grassroots LGBTQ+ agency with a site in the Bronx, told NPQ.

Rights are indivisible….Strengthening protections for one vulnerable group ultimately reinforces the resilience of all.

Coleman argues that a holistic approach is needed—one that includes funding for mental health resources, case management, safe spaces, and specialized care—and warns that legislation becomes ineffective when it is disconnected from the communities it is intended to support.

Reinforcing the Resilience of All

The initiative in New York inevitably raises the question of whether similar offices could be replicated elsewhere.

In principle, the model is transferable to large urban centers with diverse populations and histories of activism. Cities like Los Angeles, Chicago, or San Francisco already have frameworks for immigrant protection and could expand them to encompass LGBTQIA+ rights more systematically.

The challenge lies in political will and budgetary priorities. At a time when many municipalities are directing resources toward immigration rights or sanctuary protections, carving out dedicated structures for queer and trans communities requires leaders willing to argue that rights are indivisible—and that strengthening protections for one vulnerable group ultimately reinforces the resilience of all.

Jamie Roberts, cofounder of Trans Housing Atlanta Program, Inc., told NPQ, “I am delighted at Zohran Mamdani’s plan to transform New York City into a sanctuary for LGBTQIA+ communities. I would love for the City of Atlanta and other local governments to do the same. I anticipate such a plan for Atlanta—one that would include lawyers fighting against anti-trans policies and allocating millions for housing and gender-affirming healthcare—would encounter several barriers.”

Carving out space for LGBTQIA+ rights requires deliberate political will.

Roberts explained that the greatest barrier would likely come from members of the Georgia General Assembly and the governor, conservative Republicans who in recent years have passed laws criminalizing gender-affirming healthcare for minors and banning their participation in school and college sports.

“We will remain engaged in our advocacy to make the local shelter system respect the dignity of transgender and gender nonbinary people,” Roberts added.

Tracee McDaniel, executive director and founder of Juxtaposed Center for Transformation, told NPQ that Mamdani’s initiative should serve as a model for other cities. As the former chairwoman of Atlanta’s Police Oversight Board, she emphasized the urgency of creating safe spaces for trans, gender nonconforming, and nonbinary people. “The current administration is placing bull’s-eyes on our backs and using us as wedge issues to divide and conquer,” she said, arguing that this climate has enabled Republicans to draft anti-trans legislation nationwide.

McDaniel lamented that despite progress under the Obama and Biden administrations, trans communities have become “more marginalized than ever at every intersection of our lives” due to divisive political rhetoric. “I applaud New York’s mayor for his boldness, and I hope he will serve as an example for others in power to follow,” she said.

Ultimately, the creation of the Office of LGBTQIA+ Affairs represents a profound challenge: At a time when much of the city’s energy and resources are concentrated on preventing deportations and protecting immigrant communities—the most urgent concern for many New Yorkers—carving out space for LGBTQIA+ rights requires deliberate political will.

Advocates insist that expanding sanctuary protections does not undermine existing commitments but rather strengthens the city’s broader promise of safety.

“We are seeing resistance to ICE across the city, and we are seeing that be a priority for elected officials at both the city and state levels. Making New York City a sanctuary city for queer people as well as immigrants is not going to divert any power from the fact that New York is already a sanctuary city for immigrants—I think it’s just adding, it’s not taking away,” Lorelei Crean said.

Sean Ebony Coleman also underscored the need to address both sets of needs: “Expanding sanctuary protections to LGBTQIA+ rights can strengthen solidarity and show how diverse communities’ struggles are connected.”

For More on This Topic

Nonprofit Organizations Continue to Fight Against Trans Erasure

What’s Really at Stake When Funders Abandon Transgender Communities?

Transgender Rights Under Threat: Preparing for Federal Crackdowns

This story was originally reported by Shefali Luthra of The 19th. Meet Shefali and read more of their reporting on gender, politics and policy.

Laura stopped leaving her home weeks before she gave birth. She lived outside of Minneapolis, where many people had been taken by immigration officials. She thought of mothers separated from babies, of children taken to detention facilities.

By the time she went into labor, her stress was so intense that her body had stopped producing sufficient oxytocin, her doctors told her. The  hormone is critical for labor and breastfeeding. Low oxytocin levels are linked with postpartum depression and severe depression.

Her contractions began in the middle of the night in January; without many options, she called her doula. Her father had been deported years ago. Her boyfriend had been staying with his mother since his dad was detained weeks before. They worried that if he left to drive Laura, he might be taken, too.

On January 14, Laura, an immigrant from Honduras with an application for asylum, became a mom. Her boyfriend, driven by her doula, joined Laura at the hospital after she gave birth, where for at least one day, the three of them could be together. She rested while he met his new daughter, a healthy 7-pound girl.

It felt simple: “He was very happy,” Laura said.

Laura, whose last name has been withheld because she fears being targeted by immigration authorities, would have loved to see other friends and family. But from the hospital bed, she worried about the consequences they could face — if coming to meet the baby might mean risking detention, or even deportation. She had no other visitors.

Leaving the hospital as a first-time mom can feel like liberation, escaping the solitude of a hospital room and venturing into the world. But Laura traded one form of isolation for another: her one-bedroom apartment, where visitors were rare.

“I was all alone with the baby, and no one could come see me because of immigration,” Laura said.

That fear has infected Laura’s whole community — isolating her from many of the people who, in a different time, might have helped the 24-year-old adjust to her new life as a mom. That includes her boyfriend, who has hardly seen his daughter since that hospital visit.

I am afraid that one day they will get me, and I will leave the baby alone.
—Laura

Even as the federal government’s Minnesota presence is waning, Laura remains afraid of what could happen if immigration officials take her away from her girl.

“I am afraid that one day they will get me, and I will leave the baby alone,” she said in Spanish.

The Trump administration’s sweeping immigration raids across the country —  exemplified by its monthslong campaign in Minnesota — sent many immigrants inside, deterring them from seeking medical care, going to work or school, or even visiting friends or family members. Federal data suggests that detention rates are slowing, and Markwayne Mullin, the new secretary for Homeland Security, suggested he would steer the department away from sustained public raids to more targeted enforcement. Still, life has not returned to normal for many.

Isolation can allow chronic illnesses to worsen, leave people without income, and foster loneliness that can elevate the risk of depression or even post-traumatic stress disorder. But the consequences are particularly acute for people who have just given birth.

One-third of maternal deaths occur in the first year postpartum. Most are preventable, the result of untreated physical complications or severe postpartum depression. Research suggests that immigrants are less likely to have adequate postpartum health care due to limited insurance coverage. Latinas are twice as likely as White women to develop postpartum depression, and less likely to get treatment.

The first weeks and months after giving birth are challenging under the best of circumstances. Almost all postpartum people experience the “baby blues,” a brief depressive period caused by hormonal shifts after giving birth. There is sleep deprivation, late nights of feeding, pumping and figuring out infant sleep. New moms in particular often report feelings of loneliness and isolation.

And there is the physical toll. Recovery can take weeks, especially with a Cesarean section, and people can experience life-threatening conditions such as postpartum hemorrhage, preeclampsia or postpartum infection.

Doctors say newly postpartum people need support: access to medical care when needed, sleep whenever possible, and critically, the ability to rely on friends and family for help.

But immigration crackdowns have made that impossible for Laura.

“Taking a step back and thinking about postpartum, it’s one of the highest risk times for a patient that just delivered and where most of the complications can happen,” said Dr. Jesus Ruiz, a family medicine physician in North Carolina who has studied the health and wellbeing of postpartum immigrants. “It’s already difficult enough being in the postpartum state. Having a newborn, people are more prone to depression. If they are depressed, we’ll miss it.”

When Ruiz’s home state was the subject of sweeping immigration raids last November, patients increasingly skipped their postpartum visits, he said. Many expressed nervousness about going outside, even for routine errands. He is worried about the longer-term consequences for not only his patients, but also their babies, who typically need regular follow-ups with a doctor, and who can benefit in their early months of life with visits from other family members.

Eight days before her scheduled C-section, Reina’s husband was detained. She was in the kitchen of her Minneapolis-area apartment, cooking, when the phone lit up with a call from her mother-in-law. “They arrested him,” she told her, urging Reina to be strong.

For days, Reina, who has a pending asylum application and requested her last name be withheld, could barely eat or sleep, let alone care for her other three children, the oldest of whom is 14. She could only eat by reminding herself: Do it for the baby. When she arrived at the hospital on January 20, she was dehydrated and had low blood pressure. She was grateful her infant son was healthy.

After they arrived home from the hospital, Reina spent close to two weeks not leaving her home, relying only on her other children for help caring for her newborn, before a lawyer was able to secure her husband’s release.

The first night her husband came home, she said, he didn’t sleep all night — instead, he just kept looking at their baby, carrying him around.

“He said, ‘I am afraid to sleep, because I can’t believe he is here,’” she said in Spanish.

Reina’s health care provider did at-home check-ups for her and the baby. Weeks after giving birth, Reina still had low blood pressure, headaches and pain in her neck and shoulders. She wasn’t sure if it was residual complications from her delivery, or because she was so stressed about what might happen if anyone in her family goes out at the wrong time.

Even now as the stress is abating — as she is now taking her baby on small trips outside — she is still nervous about encountering immigration officials.

“I’m still afraid, but it’s not the same as it was,” she said at the end of March.

Though fewer immigration officials are on the streets of Minneapolis, “No one quite believes it’s over,” said Kate Percuoco, an early childhood educator in the city who cares for children from immigrant families. Families are still staying home from work, skipping appointments at doctors’ offices and nervous even about venturing to child care facilities like hers.

Four mothers with children in her program either were pregnant or gave birth over the course of the federal government’s increased presence in Minnesota. All expressed concern that going outside could put their families at risk. Percuoco is doing her best to help. She’s been scouring Facebook “Buy Nothing” groups for anything that might help: diapers, a crib, a car seat, a bath tub.

“The impact of this on people’s sense of safety is going to last a really really long time. Several people have commented to me, ‘I don’t want to live like this. I don’t want to live in fear. This is not a life to constantly worry that I’m going to be separated from my children,’” she said. “That sense of safety has been taken from people.”

Postpartum medical care can be critical. But it’s difficult to come by for women who, unlike Laura or Reina, don’t have someone to visit them at home. In early March, Percuoco drove one new mom to an appointment — it was the woman’s first time leaving the house since giving birth in December. The woman had been having chest pains and difficulty breathing.

Another postpartum woman Percuoco helped had high blood pressure but was too afraid to see a doctor. Instead, she used her husband’s old medication until Percuoco got her in touch with a nurse.

Dr. Rose Molina, an OBGYN in Boston and professor at Harvard Medical School who treats a large number of immigrants, said she, too, has seen fewer postpartum patients in recent months, with cancellation rates fluctuating based on when someone’s neighborhood may have experienced an immigration raid.

When she cares for postpartum patients, particularly those who are immigrants, she said, she frequently is asked about how soon they can return to work. Her patients are worried about making ends meet — earning enough money to care for their children.

We have become practically trapped by four walls. Lately, I feel alone. —Laura

“That is who they are: strong, resilient women, and all they can think about is, ‘I need to go back to work so I can pay for rent, pay for food, all these things in my life,’” she said.

After Laura left the hospital, she stayed briefly with a few friends, a chance to have a little extra company and support. There were immigration officials outside. But as long as they didn’t leave, she said, they were safe enough. She had people to rely on.

Now, back home in her one-bedroom apartment, “We have become practically trapped by four walls,” she said one afternoon, holding her daughter. It’s just the two of them.

“Lately, I feel alone.”

Her daughter sleeps in a bassinet next to her bed. On a routine morning, Laura wakes up, and then her daughter does. She feeds her baby. She cleans up a bit and cooks with groceries she has delivered. In the afternoons, she sits on her couch, holding her girl while encouraging her to nap on her lap.

Their days are confined to the few rooms in her home: the kitchen space, dining table, the couch and her bedroom. There’s a small balcony; on sunny days, light pours in from the windows. It’s the rare connection she has to the outside world. Even taking out the trash feels dangerous, Laura said..

She’s been using her savings accumulated through her job cleaning at construction sites to pay for groceries. Her partner sends money to help with bills. She has neighbors who would sometimes come by with food or who bring diapers.

One of her friends, one who has papers, is able to visit her on occasion. They eat together, and they talk about her baby, who now weighs more than 12 pounds. But they also discuss the presence of immigration officials. They wonder when things might be normal, when it might be safe again.

She feels stressed all the time — sometimes, maybe, depressed, she added.

She’s made contingency plans, she said, identifying a friend who could care for her daughter if she is deported.

Most days she spends alone with her child, whose soft toys lie strewn on the couch, by the table, on the floor.

On the best days, she said, “I feel happy. I have my baby.”

Things are changing — but slowly. At the end of March, she finally went for her first doctor’s appointment outside of her apartment. Her daughter’s father has visited three times, but only at night. “It’s less dangerous,” she said.

Eventually, she said, she hopes things will feel safe enough that she can return to work. Someday, she said, she’s sure that will happen. She’s just not sure when.

She and her daughter are beginning to better understand each other. And she has to be strong, she said — her girl needs her to be.

Chabeli Carrazana contributed reporting.

The Equal Credit Opportunity Act (ECOA) was designed to protect people from discrimination when they seek credit. It rests on a simple idea: Whether someone can buy a home, start a small business, or go to college should not depend on their race, gender, or the neighborhood they come from. Most of us rely on credit to pursue these opportunities. That is why the Consumer Financial Protection Bureau’s (CFPB’s) proposed changes to Regulation B—the implementation mechanism of ECOA—are so alarming.

The CFPB’s November 2025 proposal would undercut core ECOA protections by making lending discrimination much harder to prove. It would specifically eliminate disparate impact liability for lenders, narrow the scope of discouragement claims, and prohibit race and gender-based Special Purpose Credit Programs (SPCPs). In practice, that means giving bad-faith lenders more room to discriminate while making it harder for communities to challenge unequal treatment.

Historically, low- to moderate-income communities have been subjected to redlining—intentional discrimination based on a neighborhood’s racial composition—by financial institutions. They have also often lacked access to mainstream financial services.

And the consequences have been stark. The historical impact of redlining and present-day lending discrimination has resulted in today’s staggering racial wealth gap. In 2022, the median White household held $284,130 in wealth, more than six times that of the median Black household at $44,210.

Discrimination hides behind policies that appear neutral on paper but disproportionately exclude certain groups in practice.

The National Community Reinvestment Coalition (NCRC) works to close this gap by holding banks accountable under the Community Reinvestment Act, which requires them to reinvest in the communities from which they take deposits. That means more mortgage lending, more small business lending, more bank branches, and more investment in neighborhoods that were once written off. The ECOA complements that mission by prohibiting discrimination in credit and helping ensure that equal access to capital is more than a slogan.

However, the CFPB’s proposed rule moves in the opposite direction. One of the most troubling changes is its effort to eliminate disparate impact liability.

Disparate Impact Matters

Discrimination is not always explicit. In fact, it rarely is. Lenders do not announce their discriminatory intent. More often, discrimination hides behind policies that appear neutral on paper but disproportionately exclude certain groups in practice. For example, a lender may require applicants to meet a minimum credit score to qualify for a home loan, which appears to be a neutral policy.

Equal opportunity is not a finite resource.

Black borrowers, however, are more likely to have lower credit scores or be “credit invisible” due to long-standing structural racism and historic exclusion from mainstream financial services. Such a policy can disproportionately shut Black borrowers out.

That is exactly why disparate impact matters, because it allows regulators and advocates to identify policies that produce discriminatory outcomes, even when no one openly says the quiet part out loud.

The CFPB now suggests that addressing those inequities risks “reverse discrimination.” That argument is both cynical and wrong. Black applicants are more likely than White applicants to be denied a mortgage even after controlling for key risk characteristics, such as credit score, loan-to-value ratio, and debt-to-income ratio.

Creating fairer underwriting criteria that expand access to credit for qualified Black applicants does not somehow injure White borrowers. Equal opportunity is not a finite resource. And removing unnecessary barriers for one group does not require erecting new ones for another. Access to credit is not only shaped by more equitable policies, but also by whether people feel welcome to apply in the first place. That is why discouragement claims matter.

Under the current framework of Regulation B, discouragement can extend beyond blatant statements. It can include actions and patterns that signal to certain communities that they are not wanted as customers. Bank branch placement is a clear example. When a bank saturates affluent White neighborhoods with branches while avoiding low- and moderate-income (LMI) communities and neighborhoods of color, it sends a clear message: “We don’t want to provide our services to you.”

NCRC’s own analysis found that between 2010 and 2021, only 15 percent of the 4,130 branches that large banks opened were in majority-minority LMI neighborhoods, in contrast to 61 percent of bank branch openings in predominantly White, upper-income neighborhoods.

Under the new proposed rule, CFPB would narrow the scope of discouragement claims only to explicit oral and written statements, such as a lender publicly stating that they don’t lend to people in “risky neighborhoods.”

The Racial Wealth Gap

Then there is the attack on Special Purpose Credit Programs (SPCP), one of the most effective tools available to address longstanding inequities in access to credit. Congress authorized these programs by amending ECOA in 1974, acknowledging that equality sometimes requires more than simply banning overt discrimination. It also allows for the creation of targeted programs to meet the needs of communities that have been historically excluded.

SPCPs make that possible by encouraging financial institutions to design responsible programs for economically disadvantaged borrowers, such as down-payment assistance for first-time homebuyers or affordable small business loan products for women and entrepreneurs of color.

SPCPs are an important corrective tool meant to expand fair access in markets that have long failed to do so. Yet, the CFPB’s proposal would prohibit race- and gender-conscious SPCPs on the theory that they, too, amount to so-called reverse discrimination.

That position ignores both history and reality. A policy designed to remedy entrenched exclusion is not equivalent to a policy that created that exclusion in the first place.

The Law of the Land

Even if the proposed rule is implemented, ECOA will remain the law of the land, and economic justice advocates should not see this as a total loss.

Congress, the CFPB, and banks have a role to play in protecting equal credit opportunity. Congress should use its oversight authority to ensure ECOA remains a strong civil rights law by preserving disparate impact liability, broad discouragement protections, and Special Purpose Credit Programs as lawful tools to address longstanding inequities.

The CFPB should withdraw this proposal and return to its core mission of protecting consumers from discrimination. Banks should also expand responsible lending, branch access, and targeted programs in communities rather than retreating. Advocates must keep organizing, documenting harm, and pressing both the CFPB and Congress to defend the full promise of fair lending law. Any retreat from these protections is not a technical policy shift, but a choice to tolerate discrimination and widen the racial wealth gap.

For More on This Topic:

How Guarantees Can Advance Community Development and Racial Equity

From Precarity to Promise: How Public Policy Can Reverse the Wealth Gap

Beyond Equity: Targeted Universalism and the Closing of the Racial Wealth Gap

When I started work at a nonprofit for orphans in New York, I told myself to keep my head down, do good work, and be grateful to have a paycheck. I worked directly with the children, managing daily routines while trying to keep up with shifting expectations from management.

Common workplace problems were framed as personal failings, burnout meant poor time management, low morale meant a lack of resilience, and high turnover meant employees simply weren’t a fit. Over time, the same issues kept repeating: Staff were staying late to cover gaps without pay, and shifts changed with little notice, even when it disrupted care routines.

People were exhausted. People were scared. People were quietly leaving.

At first, staff conversations happened in hallways and group chats. Small, careful check-ins: “Is it just me?” “Are you feeling this too?” One colleague, whom we’ll refer to as Ken, worked a different shift from mine, but we kept running into the same problems: being asked to stay past our scheduled hours to cover understaffed shifts or being blamed when expectations around the children’s care changed without warning.

We discovered that we were all carrying the same stress in isolation. Once we started naming the patterns—unpaid overtime, shifting expectations, and write-ups that followed anyone who questioned them—we understood the problem was structural.

For us, organizing was listening to each other and documenting what happened when people were too tired or scared to speak. We built trust slowly, across different roles, backgrounds, and fears.

I stopped seeing myself as someone just trying to survive a job and started seeing myself as part of a collective with power.

Of course, there were moments we almost capitulated, like the time Ken spoke up during a staff meeting about staying late to cover shifts without pay, which resulted in him being written up for an “attitude” and “lack of teamwork.” After that, people stopped raising concerns openly during meetings. Conversations moved back to private messages and whispered check-ins between shifts.

At the time, it made speaking up seem like a liability. When management later called us “unprofessional” for asking questions, it didn’t feel abstract anymore. It felt like a warning.

But knowing silence isn’t harmless, we kept going.

Eventually, we learned how to speak collectively, as workers with shared demands. We wrote those demands down together: consistent staffing levels, clearer expectations for our roles, and proper pay for all hours worked. We practiced what to say before raising anything formally, and we made sure no one stood alone in those conversations. The shift was subtle but powerful: Instead of asking for favors, we started insisting on basic fairness. Instead of apologizing for existing, we named what was wrong.

Justice at work isn’t given. It’s built, slowly, imperfectly, by people who never planned to become organizers, but who refuse to stay small.

Some things changed, but not everything. Managers became more cautious about asking staff to stay beyond their shifts without pay. Schedules were shared earlier, even if not always consistently. There was more acknowledgment, however reluctant, that staffing shortages were affecting both workers and the quality of care. Conversations that used to be shut down began to happen more openly, even if they were tense. The wins were partial and fragile, but they were real.

I stopped seeing myself as someone just trying to survive a job and started seeing myself as part of a collective with power. Not perfect power. Not guaranteed power. But shared power, the kind that grows when people decide they deserve better together.

Justice at work isn’t given. It’s built, slowly, imperfectly, by people who never planned to become organizers, but who refuse to stay small.