A healthy birth begins long before a mother enters the delivery room.
It begins with having enough groceries at home. Reliable transportation to prenatal appointments. Stable housing. The ability to take time off work without wondering how the bills will get paid. For too many families, financial stress becomes another risk factor during pregnancy—one that medicine alone cannot treat.
Cleveland is home to a remarkable network of healthcare providers, early childhood organizations, and community partners working to give every child the healthiest possible start in life. The William J. and Dorothy K. O’Neill Foundation’s journey began here, evolving into two-generation Deep Impact Grantmaking and Family Interest Grantmaking focus areas.
Alongside our nonprofit partners, we’ve learned an important lesson: families already know what they need. Too often, what they lack isn’t determination or good judgment—it’s the financial resources to act on those decisions. Recently, we’ve discovered that providing direct cash can be a powerful complement to a community’s existing network of supportive services.
That understanding led us to GiveDirectly.
“What impressed me most about GiveDirectly was its unwavering commitment to dignity and transparency,” says our Board Chair and co-champion of the Dignity in Choice team, Laura O’Neill Bower. “The model trusts people rather than prescribing solutions, and it measures outcomes with remarkable rigor. That combination challenged many of my own assumptions about what effective philanthropy could look like.”
However, confidence in direct cash assistance wasn’t built overnight. The Foundation’s partnership with GiveDirectly started with grants made to support multiple remote villages in Rwanda, where we saw firsthand what happens when families are trusted with the resources to make their own decisions. Rather than dictating solutions, cash gave people the flexibility to address the challenges standing most directly in their way. The results reinforced a simple but powerful truth: people experiencing hardship are remarkably capable of deciding what their families need most.
In 2024, two of our Family Interest Grantmaking teams, Dignity in Choice and Birth Justice, saw an opportunity to test this same philosophy closer to home. Rx Kids, the nation’s first community-wide prenatal and infant cash prescription program, had successfully launched in Flint, Michigan and was seeking philanthropic support to expand into the eastern Upper Peninsula, an underserved rural part of the state.
Founded by Dr. Mona Hanna, Rx Kids provides every eligible pregnant person with $1,500 during pregnancy, followed by $500 each month throughout their baby’s first 6-12 months of life. GiveDirectly, the program administrator, manages the distribution of payments to eligible families, ensuring the funds are delivered safely, securely and efficiently.
There are no complicated applications. No income tests. No restrictions on how families use the money—just trust.
It may sound unconventional. Yet the evidence is becoming increasingly difficult to ignore. In just over two years, Rx Kids has reached more than 15,000 families across nearly 60 Michigan communities. Research has demonstrated increased prenatal care, fewer preterm births, greater financial stability, and fewer child welfare investigations.
Giving families cash and trusting them works.
We are thrilled to partner with GiveDirectly and First Year Cleveland to bring this innovative public-private partnership to Ohio, the birthplace of our foundation. This fall, Rx Kids will launch in Cleveland neighborhoods where maternal and infant health disparities remain among the greatest.
“I believe this program is important because giving people financial support will absolutely have a positive impact,” says Alicia Steen, an O’Neill family member and co-champion of the Foundation’s Birth Justice work. “Whether it lowers stress during pregnancy and postpartum, gives families a financial cushion, or helps them pay for essential needs, families know what will make the biggest difference for themselves and their babies.”
Mary France Walker, an O’Neill family member and Foundation trustee adds that, “Bringing a child into the world is one of life’s greatest joys, but it can also be one of its most stressful seasons. If we can remove even one source of anxiety by giving families the financial flexibility to meet their own needs, we’re giving both parents and babies a healthier start.”
The true innovation isn’t operational though—it’s philosophical.
Direct cash starts from a different premise: parents know their families better than anyone else. A doctor can’t know whether a mother needs to repair her car to get to prenatal appointments. A funder can’t know whether this month’s greatest need is rent, diapers, groceries, or utilities. Parents can.
Direct cash recognizes that reality. It replaces bureaucracy with trust, restrictions with choice, and assumptions with dignity.
“When the opportunity arose to help bring the Rx Kids model to Ohio, the decision was an easy one,” says O’Neill Bower. “It aligned perfectly with our belief that when we trust families, invest early, and partner with communities, we create the conditions for healthier children, stronger families, and brighter futures.”
Rx Kids will launch this fall in Cleveland’s highest-need neighborhoods. But ensuring every eligible family can benefit will require more than one foundation. It will require a community to rethink how we invest in families. We all care about maternal and infant health, about improving birth outcomes, about reducing disparities, and about giving every Cleveland baby a fair start in life; and we invite you to join us.
Together, we can help ensure that every child begins life with something every family deserves: stability, dignity, and opportunity to thrive.
To support Rx Kids Cleveland, visit givedirectly.org/rxkids-cleveland and join us at The City Club of Cleveland with Dr. Mona Hanna of Rx Kids and Angela Newman-White of First Year Cleveland to learn more about this work.
The Birth Justice team believes that justice and joy can, and should, coexist during pregnancy, birth, and infancy. The team’s grantmaking will support organizations that offer solutions to end the disparities in birth outcomes and lead to happier and healthier beginnings for families.
The Dignity in Choice, Direct Cash Assistance team believes that dignity and self-reliance will flourish when people have adequate resources and choice. The team’s grantmaking supports organizations that provide direct cash transfers to low-income individuals both domestically and internationally through monthly income programs. Individuals, families, and communities are lifted through this simple and effective strategy.
