In San Francisco, racism and birth outcomes are intertwined. Black and Pacific Islander (PI) families experience adverse birth outcomes at significantly higher rates than other communities. Before a Black or PI child sets foot in the world, they are affected by historical and ongoing discrimination in housing, employment, criminal justice, and health care. Expecting Justice takes a transformational approach that values and includes Black and Pacific Islander women throughout their lives in order to improve birth outcomes. We envision that by the year 2030, every birth within San Francisco's Black and PI communities will be healthy and full term.