GiveBetter x SF

SisterWeb Community Doula Network

Culturally congruent prenatal, birth, postpartum, workforce, and hospital-systems support

Research time: ~17 min on GPT-6 Astra Lite + GPT-5.6 Sol
  • Source audit — checked claims, assumptions and calculations.
  • Research — reviewed programs, finances and impact evidence.
  • Modeling — estimated costs, QALYs and uncertainty.

Published: 10 September 2026.

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Summary

What do they do? SisterWeb provides no-cost culturally congruent prenatal, labor/birth and postpartum doula support in San Francisco. It also employs and mentors doulas, trains apprentices and community members, coordinates with hospitals, distributes supplies, conducts research and field-building, and works on systems accountability. More

Why this approach interests us

  • Randomized evidence supports lower cesarean rates in pooled trials and more consistent improvements in anxiety, postpartum follow-up and breastfeeding initiation. SisterWeb provides unusually intensive, culturally congruent care and reports constrained enrollment and a prior program closure for lack of funds.

Our main reservations

  • The US-only cesarean RCT subgroup is inconclusive, SisterWeb reports no controlled clinical comparison, 103 client episodes are not completed births, public and Medi-Cal funding can displace gifts, and current standalone expense is unavailable.

What do you get for your dollar?

Under an explicitly judgmental signed prior-weighted illustration, a $100,000 unrestricted gift corresponds to $63.2 million per better life (10 modeled QALYs), or $73.4 million under an illustrative gross-resource sensitivity. Central is $96.4 million. Maternal and infant deaths receive zero credit; only finite morbidity is modeled. Inspect the model, assumptions and scenarios.

modeled ordinary gift
$63.2M — signed prior-weighted donor cost per 10 modeled QALYs; not an empirical quote
central illustration
$96.4M — per 10 modeled QALYs; mortality gets zero credit
favorable stress
$5.18M — still far above the discovery threshold and supplies most weighted QALYs
bay / sf share
100% / 98.05% — signed service-geography-informed assumptions; SF is nested within Bay
funding room
Plausible, unpriced — private-funding need is credible, but public awards and Medi-Cal create substitution

1. What do they do?

SisterWeb provides no-cost culturally congruent prenatal, labor/birth and postpartum doula support in San Francisco. It also employs and mentors doulas, trains apprentices and community members, coordinates with hospitals, distributes supplies, conducts research and field-building, and works on systems accountability.

Enroll a pregnant client

The 103 FY2023-24 clients are treated as unique care episodes, not completed courses, births, infants or dyads.

Provide full-spectrum doula care

The intended model includes intake, three prenatal visits, birth attendance, four postpartum visits and between-visit support; completion is not publicly reported.

Coordinate with clinical partners

The Champion Dyad Initiative links doulas with five SF birthing partners. Doulas provide nonclinical support and are not credited for obstetric decisions.

Build workforce and systems

Training, apprenticeship, mentoring, supplies, advocacy, research and hospital feedback may matter, but receive no separate QALYs in this model.

Scope of this review. This is a whole-SisterWeb-project model, not a whole-Heluna model. SisterWeb appears separately tax-exempt in 2025 and a 2026 HRC award lists no sponsor, but a Heluna-sponsored DPH contract runs through June 2027 and remains on an April 2026 program list. The legal/operational transition is unresolved. No current standalone filing exists, so $0.9M–$1.5M annual expense is an explicit proxy range.

2. Monitoring and information sharing

Seven RCTs for cesarean outcome; 2,497 participants across eight RCTs overall

Systematic review and meta-analysis; primary analysis of randomized trials. Cesarean 17.5% versus 23.6%, RR 0.71 (0.53–0.95); I2 60.1% and borderline small-study evidence. US-only RCT subgroup RR 0.71 (0.47–1.06).

Our assessment. Supports a possible cesarean pathway, but not a SisterWeb effect. Central shrinks far below the crude absolute difference.

Heterogeneous doula programs and perinatal populations

Systematic review of 21 clinical/pilot interventions, 17 randomized. Most consistent evidence for anxiety, postpartum follow-up and breastfeeding initiation; cesarean and pain results varied.

Our assessment. Supports a finite psychosocial pathway and zero mortality claim; fidelity, crossover and population transfer remain uncertain.

FY2023-24 SisterWeb activities

Organization impact one-pager. 103 clients received care; 85% initiated breastfeeding, 61% continued at six weeks; seven benefited doulas, 20 trainees and 131 coordination instances.

Our assessment. Establishes scale and portfolio, not completed courses, comparison outcomes or mother-infant dyads.

Community doula program in San Francisco

SisterWeb process/time-use study. Documents intensive prenatal, birth, postpartum and between-visit work within a cohort/mentor model.

Our assessment. Supports implementation intensity, not clinical causal outcomes.

Historical and current SisterWeb project scope

Official local-government funding records. Historic city funding was $900K annually; a 2022 Heluna-sponsored contract scheduled $675K annually through June 2027; April 2026 DPH lists that contract at $512.5K; a separate HRC award is $300K annually and lists no sponsor.

Our assessment. If current lines are nonoverlapping they total $812.5K. This anchors a tight expense floor but does not resolve overlap, legal recipient, total expense or marginal private funding.

3. Qualitative assessment

Randomized evidence supports lower cesarean rates in pooled trials and more consistent improvements in anxiety, postpartum follow-up and breastfeeding initiation. SisterWeb provides unusually intensive, culturally congruent care and reports constrained enrollment and a prior program closure for lack of funds.

Key reservations

  • The current legal entity appears new and has no public Form 990 or audited standalone expense.
  • A Heluna-sponsored contract remains active post-new-EIN; the legal/operational transition, recipient entity and overlap with the sponsor-free HRC award are not reconciled.
  • The newest 2024-25 Canva impact report was not reliably machine-readable; the model uses the latest accessible 103-client figure from FY2023-24.
  • Clients receiving any care are not completed courses, births, infants or dyads; attrition and birth attendance are unknown.
  • SisterWeb has no controlled local maternal or infant clinical endpoint evaluation.
  • Pooled doula trials are heterogeneous, and the US-only cesarean subgroup was inconclusive.
  • Cesarean, psychosocial, preterm morbidity, completion, expense, deployability, realization, weights, geography and gross multipliers are explicit priors.
  • Medi-Cal reimbursement and public contracts may complement or displace unrestricted gifts.
  • Doulas are nonmedical support; clinical outcomes are not automatically attributed to them.
  • The signed expected value is dominated by the 5% favorable stress case and should not be used for fine ranking.

Benefits not included in our estimate

  • Maternal mortality and infant mortality
  • Breastfeeding initiation and continuation
  • Postpartum follow-up beyond the finite psychosocial allowance
  • Care coordination and hospital-systems accountability
  • Doula wages, benefits, career development, apprenticeship, mentoring and workforce diversity
  • Perinatal supplies and broader family support
  • Research, advocacy, training dissemination and national field-building
  • Avoided obstetric spending, because it is not donor cash and local causality is unmeasured

4. What do you get for your dollar?

Signed prior-weighted modeled ordinary gift: $63.2M per 10 QALYs; central: $96.4M.

The model converts 103 client episodes to completed-course sensitivities, assigns finite cesarean-recovery, psychosocial and preterm-morbidity QALYs, scales a $100,000 gift against an annual expense proxy, and applies gift deployability and realization. A 25% null and 10% net-harm case are included. Ordinary obstetric care is usual care and not added.

A better life is our comparison unit of 10 additional quality-adjusted life years (QALYs), potentially spread across people. These are uncertain estimates, not measured returns or verified donation offers.

How we calculate the estimate

CENTRAL MODELED GIFT COST: 10 × $100,000 ÷ [103 episodes × 80% completion × 0.00395 finite QALY/completion × ($100,000 ÷ $1.2M expense proxy) × 45% deployability × 85% realization]
$96,388,562 per 10 modeled QALYs; 0.010375 gift-attributed QALY

Model inputs and assumptions
FY2023-24 clients receiving care
103 (range: 103 in all cases). Official one-pager. Care-coordination events, births and infants are not added. Moderate as people receiving some care; low as completed courses.
Full-course completion
80% (range: 60% harm / 80% null and central / 90% favorable). SisterWeb describes intended scope and survey eligibility for completers, but supplies no attrition denominator. Low; current completion not reported.
Annual whole-project expense proxy
$1.2M (range: $1.5M / $1.2M / $0.9M). April 2026 DPH lists $512.5K and HRC awards $300K annually; these may total $812.5K if nonoverlapping. The $0.9M favorable floor is therefore tight, not a safe lower bound; central allows other resources. Very low; not audited current expense.
Absolute cesarean change
1.5 percentage points avoided (range: 0.5pp harm / 0 / 1.5pp / 4pp benefit). Pooled RCT crude difference was 6.1pp, but heterogeneity and small-study concerns were material and the US-only subgroup CI crossed one. Central heavily shrinks it. Low for pooled trials; very low for SisterWeb.
Finite QALY per cesarean avoided
0.03 (range: 0.03 / 0 / 0.03 / 0.08). Short recovery and complication sensitivity only; no maternal mortality credit or avoided-cost deduction. Low; judgmental morbidity bridge.
Finite anxiety/birth-experience benefit
30% × 0.04 utility × 0.25 year (range: 10% × -0.04 × .25 / 0 / 30% × .04 × .25 / 50% × .08 × .50). Clinical-trial reviews most consistently support anxiety and negative birth-experience direction; magnitude and SisterWeb transfer are judgmental and time-limited. Low-moderate direction; low magnitude.
Finite preterm morbidity sensitivity
0.1pp × 0.5 QALY (range: 0 / 0 / 0.1pp × .5 / 0.5pp × 1). Observational associations are not imported causally. No infant death is credited and the morbidity quantity is explicitly bounded. Very low; not a SisterWeb or RCT estimate.
Gift funding/capacity deployability
45% (range: 20% harm / 45% null-central / 70% favorable). Private gifts are flexible and capacity need is credible, but public contracts and Medi-Cal can substitute. Low.
Gift-to-completed-outcome realization
85% (range: 75% / 85% / 85% / 95%). Discounts delay, hiring, continuity failure and incomplete service. Low.
Scenario prior weights
10% harm / 25% null / 60% central / 5% favorable (range: fixed for illustration). Local clinical effects and current marginal finances are missing. A small favorable weight preserves the RCT-positive tail without letting it become the central claim. Subjective; not empirically calibrated.
Illustrative gross-resource multiplier
1.15× (range: 1.30× / 1.15× / 1.15× / 1.05×). Flags partner coordination and in-kind resources. Neither measured nor a lower bound; counterfactual ordinary obstetric care is excluded. Very low; sensitivity only.
Bay and nested SF impact shares
100% Bay / 95% SF (range: Bay 100%; SF 95% except 100% favorable). City award specifies SF homes, community settings and birthing facilities. Beneficiary residence is not separately tabulated. High for service location; low for residence.

Illustrative $100,000 unrestricted gift

  • Harm (10% prior weight): Modeled net harm. −0.000711 gift QALY; conflict, privacy/autonomy loss, distress or delayed escalation sensitivity; no positive cost ratio.
  • Null (25%): No positive QALYs. Gift and resources are spent; health QALYs are zero and stand-alone cost is infinite.
  • Central (60%): $96.4M donor cost per 10 QALYs. 0.010375 gift QALY; $111M illustrative gross-resource sensitivity; $36.9M whole-project expense-proxy diagnostic.
  • Favorable stress (5%): $5.18M donor cost per 10 QALYs. 0.19316 gift QALY; $5.44M illustrative gross sensitivity. This case contributes most weighted QALYs.
  • Signed prior-weighted: $63.2M donor cost per 10 QALYs. 0.015812 signed expected gift QALY; $73.4M illustrative gross sensitivity; 100% assumed Bay and 98.05% assumed nested SF share.

Uncertainty. Scenario inputs and weights are analyst priors, not confidence intervals, audited SisterWeb finances or observed causal effects. Maternal and infant mortality credit is zero. The favorable case dominates weighted QALYs despite only 5% weight, so the headline is right-tail-sensitive. Zero funding additionality returns zero QALYs; the harm case permits negative QALYs.

5. Funding and previous grants

Obtain a current whole-project budget and new-entity filing, unduplicated enrollment/completion/birth counts, payer billing and collections, a priced next-$100,000 use, residence shares, and comparative linked birth outcomes.

RFMF is plausible but unpriced. SisterWeb says private gifts enable full-spectrum care beyond restricted government funding, a Latine-serving program closed for lack of funds, and referrals continued during closed enrollment. Against this, April 2026 DPH lists $512.5K and HRC awards $300K annually; if nonoverlapping, current public awards total $812.5K. The Heluna/new-EIN recipient transition and overlap are unresolved. Medi-Cal can also reimburse roughly $3,153–$3,263 for a standard package. No current budget, contract crosswalk, payer reconciliation, wait-list price or next-$100,000 commitment is public.

This review does not establish a verified marginal funding offer or a complete history of grants.

Donate

Opens the organization’s giving page. A general donation may not fund the specific activity modeled here; confirm allocation with the recipient.

6. Sources

  1. Sisterweb Community Doula Network (EIN 93-1924851). Internal Revenue Service EO BMF via ProPublica Nonprofit Explorer API. IRS-derived exempt-organization registry record; active 501(c)(3), no filings returned. Published: IRS ruling date 2025-02; retrieved: 2026-09-10.
  2. Donate. SisterWeb. Official organization donation page. Published: Undated/current; retrieved: 2026-09-10.
  3. SisterWeb donation campaign. Givebutter, linked from SisterWeb. Officially linked donation campaign and EIN identity. Published: Current campaign; retrieved: 2026-09-10.
  4. Our Impact. SisterWeb. Official organization impact hub. Published: Current page; retrieved: 2026-09-10.
  5. 2023-2024 Fiscal Year Impact One-Pager. SisterWeb. Official organization impact report. Published: FY2023-24; retrieved: 2026-09-10.
  6. Listening with Care: How SisterWeb Monitors Client Satisfaction Surveys. SisterWeb. Official organization methods post. Published: 2025-04-22; retrieved: 2026-09-10.
  7. RFP 100 Grant Agreement for Commission Approval. San Francisco Human Rights Commission. Official city award list. Published: 2026-02-09; retrieved: 2026-09-10.
  8. DPH Contracts Report. San Francisco Health Commission. Official city contract report. Published: 2021-05-04; retrieved: 2026-09-10.
  9. Contract 1000026912: Heluna Health, Fiscal Sponsor of SisterWeb. San Francisco Health Commission. Official city contract summary. Published: 2022-11-08; retrieved: 2026-09-10.
  10. Contracted Programs. San Francisco Department of Public Health. Official current contracted-program list. Published: 2026-04-17; retrieved: 2026-09-10.
  11. Intrapartum Doula Support and Cesarean Delivery Rates: A Systematic Review and Meta-analysis. Obstetrics & Gynecology / PubMed. Peer-reviewed systematic review and meta-analysis. Published: 2025-05-22; retrieved: 2026-09-10.
  12. Doula Care and Health Outcomes: A Systematic Review. JAMA Network Open / PubMed. Peer-reviewed systematic review. Published: 2026-04-01; retrieved: 2026-09-10.
  13. Continuous support for women during childbirth. Cochrane. Systematic review. Published: 2017; retrieved: 2026-09-10.
  14. What, when, and how long? Doula time use in a community doula program in San Francisco. Women's Health. Peer-reviewed SisterWeb process study. Published: 2023; retrieved: 2026-09-10.
  15. Update about Semilla Sagrada Community Doula Program. SisterWeb. Official organization funding/closure notice. Published: 2023-12-22; updated 2025-03-25; retrieved: 2026-09-10.
  16. An Interprofessional Collaboration Between a Community-Based Doula Organization and Clinical Partners: The Champion Dyad Initiative. Maternal and Child Health Journal / PubMed Central. Peer-reviewed SisterWeb implementation study. Published: 2025; retrieved: 2026-09-10.
  17. Medi-Cal FFS Doula Billing Codes Chart. California Department of Health Care Services. Official state reimbursement schedule. Published: Rates effective 2024-01-01; retrieved: 2026-09-10.

Annual expenses: years and sources

Average annual expenses (three consecutive fiscal years): Not available. Organization size is separate from the modeled cost-effectiveness of a donation.

Sisterweb Community Doula Network

Standalone SisterWeb project/entity actual expense; unavailable.

IRS-derived registry for EIN 93-1924851 returns no filings with or without extracted data. Existing evidence establishes a February 2025 exemption ruling and unresolved transition from Heluna fiscal sponsorship. Government contract awards, modeled $0.9M–$1.5M expense proxy, and Heluna's whole-organization expense are not SisterWeb actual annual expense. No defensible three-year series found. Registry source: https://projects.propublica.org/nonprofits/api/v2/organizations/931924851.json