This study examined the effectiveness of the Healthy Babies Healthy Start maternal health program that emphasises racial equity and home visitation, in improving birth outcomes for Black relative to White women using Michigan state- and Kalamazoo County-level birth certificate records from 2008-10. In spite of a 2-fold higher smoking rate, Black health program participants delivered higher birth-weight infants than did Black nonparticipants (p = 0.05). Although White participants received significantly more prenatal care than White nonparticipants, they experienced similar birth outcomes.