Unconditional Cash Transfers Following Childbirth Increases Breastfeeding
The U.S. is facing a maternal health crisis with higher rates of maternal mortality than any other high-income country. Social and economic factors, including income, are recognized determinants of maternal morbidity and mortality. In addition, more than half of pregnancy-related deaths (deaths occurring during pregnancy or within one year after delivery) occur in the postpartum year.
In what is believed to be the first review to summarize evidence on the effect of unconditional cash transfers (UCTs) on postpartum health outcomes in the U.S., researchers have found strong evidence that UCTs increase breastfeeding rates and result in little to no difference in postpartum mood.
Mara Murray Horwitz, MD, MPH“UCTs provide low-income parents with the ability to cover expensive costs following childbirth which can ease financial strain and allow more time to rest and bond with their baby. Healthier parents and children mean fewer hospital visits, better child development, and stronger families – all of which can save the public money in the long run and build healthier, thriving communities,” explained first author Sahar Choudhry, MPH, operations manager of StreetCred, a medical-financial partnership at Boston Medical Center. The senior and corresponding author is Mara Murray Horwitz MD, MPH, assistant professor of medicine at Boston University Chobanian & Avedisian School of Medicine and a primary care physician at Boston Medical Center.
The researchers reviewed research articles to see how different types of UCT programs affect postpartum (0 to 2 years after delivery) health outcomes in the U.S. Types of UCTs included social programs such as tax credits, disability benefits from Social Security, and direct cash transfers. After finding all eligible articles, they conducted a dual data extraction, followed by a study quality and strength of evidence assessment for each eligible article. Ultimately, they found 11 reports from six studies. Four of these studies analyzed three social programs, and two were experiments that gave cash directly to low-income people after giving birth.
Based on their review, the researchers concluded that UCTs increased breastfeeding across a variety of different settings and populations. Breastfeeding can improve maternal health in many ways, such as lowering the risks of future high blood pressure, diabetes, breast cancer, and ovarian cancer. “Future studies should examine more closely the mechanisms by which UCTs increase breastfeeding, and any other factors that play into it such as work or childcare, so that interventions can be designed for maximum impact,” adds Choudhry.
Additionally, the review found that UCTs of different types (e.g., tax credits, disability benefits, and direct cash transfers), all administered to people with low incomes, resulted in little to no difference in postpartum mood (namely depressive symptoms). Some of the authors of those analyses suggested that the UCTs were not large enough, or were not studied for a sufficient amount of time, to truly understand their impact on maternal depression.
Finally, this review highlights the lack of postpartum outcome data collected after UCTs. The researchers recommend that UCT programs collect data on a wider set of postpartum outcomes, especially those associated with delivery complications, mental health, and heart disease. They also highlight the need for increased collaboration between social scientists and clinicians in designing effective interventions to guide public health policy and maternal health outcomes.
Watch the video from the Annals of Internal Medicine or read the findings online.