New study links unconditional cash transfers with improvement in prenatal care utilization
A new study published in JAMA Network Open finds that Rx Kids, the nation’s first community-wide prenatal and infant cash prescription program, is driving measurable improvements in maternal and infant health care. Adequate and timely prenatal care is crucial for healthier births and strong maternal outcomes. The findings offer compelling peer-reviewed evidence that unconditional cash support during pregnancy and infancy can positively impact prenatal care utilization.
Launched in Flint, Michigan in January 2024, Rx Kids has expanded to 11 communities across the state, reaching more than 3,700 families and delivering over $16 million in direct support. Recently, the State of Michigan made a historic $270 million investment to expand the program over the next three years — an effort expected to reach nearly 100,000 babies, or one-third of all births in Michigan.
In this latest research, Unconditional Cash Transfers and Prenatal Care Utilization in Flint, Michigan, results indicate that Rx Kids significantly improved maternal engagement with prenatal care, outperforming comparison cities by 2025. Following the program’s launch, Flint experienced a 5.6 percentage points rise in the proportion of women initiating care in the first trimester and a 9.1 percentage point increase in adequate levels of prenatal care. Importantly, Flint also saw a 1.9 percentage point decrease in births with no prenatal care, underscoring the program’s impact on earlier and more consistent utilization of prenatal care.
“The perinatal period is a time of profound economic vulnerability, and too often, that means missed care and risky births,” said Dr. Mona Hanna, director of Rx Kids and associate dean of public health at the MSU College of Human Medicine. “Rx Kids is flipping that script. We’re seeing moms engage earlier and more often with their doctors, because they finally have the financial breathing room to prioritize their health.”
Rx Kids was designed to address the acute hardship faced by families during pregnancy and infancy, when income plunges and expenses rise. The program provides $1,500 during pregnancy and $500 per month for babies during the first 6 to 12 months of life. This support helps families afford essentials like baby supplies, food, housing, and childcare.
“What’s important to understand about Rx Kids is that no one is told to seek more prenatal care, it’s not a requirement or condition,” said Luke Shaefer, Rx Kids co-founder, professor of public policy, and director of Poverty Solutions at the University of Michigan. “When people have the necessary resources, they make the choices that are best for themselves and their families. This study shows that dignity and trust, paired with support, lead to better health outcomes.”
“In conclusion, providing income support for expecting mothers and infants is a common-sense way to assist people during times when too many do not receive adequate income. The health impacts of that inadequate income are all too clear, and to improve population health the US will need to establish a much more comprehensive system of family benefits. Well-designed and rigorously evaluated programs like Rx Kids help show us how we can do that” said Dr. Seth Berkowitz of Department of Medicine at University of North Carolina at Chapel Hill in an Invited Commentary published today in JAMA Network Open.
Previous research from Rx Kids has shown improvements in maternal and infant health and improved family financial stability, including fewer preterm births, reduced NICU stays, lower eviction rates, and better access to nutritious food. The program has also shown demonstrable improvements to maternal mental health and wellbeing.
Rx Kids is led by the Michigan State University-Hurley Children’s Hospital Pediatric Public Health Initiative, in collaboration with Poverty Solutions at the University of Michigan, and administered by GiveDirectly.
