Can Cash Payments Improve the Health of Pregnant People and Children?

By Claudia Boyd-Barrett

It was like money falling from the sky.

Except the city of Los Angeles would be sending it to her in a debit card every month. A thousand dollars. To spend however Sara Calderon and her family wanted.

For the first time in two years, the 25-year-old mother from South L.A. felt the clouds of hardship start to part. It had been a dark two years. Calderon and her partner had both lost their jobs in early 2020, at the start of the pandemic, kickstarting a cycle of debt as they fell increasingly behind on rent and utility payments and were forced to put basic necessities on credit cards.

And there were health challenges. Calderon, who gave birth to her first child during the stressful height of pandemic lockdown, developed preeclampsia and postpartum depression, complicating her entry into motherhood. When she received the call about being accepted into the guaranteed income program through the Los Angeles’ Community Investment for Families Department, she was pregnant with her second child. She had been worrying constantly about her family’s financial situation as she juggled parenting, a new job as a teacher’s assistant and completing an associate degree.

“I was so happy, so happy,” said Calderon, who had applied for the program several months prior, but had forgotten about it because she didn’t expect to be selected.  “I felt some of the stress leave my body.”

In February, Calderon received her final monthly payment of $1,000, capping her participation in the Basic Income Guaranteed: Los Angeles Economic Assistance Pilot (BIG:LEAP), one of a growing number of guaranteed income pilot programs across California providing regular, no-strings-attached cash payments to low-income people in an attempt to address economic inequalities.

Several of these programs, including the BIG:LEAP, target pregnant people and families with children. That’s because, by helping parents and caregivers gain financial stability, guaranteed income has the potential to improve the lives and health of children as well. Poverty and other stressors during pregnancy and childhood, especially early childhood, have been shown to harm the physical, developmental and mental health of children, problems that can persist into adulthood and perpetuate cycles of poverty.

The goal, said Aaron Strauss, the program’s manager, “is to break the multigenerational cycle of poverty in Los Angeles.”

Other guaranteed income programs

Communities of color often lack generational wealth, which can provide a financial cushion during difficult times. This is largely due to historical and systemic inequalities that have led to fewer economic opportunities and hampered wealth accumulation. It’s also at least partially why these communities were hit hardest both physically and financially by the pandemic.

The BIG:LEAP welcomed people of all races and ethnicities into the program, but targeted those living under the federal poverty line who had experienced economic or medical hardship related to COVID-19. Over 50,000 people applied for the program; 3,200 participants were selected at random, provided they met the criteria. The $38.5-million program, which will soon end, was funded almost entirely by the city of Los Angeles.

“We found that our cohorts really reflect the faces of poverty in the city of Los Angeles,” Straus said. “Eighty percent are women, over half are Hispanic, the significant majority are people of color in general.”

Payments to the last cohort of participants in the BIG:LEAP will wrap up early this year, and data from the program will be analyzed by the University of Pennsylvania’s Center of Guaranteed Income Research to gauge the pilot’s impact. Findings will be published next year. Straus said the city doesn’t have the budget to continue the program, but is considering putting together another, smaller guaranteed income pilot, possibly targeting people who are housing insecure.

In addition to the BIG:LEAP, several other guaranteed income programs in California are working or plan to work with pregnant women and families.

These include the Abundant Birth Project in San Francisco, which provides $1,000 per month to nearly 150 Black pregnant and postpartum people and aims to address racial and income disparities that affect birth outcomes; the Sonoma County Pathway to Income Equity, a two-year pilot program that will provide a guaranteed minimum income of $500 a month to 305 low-income families and study the impact on reducing poverty; and the Yolo County Basic Income, providing a basic income of between $1,200 and $1,500 a month to 55 families with a child under the age of 6 or pregnant who are enrolled in other social support or housing programs.

The state is providing $25 million for seven additional pilot programs. In 2022, California became the first state to fund guaranteed income pilots. The seven programs will serve almost 2,000 pregnant people and former foster youth across California, who will receive monthly payments ranging from $600 to $1,200 per month for a period of 12 to 18 months. For example, the McKinleyville Community Collaborative will provide 18 monthly payments of $1,000 each to 150 Humboldt County Medi-Cal recipients in their first or second trimester of pregnancy. Each program will be evaluated by the Urban Institute and UC Berkeley.

The programs aim to help Californians during life transitions, “such as the birth of a child or entry into independence after extended foster care,” California Department of Social Services Director Kim Johnson said in a statement announcing the grant program.

When financial stress gives way to health challenges

Pregnant women and their babies are especially vulnerable to the effects of stress, which is often tied to poverty and exposure to violence.

Research led by Nicki Bush, a professor of psychiatry and pediatrics at UC San Francisco, has found that the children of moms who experienced hardship during pregnancy have a higher risk of mental and physical health problems, including clinical depression. She’s also found an association between a pregnant woman’s exposure to domestic violence and neighborhood crime, and poor behavioral and mental health for their babies at 1 year old. A mother’s exposure to violence during her own childhood can impact the health of her offspring too, a concept sometimes referred to as the intergenerational transmission of trauma.

“It’s really important to understand that these intergenerational health effects are universal, but there are communities that are exposed to much higher rates of adversity and have many fewer buffers that can protect them from these risks,” Bush said. “We find that there are groups of women, based on income or histories related to the color of their skin and discrimination and systemic policies, that have greater exposure to these types of challenges.”

Meanwhile, stress during pregnancy can exacerbate the impact of environmental pollution on the mother and baby’s health — a problem that disproportionately impacts people of color due to structural inequities and racism. A recent study by the University of Southern California found that higher levels of psychological stress among Latina women living in areas of Los Angeles with high air pollution correlated with increased risk of giving birth to an underweight baby. Low birthweight babies are more likely to suffer short and long-term health problems such as breathing issues, jaundice, developmental delays and heart disease.

Lead study authors Carrie Breton and Zhongzheng Niu said the link is likely due to stress hormones interfering with the body’s ability to fight inflammation and oxidative stress caused by air pollution. In a pregnant person, this can influence the flow of nutrients and oxygen in the blood to the baby.

“If you’re very stressed out during pregnancy and you also are exposed to higher levels of pollution, those things combine,” Breton said. “It makes things worse.”

But targeted financial support for pregnant women and families with young children, such as that provided by guaranteed income programs, could make a significant difference, Bush said.

One ongoing study called Baby’s First Years is measuring whether unconditional $333 monthly cash payments to low-income mothers during the first few years of a baby’s life impacts the child’s brain development. An initial analysis of data from the study found that babies of moms that received the payment showed brain activity associated with higher cognitive, language and social-emotional skills at age one as compared to babies in a control group.

Another program in Manitoba, Canada, that provides the equivalent of up to $60 a month in unconditional cash to low-income Indigenous women during the two later trimesters of pregnancy was found to reduce the risk of preterm birth and low birth weight, increase breastfeeding and vaccination rates, and lower children’s risk for developmental problems.

Closer to home, the one-year expansion of the child tax credit as part of COVID-19 relief efforts improved the mental health of the adults that received it, which could in turn improve the mental health of their children, Bush said. It also lifted 3.7 million children out of poverty. Experiencing poverty early in life is associated with lower school achievement, reduced earnings and poorer health, as well as differences in brain development compared to children who grow up in more affluent households.

‘The space to invest in themselves’

Research on guaranteed income programs is in its infancy, but so far the results are promising. A groundbreaking 2019 pilot program in Stockton that provided $500 a month to 125 randomly selected residents for two years found that the program dramatically increased participants’ financial stability, reduced depression and anxiety, boosted employment rates and allowed for greater self-determination. Analysis of participants’ monthly expenditures — which was tracked through the debit cards on which they received their stipends — showed they mostly spent the money on food, utilities, car maintenance and transportation. Less than 1 percent of the money went toward tobacco and alcohol.

The BIG:LEAP has observed similar expenditure trends and positive benefits to participants, Strauss said, although a full evaluation of the program by University of Pennsylvania’s Center of Guaranteed Income Research is pending. Expenditures include catching up with bills, paying for health care or food, buying school supplies for their kids, investing in school tuition or starting a small business.

“We have heard anecdotes from folks that they’ve used the funds to secure their future — some are able to make investments that allow them to take higher paying jobs, for example repairing a car that now lets them get farther to a higher-paying job, or investing in a computer or tuition for school,” Strauss said. “In that sense, we believe guaranteed income is a positive investment in folk’s futures because it gives them the space to invest in themselves.”

The guaranteed payments are not intended to replace a recipient’s existing income. Most participants also have jobs or receive some support through other public assistance programs such as CALWORKS, CalFresh and Medi-Cal.

Sara Kimberlin, senior policy fellow at the California Budget Center, said providing unrestricted cash support gives people the flexibility to address their most pressing needs, while respecting their dignity and ability to decide for themselves what they need most. That differs from the standard, more widely available public assistance programs such as CalWORKS, which imposes work requirements for many participants, and the Supplemental Nutrition Assistance Program or CalFresh, also known as food stamps, which is restricted to grocery purchases. Kimberlin said the results of California’s current expansion of guaranteed income programs could provide information on how to improve the effectiveness of existing public assistance programs, as well as offer a model for additional cash assistance programs that target specific groups such as pregnant women and young families.

Guaranteed income programs could also be used to assist people who are experiencing or vulnerable to domestic violence, Kimberlin added. Flexible cash support could make it easier for survivors to quickly access the funds they need to obtain housing or other resources they need to seek safety. Cinthia Chicas, a management analyst for the BIG:LEAP said at least one participant used the funds to help her leave an abusive relationship and buy food and clothes for her children.

“The stress of dealing with a (domestic violence) situation you’re exiting, and the trauma can be a barrier to navigating processes to access different types of programs and resources,” Kimberlin said. “A core tenet (of guaranteed income) is reducing burdensome requirements and minimizing red tape.”

Calderon, who received her final $1,000 payment in February, used the money to lift her family out of a financial hole and improve her career prospects.

Before entering the program, she was on the verge of quitting community college because she had no computer to do her homework and didn’t have a car to get to class. With the additional money she was able to purchase a computer and a used car and is now on track to complete her associate degree in sociology in December. She then hopes to gain a bachelor’s degree in social work. Her boyfriend, meanwhile, has obtained a tax preparer certificate. They’ve built some savings, and Calderon said her mental health has improved because some of the financial stress is gone.

“It just makes me feel more positive knowing I have a little more advantage than I did last year,” she said. “I’m actually very excited for what the future holds, now that I had a little bit of help.”

Guaranteed income programs are currently not widely available and most target specific populations, However, the number of programs is growing. Here is a way to find city-led guaranteed income programs in your area and a list of state-funded guaranteed income programs in California.

If you or someone you know is experiencing domestic violence, contact the National Domestic Violence Hotline at 1-800-799-7233 for support and referrals, or text “START” to 88788.

This story is published collaboratively with Grist and Next City as part of the Equitable Cities Reporting Hub for Environmental Justice.


This article first appeared on California Health Report and is republished here under a Creative Commons license.



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