The Case for Spending Way More on Babies
Holding her infant patients, Dr. Mona Hanna-Attisha felt a deep sense of frustration. “I’m doing everything I’m supposed to do as a pediatrician,” she told me, describing counseling her patients’ parents about vaccines, a healthy diet, safe sleeping, and car seats. But Hanna-Attisha practices in Flint, the poorest city in Michigan and one in which more than half of children grow up in poverty. That poverty means her patients are more likely to miss milestones and fail to thrive, and more likely to grow up to have heart disease and diabetes, or to experience psychological distress. She felt like she was only ever applying a “Band-Aid,” she said. Poverty’s “a really big problem. I can’t fix that.”
Except it turns out that she can. Over the past half decade, four dozen cities have piloted cash-transfer programs, giving no-strings-attached money to residents. Hanna-Attisha watched with shock as Congress did basically the same thing, passing an enormous, albeit temporary, child allowance as part of a pandemic-relief package, giving large monthly grants to parents in the last six months of 2021. She decided to set up a local version in Flint. Working with Luke Shaefer, a professor of social work at the University of Michigan, she created Rx Kids, which last month started sending $1,500 to every pregnant person in the city and $500 a month for their child’s first year. It is a “prescription” against poverty, Hanna-Attisha told me.
It is also something the whole country should do. There’s a strong case that Congress should be spending way more money on kids. There’s a really, really strong case that it should be handing out cash to babies.
The case for showering new parents with financial support is particularly relevant now. The Supreme Court, in striking down Roe v. Wade, has increased the number of children born to financially distressed families; states with no or severely limited access to abortion have done little to support new parents. And Congress is debating whether and how to expand the child tax credit. Legislation that has passed the House would lift roughly half a million children above the poverty line (though the temporary child allowance kept more than 3 million of them out of poverty); the bill is stalled in the Senate.
As a general point, the United States, despite being the richest society Earth has ever known, tolerates astonishingly high rates of child poverty. Kids are two or three times as likely to grow up in poverty in the United States as they are in most of our rich-country peers. That is a direct consequence of the United States spending such a small share of its GDP on family benefits such as public child care, home visits, and payments to new parents—a smaller share than all other OECD countries except Turkey, Costa Rica, and Mexico. The country is also an outlier in lacking a comprehensive paid-family-leave program and child care for kids 5 and under.
Problems of poverty are acute in Flint, where the median income is half the statewide average. So too are health disparities; less than a decade ago, thousands of families were exposed to dangerously high levels of lead in the public water system, a crisis that Hanna-Attisha studied and drew attention to. Lawrence Reynolds, the former president of Mott’s Children’s Health Center in Flint, described poverty and health as deeply intertwined. New parents in the city, he told me, are forever asking themselves: “Shall I spend my money on gas to get to work or go to the doctor’s office or get the kids to school? Do I take a day off without pay, because I’m in a sector of the economy where paid time off is limited or nonexistent? Do I get a week of formula if I’m not breastfeeding? Do I have the dollars ready to cover that? Can I go to my prenatal visits?”
Having cash on hand helps parents answer those questions, reducing stress and lowering the chance of skipped meals, missed appointments, and lost opportunities. Shaefer told me he also saw Rx Kids as “an invitation” into the health system and the broader system of benefits aimed at low-income parents, such as Medicaid, the earned-income tax credit, and food stamps. “People show up for cash. They don’t show up for other stuff,” he told me. Welfare programs are punitive and stigmatizing; disability benefits can be too difficult and confusing to use. Rx Kids is just cash with no conditions, its funds coming from private donors, COVID-relief allocations, and state TANF (Temporary Assistance for Needy Families) money. The application is simple, with no means testing or income requirements.
The evidence on cash-for-kids programs is compelling. Poverty in childhood is associated not just with poverty in adulthood, but with worse health outcomes, reduced educational attainment, and a shorter life span. As a result, transfers pay big dividends, sometimes huge dividends, in improved health and bolstered incomes. The evidence on cash-for-babies is even more compelling. “Poverty peaks right at childbirth and persists for that first year of life,” Hanna-Attisha told me, because the majority of new parents with no or little paid leave have to reduce their work hours or drop out of the labor force. “That most economically vulnerable time is the most neurodevelopmentally important time,” she said, as a child’s brain doubles in size in the first year of life.
The hope is that Rx Kids will improve “maternal morbidity and mortality, prematurity, low birthweight, breastfeeding initiation, and NICU admission,” Hanna-Attisha told me. But it will likely have benefits far beyond that. And it should be implemented far beyond Flint. Already, Michigan is pushing to make Rx Kids a universal program across the state, first by expanding it to six additional cities, including Detroit. “We will lower costs for new moms and ensure they and their babies can make it in Michigan,” Governor Gretchen Whitmer said in a statement. Legislators in Washington should do something similar.
Annie Lowrey is a staff writer at The Atlantic.
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