The 2021 Child Tax Credit expansion and perinatal health

• In Event: Uneven Impacts of Universal Policies related to Health and Economic Equity

Abstract

Introduction/Background: Poverty alleviation policies play an important role in mitigating socioeconomic and racial/ethnic disparities in maternal and infant health outcomes. The 2021 temporary expansion of the Child Tax Credit (CTC) provided monthly payments of up to $300 per child during July-December 2021 and allowed the most economically disadvantaged families to qualify. It has been linked to decreased child poverty, material hardship and food insecurity, but few studies have examined effects on perinatal health.

 

Purpose: This study investigated how the CTC expansion affected perinatal health, building on prior work by examining additional outcomes, longer follow-up, and subgroup effects. Using a quasi-experimental design in two large national datasets, we compared changes in perinatal outcomes before versus after CTC expansion among eligible versus ineligible pregnant people. Such evidence is needed to inform ongoing federal and state policymaking to promote health equity during a critical period of the lifespan.

 

Methods: Data were drawn from national birth certificate files (January 2021-February 2022; N=3,487,943) and the Pregnancy Risk Assessment Monitoring System (PRAMS; January-December 2021; N=28,874). Using quasi-experimental difference-in-differences and event-study analyses in each data set, we compared changes in perinatal outcomes before versus after the 2021 CTC expansion for CTC-eligible versus ineligible individuals. Outcomes included gestational hypertension, gestational diabetes, birthweight, preterm birth (<37 weeks’ gestation), low birthweight (<2,500 grams), small-for-gestational-age (SGA), and large-for-gestational-age (LGA).

 

Results: In birth certificates, the CTC expansion was associated with reduced birthweight (-5.54 grams, 95%CI: -7.83, -3.25) and reduced LGA births (-0.26 percentage points, 95%CI: -0.38, -0.14). In PRAMS, the CTC expansion was associated with reduced SGA (-2.77 percentage points, 95%CI: -4.99, -0.55). There was no association for other outcomes. Among subgroups, individuals without Medicaid had decreased birthweight; individuals with lower education, Medicaid, and those who were unmarried had reduced SGA births.

 

Conclusions: The 2021 CTC expansion was associated with improvements in birthweight distribution, perhaps due to decreased financial insecurity, with more positive impacts on SGA among those of lower socioeconomic status. The CTC expansion expired in 2022, but it remains an actively discussed policy at the state and federal levels; this study informs these discussions.

Author

• Deborah Karasek, Oregon Health & Science University
  Presenting Author