The Association between Pregnancy-Specific TANF Policies and Perinatal Health

• In Event: State Policy Contexts and Inequality in Family Well-Being

Abstract

Introduction: The Temporary Assistance for Needy Families (TANF) program has the potential to disrupt the well documented link between poverty and health by providing material resources for low-income families. However, TANF eligibility criteria, cash benefit levels, and program requirements vary substantially by state, which ultimately impacts access to the program and likely plays a role in health differences across states. However, few studies have examined the health effects of TANF policies that are specific to the pregnancy period. For example, only some states allow pregnant individuals to receive TANF benefits when they have no other child. Variation in these rules create differential access to TANF during pregnancy, an important consideration when studying the health effects of TANF on birth outcomes.  

Research Question: This paper examines how state-level TANF policies specific to pregnancy are associated with perinatal health. 

Methods: We analyzed perinatal health data from the 2000-2022 Pregnancy Risk Assessment Monitoring System (PRAMS), including dichotomous measures of preterm birth, low birthweight, small-for gestational age, and continuous measures of gestational age and birthweight (N=229,846). To create the policy exposure, we combined policies relevant to pregnant individuals into an index of policy generosity that included: 1) the month of pregnancy when pregnant individuals without other children become eligible, 2) the number of individuals eligible for benefits within the family, 3) if time limits are extended or paused during pregnancy, 4) the month of pregnancy if individuals are exempt from work requirements,  and 5) the amount of benefits for a 3-person family divided by the state’s median income (to adjust for cost of living). We scaled each indicator to be between 0-1, summed the indicators to create the index, and standardized the index across the study period. Higher values indicated greater generosity. We then estimated linear regression models for each birth outcome that included an interaction between the policy generosity index and an indicator of TANF eligibility based on maternal education and marital status, as well as controls for individual and state characteristics, state and year fixed effects, and errors clustered by state. 

Results: The mean value of the policy indicator was 1.46, with a standard deviation of 0.66. In states with more generous TANF policies, individuals more likely to be eligible for TANF reported better health outcomes. For example, a one standard deviation increase in the policy generosity index was associated with a 0.40 percentage point (pp; 95%CI -0.74, -0.05) decrease in preterm birth, 0.96 pp (-1.33, -0.60) decrease in low birthweight, 0.99 pp (95%CI -1.34, -0.64) decrease in small-for-gestational age, and an increase in birthweight by 14.75 grams (95%CI 8.20, 21.30). 

Conclusion: Our results show that state policies that provide greater access to TANF during pregnancy were associated with better birth outcomes for a population more likely to participate in TANF. These findings have important policy implications given the strong association between poverty and poor perinatal health. Although only 33 states allow pregnant individuals without other children to participate in TANF, this study suggests that all states should consider expanding access.

Author

• Emily Dore, Tufts University
  Presenting Author