Expiration of pandemic-era nutrition benefits and perinatal health among low-income families in the US

• In Event: Nutrition Assistance Policies: Changes, Participation, and Health Outcomes

Abstract

Background:Beginning in March 2020, the United States Congress issued emergency allotments that increased monthly benefits of the Supplemental Nutrition Assistance Program (SNAP)—a nutrition program for low-income Americans—to mitigate economic hardship during the COVID-19 pandemic. These temporary increases substantially expanded the resources available to participating households and were intended to address heightened food insecurity during the public health crisis. US states began to terminate emergency allotments in a staggered fashion starting in 2021, and all states terminated them by March 2023 at the end of the federal public health emergency. This staggered policy rollback created variation across states and over time in benefit levels. Leveraging this variation provides an opportunity to examine the effects of SNAP benefit reductions on perinatal health outcomes, a critical period with long-term implications for both maternal and child health.

Methods:We used national serial cross-sectional data from the 2020–2022 US Pregnancy Risk Assessment Monitoring System (N=20,054). We implemented a quasi-experimental difference-in-difference-in-differences study design, comparing SNAP-eligible and near-eligible individuals in states that terminated emergency allotments and those that did not, before and after expiration. Models were adjusted for individual and state-level covariates to account for potential confounding factors. We considered individuals to be exposed to the expiration of SNAP emergency allotments if they gave birth three months after emergency allotments expired in each state, allowing time for policy changes to affect pregnancy conditions. Parent outcomes included gestational weight gain, gestational hypertension, gestational diabetes, depression during pregnancy, and prenatal care utilization. Infant outcomes included birthweight, gestational age, and whether birthweight was appropriate-, small-, or large-for-gestational-age.

Results:SNAP emergency allotment expiration was associated with lower birthweight (-72.00 grams; 95% CI: -127.89, -16.10), lower likelihood of birthweight being large-for-gestational-age (-3.29; 95% CI: -6.43, -0.15), and higher likelihood of birthweight being small-for-gestational-age (4.81; 95% CI: 1.82, 7.80). Some but not all findings were robust to alternative specifications, and results for maternal outcomes were less consistent.

Implications:Observed reductions in birthweight distribution were perhaps due to financial strain and food insecurity brought on by reduced SNAP benefits. These findings highlight the potential consequences of reductions in nutrition assistance for perinatal health, particularly among economically vulnerable populations. Future work should examine longer-term outcomes for parents and children, as well as impacts of more recent reductions in SNAP benefits.

Author

• Daniel Francisco Collin, Harvard University
  Presenting Author