Abstract
BackgroundIn Manitoba, Canada, low-income pregnant women are eligible for the Healthy Baby Prenatal Benefit, an unconditional income supplement of up to CAD $81/month, during their latter two trimesters. Our objective was to determine the impact of the Healthy Baby Prenatal Benefit on birth and early childhood outcomes among Manitoba First Nations women and their children.MethodsWe used administrative data to identify low-income First Nations women who gave birth 2003–2011 (n = 8209), adjusting for differences between women who received (n = 6103) and did not receive the Healthy Baby Prenatal Benefit (n = 2106) with using propensity score weighting. Using multi-variable regressions, we compared rates of low birth weight, preterm, and small- and large-for-gestational-age births, 5-min Apgar scores, breastfeeding initiation, birth hospitalization length of stay, hospital readmissions, complete vaccination at age one and two, and developmental vulnerability in Kindergarten.ResultsWomen who received the benefit had lower risk of low birth weight (adjusted relative risk [aRR] 0.74; 95% CI 0.62–0.88) and preterm (aRR 0.77; 0.68–0.88) births, and were more likely to initiate breastfeeding (aRR 1.05; 1.01–1.09). Receipt of the Healthy Baby Prenatal Benefit was also associated with higher rates of child vaccination at age one (aRR 1.10; 1.06–1.14) and two (aRR 1.19; 1.13–1.25), and a lower risk that children would be vulnerable in the developmental domains of language and cognitive development (aRR 0.88; 0.79–0.98) and general knowledge/communication skills (aRR 0.87; 0.77–0.98) in Kindergarten.ConclusionsA modest unconditional income supplement of CAD $81/month during pregnancy was associated with improved birth outcomes, increased vaccination rates, and better developmental health outcomes for First Nations children from low-income families.
Highlights
In Manitoba, Canada, low-income pregnant women are eligible for the Healthy Baby Prenatal Benefit, an unconditional income supplement of up to CAD $81/month, during their latter two trimesters
A modest unconditional income supplement of CAD $81/month during pregnancy was associated with improved birth outcomes, increased vaccination rates, and better developmental health outcomes for First Nations children from low-income families
Women living in poverty during the prenatal period are more likely to experience adverse birth outcomes [5, 6], which contribute to many subsequent health, developmental and cognitive challenges as their children grow [7,8,9,10]
Summary
In Manitoba, Canada, low-income pregnant women are eligible for the Healthy Baby Prenatal Benefit, an unconditional income supplement of up to CAD $81/month, during their latter two trimesters. Women living in poverty during the prenatal period are more likely to experience adverse birth outcomes (including low birth weight and preterm birth) [5, 6], which contribute to many subsequent health, developmental and cognitive challenges as their children grow [7,8,9,10]. Programs providing income supplements (i.e., cash benefits or cash transfers) to low-income pregnant women are an increasingly common initiative, especially in lowand middle-income countries (LMICs) [11] Eligibility for these income supplements is often conditional upon the expectant mother complying with pre-determined requirements, such as regular visits to a health facility for prenatal care. Income supplement programs for low-income pregnant women living in high-income countries are relatively rare, despite widening health inequities in birth outcomes in many of these places [18]
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