A decade ago, a water lead crisis launched Flint, Michigan, into national headlines. But for years, the city of roughly 80,000 has also quietly carried the weight of a tragically high newborn mortality rate.
In 2024, there were 9.4 infant deaths for every 1,000 births in Flint — nearly twice the mortality rate of 5.54 in the US, which itself outpaces all other high-income nations.
But a new study shows that there might be a way to reverse that grim trend — a method that seems to have already made an enormous difference in Flint.
Over the last two years, Flint has been testing a no-strings-attached cash transfer program, Rx Kids, administered through nonprofit GiveDirectly. Pregnant women in the city were given a lump sum of $1,500 at the start of their enrollment, typically in the first 16 weeks of pregnancy, followed by $500 every month until one year after childbirth.
New findings released this week from an Rx Kids study tracking the program showed that neonatal mortality — which refers to the period up to a month after birth — dropped by nearly half in Flint, from 9.4 to 5.1 deaths per 1,000 live births, after mothers received cash assistance.
It’s important to note that Rx Kids has only collected data up to the neonatal period — it’s still unclear what the outcomes might look like for the first year of infancy.
Nevertheless, Mona Hanna, associate dean for public health at Michigan State University and co-director of Rx Kids, who is also the lead author on the study, stressed the importance of intervening specifically during pregnancy and the year after birth. That stretch of time, which is known as the perinatal period, is when low-income families often take on significant financial burden as their expenses rise and incomes remain low.
According to Hanna, Flint mothers spent the money largely as child allowance: baby supplies were the top expense, followed by rent and food. Some of the benefits of direct cash transfer may also have been behavioral. A previous study on the same Rx Kids Flint cohort found that expectant mothers were less likely to engage in high-risk behaviors, such as smoking, during pregnancy. That, in turn, may have led to lower NICU admissions and healthier birth outcomes.
Hanna suggests that one of the most important effects of direct cash transfers could have been increased access to prenatal care.
“For a baby to not be born [prematurely], they have to have good prenatal care, and we saw that,” Hanna said. As she explains it, mothers who enrolled in the program were able to get “the screening and the treatment and all these other resources they need. We’re seeing better nutrition security and satisfaction. That’s important for healthier births.”
Flint may have been particularly well positioned to benefit from the Rx Kids cash transfers, especially because of the relative simplicity of the program’s setup. It’s a city with a relatively small population, and more than 90% of pregnant mothers in the entire geographic region enrolled in the program. That high uptake rate can be partly explained by the program’s low barrier to entry. As long as you live in a Flint zip code, you can receive money.
Unconditional cash transfers have had promising results in other contexts, too. A study first published last summer found that after unconditional cash transfers to households in Kenya, infant deaths dropped by 48 percent. Hospital deliveries increased, and recipients had better access to maternal healthcare and nutrition services.
In the US, other findings on the benefits of direct cash transfers have been a little more complicated. One of the biggest challenges came from the Baby’s First Years Study, which ran for four years between 2018 and 2022 and gave $4,000 a year to low-income families with young children in a large randomized controlled trial. The trial found no significant effects on child development.
Nigel Paneth, an emeritus professor of epidemiology at Michigan State University, has studied preterm births for decades. He described the Rx Kids study findings as promising, but notes there are limitations built into the design of the study, which, like many other community-level population studies, did not have a randomized control group for the sake of comparison. He said that if the program was to ever expand, “you would have to see if this effect is generalizable and not just” the product of some other factor.
“I also think we’re really obligated to begin to try to see if we can figure out the mechanism,” Paneth said. “What is going on? What might happen in pregnancy that a cash transfer would change? It’s not intuitively obvious what that might be.”
The question of scale also remains notable. Providing a total of $7,500 per family in a relatively small urban area is one thing, but spreading the same amount of cash to families around the country could easily become prohibitively expensive. That said, Rx Kids is expanding its testing ground, building out similar programs in over 60 locations across Michigan, with financial support from the state itself.
“Poverty is a pathogen. It makes kids sick and communities sick,” Hanna said. “With more funding, we could go anywhere.”