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A monthly benefit provided to women with low income during the second and third trimesters of pregnancy was associated with improved newborn and early childhood health outcomes, according to a retrospective cohort study from Manitoba, Canada. But as the amount of the stipend remained the same, the positive association decreased over time.

“Manitoba really has a one-of-a-kind program in the Healthy Baby program. It’s now been in place for more than 20 years, and we have great longitudinal data on parents and infants who received the benefit,” study author Jennifer Enns, PhD, lead research associate at the University of Manitoba’s Manitoba Centre for Health Policy in Winnipeg, told Medscape Medical News. “This study was an opportunity to produce key evidence on a program that my colleagues and I have shown can really make a difference for Manitoba families.”

The article was published on August 14 in JAMA Network Open.

Earlier Findings Confirmed

Overall, 9.1% of women in Manitoba live in poverty, according to a 2024 paper. Single-parent families headed by women are at higher risk for poverty (23.9%).

In 2001, Manitoba’s government instituted the Healthy Baby Prenatal Benefit, which distributed $81.41 per month for 6 months to pregnant women with low income. The program also provided referrals to Public Health Services and resources, a Healthy Baby Community Support program, and a connection to early prenatal care.

The researchers obtained data from the Manitoba Population Research Data Repository at the Manitoba Centre for Health Policy, focusing on singleton pregnancies for which newborn risk data were available. They also obtained administrative data from the Healthy Baby Program.

The study population was divided between 17,970 women who received income assistance and 8301 women who did not. The birth outcomes analyzed included low birth weight, preterm birth, small- and large-for-gestational-age births, and breastfeeding initiation. The researchers also looked at the following childhood development outcomes at kindergarten, as measured by the Early Development Instrument (EDI): physical health and well-being, social competence, emotional maturity, language and cognitive development, and communication skills and general knowledge.

The initial results of this study confirmed those of earlier investigations, showing substantial benefits for birth and development outcomes among the offspring of women who received the benefit. At the start of the study period in 2003, receiving the benefit was associated with increased likelihood of breastfeeding initiation (relative risk [RR], 1.06) and large-for-gestational-age births (RR, 1.13) and a lower likelihood of preterm birth (RR, 0.72), low birth weight (RR, 0.68), and small-for-gestational-age births (RR, 0.83). The benefit also was associated with decreased vulnerability among children at kindergarten age in the domains of language and cognitive development (RR, 0.77) and communication skills and general knowledge (RR, 0.83).

As the program continued, the benefit remained the same; no adjustments for inflation were made. Follow-up data for children born in 2013 found that the association between the benefit and positive outcomes was no longer significant. The RR for developmental vulnerability in language and cognitive development was 1.07, and the RR for developmental vulnerability in communication and general knowledge was 0.93. There were also no further significant differences between groups for any of the other three EDI domains by the end of the study period. 

“Inflation and the declining buying power of $81.41 per month since 2001 are the major drivers of the way that we saw the benefits’ effectiveness drop over time,” Enns said. “Some of the ways the benefit likely works are by reducing stress, helping parents eat better, and giving them an opportunity to prepare for the birth of their child, which is what recipients of the benefit told us in this study.”

Inflation calculators estimate that the original benefit from 2001 would need to be around $135 in 2025 to have the same buying power. The province increased the benefit in 2024, based on a sliding scale, with a maximum benefit of $162.82 monthly for women with a net income of $21,744 or less.

Among the study’s limitations was its reliance on administrative data. Certain populations, such as First Nations and Métis mothers, may not be reliably represented. “Where administrative data fall short is that they usually depend on people making contact with a system or service for them to appear in our databases,” Enns said. “Sometimes we have to get creative in thinking about who isn’t accessing certain health or social services and why. For this study, we had data on everyone who received the Healthy Baby Prenatal Benefit, and then we also used income and doctor’s visit data to identify people who would have been eligible (that is, they were pregnant and had low income) but did not apply.”

Financial Stability Crucial

Commenting on the study for Medscape Medical News, Jessica Madden, MD, board-certified neonatologist, lactation consultant, and medical director at Aeroflow Breastpumps, said, “This is a well-executed population-level analysis using administrative data and appropriate statistical methods to compare families who did and did not receive the benefit. The design is not randomized, so unmeasured confounding cannot be ruled out, but the authors’ use of propensity scoring and inverse probability weighting makes the findings credible. The long time frame adds value because it shows how the effect of the program shifted over nearly two decades.”

The results were not surprising, but they were important, Madden continued. “We know that financial stability during pregnancy supports healthier birth outcomes, including lower rates of preterm birth and low birth weight. What stood out here was that the benefit’s positive impact faded over time as the monthly amount stayed flat. That [finding] reinforces a practical point: Programs need to keep pace with inflation to remain effective.”

The Canadian Institutes for Health Research supported this study. Enns and Madden reported having no relevant financial relationships.

Marijke Vroomen Durning, RN, is a freelance health and medical journalist based in Montreal. Her work has appeared in professional and consumer outlets, including The Physiologist, Weill Cornell University, CURE Magazine, WebMD, HealthyWomen.org, and many more.