Cash Transfers and Their Effect on Maternal and Young Children's Health: A Randomized Clinical Trial

Importance:Mothers and children in low-income households are more likely to experience worse mental and physical health than those from higher-income households. Objective:To determine the effect of 4 years of monthly unconditional cash transfers on the mental health of mothers with low-income and the physical health of mothers and children. Design, Setting, and Participants:This was a parallel-group, randomized clinical trial conducted from May 2018 to July 2023. Mother-infant dyads were recruited (May 2018-June 2019) from postpartum wards in 12 hospitals in 4 cities: Omaha, Nebraska; Minneapolis/St Paul, Minnesota; New Orleans, Louisiana; and New York, New York. Data were analyzed from September 2023 to February 2025. Interventions:Mothers were randomly assigned to receive either a high-cash gift ($333 per month) or a low-cash gift ($20 per month) on debit cards. The cash gifts continued for the first 6 years of their children's lives. Data analyzed here were collected after 4 years of monthly transfers. Main Outcomes and Measures:Outcomes were preregistered and measured around the child's fourth birthday. Maternal outcomes included depression, anxiety, and body mass index (BMI). Child outcomes included age- and sex-adjusted BMI percentile and maternal report of child health (overall health, times sick in the past year, and presence of chronic health conditions). Results:A total of 1000 mother-infant dyads (mean [SD] maternal age, 27.0 [5.8] years) were included in this study. Among those mothers, 400 were randomly assigned to receive the $333 high-cash gift and 600 received the $20 low-cash gift on debit cards. Data were available from 891 mother-child dyads. No statistically detectable group differences were found in maternal depressive symptoms (effect size [ES], 0.04; 95% CI, -0.08 to 0.17; P = .51), anxiety (ES, 0.12; 95% CI, -0.02 to 0.25; P = .09), or BMI (ES, -0.06; 95% CI, -0.21 to 0.09; P = .42). In addition, there were no statistically detectable group differences in child BMI percentile (ES, -0.03; 95% CI, -0.17 to 0.12; P = .73) or overall child health (ES, 0.08; 95% CI, -0.07 to 0.22; P = .30). Conclusions and Relevance:Monthly unconditional cash transfers totaling approximately $15 000 over 4 years to mothers with low incomes did not improve maternal mental health, maternal or child BMI, or maternal report of children's health. These results could reflect the absence of causal connections between cash transfers and health, the possibility that impacts of early childhood income may not appear until later in life, or that an 18% increase in income is insufficient to overcome the structural vulnerabilities associated with poverty that contribute to health. Trial Registration:ClinicalTrials.gov Identifier: NCT03593356.