Impacts of the 2021 child tax credit advance monthly payments on birth outcomes in the United States: a natural experiment

We estimated impacts of monthly cash transfers during pregnancy on birth outcomes in the United States through the natural experiment of the 2021 expanded Child Tax Credit. We used US vital statistics birth certificate data 2016 to 2023. We estimated the association between total amount of CTC a pregnant person was eligible to receive during pregnancy (based on number of previous live births, time since last previous live birth, and timing of pregnancy relative to CTC payments) and small for gestational age (SGA, <10th percentile weight for gestational age) and low birth weight (LBW, < 2500 grams). We controlled for time-dependent autocorrelation, individual-level characteristics, COVID-19 hospitalizations, and presence of other pandemic-era safety net programs. We found that a $1000 increase in total pregnancy CTC was associated with an 0.72 percentage point decrease in SGA (95% CI, -0.74 to -0.70) and an 0.49 percentage point decrease in LBW (95% CI, -0.50 to -0.47), correlating to 6.7% and 8.2% decreases in SGA and LBW, respectively. The association between the CTC and birth outcomes was largest among non-Hispanic White and smallest among foreign-born Hispanic people. Our results align with prior studies' findings that cash transfers during pregnancy are associated with moderate declines in adverse birth outcomes.