How Does SNAP Access Prior to Pregnancy Affect Maternal and Infant Health Outcomes?

Policy Points Reimposing work requirements for the Supplemental Nutrition Assistance Program-by removing temporary, location-based waivers-causes a decline in food assistance participation among childless women. This loss of nutritional support prior to pregnancy is linked to tangible, negative health outcomes for their infants. Analyses show that, when work requirements are reimposed, there are statistically significant increases in very low birth weight and very preterm births. These adverse effects are found among first-time mothers, the group most likely to have been subject to these work requirements as "able-bodied adults without dependents" just prior to their pregnancy. CONTEXT: Able-bodied adults without dependents (ABAWDs) are eligible for Supplemental Nutrition Assistance Program benefits for only 3 months in any 36-month period, after which they are subject to a work requirement to continue receiving benefits. Because ABAWDs may later have children, this work requirement for childless adults may affect the health of pregnant women and their infants through the mother's nutritional well-being prior to pregnancy. The objective of this study was to examine whether temporary county-level waivers of these work requirements improved health outcomes for mothers and their infants. METHODS: This study used restricted National Vital Statistics System natality data from 2004 to 2018, with virtually every birth in the United States in that period, linked at the county-month level to a dataset of ABAWD work-requirement waivers in the year prior to pregnancy. Several binary maternal and infant health outcomes were examined in intent-to-treat analyses using two-way fixed-effects regressions and event studies with application of an estimator robust to heterogeneous treatment effects. The analysis also controlled for economic conditions upon which waiver eligibility is determined. FINDINGS: Statistically significant increases in adverse birth outcomes were found for first-time mothers exposed to (re-introduced) work requirements just before pregnancy, including a 14% increase in very low birth weight infants and a 10% increase in very preterm births relative to baseline rates. In contrast, the introduction of a waiver was associated with little change in birth outcomes. For maternal outcomes, the removal of a waiver was unexpectedly associated with a significant reduction in eclampsia and a decline in labor inductions. The study found little to no effect of waiver status on other maternal outcomes, such as diabetes or cesarean section rates. CONCLUSIONS: This study found evidence that work requirements for food benefits may harm infant health, particularly when waivers are terminated. These results provide evidence that may inform policymakers weighing the costs and benefits of modifications to ABAWD work requirements.