Changes in Neonatal Mortality After Prenatal and Infant Cash Transfers

Neonatal mortality (death before 28 days of life) contributes to the United States's persistently poor infant mortality ranking among high-income countries. In January 2024, Rx Kids, a community-wide maternal and infant health program that provides unconditional cash support during pregnancy (US$1500) and infancy (US$500/month through age 1 year) launched in Flint, Michigan, to improve health and reduce disparities. Using statewide vital records data from 2021-2025 for all Michigan infants, we evaluated whether there were changes in neonatal mortality in Flint relative to the rest of Michigan following Rx Kids implementation. From 2021-2024, the neonatal mortality rate in Flint was significantly higher than the average for the rest of the state (10.2 vs. 4.0 deaths per 1,000 live births; p<0.001). In 2025, Flint's neonatal mortality rate declined to 5.1 deaths per 1,000 live births, a 50% reduction from the preceding 4 years. The disparity between Flint and the rest of the state was eliminated (5.1 vs. 3.9 deaths per 1,000 births; p=0.567). This preliminary population-level analysis suggests direct support during pregnancy and infancy may be a promising strategy for improving neonatal survival and reducing intractable population-level disparities.