Unconditional cash transfers may increase breastfeeding but have little effect on postpartum mood

1. In this systematic review, strong evidence showed that unconditional cash transfers may increase breastfeeding in diverse populations.

2. There was no significant association between cash transfers and postpartum mood.

Evidence Rating Level: 1 (Excellent)

Study Rundown: Compared with other high-income countries, the United States suffers from significantly higher rates of maternal mortality. Studies have shown that unconditional cash transfers (UCTs) may improve pregnancy-related outcomes and key drivers of maternal mortality. This systematic review aimed to assess the literature regarding the impact of UCTs on postpartum outcomes in the United States. Strong evidence suggested that UCTs increased breastfeeding, including the number of days that breast milk was provided and the number of mothers who were able to breastfeed. High-quality evidence also suggested that UCTs increased parental engagement by self-report. Good-quality evidence did not show any association between UCTs and self-reported alcohol and tobacco use 1 year after delivery. High-quality evidence also showed that the amount of UCT had little or no effect on postpartum mood, while low-quality evidence showed that they led to little or no difference in psychological stress or adult relationship quality. A good-quality analysis showed that people receiving a larger UCT amount were more likely to change their behavior to prevent contracting COVID-19 but were equally likely to be diagnosed with the disease. The generalizability of this study was limited by possible reporting bias, possible residual confounding, and the heterogeneity of evidence which precluded a meta-analysis. Nevertheless, this study suggested that UCTs can encourage breastfeeding in various populations but may not influence postpartum mood.

Click to read the study in AIM

Relevant Reading: Conditional cash transfers, uptake of maternal and child health services, and health outcomes in western rural China

In-Depth [systematic review]: This study aimed to assess the evidence surrounding UCTs and postpartum health outcomes in the United States. The definition of UCTs was broad, encompassing tax credits and refunds, Supplemental Security Income (SSI) disability benefits, and direct cash transfers (DCTs). Postpartum health was defined as any health outcome or health-related behavior in someone who was postpartum between 1 day and 2 years post-delivery, and outcomes were divided into 5 categories: infant or child care (including breastfeeding), other reproductive health outcomes (e.g., fertility), substance use, other mental health outcomes (e.g., depression), and other health outcomes. A total of 11 reports from 6 different studies were selected; 4 studies were quasi-experimental analyses of American UCT social programs, while 2 studies were randomized controlled trials (RCTs) that examined DCT interventions. Strong evidence in 4 studies showed that UCTs increased breastfeeding, including the number of days when breast milk was provided, while analysis of one RCT showed that UCT amount did not affect whether breastfeeding was initiated or continued. A good-quality analysis of one RCT did not find any association between UCT amount and self-reported alcohol and tobacco use 1 year after delivery. Strong evidence in 3 studies showed that UCT led to little or no difference in postpartum mood, and a good-quality analysis of one RCT did not find links between UCT amount and the number or severity of depressive symptoms. Weak evidence was provided in 1 study that UCTs may lead to little or no difference in psychological stress, while another study also showed weak evidence that UCTs did not affect relationship quality. Overall, this study suggested that UCTs may be associated with increased breastfeeding but little or no change in postpartum mood.

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