Flint, Mich., has one of the country's highest rates of child poverty — something that got a lot of attention during the city's lead water crisis a decade ago. And a pediatrician who helped expose that lead problem has now launched a first-of-its-kind move to tackle poverty: giving every new mother $7,500 in cash aid over a year.
On a recent day at her clinic, pediatrician Mona Hanna-Attisha is helping get out the word about the new program, which started in January.
"Oh, hi baby!" she coos, as she pops into a checkup for 2-day-old Rowan. His mother, Hailey Toporek, is 19 and realized she was pregnant only 10 days before delivery. "I'm very nervous," she tells Hanna-Attisha.
Toporek is still living at home and is here with her mom. They're both amazed to learn Toporek will get $500 a month for the next year. She knows right where it will go first.
"Diapers. Formula. Just to take care of him, honestly," Toporek says. "It's been difficult for me, but I got my mom here to help."
Her mom, Heather Toporek, works at an assisted living facility for disabled adults and had to take off work because her daughter doesn't have a driver's license. She says the extra cash will make it easier to do that for the many doctor's appointments to come.
"Somebody's got to be there, and if that means it's me then, you know, that's a whole day's pay that I'm going without," Heather Toporek says.
Beyond helping with costs, she says this unexpected money will be life-changing. While it may not seem like much to some, Heather Toporek says, it could allow her daughter to finish high school and pursue her dream of studying forensics.
A baby's first year is crucial for development. It's also a time of peak poverty
Flint's new cash transfer program, Rx Kids, starts during pregnancy. The first payment is $1,500 to encourage prenatal care. After delivery, mothers will get $500 a month over the baby's first year.
"What happens in that first year of life can really portend your entire life course trajectory. Your brain literally doubles in size in the first 12 months," says Hanna-Attisha, who's also a public health professor at Michigan State University.
A baby's birth is also a peak time for poverty. Being pregnant can force women to cut back hours or even lose a job. Then comes the double whammy cost of child care.
Research has found that stress from childhood poverty can harm a person's physical and mental health, brain development and performance in school. Infants and toddlers are more likely than older children to be put into foster care, for reasons that advocates say conflate neglect with poverty.
In Flint, where the child poverty rate is more than 50%, Hanna-Attisha says new moms are in a bind. "We just had a baby miss their 4-day-old appointment because mom had to go back to work at four days," she says.
When her first child was born two years ago, a different mom, Tateyanna Taylor, didn't miss a single day working third shift at a Taco Bell. She's now 24 and had a second child in January, during an especially rough time financially.
Taylor says one day last fall while she was pregnant, she was at her factory job steaming seat covers for cars to get the wrinkles out. The room was hot. "I was going a little faster than I should have been going and I was basically working myself up sweating," she says. "Next thing I know, I was getting myself up off the floor."
She says she wasn't exactly fired, but it was made clear she could no longer do that specific job.
In January, a few weeks after her son was born, Taylor started working at a different plant for $16 an hour. She catches a 5 a.m. bus downtown for the commute to her 7 a.m. shift. She lives with her mother, who watches both children.
When Taylor found out she'd be getting extra monthly payments for a year, she and her mother were $300 behind on rent. She says the money is a "blessing," though not exactly transformative. "I mean, $500 only goes so many ways," she says. "So it's really just only the bills."
The pandemic added to evidence about the benefits of child cash transfers
Among richer nations, the U.S. is an outlier in not offering more generous child cash benefits.
"This is something that has been tried over and over and over again, in country after country," says Luke Shaefer, a poverty expert at the University of Michigan and co-director of Flint's cash aid program. In fact, Hanna-Attisha was delighted to learn recently that when she was born in the U.K., her mother got cash payments. "And my mom just shrugged her shoulders and said, 'Of course we did.' Everybody got money. That was normal."
Studies have found such payments reduce financial hardship and food insecurity and improve mental and physical health for both mothers and children.
The U.S. got a short-lived taste of that in 2021. Congress temporarily expanded the child tax credit, boosting payments and also sending them to the poorest families who had been excluded because they didn't make enough to qualify for the credit. Research found that families mostly spent the money on basic needs. The bigger tax credit improved families' finances and briefly cut the country's child poverty rate nearly in half.
"We saw food hardship dropped to the lowest level ever," Shaefer says. "And we saw credit scores actually go to the highest that they'd ever been in at the end of 2021."
Critics worried that the expanded credit would lead people to work less, but there was little evidence of that. Some said they used the extra money for child care so they could go to work.
As cash assistance in Flint ramps up, Shaefer will be tracking not just its impact on financial well-being, but how it affects the roughly 1,200 babies born in the city each year.
"We're going to see if expectant moms route into prenatal care earlier," he says. "Are they able to go more? And then we'll be able to look at birth outcomes," including birth weight and neonatal intensive care unit (NICU) admissions.
Since the pandemic, dozens of cash aid pilots have popped up across the nation. But unlike them, Rx Kids is not limited to lower-income households. It's universal, which means every new mom will get the same amount of money. "You pit people against each other when you draw that line in the sand and say, 'You don't need this, and you do,' " Shaefer says. It can also stigmatize families who get the aid, he says, as happened with traditional welfare.
Shaefer and Hanna-Attisha hope that including everyone will create a broader sense of community and civic engagement, and they plan to measure that, too. Their research will track birth rates, whether fewer people move out of Flint, gun violence, voter participation, and faith in government — which took a major hit during the lead water crisis.
So far, there's more than $43 million to keep the program going for three years. Funders include foundations, health insurance companies and the state of Michigan, which allocated a small part of its federal cash aid, known as Temporary Assistance for Needy Families.
TANF, as it's called, is intended for the poorest Americans, but it's been dramatically cut back and diverted to other uses over the years. Hanna-Attisha says using TANF for new moms is something other states could copy. And she's heard from several places around the country interested in creating their own programs. Michigan Gov. Gretchen Whitmer's budget proposal also included money to expand the model in Flint to several other cities.
Money can buy more time for bonding with a baby
Alana Turner can't believe her luck with Flint's new cash benefits. "I was just shocked because of the timing of it all," she says.
Turner is due soon with her second child, a girl. She lives with her aunt and her 4-year-old son, Ace. After he was born, her car broke down and she was seriously cash-strapped, negotiating over bill payments. This time, she hopes she won't have to choose between basic needs.
"Like, I shouldn't have to think about choosing between are the lights going to be on or am I going to make sure the car brakes are good," she says.
Turner's boyfriend is a truck driver and lives in his own place. She works full time in property management, plus 10 to 12 hours a week for a call center. Her aunt's house is paid off, so they share only the cost of utilities and food. Her son also gets about $80 a month in food assistance. And yet, by mid-month, she's often at the local food pantry, where the line can stretch five blocks.
"My goal that I have in my head, to set aside money every week for the baby, I definitely haven't met that goal," she says.
But since she'll be getting an unexpected $7,500 over the next year, Turner has a new goal. With her first child, she was back on the job in less than six weeks. Now, she hopes she'll be able to slow down and spend more time with her daughter.
"I don't want to sacrifice the time with my newborn like I had to for my son, if I don't have to," she says.
