Additional data is needed to assess the impact of the 1996 welfare reform law in the United StatesAssessing the effects of welfare reform policies on reproductive and infant health. Am J Public Health.
- Birn, Anne-Emanuelle ScD
- Hanson, Karla L. PhD
- Wise, P
- Chavkin, W
- Romero, D
BACKGROUND
Aid to Families with Dependent Children (AFDC) was the federal cash assistance program formerly linked with Medicaid. When AFDC was replaced in 1996 with the new block program, Temporary Assistance to Needy Families (TANF), the link between welfare and health insurance was broken. Medicaid enrolment has subsequently fallen. TANF encourages return to employment and reduced childbearing for recipients, most of whom are women (and children).
OBJECTIVE
To identify the obstacles in calculating the effects of welfare reform on maternal and infant health.
METHOD
Overview of methodological issues.
LITERATURE REVIEW
None stated. 79 references.
MAIN OUTCOMES
Childbearing (sexual activity; contraceptive use; abortion rates; fetal loss) and pregnancy-related outcomes (prenatal care; late miscarriage; low birthweight; infant mortality; preterm delivery; maternal mortality).
MAIN RESULTS
There is very limited evidence suggesting any link between AFDC and childbearing decisions, although there are known links between socio-economic status and pregnancy outcomes. Estimating the impact of TANF on pregnancy outcomes is difficult, however. It requires identifying the correct methodological approach; accounting for the time lag between policy changes and when they can plausibly affect outcomes; identifying families affected by the change from AFDC to TANF; overcoming low statistical power due to rare events (such as neonatal or maternal mortality); performing subgroup analysis (of women with chronic illnesses, low education, mental health problems, sick children, or immigrants). While there are several national, state-level and special data sets that may be used to study this issue, there is no straightforward solution.
AUTHORS' CONCLUSIONS
Welfare reform could have serious implications for the health and well being of millions of Americans, particularly women and children. It is essential that the health consequences of the reforms be studied and methodological issues addressed.