Welfare reform and infant health: the impact of mandatory maternal employment

Abstract

On August 22, 1996, Congress passed the Personal Responsibility and Work Opportunity Reconciliation Act of 1996 (PRWORA), fundamentally changing the U.S. welfare program. The hallmark of this “Welfare Reform” was the requirement that adult recipients, predominantly single mothers, work to receive benefits. Within 10 years, employment among female welfare recipients increased 135%. Previous research evaluating the impact of this rise in maternal employment on child well-being found positive effects on younger children when both employment and income increased, but adverse effects on adolescents. Welfare Reform’s impact on infants (< 1 year) has not been well-studied.

To assess the relationship between PRWORA’s work provisions and infant health, crosssectional regression analyses were performed for 1998-2002, using the state as the unit of analysis. Independent variables included three work provisions, as applied to mothers of infants: (a) Exemption (months exempted from work after infant’s birth), (b) Hours (work hours required per week), and (c) Sanctions (penalties for work noncompliance). Earnings disregards (income supplement policies) were also considered. Measures of infant mortality were chosen as dependent variables, and controls were introduced for macroeconomic conditions, race, baseline mortality, and teen births. With no infant mortality dataset identifying welfare status, the population was approximated using unmarried women with less than a high school education.

States with more stringent sanctions policies had statistically significant higher postneonatal mortality (PMR, days 28-364) in the study population in 1999. When earnings disregards were added, the stringency of sanction policy increased in significance with 1999 PMR and was significant for higher overall infant mortality (IMR, days 1-364). States with more stringent earnings disregards had significantly higher IMR in the study population in 1998, 1999, and 2001--during the neonatal period (NMR, days 1-27) in 1999 and 2001--and states with more stringent exemption policies had significantly higher neonatal mortality (NMR) in the study population in 2001. The analysis confirms a role of Black race in the regression model, but does not verify whether the relationships between PRWORA’s work policies and infant mortality are independent or mediated through other variables.