Early and overall neonatal mortality may have declined in Flint, Michigan, following the introduction of an unconditional prenatal and infant cash transfer program.
In the historical cohort study, investigators analyzed statewide birth and death certificate data from 2021 through 2025. They examined changes following the January 2024 launch of Rx Kids, a community-wide program providing a 1-time prenatal payment of $1,500 followed by monthly payments of $500 throughout an infant's first year. The program had a 98% participation rate.
The investigators evaluated early neonatal mortality and overall neonatal mortality, defined as mortality before 7 and 28 days of life, respectively. Mortality rates were calculated per 1,000 live births and compared geographically across the study period. The analysis used descriptive comparisons and statistical tests to assess differences between Flint and the rest of Michigan.
From 2021 through 2024, Flint recorded 32 early neonatal mortalities and 41 total neonatal mortalities among 4,036 live births. Early neonatal mortality was 7.9 deaths per 1,000 live births vs. 3.3 per 1,000 live births in the rest of Michigan. Overall neonatal mortality was 10.2 per 1,000 live births in Flint vs. 4.0 per 1,000 live births elsewhere in the state. Both geographic differences were statistically significant.
In 2025, early neonatal mortality in Flint declined to 2.0 mortalities per 1,000 live births, representing a 74% reduction from the 2021 to 2024 rate. The corresponding rate in the rest of Michigan was 3.3 per 1,000 live births.
Overall neonatal mortality in Flint declined to 5.1 per 1,000 live births in 2025, representing a 50% reduction from the preceding 4-year period. In comparison, the rate in the rest of Michigan remained relatively stable at 3.9 per 1,000 live births.
Although Flint's overall neonatal mortality rate remained numerically higher than that of the rest of Michigan, the differences in both early neonatal and overall neonatal mortality were no longer statistically significant in 2025.
Timing and magnitude of the declines were consistent with previously documented improvements in financial stability, housing security, and prenatal care utilization following Rx Kids implementation. Earlier research also associated the program with reductions in smoking during pregnancy, preterm birth, and low birth weight, with the largest estimated effects observed by the program's second year.
The investigators suggested that increased access to safe sleep education and infant supplies may have improved infant sleep environments. However, the current analysis did not directly assess these potential mechanisms.
The study had several limitations. Michigan's 2025 vital records remained provisional, and the relatively small number of neonatal mortalities meant that minor changes in event counts could affect mortality rates. The investigators were unable to link individual birth and mortality records, preventing an individual-level difference-in-differences analysis. Continued evaluation beyond 2025 and in additional communities is needed to determine whether the observed improvements persist.
"These preliminary findings suggest that direct perinatal economic support may represent a promising strategy for improving neonatal survival and reducing intractable population-level disparities," wrote lead study author Mona Hanna, MD, of Michigan State University–Hurley Children's Hospital Pediatric Public Health Initiative, and colleagues.
Full disclosures of the study authors can be found in the study.
Source: JAMA Pediatrics
