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Opinion | Treating poverty to prevent preterm births and newborn deaths
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In 1985, I attended one of the first international conferences on the prevention of preterm birth. Held in Evian, France, the meeting brought together researchers from around the world to tackle one of the most persistent challenges in maternal and child health.
At the time, the concept of prematurity prevention was new, and experts proposed a wide range of solutions: monitoring painless contractions, prescribing medications to stop labor, recommending strict bed rest, placing stitches in the cervix, expanding prenatal care and increasing home visiting programs. Alas, with few exceptions, most interventions failed to reduce rates of preterm birth.
That meeting launched decades of research supported by the National Institutes of Health, The March of Dimes and other foundations. Researchers explored biological pathways, social determinants, nutrition, infection, stress, and genetics. New interventions followed: micronutrient supplementation, treatment of vaginal infections, social support programs, progesterone therapy, low-dose aspirin, and specialized nutritional approaches. Some showed promise for certain women, but none delivered the breakthrough that researchers had hoped for. In 1985, the US preterm birth rate was 9.8%. Forty years later, in 2025, it was 10.4%.
This failure matters because preterm birth is more than just an obstetrical complication. It is the single leading cause of neonatal mortality and an important contributor to lifelong neurodevelopmental disability and health care costs.
Poverty is one of the strongest predictors of preterm birth and many programs to prevent preterm birth have been targeted to poor women. But a more direct approach – providing financial support – has not been tried until now. As the economist John Kenneth Galbraith said, in describing the several anti-poverty programs of the Lyndon Johnson administration: “One possible remedy for poverty would be to give the poor income; this alone was excluded.” (Galbraith, JK: A Life in our Times. Boston: Houghton Mifflin,1981. p.452)
But now, in Flint, one of the nation’s poorest cities, with support from philanthropy and the State of Michigan, the Rx Kids program was launched in 2024. Developed at the College of Human Medicine at Michigan State University, the program provides every pregnant mother in Flint with $1,500 during pregnancy and $500 a month during the infant’s first year of life.
A rigorous evaluation showed substantial improvements in the lives of participating mothers after the program was implemented. Compared with mothers outside the program area, Flint mothers reported greater improvements in economic stability and psychological well-being. They were more likely to begin prenatal care early and less likely to smoke in pregnancy.
But even more importantly, it appears that the program reduced the preterm delivery rate. During the first 18 months of the program, Flint’s preterm birth rate declined by approximately 18%, while preterm birth rates remained steady statewide and actually increased in a group of 21 Michigan cities that closely matched Flint in population size, racial composition, and poverty rates. Flint had fewer NICU admissions than would have been expected without the program, which I estimate likely saved $4 million in health care expenditures during the program’s first 18 months.
And, in parallel to the lowered preterm birth rate, neonatal mortality in Flint was halved. Between 2020 and 2024, babies born in Flint were more than twice as likely to die in their first month of life as babies in the rest of Michigan, but in 2025, their neonatal death rate was nearly the same as that of the rest of the state.
Financial hardship during pregnancy affects maternal and fetal health in ways that medicine alone cannot fully overcome. Yet it is striking that we rarely address the problem of poverty directly. Efforts to prevent preterm birth have focused largely on medical interventions delivered during pregnancy. Flint’s experience suggests that addressing the economic conditions surrounding pregnancy may be as important as addressing its biological complications.
Rx Kids has now expanded beyond Flint to over 50 communities across Michigan, which will allow us to see whether a simple investment in families during pregnancy and infancy can improve health, reduce medical costs, and prevent the tragedy of preterm birth and neonatal death.
Forty-one years after that conference in Evian, one of the most promising approaches to preterm birth prevention emerged from a Midwestern city that decided to trust parents and provide them with something they needed.
Money.
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