Associations Between Unconditional Cash Transfers and Postpartum Outcomes in the United States : A Systematic Review.

Background: Unconditional cash transfers (UCTs) through social programs or direct cash transfers (DCTs) may address drivers of pregnancy-related morbidity and mortality.

Purpose: To summarize evidence on UCTs and postpartum outcomes in the United States.

Data Sources: PubMed, Embase, Web of Science, Social Science Research Network, and structured internet searches through 28 January 2025.

Study Selection: Primary research reporting associations between UCTs and postpartum outcomes (0 to 2 years after delivery) in the United States.

Data Extraction: Dual data extraction with predefined outcomes: infant or child care, reproductive health, substance use, other mental health outcomes, and other outcomes. Study quality was assessed using the Cochrane Risk of Bias 2 and ROBINS-I (Risk Of Bias In Non-randomised Studies - of Interventions) tools. Strength of evidence (SOE) was assessed using the GRADE (Grading of Recommendations Assessment, Development and Evaluation) approach.

Data Synthesis: Eleven reports from 6 studies were identified. Four quasi-experimental (QE) studies examined 3 different social programs, 2 of which targeted populations with low incomes. Seven reports from 2 randomized controlled trials (RCTs) examined DCTs to postpartum persons with low incomes. The evidence on UCTs showed an increase in breastfeeding (high SOE [2 RCTs, 2 QE studies]), little or no difference in postpartum mood (high SOE [1 RCT, 2 QE studies]), and low SOE or insufficient evidence for all other associations.

Limitations: Unpublished studies and those not published in English may have been missed. Nonrandomized studies were subject to reporting or recall bias, reducing SOE. Study heterogeneity prevented meta-analysis.

Conclusion: Unconditional cash transfers increase breastfeeding in diverse settings and populations and result in little or no difference in postpartum mood specifically in persons with low incomes. No studies examined DCTs given during pregnancy. More evidence is needed on associations between UCTs and key clinical outcomes, such as postpartum maternal morbidity and mortality.

Primary Funding Source: None. (Registered on Open Science Framework [https://osf.io/4c3nx]).