To assess changes in early and overall neonatal mortality in Flint, Michigan, after the January 2024 launch of the Rx Kids cash-transfer program.
Approach:
Design and data: Historical cohort study using Michigan birth and death certificate data from 2021–2025; investigators compared Flint with the rest of the state.
Program: Rx Kids provided a one-time prenatal payment of $1,500 and monthly payments of $500 during an infant’s first year; participation was 98%.
Outcomes: Early neonatal mortality was death before 7 days; overall neonatal mortality was death before 28 days. Rates were calculated per 1,000 live births.
Key Findings:
From 2021–2024, Flint had 7.9 early neonatal deaths per 1,000 live births versus 3.3 elsewhere in Michigan, and 10.2 overall neonatal deaths versus 4.0; both differences were statistically significant.
In 2025, Flint’s early neonatal mortality rate was 2.0 per 1,000 live births, 74% below its 2021–2024 rate. The rate elsewhere in Michigan was 3.3.
Flint’s overall neonatal mortality rate fell to 5.1 per 1,000 in 2025, a 50% reduction from 2021–2024; the rate elsewhere in Michigan was 3.9 and remained relatively stable.
In 2025, differences between Flint and the rest of Michigan were no longer statistically significant for either outcome.
Interpretation:
The authors described the findings as preliminary and said the timing and magnitude of the declines were consistent with previously documented improvements following Rx Kids. They noted that the current analysis did not directly assess possible mechanisms, including changes in infant sleep environments.
Limitations:
Michigan’s 2025 vital records were provisional.
The small number of neonatal deaths meant that small changes in event counts could affect rates.
Birth and mortality records could not be linked, preventing an individual-level difference-in-differences analysis.
The authors called for evaluation beyond 2025 and in additional communities to determine whether improvements persist.
Conclusion:
The authors wrote that direct perinatal economic support may be a promising strategy for improving neonatal survival and reducing population-level disparities.
