Amaryllis Castillo starts her day at 7:45 a.m., beginning her work as a certified home health aide. Pregnant at 26 weeks and a mother of two, she spends six hours caring for elderly patients, accompanying them to activities and lunch outings. Following her first job, she clocks in at 5 p.m. for her second job in customer service, working until 9 p.m. She is able to work from home, allowing her to be with her 12 and two-year-old children. Despite working over 50 hours a week between these two jobs, Castillo, based in Philadelphia, struggles to cover her expenses including rent, daycare, car payments, utilities, and groceries. Unfortunately, she earns too much to qualify for food stamps. Neither of her jobs provides benefits like health insurance, paid sick leave, a 401(k), or paid time off for her upcoming childbirth. “I’m just making it happen,” she says.
In the United States, the approach to pregnancy and childbirth typically leaves families to navigate the transition to parenthood alone. Unlike many other countries, the U.S. does not have a national paid parental leave policy, and while some states have introduced their own paid leave programs, Pennsylvania is not among them. These programs often do not cover all workers, leaving many without support. Additionally, there is a lack of national initiatives to address or prevent postpartum mood disorders (PPMDs), such as postpartum depression, anxiety, PTSD, and postpartum psychosis, which affect a significant percentage of new mothers.
Financial strain is one of the factors that can contribute to the development of PPMDs. Research shows that being low-income increases the risk of depression, and a history of mental health disorders is a significant predictor of PPMDs. Financial difficulties have been found to play a role in the likelihood of experiencing postpartum depression. The impact of these mood disorders is substantial, with suicide being a leading cause of pregnancy-related deaths in the U.S. PPMDs also incur significant costs, with health care expenses, lost work time, and increased use of public services adding up to billions of dollars in public expenditure over time.
In response to these challenges, new programs in cities like Philadelphia and Flint, Michigan are implementing innovative solutions, such as a universal basic income for pregnant individuals and new mothers during the first year postpartum. These programs aim to address the fragmented nature of existing paid leave programs and mitigate the effects of PPMDs. The success of initiatives like Rx Kids in Flint has inspired proposals for similar programs at the federal level. By providing financial support during pregnancy and the postpartum period, these programs have the potential to improve health outcomes for mothers and babies, reduce parental stress, and positively impact child development and educational attainment. Studies have shown that cash transfer programs can have a range of benefits, including reducing anxiety symptoms and enhancing infant brain development.
Since 1945, there have been notable improvements in the health of parents and children over time. In the United States, specific programs have highlighted the significant role that cities can play in alleviating financial stress, which in turn reduces the risk of developing postpartum mood disorders (PPMD) and associated negative outcomes. While it may not be possible to prevent all instances of postpartum mood disorders, mitigating financial stressors could serve as a protective factor.
The initiative “Three Cities Take On Post-Partum Health” follows the stories of individuals like Castillo, a mother from Philadelphia benefiting from the Philly Joy Bank program. This program provides $1,000 a month to 250 mothers from three city neighborhoods, starting in the second trimester of pregnancy until the child’s first birthday. The financial assistance has already made a significant impact on recipients like Castillo, who has been able to open a savings account, afford life insurance, and allocate funds towards her education and future career goals. Additionally, the program supports mothers in taking time off work after childbirth, although the monthly stipend may not cover all expenses during that period.
The Philly Joy Bank, launched in June 2024, is supported by local philanthropic organizations and managed by the city’s Department of Health. It was developed through collaboration within the Community Action Network, aiming to reduce infant mortality by alleviating stress among pregnant individuals. The program enrolls mothers from neighborhoods with high rates of low birthweights and preterm births, providing unconditional financial support alongside optional additional services like financial counseling.
Another program, Rx Kids in Flint, offers a universal approach compared to the Philly Joy Bank. Launched in January, this public-private partnership ensures that every new mother in Flint is eligible for financial assistance. The initiative utilizes government funding from Temporary Assistance for Needy Families (TANF) and philanthropic contributions to provide $1,500 during the second trimester of pregnancy and $500 monthly for the baby’s first year, with no strings attached.
Both programs exemplify innovative strategies to support maternal and child health, demonstrating the positive impact of financial assistance and community collaboration in addressing postpartum challenges and promoting overall well-being.
Dr. Mona Hanna, co-founder of Rx Kids, associate dean of public health, and professor at Michigan State University College of Human Medicine, emphasizes the importance of meeting the needs of children. In 2015, Dr. Hanna, a pediatrician, discovered high levels of lead in Flint’s water affecting the city’s children. She took the lead in launching a community initiative to address the crisis. Luke Shaefer, a co-founder of the program and a professor at the University of Michigan, identified a provision in state TANF funds that allows families to receive financial aid for up to four months during an economic crisis without facing time limits or work requirements. Shaefer and Hanna successfully argued that childbirth should be considered an acute crisis, as it is a time when families experience financial strain due to reduced earnings and increased expenses. They emphasized the critical importance of supporting families during pregnancy and the newborn period for child development.
Through philanthropic support, Hanna and Shaefer were able to offer the program to all families in Flint who have a baby, not just those eligible for Medicaid. They extended the support to a year, making it a universal program aimed at providing dignity to families in need. The initiative has seen high participation rates and positive outcomes, including reduced depressive symptoms and improved wellbeing among participants. Early data also suggests improvements in prenatal care, birth weight, and housing stability for families involved in the program.
The success of Rx Kids has inspired other communities in Michigan to consider adopting the program, with Kalamazoo set to launch in February. Michigan Governor Gretchen Whitmer has allocated additional TANF funding in the state’s budget to expand the program to low-income areas across Michigan. Hanna and Shaefer are working on securing public-private partnerships to further support the program’s growth and are exploring possibilities of implementing similar initiatives in rural parts of the state.
Dr. Stacey Kallem, from the Philadelphia Department of Public Health, highlights the potential of programs like Philly Joy Bank to influence federal funding for maternal and child health. Effective programs could lead to changes in funding mechanisms, allowing for more flexible use of resources to support families in need.
Guaranteed income programs have the potential to be transformative if proven effective. Should programs like these demonstrate positive outcomes and cost savings for communities, it raises the question of reevaluating government funding mechanisms. The flexibility exhibited by cash transfer initiatives in Philadelphia and Flint exemplifies the agility of local governments, as noted by Rachel Louise Moran, a history professor at the University of North Texas. Moran emphasizes the challenges faced at the federal level in supporting mothers with postpartum depression, citing difficulties in navigating entrenched political issues. In contrast, local governments can act more decisively without the constraints of national politics.
The California Abundant Birth Project, which offers unconditional cash assistance to expectant mothers at risk of preterm birth, illustrates a localized approach to addressing maternal mental health. Overcoming prevailing American attitudes that frame postpartum mood disorders as individual problems is crucial, given their broader societal impacts. City initiatives like Santa Barbara and Toronto’s inclusion of resources for postpartum depression underscore the importance of recognizing this issue as a public health concern.
Distinct from traditional support models, programs such as the Philly Joy Bank, Rx Kids, and Abundant Birth Fund provide unconditional cash assistance, diverging from the legislative-focused strategies of major advocacy groups. The direct financial support offered by these initiatives is particularly valuable in alleviating stress and financial strain for recipients like Castillo. The success of such programs underscores the need for a more systemic and inclusive approach to addressing maternal mental health challenges.
This collaborative report with The 19th, a nonprofit newsroom focusing on gender and policy issues, was developed in partnership with Next City, a publication dedicated to urban affairs.
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