Contraception use and satisfaction among mothers with low income: Evidence from the Baby's First Years study.

OBJECTIVES: Low income can lead to limited choice of and access to contraception. We examine whether an unconditional cash transfer (UCT) impacts contraceptive use, including increased satisfaction with and reduced barriers to preferred methods, for individuals with low income. STUDY DESIGN: Baby's First Years is a randomized control study of a monthly UCT to families with low incomes. The study enrolled 1000 mothers at the time of childbirth across four US sites in 2018-2019; 400 were randomized to receive a UCT of $333/mo and 600 were randomized to receive $20/mo for the first years of their child's life. We use intent-to-treat analyses to estimate the impact of the cash transfer on contraception use, satisfaction with contraception method, and barriers to using methods of choice. RESULTS: Over 65% of mothers reported using some type of contraception, and three-quarters reported using the method of their choice. We find no impact of the UCT on mothers' choice of, satisfaction with, or barriers to contraception. However, the cash transfer was associated with trends toward using multiple methods and greater use of short-term hormonal methods. CONCLUSIONS: We find high levels of satisfaction with current contraceptive use among mothers of young children with low income. Receipt of monthly UCTs did not impact contraception methods, perceived barriers to use, or satisfaction. Yet, 25% were not using the method of their choice, despite the provision of cash, indicating that this cash amount alone may not be sufficient to impact contraceptive use or increase satisfaction. IMPLICATIONS: Satisfaction with contraception use among low-income populations may be higher than previously documented. Nevertheless, provision of modest financial resources alone may not sufficiently address access, availability, and satisfaction for individuals with low-incomes of childbearing age. This suggests the importance of exploring how other nonfinancial factors influence reproductive autonomy, including contraceptive use.

A Research Note on Trends in the Stock and Flow of Child Support Agreements.

In this research note, we demonstrate that trends in the likelihood of child support agreements differ by marital history (i.e., never-married vs. ever-married) and by whether measures rely on the stock of families (i.e., all those in which children live apart from a parent) or the flow (i.e., those that include children who newly live apart from a parent) in a given year. While previous research has highlighted difference by marital history, the contrast between stock and flow is a new contribution. Trends are typically measured with reference to the stock of cases, even while the flow of cases, which more immediately reflects concurrent policy changes, is more relevant in many contexts. Interpretations of recent declines in child support agreements in the stock of cases-referenced as evidence for both mandating participation and the impracticality of requiring child support-may be better informed by considering the flow of cases. We find the flow of previously married mothers increasingly likely to have child support agreements while the likelihood is relatively consistent over time for never-married mothers. For both groups, using the flow measure, we find notable increases in agreements without payments due in the most recent period. These findings underscore the importance of differentiating stock and flow, and by marital history, in considering the proportion with agreements as an indicator of the effectiveness of current policy.

Associations between maternal stress and infant resting brain activity among families residing in poverty in the U.S.

Growing evidence suggests that maternal experiences of stress shape children's functional brain activity in the first years of life. Individuals living in poverty are more likely to experience stress from a variety of sources. However, it is unclear how stress is related to resting brain activity among children born into poverty. The present study examines whether infants born into households experiencing poverty show differences in brain activity associated with maternal reports of experiencing stress. The analytic sample comprised 247 mother-infant dyads who completed maternal questionnaires characterizing stress, and for whom recordings of infant resting brain activity were obtained at 1 year of age (M=12.93 months, SD=1.66; 50% female). Mothers (40% Black, non-Hispanic, 40% Hispanic, 12% White, non-Hispanic) who reported higher stress had infants who showed more resting brain activity in the lower end of the frequency spectrum (relative theta power) and less resting brain activity in the middle range of the frequency spectrum (relative alpha power). While statistically detectable at the whole-brain level, follow-up exploratory analyses revealed that these effects were most apparent in electrodes over frontal and parietal regions of the brain. These findings held after adjusting for a variety of potentially confounding variables. Altogether, the present study suggests that, among families experiencing low economic resources, maternal reports of stress are associated with differences in patterns of infant resting brain activity during the first year of life.

The impact of a poverty reduction intervention on infant brain activity.

Early childhood poverty is a risk factor for lower school achievement, reduced earnings, and poorer health, and has been associated with differences in brain structure and function. Whether poverty causes differences in neurodevelopment, or is merely associated with factors that cause such differences, remains unclear. Here, we report estimates of the causal impact of a poverty reduction intervention on brain activity in the first year of life. We draw data from a subsample of the Baby's First Years study, which recruited 1,000 diverse low-income mother-infant dyads. Shortly after giving birth, mothers were randomized to receive either a large or nominal monthly unconditional cash gift. Infant brain activity was assessed at approximately 1 y of age in the child's home, using resting electroencephalography (EEG; n = 435). We hypothesized that infants in the high-cash gift group would have greater EEG power in the mid- to high-frequency bands and reduced power in a low-frequency band compared with infants in the low-cash gift group. Indeed, infants in the high-cash gift group showed more power in high-frequency bands. Effect sizes were similar in magnitude to many scalable education interventions, although the significance of estimates varied with the analytic specification. In sum, using a rigorous randomized design, we provide evidence that giving monthly unconditional cash transfers to mothers experiencing poverty in the first year of their children's lives may change infant brain activity. Such changes reflect neuroplasticity and environmental adaptation and display a pattern that has been associated with the development of subsequent cognitive skills.

Present as a partner and a parent: Mothers' and fathers' perspectives on father participation in prenatal care.

Supportive father involvement during pregnancy can positively impact maternal and child outcomes. Father participation in prenatal care is increasing, yet little research exists to understand how mothers and fathers experience father participation in prenatal care and their preferences for father participation. We interviewed expectant first-time mothers (N = 22) and fathers (N = 20) to learn about fathers' participation in prenatal care, perceptions of providers' treatment of fathers, and preferences for father participation. Interviews were coded using principles of grounded theory. Father participation ranged from attendance at visits considered "important" (e.g., ultrasounds) to attendance at every appointment. Experiences of father participation varied, with many describing it as both an important act of support for the mother and part of assuming the role of father. Most participants saw great value in father participation in prenatal care as an opportunity for fathers to learn how to support a healthy pregnancy, bond with their developing baby, and share joy and/or worries with mothers. Participants generally felt that fathers were made to feel welcome and wanted providers to be inclusive of fathers during appointments. Results of this study suggest that father participation presents an opportunity for prenatal care providers to foster fathers' positive involvement in pregnancy, support for mothers, and preparation to parent.

El apoyo participativo del papá durante el embarazo puede tener un impacto positivo en el resultado materno y del niño. La participación del papá en el cuidado prenatal está aumentando, sin embargo, existe poca investigación para comprender cómo las mamás y los papás experimentan la participación del papá en el cuidado prenatal, y sus preferencias en cuanto a la participación del papá. Entrevistamos a madres primerizas embarazadas (N = 22) y papás (N = 20) para conocer acerca de la participación de los papás en el cuidado prenatal, las percepciones que acerca de los papás tenían quienes ofrecen el tratamiento, así como las preferencias en cuanto a la participación del papá. Se codificaron las entrevistas usando principios de teoría fundamentada. La participación del papá osciló desde el asistir a visitas consideradas "importantes" (v.g. el ultrasonido) hasta el asistir a cada cita. Las experiencias de la participación del papá variaron, y muchos las describieron como un acto importante de apoyo para la mamá y parte de asumir el papel de papá. La mayoría de los participantes vio un gran valor en la participación del papá en el cuidado prenatal, así como una oportunidad para los papás de aprender cómo prestar apoyo a un embarazo sano, establecer una relación con su bebé en desarrollo y compartir las alegrías y/o las preocupaciones con las mamás. Los participantes generalmente sintieron que a los papás se les hizo sentir bienvenidos y querían que quienes prestaban el cuidado incluyeran a los papás durante la cita. Los resultados de este estudio sugieren que la participación del papá presenta una oportunidad para quienes prestan el cuidado prenatal de fomentar una participación positiva en el embarazo, el apoyo a las mamás y la preparación para ser padre.

La participation d'appui du père durant la grossesse peut affecter de manière positive les résultats maternels et l'enfant. La participation du père au soin prénatal augmente et cependant il existe peu de recherches permettant de comprendre comment les mères et les pères font l'expérience de la participation du père au soin prénatal et leurs préférences pour la participation du père. Nous avons interviewé des mères attendant leur premier enfant (N = 22) et des pères (N = 20) afin de découvrir la participation des pères au soin prénatal, les perceptions de manière dont les prestataires traitent les pères, et les préférences pour ce qui concerne la participation des pères. Les entretiens ont été codés en utilisant les principes de théorie ancrée. La participation du père est allée de la présence aux visites considérées comme étant "importantes" (comme par exemple les ultrasons) à la présence à chaque rendez-vous. Les expériences de la participation des pères ont varié, la plupart des participants la décrivant comme étant à la fois un acte de soutien important pour la mère et une partie du fait d'assumer le rôle de père. La plupart des participants ont ressenti une grande valeur en la participation du père dans le soin prénatal, en la considérant comme une chance pour les pères d'apprendre comment soutenir une grossesse saine, de se lier avec leur bébé se développant et de partager la joie et/ou les inquiétudes avec les mères. Les participants ont généralement ressenti que les pères étaient bien accueillis et souhaitaient que les prestataires incluent les pères durant les rendez-vous. Les résultats de cette étude suggèrent que la participation du père présente une opportunité pour les prestataires de soin prénatal de cultiver une participation positive des pères à la grossesse, au soin des mères et à la préparation au parentage.