The Impact of the 2021 Child Tax Credit on Perinatal Health: Evidence From the Expansion and Postexpiration Periods.

Abstract

The perinatal period is a pivotal life stage that profoundly influences lifelong health and well-being. In 2021, the U.S. temporarily expanded the Child Tax Credit, providing monthly payments during July-December 2021 and the remaining lump-sum payment during the 2022 tax season. This study examines the impact of the 2021 expansion on perinatal health among low-income families. Data were drawn from national birth certificate data (January 2021-December 2022) and were restricted to women covered by Medicaid, who are likely to be low income. A quasi-experimental event-study design was used to compare perinatal outcomes over time between women with and without previous live births, who had different exposure patterns to the 2021 expansion (N=2,485,813). Analyses were conducted in January-May 2025. The Child Tax Credit expansion was associated with increased appropriate-for-gestational-age births and decreased small-for-gestational-age and large-for-gestational-age births. Effects were most pronounced immediately after expiration of monthly payments (1.17 percentage points; 95% CI=0.45, 1.88)-potentially reflecting the cumulative impact of 6 months of income support-and several months after the lump-sum distributions, waning by the end of 2022. For maternal outcomes, an increased likelihood of hypertensive disorders of pregnancy and a decreased likelihood of no/late prenatal care were observed during the monthly payments period and persisting through the end of 2022. Sensitivity analyses supported the robustness of the findings. These results suggest that the expanded Child Tax Credit had positive effects on certain perinatal outcomes among low-income families, highlighting the potential of income support policies to reduce health inequities during a critical life stage and informing policymaking.