More generous EITC payments benefit maternal health

A study suggests that economic support reduces alcohol misuse and depressive symptoms among low-income mothers.

In states with more generous earned-income tax credits, mothers who have recently given birth are less likely to report binge drinking; those who were single and those who had less education were also less likely to report symptoms of depression, according to a study by researchers from the University of Washington school of Public Health and Medicine.

“The study is additional evidence that anti-poverty policies can have a big impact on health measures,” said lead author Erin Morgan, a PhD graduate of the UW Department of Epidemiology and fellow at Harborview Injury Prevention Research Center (HIPRC). She studies injury, suicide prevention, gun violence and health equity.  

The study was published in January in the journal Preventive Medicine Reports. Ali Rowhani-Rahbar, an associate professor of epidemiology, was senior author.

Morgan and colleagues examined whether more generous payments through Earned Income Tax Credits (EITC) were associated with reductions in alcohol misuse and symptoms of depression among women who had recently given birth. About 30% of single mothers in the United States live at or below the poverty level, and such poverty is associated with a higher risk of depression and substance abuse.  

The federal EITC provides subsidies to low-income working families, and many states have adopted their own EITC programs to supplement the federal payments. This allowed the researchers to compare outcomes across states with more or less generous benefits.

Researchers examined data from a national survey of mothers who have given birth in the previous two to four months. The survey is conducted by state health departments in partnership with the U.S. Centers for Disease Control and Prevention. The mothers were selected randomly for the survey, so it includes responses from women from all levels of society, not just low-income mothers who qualify for EITC benefits. 

In the study, the researchers focused on the mothers’ reported alcohol consumption, diagnosed depression and depression symptoms in the weeks after delivery.  Chronic heavy alcohol use was defined as seven or more drinks per week and binge drinking as having four or more drinks in one sitting. Depressive symptoms were identified as feeling “down, depressed, or hopeless” most of the time and having “little interest or little pleasure in doing things you used to enjoy” since delivery. 

Alcohol misuse and depression was common among these mothers, the researchers found.  When asked about alcohol use before pregnancy, 8% of the survey respondents reported heavy alcohol consumption and 28.5% reported binge drinking. One-third reported depressive symptoms post-delivery, and two-thirds reported little or no interest in engaging in activities they previously enjoyed. 

During the study period, the state support ranged from 3.5% to 37% of the federal credit, for a maximum of an additional $1,800 a year. In states that provided additional EITC payments, however, alcohol misuse was less, with a 6% lower prevalence of chronic heavy alcohol use and 4% lower prevalence in binge drinking with each 10-percentage-point increase in the supplemental benefit. 

Morgan noted that since that the survey included many women who were not from low-income groups, the reduction of alcohol misuse due to more generous EITCs is probably stronger than the findings indicate. “The effect is probably being diluted by having high-income mothers in the survey,” she said.

Overall, the generosity of state EITC supplements was not associated a reduction of diagnosed depression or depressive symptoms. But among less-educated mothers (high school education or less), a group more likely have a lower paying job and thus more likely to qualify for EITC, there was a 6% decrease in depressive symptoms since birth with each 10-percentage-point  increase in benefits. And among women unmarried at the time of the most recent birth, there was a 5% decrease in the prevalence of binge drinking and an 8% decrease in postpartum depressive symptoms.

“Our findings suggest that when you target upstream factors like poverty, you can reduce the risk of downstream problems like alcohol misuse and mental health problems,” Morgan said. “When we’re looking to improve health, it’s important to think about policies that aren’t specifically health-directed but still affect health.”

This work was supported by the U.S. Centers for Disease Control and Prevention (CE002945-01).