A natural experimental evaluation of UK welfare grants in pregnancy and the early years: a mixed methods study

Children growing up in low-income households have, on average, worse health than their more advantaged peers. Many welfare systems seek to reduce child poverty rates and improve children’s life chances, including in the UK, where cash payments are offered to low-income families in pregnancy and the first years of life. While there is some international evidence for the health benefits of policies like these, we know very little about the impacts of UK specific investments, whether they are successful in supporting early years’ outcomes, and if their design could be improved to maximise their benefits for population health and reducing inequalities. We will evaluate two specific early years’ policies. The first is the change in eligibility criteria for the Sure Start Maternity Grant (SSMG) (£500 given to low-income mothers in pregnancy) when payments became restricted to first births only in 2011. The second is the introduction of the Scottish Best Start Grant (BSG) which replaced the SSMG in 2018. The BSG comprises three payments in the early years, totalling £1006-£1383, given to all children in low-income families regardless of birth order. We will produce, for the first time, estimates of and explanations for the short and long-term impacts of these policies on child and maternal health and health inequalities. This three-year, natural experiment study will take a mixed methods approach, with work package (WP) 0 integrating qualitative, quantitative and health economic evaluations. In WP1, a stakeholder panel and Lived Experience panel will feed in across the life of the project to ensure our questions, findings and outputs are framed to maximise the benefit to the families these policies are designed to support. In the quantitative evaluation (WP2&3), we will use controlled interrupted time-series analysis, in whole-of-population administrative datasets for all UK countries. We will focus on two policy interruptions – the change in SSMG eligibility criteria in 2011 (control group is first born children who were unaffected) and the switch from SSMG to BSG in Scotland in 2018 (compared to children living in the rest of the UK). Our primary outcomes are immunisation uptake, maternal mental health and child hospitalisations. Inequalities will be considered by area deprivation and, where possible, single parenthood, family size and social class. The qualitative evaluation (WP 4) will use ethnographically informed interviews that privilege life stories, to understand if and how these policies influence health and inequalities. Interviews with eighty parents (20 from each UK nation) will be conducted in-person or online (according to interviewee preference), supported by Life Grids and PhotoVoice methods. Peer researchers will be paid members of our research team and support the qualitative work, triangulation of findings across the work packages and dissemination to public and policy audiences. In WP 5, health economic modelling will extrapolate the short-term effectiveness estimates from WP3 into the long-term using an existing birth cohort microsimulation modelling platform (LifeSim). Our findings will provide evidence to help inform early years decision-makers across the UK responsible for improving child and maternal outcomes. Findings and co-produced recommendations for change will be disseminated via a project website, blogs, podcasts, academic presentations and papers, policy briefings and final dissemination events.