New York City’s right-to-counsel program, which offers free legal representation to low-income tenants facing eviction, significantly reduced the risk of adverse birth outcomes among infants born to Medicaid-insured parents, according to a new study led by UCLA researchers.
Evictions often contribute to poor health outcomes, and they are more common among renters with children (10.4%) compared to those without children (5%). Researchers highlight that evictions during pregnancy warrant special attention, in that they put the health of both pregnant people and infants at risk. Prior analyses have documented associations between evictions during pregnancy and adverse birth outcomes.
In 2017, New York City launched the United States’ first right-to-counsel program, providing lawyers to low-income tenants in select ZIP codes. The phased implementation allowed for a “natural experiment” to see whether the program would be associated with improved birth outcomes.
Using birth certificate data on all Medicaid-insured live births in New York City from January 2016 to February 2020, provided by the NYC Department of Health and Mental Hygiene’s Bureau of Vital Statistics, researchers looked at rates of adverse birth outcomes for 260,493 infants.
The authors found that implementing right-to-counsel for low-income tenants in NYC significantly reduced the risk of adverse birth outcomes, showing an absolute 0.73 percentage-point drop in low birthweight in treated ZIP codes compared to untreated areas. Preterm birth rates also improved by 0.91% percentage points. They conclude the program was associated with a 0.96 percentage-point reduction in either adverse birth outcome (low birthweight or preterm birth) among infants born to Medicaid-insured parents. Researchers say that at the population level, this reduction equates to 600 fewer infants born preterm or low birthweight each year in NYC.
“Our study demonstrates that benefits of right-to-counsel go beyond promoting housing security – the program might also benefit the health of low-income communities,” said Kathryn M. Leifheit, PhD, MSPH, principal investigator of the study and assistant professor of Pediatrics at UCLA. “By preventing adverse birth outcomes, eviction prevention through right-to-counsel can have a lasting impact on children’s health and development.”
These results are relevant, as multiple other cities and states weigh the costs and benefits of implementing their right-to-counsel programs. Los Angeles County recently passed a right-to-counsel measure, while the Los Angeles City Council is due to vote on a measure this fall.
Additional contributors:
- Other UCLA faculty involved:
- Katherine L. Chen, DGSOM GIM-HSR
- Frederick Zimmerman, UCLA Fielding School of Public Health
- Current and former UCLA trainees
- Cecile Yama, National Clinician Scholar Program, DGSOM
- Achyuth Sriram, DGSOM Pediatrics
- Nathaniel Anderson, UCLA Fielding School of Public Health
- This work was conducted in collaboration with Drs. Alison Gemmill and Craig Pollack of the Johns Hopkins School of Public Health
- Funding from the UCLA Ziman Center for Real Estate
- The authors thank the UCLA Ziman Center for Real Estate’s Rosalinde and Arthur Gilbert Program in Real Estate, Finance and Urban Economics for generous funding.
Article: Leifheit KMChen KLAnderson NW, et al. Tenant Right-to-Counsel and Adverse Birth Outcomes in New York, New York. JAMA Pediatr. Published online October 28, 2024. doi:10.1001/jamapediatrics.2024.4699
