A recent study published in JAMA Pediatrics, “Tenant Right-to-Counsel and Adverse Birth Outcomes in New York, New York,” demonstrates how guaranteed legal representation for tenants facing eviction can positively impact birth outcomes for lower-income families. In 2017, New York City became the first U.S. city to implement a right-to-counsel program, offering free legal support to renter households with incomes below 200% of the federal poverty level who were facing eviction. The program was introduced gradually across different ZIP codes, prioritizing areas with high eviction rates and limited legal resources. The new article finds that, in addition to being associated with reducing participants’ eviction risk by half, exposure to right-to-counsel during pregnancy was associated with significant reductions in the probability of negative birth outcomes.
The researchers were particularly interested in examining birth outcomes, as previous studies have linked the stresses of eviction and housing instability to higher rates of low birth weight and preterm births. Pregnancy is a period of heightened sensitivity, and eviction-related stress during this time can adversely affect both maternal and fetal health. The study aimed to explore whether the availability of legal representation could help to improve birth outcomes by reducing housing instability and the risk of eviction.
The study used a retrospective cohort design that replicated a natural experiment, analyzing Medicaid-insured births across ZIP codes with and without right-to-counsel access. The researchers gathered data on live births from January 2016 to February 2020 through New York City’s Bureau of Vital Statistics. The study included 260,493 births, with 17% occurring in neighborhoods that had right-to-counsel implemented during the birthing parent’s pregnancy. The researchers analyzed the probability of low birth weight (below 2,500 grams) and preterm birth (under 37 weeks gestation), as well as a composite measure to capture births affected by either or both conditions as an overall indicator of adverse birth outcomes. They also incorporated a nine-month lag between right-to-counsel implementation and birth outcomes to ensure that an entire pregnancy was covered by access to legal counsel. A “difference-in-differences” approach was used by comparing birth outcomes in ZIP codes with (treated) and without (untreated) right-to-counsel to assess how birth outcomes changed in treated areas over time relative to untreated areas, adjusting for demographic and seasonal variables.
The results indicated a statistically significant reduction in adverse birth outcomes among infants born to Medicaid-insured parents in ZIP codes with right-to-counsel. The researchers found that the probability of low birth weight decreased by 0.73 percentage points, and preterm births decreased by 0.91 percentage points. Overall, the composite measure of adverse birth outcomes showed a 0.96 percentage point reduction, or roughly 600 fewer infants born with these adverse birth outcomes per year. These findings show the potential health benefits of providing legal support to tenants facing eviction, as reduced housing instability can alleviate significant stressors for pregnant individuals.
This study highlights the public health implications of housing instability and the broader societal benefits of eviction prevention policies. For policymakers and advocates, the results provide compelling evidence that housing stability is a critical factor in maternal and child health. The significant reduction in adverse birth outcomes suggests that right-to-counsel programs can have life-long health impacts on low-income children, potentially reducing healthcare costs and improving quality of life over time. The findings also suggest that social policies designed to improve housing security can have positive effects that extend beyond the immediate legal outcomes, influencing population health and addressing disparities that have long-term consequences for minority and low-income communities.
As tenant right-to-counsel gains traction in other cities and states, this study provides a strong foundation for considering such programs as part of broader health and equity initiatives. The authors highlight that prior research has shown preterm births to have a societal cost of over $80,000, suggesting that each year of right-to-counsel could result in almost $50 million in cost savings. The authors advocate for the nationwide expansion of these programs, noting that since New York’s implementation (and as of the article’s publication), 17 additional cities or counties and five states have adopted similar initiatives. They also encourage policymakers to integrate health metrics into future evaluations of right-to-counsel programs, helping lawmakers recognize the broader health benefits and societal value of tenant protections as part of a comprehensive social support strategy. To learn more about NLIHC’s advocacy on right-to-counsel and other tenant protections, please visit our State & Local Innovation webpage.
The article can be found at: https://bit.ly/4hHl8Hx.