Title: Evaluation of Health in Pregnancy Grants in Scotland
Funder: Chief Scientist Office (Scotland)

Abstract: The Health in Pregnancy Grant was a universal payment of £190 made to women who had reached the 25th week of pregnancy and had received health advice from a midwife or doctor. The grant was designed to provide additional financial support in the last months of pregnancy towards a healthy lifestyle including diet and it was suggested that the link to the requirement for pregnant women to seek health advice from a health professional may provide a greater incentive for expectant mothers to seek the recommended health advice at the appropriate time. The grant was introduced for women with a due date on or after 6th April 2009 but was subsequently withdrawn the last payments being made to women who had reached the 25th week of pregnancy by 1st January 2011.The grant was paid by HM Revenue and Customs (HMRC) on receipt of a claim form available from and partly completed by the midwife or doctor. Payment was made directly into a bank account with a telephone helpline available to provide support through the claim process including options for payment in the event of difficulties opening a bank account. Take up of the grant was said to be at about the same level as for child benefit (98-99%; personal communication HMRC). Advice was offered as normal by doctors and midwives. Payment was made by HMRC.Administration was by HMRC; the cost of the grant was met by the Treasury.The objective is to evaluate the effect and cost-effectiveness of the Health in Pregnancy Grant. We will do this by assessing the difference in birthweight for babies born to those mothers who were eligible for the Health in Pregnancy Grant with babies born before the Health in Pregnancy Grant was introduced or after it was withdrawn. The study will be based in Scotland because of the availability of high quality routinely collected maternal and neonatal data available for a geographical population; our findings will be applicable to the rest of the UK. Specific questions the research project will address are:1) Were there differential impacts of the intervention for particular subgroups defined by socioeconomic (both area deprivation and individual occupational social class) demographic (marital status age maternal height) or obstetric (parity previous Caesarean section) factors or for selected combinations of these groups?2) Was the Health in Pregnancy Grant cost effective? How did cost-effectiveness vary across important subgroups identified as having differential outcomes?We will analyse the effect of the intervention on an intention to treat basis. The eligible participants will be all women who reached the 25th week of pregnancy in Scotland with a due date between 6th April 2009 and and 16th April 2011. The grants will be evaluated using an interrupted time series approach; the comparator will therefore be all births in Scotland with a due date between 1st January 2004 and 28th February 2009 and between 1st June 2011 and 31st March 2013. The primary outcome will be birthweight among singleton live births; secondary outcomes will include gestation at booking booking by 25 weeks stillbirths and neonatal deaths very low (<1500g) and low (<2500g) birthweight gestational age preterm (<36 weeks and <32 weeks) weight for dates (standardized and small and large for gestational age) and 5 minute apgar score.


Research activity codes: 3.1 PRIMARY PREVENTION INTERVENTIONS TO MODIFY BEHAVIOURS OR PROMOTE WELL-BEING
Health categories: REPRODUCTIVE HEALTH AND CHILDBIRTH