About

Lia Haskin Fernald, PhD, is a professor of Public Health at UC Berkeley. Her work focuses on using rigorous methodology to address inequalities, particularly in the areas of early child development, health and nutrition, and economic and safety net programs. She leads research projects that integrate and holistically approach child development interventions, such as the RINEW project in Bangladesh, and assesses community experiences with safety net supports, exemplified by the ACCESS survey in California. Additionally, she is involved in scaling up support for early child development through initiatives like the MAHAY project in Madagascar. Her research aims to improve outcomes for vulnerable populations by combining expertise in public health, economics, and social policy.

Research topics

• Medicine
• Biology
• Internal medicine
• Nursing
• Psychology
• Ecology
• Gerontology
• Psychiatry
• Environmental health

Selected publications

• Safety net program participation and churning during the COVID-19 pandemic: a longitudinal analysis of low-income California families

  SSM - Population Health · 2026-05-01

  articleOpen accessSenior authorCorresponding

  Studies of participation in US safety net programs consistently find improvements in health equity, yet few have measured multi-program participation over time, or linked these trajectories to health during the COVID-19 pandemic. This study characterizes longitudinal participation phenotypes in SNAP, WIC, and Medicaid and examines their associations with mental and physical health. We used longitudinal data from a cohort of low-income families (n=361, 2019–2023) and applied sequence analysis (Hamming distance) and cluster analysis to identify distinct trajectories of program use. We then characterized sociodemographic profiles across clusters and applied regression analyses to estimate associations between the safety net use phenotypes and self-reported health. We identified six unique trajectories of participation. While program use increased initially (2019-2021), it was followed by declines and “churning” (cyclical loss/gain) in 2022-2023. The most prevalent clusters were “all programs” (25%) and “rapid churning” (22%). Consistent with the hypothesis that administrative burdens harm health, participants with stable, full participation (“all programs”) had consistently lower prevalence of adverse health outcomes compared to other clusters. Vulnerable groups (lower-income, racial/ethnic minorities) were disproportionately represented in high-churn clusters. Administrative volatility and “churning” were common, and results suggest that stability in coverage is a key driver of health equity. Policymakers should prioritize specific administrative safeguards, such as cross-program coordination, data sharing, and recruitment strategies to support vulnerable groups. • We examined longitudinal trajectories in multi-program use from 2019-2023 • We found evidence of safety net program churning, especially for SNAP • We found differences in demographic characteristics and health across safety net trajectories • We illuminate potential barriers to accessing multiple safety net programs for vulnerable groups

  PublisherDOI

• Effects of Cash Transfers on Child Health and Development

  The MIT Press eBooks · 2026-03-10 · 1 citations

  book-chapterOpen access1st authorCorresponding
  PublisherDOI

• Associations Between Micronutrient Status, Hormones, and Immune Status During Pregnancy and Child Growth in Rural Bangladesh: A Prospective Cohort Study

  Current Developments in Nutrition · 2025-11-08

  articleOpen access

  Background: Poor growth in early childhood is associated with increased mortality, impaired cognitive development, and reduced adult economic productivity, which may result in higher risks of social immobility and intergenerational poverty. Objective: We aimed to evaluate whether maternal hormones, immune status, and micronutrient status during all trimesters of pregnancy were associated with child growth outcomes in the first two years after birth. Methods: values were adjusted using the Benjamini-Hochberg procedure. We used generalized additive models, adjusted for covariates, and reported the mean difference in outcomes between the 25th and 75th percentiles of the exposure distribution. Results: = 636), at 3 mo of age, maternal AGP and RBP were positively associated with infant WLZ. By 14 mo, higher maternal estriol was linked with higher LAZ, and RBP remained positively associated with WLZ. At 28 mo, maternal estriol showed a negative association with IGF-1, and a higher cytokine sum score was negatively associated with WLZ. Conclusions: These findings suggest the possible pathways through which maternal biomarkers influence early childhood growth, highlighting the intrauterine environment's critical role in shaping developmental outcomes.The parent trial was registered at clinicaltrials.gov (NCT01590095).

  PublisherDOI

• Effects of an early water, sanitation, hygiene, and nutritional intervention on child development at school age: a 7-year follow-up of a cluster-randomized trial in rural Bangladesh

  medRxiv · 2025-02-26 · 1 citations

  preprintOpen accessSenior author

  Abstract Background A previous cluster-randomized controlled trial in Bangladesh found that individual or combined water, handwashing, sanitation, and nutrition interventions during pregnancy and after birth improved developmental outcomes of children at 1 and 2 years of age. We aimed to determine if these intervention effects were sustained at school-age. Methods and Findings Pregnant women were enrolled between May 2012 and July 2013 and randomized into chlorinated drinking water (W); improved sanitation (S); handwashing with soap (H); combined WSH; nutrition counselling and provision of lipid-based supplements (N); combined WSH+N, or a passive control arm (C) (N=5,551). We followed-up enrolled mothers and children 5 years after intervention completion. Primary outcomes were child cognition, fine motor abilities, behaviour, school achievement, and executive function; secondary outcomes were maternal mental health and the home environment. We conducted intention to treat analyses using generalized linear models to determine unadjusted and adjusted comparisons between each arm and the control, accounting for pair-matching and block level clustering. Between September 2019 and February 2021, we re-enrolled 3,832 children. Children in the WSH+N, N, and S arms had improved cognitive scores on one or more domains compared to the control arm, with adjusted effect sizes between 0.10 (95%CI: 0.00, 0.20) and 0.15 (0.03, 0.27). Children in all arms except S had improved prosocial behaviour, with effect sizes between 0.21 (0.07, 0.34) and 0.33 (0.17, 0.49). No intervention effects were observed for fine motor, difficult behaviours, executive functioning, or school achievement. Maternal depressive symptoms were improved in the WSH+N, H, and N arms, and the stimulating home environment was improved in all intervention arms. Data collection for this study was interrupted by a 6-month pause at the start of the COVID-19 pandemic. Conclusions At 7 years of age, we found small, sustained impacts of early water, sanitation, hygiene, and nutrition interventions on child cognitive and social-emotional outcomes, the stimulating home environment, and maternal mental health. Future work to determine the mechanisms underlying these intervention effects will further inform the design of early interventions to improve child health and development. Trial registration Follow-up trial: ClinicalTrials.gov , NCT04443855 Original WASH-Benefits Bangladesh (WASH-B): ClinicalTrials.gov , NCT01590095

  PublisherOA PDFDOI

• Big Sisters

  The Journal of Human Resources · 2025-08-08 · 1 citations

  articleOpen access

  <h3>Abstract</h3> We model household investments in young children when parents and older siblings share caregiving responsibilities and investments by older siblings contribute to young children’s human capital accumulation. To test the predictions of our model, we estimate the impact of having an older sister (as opposed to an older brother) on early childhood development in a sample of rural Kenyan households with otherwise similar family structures. Having an older sister rather than an older brother improves younger siblings’ vocabulary and fine motor skills by more than 0.1 standard deviations.

  PublisherOA PDFDOI

• Evaluation of a multicomponent child development intervention delivered through the government health system: a feasibility study

  BMJ Global Health · 2025-07-01

  articleOpen accessSenior author

  INTRODUCTION: Small efficacy trials have demonstrated that multicomponent interventions can improve early child development. We evaluated the large-scale delivery of a multicomponent intervention delivered by government health workers throughout a rural subdistrict in northwestern Bangladesh. METHODS: We evaluated a group-based, multicomponent intervention with a curriculum covering responsive parenting, caregivers' mental health, lead exposure prevention strategies at the household level, water, sanitation, hygiene and nutrition. Group sessions were held throughout a rural subdistrict of Bangladesh (August 2019-March 2020). A longitudinal sample of caregivers (n=517) of children 6-24 months was assessed at baseline and endline (primary cohort), and 1179 additional caregivers were assessed only at endline (supplementary cross-sectional). Outcomes were the variety of child play activities and materials, number of books, caregiver depressive symptoms and nutrition and lead knowledge. For primary analyses, we used difference-in-difference. RESULTS: Over half (n=276, 53%) of the cohort participants attended any of the 16 intervention sessions and of these, 83% (228) attended 2+. Caregivers attending 2+ sessions, compared with ≤1 session, had more play materials (adjusted mean difference: 0.58; 95% CI: 0.30, 0.85) and were more likely to have any children's books (adjusted prevalence difference (aPD): 0.26; 95% CI: 0.18, 0.34), to have heard of lead (aPD: 0.13; 95% CI: 0.07, 0.19) or to know how to avoid harm from lead (unadjusted PD: 0.13; 95% CI: 0.08, 0.17). These findings were similar to those from the supplementary cross-sectional analysis. There were no differences in caregiver depressive symptoms in either analysis. More child play activities and nutrition knowledge were associated with attendance in the cross-sectional sample. CONCLUSIONS: A multicomponent child development intervention delivered by government health workers increased the presence of children's toys and books and caregiver knowledge of lead in families who attended two or more sessions. Further adaptation and alternative delivery methods are likely to improve the reach and the breadth of impacts. TRIAL REGISTRATION NUMBER: NCT04111016.

  PublisherOA PDFDOI

• Maternity leave and breastfeeding during COVID: a cross-sectional study

  International Breastfeeding Journal · 2025-11-19

  articleOpen accessSenior author

  Maternity leave is an important driver of a woman’s ability to breastfeed, but this association may have changed during the COVID pandemic, which introduced new employment dynamics and breastfeeding challenges for mothers in the workforce. Our objectives were to examine the associations between maternity leave length and type of maternity leave (paid vs. unpaid) with breastfeeding initiation and breastfeeding duration during the pandemic, and to compare our findings with pre-pandemic data. Our sample was 3,683 recently postpartum women, currently in the workforce, who had given birth between March-December 2020 in the US. Data were obtained from the Pregnancy Risk Assessment and Monitoring System (PRAMS) survey, a population-based surveillance system developed by the Centers for Disease Control (CDC) in the US. We examined associations between taking longer maternity leave compared with shorter (≥ 3 vs. < 3 months), and breastfeeding initiation or continuation (at 1, 2, and 3 months after delivery). We also examined heterogeneity in the associations between maternity leave and breastfeeding by a range of characteristics. During COVID, having a longer maternity leave was not associated with breastfeeding initiation or continuation. These results contrast with pre-pandemic findings from the same cohort, in which a longer maternity leave was associated with more breastfeeding. In tests of heterogeneity in our current analysis, women who were younger, not married, less educated, or who did not receive any pay during their leave were less likely to continue breastfeeding if they took a shorter maternity leave than if they took a longer maternity leave. The COVID pandemic created a natural experiment for exploring associations between employment and breastfeeding among women in the workforce. Our results suggest that the conditions of the pandemic may have minimized average differences in breastfeeding outcomes by maternity leave length because more women were at home. However, our study highlighted that benefits were concentrated among women who were older, more educated, married, and who received paid leave, reinforcing the urgent need to support women who face greater economic and social disadvantages within the US.

  PublisherOA PDFDOI

• Lived Experiences of Families Navigating Safety Net Expansions and Retractions During the Pandemic: A Qualitative Study

  American Journal of Public Health · 2025-08-28 · 4 citations

  articleOpen access

  Objectives. To understand the experiences of families with low income in California with pandemic safety net support expansions and retractions, including barriers to program access. Methods. Using open-ended questions, we explored the self-reported experiences of pandemic-era safety net expansions and expirations between January and June 2023 among a group of caregivers of young children (n = 44). We used the Immersion-Crystallization technique to analyze the data, creating a codebook and identifying themes as they emerged. Results. We identified 4 main themes, including appreciation for safety net expansions, varied experiences because of the timing of supports, challenges meeting basic needs after expirations, and administrative burdens significantly impairing program access. Conclusions. The study themes highlighted how expansions to policies like the Child Tax Credit and Supplemental Nutrition Assistance Program improved food and housing security, and that unpredictable benefits, although appreciated, also added stress. Public Health Implications. State and federal policymakers should consider the poverty reduction and food and housing security benefits of expansions to pandemic-era supports that have expired when crafting future policy. They should pay special attention to addressing administrative barriers to reduce poverty-related health inequities. ( Am J Public Health. 2025;115(11):1836–1847. https://doi.org/10.2105/AJPH.2025.308201 )

  PublisherOA PDFDOI

• Assessing the value-added contributions of community health workers and communities to early child development: a longitudinal study in a low-income setting

  BMJ Public Health · 2025-02-01 · 1 citations

  articleOpen access

  Background: Early child development (ECD) programs in low-resource settings can be effective when delivered through community health workers (CHWs), but there are significant challenges when moving to scale. This analysis aimed to determine the value-added, or relative effectiveness, of CHWs and communities on ECD outcomes within a home-visiting trial and examine associations between observable characteristics of the CHW or community and value-added. Methods: We analysed data from the four treatment arms of a cluster-randomised trial conducted in 100 communities in rural Madagascar from 2014 to 2016. CHWs (one per cluster) and enrolled children (0-12 months) were surveyed at baseline and 2 years later. Child development scores were assessed using the Ages and Stages Questionnaire-Inventory (ASQ-I) and were internally age-standardised. We determined value-added by estimating CHW/community-level fixed effects on ASQ-I Z-score trajectories (change from baseline to endline), conditional on baseline ASQ-I Z-score and child and household characteristics. We also assessed associations between value-added and observable CHW and community-level characteristics. Results: We analysed data from 1456 children present at baseline and endline. CHW/community fixed effects explained 26% of ASQ-I trajectory variance and estimates ranged from -1.68 SD to 1.31 SD. CHWs who had another income-generating position were associated with a 0.54 SD (95% CI 0.22, 0.87) increase in ASQ-I Z-score from baseline to endline. Greater increases in children's ASQ-I Z-scores were also associated with communities that had better healthcare, education and transportation infrastructure and were less geographically dispersed. Conclusions: Children gained or lost over one standard deviation of ASQ-I Z-score depending on the community and CHW where they lived. Children's development trajectories benefitted from CHWs involved in an external income-generating activity and communities with better access to healthcare, education, and transportation. Careful consideration of the contexts in which child development interventions are implemented and potential correlates of improved CHW performance are crucial for improved outcomes.

  PublisherOA PDFDOI

• Associations Between Intimate Partner Violence, Depression, Perceived Stress, and Child Growth

  Current Developments in Nutrition · 2025-05-01

  articleOpen access

  Fortification and Biofortification Meal/Menu, and Food Group Diversity Meal/Menu).The purpose of this study was to validate benchmarks for these metrics and sub-metrics.Methods: The validation of the GDQS-Meal and Menu benchmarks included identifying school meal/menu data from five countries; tabulating the GDQS-Meal and Menu metrics for each of the meals/menus for three age groups (24-59 months, 5-9 years, 10-14 years); matching food items in the school meal/ menu data with energy and 11 critical nutrients of public health concern; comparing the nutrient levels of the meals/menus with the recommended meal/menu amount for each nutrient; calculating nutrient ratios to compare the nutrient level provided in each meal/menu to the recommended amount for each nutrient (1/3 of age-and sex-specific Recommended Dietary Allowances); and comparing the set of nutrient ratios to the GDQS-Meal and Menu scores and benchmarks.Results: The results from the validation analyses show that across the meals and menus analyzed the proposed benchmarks meaningfully discriminate between meals and menus that are of lower and higher nutritional quality.Results were consistent across the 5-9-and 10-14-year age groups for all metrics and submetrics.Limited data for the 24-59-month age group precluded robust analyses but indicated validity for the Fortification and Biofortification Meal/Menu sub-metric.Conclusions: The results from the validation study suggest that the GDQS-Meal and Menu benchmarks provide an objective measure by which to evaluate the nutritional quality of school meals and menus comparably over time, across schools, contexts, and countries.The benchmarks provide interpretable cut-points on which to make decisions for improving the quality of the meals and menus in institutional settings.

  PublisherOA PDFDOI

Recent grants

• NIH Grant F31MH011475

  NIH · $29k

• NIH Grant K01TW006077

  NIH · $358k · 2006

• Effects of Supplementation and Stimulation on Child Development: the MAHAY study

  NIH · $138k · 2018–2020

Frequent coauthors

• Ann M. Weber

  University of Nevada, Reno

  68 shared

• Emanuela Galasso

  64 shared

• Benjamin F. Arnold

  Global Brain Health Institute

  64 shared

• Dilys Walker

  Global Brain Health Institute

  52 shared

• Stephen P. Luby

  Stanford University

  51 shared

• Heather A. Knauer

  University of Michigan–Ann Arbor

  51 shared

• John M. Colford

  Berkeley Public Health Division

  49 shared

• Christine P. Stewart

  45 shared

Labs

• CEGAPI

Education

• M.B.A.

  University of California Berkeley

  2000

• Ph.D.

  University College London

  1999

• BA

  Swarthmore College

  1994

Awards & honors

• Fulbright Scholar – Jamaica