Conditional or Unconditional Cash Transfers?

This post is part of a series of posts on cash transfers and maternal health. To read other posts in the series, click here. If CCTs are a part of your work or research, we’d love to hear from you. Contact us at clindahl@engenderhealth.org if you are interested in writing a guest post on the topic.

Dean Karlan and Jacob Appel from Innovations for Poverty Action argue in Foreign Policy about aid and development projects in general, “Looking at all the pitfalls of specific aid projects, an increasing cadre of experts has argued in recent years that it’s better to just give recipients cash. That way, every individual can make a choice about what it is he or she needs most.” In the absence of market failures and donor priorities, they believe “there is a strong argument for simply providing cash.”

While conditional cash transfers (CCTs) for maternal health have shown increases in the use of skilled birth attendance, few programs (if any) exist that provide unconditional cash transfers (UCTs) to pregnant women. According to Baird et al., “studies find that the UCTs reduce child labor, increase schooling, and improve child health and nutrition. Hence, UCTs also change the behaviors on which CCTs are typically conditioned.” No completed studies have randomly assigned participants to a CCT group, a UCT group and a control group, according to Baird and her co-authors. They note a couple of examples where it seems as thought CCTs may be more effective than UCTs, but the evidence is unclear. Also, one can safely assume that the administration of a CCT is more costly than a UCT, raising questions of efficiency.

Could UCTs promote maternal and child health?

In Poor Economics, Abhijit Banerjee and Esther Duflo argue: “the social returns of directly investing in children and pregnant mother nutrition are tremendous. This can be done by giving away fortified foods to pregnant mothers…or even by giving parents incentives to consume nutritional supplements.” However, a paper by Alfredo Burlando (which we discussed briefly on the MHTF blog) suggests that knowingly pregnant women were better able to weather income shocks that women who were early in their pregnancy through a variety of mechanisms. The women who knew they were pregnant had better nutrition and gave birth to healthier children as a result. This implies that women do not need conditions in order to act healthy and a lack of money may be the reason that care is not always sought or proper nutrition achieved.

Unconditional cash transfers to caregivers of children (mostly women) have shown positive impacts on child health in South Africa, according to Aguero et al.: “this paper has shown that these targeted, unconditional CSG [Child Support Grant] payments have bolstered early childhood nutrition as signalled by child height-for-age.” As such targeted, unconditional grants to pregnant women have the possibility of promoting maternal outcomes and improving the lives of poor women.

While improvements in maternal health have been made with reduction in maternal mortality, further efforts are needed in order to fully address the problem. Although there are many health system solutions that can improve maternal health, experimentation at a micro level can allow us to find solutions that can work on the margins. It seems that providing cash to pregnant women may be an intervention that would lead to improved outcomes for both mothers and children and may be done more efficiently than other interventions.