Cash Transfers, Early Marriage, and Fertility in Malawi and Zambia.
Ontology highlight
ABSTRACT:
SUBMITTER: Dake F
PROVIDER: S-EPMC6662603 | biostudies-literature |
REPOSITORIES: biostudies-literature
Similar Datasets
Project description:Cash transfer programs are rapidly becoming a key component of the social safety net of many countries in Sub-Saharan Africa. The primary aim of these programs is to help households improve their food security and smooth consumption during periods of economic duress. However, beneficiary households have also been shown to use these programs to expand their microentrepreneurial activities. Cluster-randomized trials carried out during the rollout of large-scale programs in Malawi and Zambia reveal that children may increase their work in the household enterprise through such programs. Both programs increased forms of work that may be detrimental to children, such as activities that expose children to hazards in Malawi and excessive working hours in Zambia. However, both programs also induced positive changes in other child well-being domains, such as school attendance and material well-being, leading to a mixed and inconclusive picture of the implications of these programs for children.
| S-EPMC9997202 | biostudies-literature
Project description:Unconditional cash transfers have demonstrated widespread, positive impacts on consumption, food security, productive activities and schooling. However, the evidence to date on cash transfers and health-seeking behaviours and morbidity is not only mixed, but the evidence base is biased towards conditional programmes from Latin America and is more limited in the context of Africa. Given contextual and programmatic design differences between the regions, more evidence from Africa is warranted. We investigate the impact of unconditional cash transfers on morbidity and health-seeking behaviour using data from experimental and quasi-experimental study designs of five government cash transfer programs in Ghana, Malawi, Zambia and Zimbabwe. Programme impacts were estimated using difference-in-differences models with longitudinal data. The results indicate positive programme impacts on health seeking when ill and on health expenditures. Our findings suggest that while unconditional cash transfers can improve health seeking when ill, morbidity impacts were mixed. More research is needed on longer-term impacts, mechanisms of impact and moderating factors. Additionally, taken together with existing evidence, our findings suggest that when summarizing the impacts of cash transfers on health, findings from conditional and unconditional programmes should be disaggregated.
| S-EPMC9113146 | biostudies-literature
Project description:In Africa, state-sponsored cash transfer programs now reach nearly 50 million people. Do these programs raise long-term living standards? We examine this question using experimental data from two unconditional cash transfer programs implemented by the Zambian Government. We find far-reaching effects of the programs both on food security and consumption as well as on a range of productive outcomes. After three years, household spending is on average 67 percent larger than the value of the transfer received, implying a sizeable multiplier effect, which works through increased non-farm activity and agricultural production.
| S-EPMC6687333 | biostudies-literature
Project description:The Social Cash Transfer Programme (SCTP) in Malawi is a cross-sectoral policy with impacts on health, education, nutrition, agriculture and welfare. Implementation of the SCTP requires collaboration across sectors and across national and international stakeholders. Economic evaluation can inform investment by indicating whether benefits exceed costs, but economic evaluations that provide an overall benefit-cost ratio typically assume a common agreed objective and agreed set of value judgements. In reality, the various stakeholders involved in the delivery of the SCTP may have different remits and objectives and may differ in how they value the impacts of the programme. We use the SCTP as a case study to illustrate a cross-sectoral analytical framework that accounts for these differences. The stakeholders that contribute to the SCTP include the Ministry of Gender, Ministry of Finance, Ministry of Economic Planning and Development and Global Fund. We estimate how the SCTP changes outcomes in education, health, net production and poverty, and distinguish outcomes in three groups: SCTP recipients; population in Malawi not eligible for the SCTP and population in other countries. After estimating the direct effects and opportunity costs from investing in the SCTP, we summarize the results according to different perspectives. The SCTP is estimated to provide benefits in excess of costs from the perspective of national stakeholders. From the perspective of an international donor interested in health outcomes, its health benefits do not outweigh the opportunity costs unless health improvement in SCTP recipients is valued at 18 times that of other potential spending beneficiaries or the donor values broader outcomes than health alone. This work illustrates the potential of a cross-sectoral economic evaluation to guide debate about stakeholder contributions to the SCTP, and the value judgements required to favour the SCTP above other policy options.
| S-EPMC8757493 | biostudies-literature
Project description:There is promising recent evidence that poverty-targeted social cash transfers have potential to improve maternal health outcomes; however, questions remain surrounding design features responsible for impacts. In addition, virtually no evidence exists from the African region. This study explores the impact of Zambia's Child Grant Program on a range of maternal health utilization outcomes using a randomized design and difference-in-differences multivariate regression from data collected over 24 months from 2010 to 2012. Results indicate that while there are no measurable program impacts among the main sample, there are heterogeneous impacts on skilled attendance at birth among a sample of women residing in households having better access to maternal health services. The latter result is particularly interesting because of the overall low level of health care availability in program areas suggesting that dedicated program design or matching supply-side interventions may be necessary to leverage unconditional cash transfers in similar settings to impact maternal health.
| S-EPMC5488682 | biostudies-literature
Project description:In the United States, underachieving fertility desires is more common among women with higher levels of education and those who delay first marriage beyond their mid-20s. However, the relationship between these patterns, and particularly the degree to which marriage postponement explains lower fertility among the highly educated, is not well understood. We use data from the National Longitudinal Survey of Youth 1979 cohort to analyze differences in parenthood and achieved parity for men and women, focusing on the role of marriage timing in achieving fertility goals over the life course. We expand on previous research by distinguishing between entry into parenthood and average parity among parents as pathways to underachieving, by considering variation in the impact of marriage timing by education and by stage of the life course, and by comparing results for men and women. We find that women with a bachelor's degree who desired three or more children are less likely to become mothers relative to women with the same desired family size who did not attend college. Conditional on becoming mothers, however, women with at least a bachelor's degree do not have lower completed family size. No comparable fatherhood difference by desired family size is present. Postponing marriage beyond age 30 is associated with lower proportions of parenthood but not with lower parity among parents. Age patterns are similar for women and men, pointing at social rather than biological factors driving the underachievement of fertility goals.
| S-EPMC7732806 | biostudies-literature
Project description:BackgroundGiven the success of cash programs in improving health outcomes and addressing upstream drivers of HIV risk such as poverty and education, there has been an increasing interest in their potential to improve HIV prevention and care outcomes. Recent reviews have documented the impacts of structural interventions on HIV prevention, but evidence about the effects of cash transfer programs on HIV prevention has not been systematically reviewed for several years.Methods and findingsWe did a systematic review of published and unpublished literature to update and summarize the evidence around cash programs for HIV prevention from January 2000 to December 17, 2020. We included studies with either a cash transfer intervention, savings program, or program to reduce school costs. Included studies measured the program's impact on HIV infection, other sexually transmitted infections (STIs), or sexual behaviors. We screened 1,565 studies and examined 78 in full-text review to identify a total of 45 peer-reviewed publications and reports from 27 different interventions or populations. We did not do a meta-analysis given the range of outcomes and types of cash transfer interventions assessed. Most studies were conducted in sub-Saharan Africa (N = 23; South Africa, Tanzania, Malawi, Lesotho, Kenya, Uganda, Zimbabwe, Zambia, and eSwatini) followed by Mexico (N = 2), the United States (N = 1), and Mongolia (N = 1)). Of the 27 studies, 20 (72%) were randomized trials, 5 (20%) were observational studies, 1 (4%) was a case-control study, and 1 (4%) was quasi-experimental. Most studies did not identify a strong association between the program and sexual behaviors, except sexual debut (10/18 finding an association; 56%). Eight of the 27 studies included HIV biomarkers, but only 3 found a large reduction in HIV incidence or prevalence, and the rest found no statistically significant association. Of the studies that identified a statistically significant association with other STIs (N = 4/8), 2 involved incentives for staying free of the STI, and the other 2 were cash transfer programs for adolescent girls that had conditionalities related to secondary schooling. Study limitations include the small number of studies in key populations and examining interventions to reduce school costs and matched saving programs.ConclusionsThe evidence base for large-scale impacts of cash transfers reducing HIV risk is limited; however, government social protection cash transfer programs and programs that incentivize school attendance among adolescent girls and young women show the greatest promise for HIV prevention.
| S-EPMC8668130 | biostudies-literature
Project description:BackgroundChild marriage has long been a public health concern around the world, because it has the potential to deprive adolescent girls of their sexual reproductive health rights and limits their ability to reach their full potential in life. The prevalence of child marriage has been consistently higher in sub-Saharan Africa than elsewhere. However, fewer studies have explored the influence of both individual and community-level influences on early marriage in sub-Saharan Africa. This study, therefore, examined individual and community-level factors associated with child marriages in Zambia.MethodsData came from the Zambia Demographic and Health Surveys (ZDHS) conducted in 2007, 2013-14 and 2018. A pooled weighted sample of 9990 women aged 20-29 years was used in the analysis. Stata software version 17 was used to perform statistical analysis, taking into account complex survey design. The association between individual- and community- level factors and early marital behavior was assessed using multilevel logistic regression models.ResultsThe prevalence of child marriage among women aged 20-29 was 44.4 percent (95% CI: 42.1, 46.7) in 2018, declining from 51.5 percent (95% CI: 48.9, 54.0) in 2007. Women with secondary or higher level of education [aOR = 0.36, 95% CI = 0.26-0.49] and [aOR = 0.07, 95% CI = 0.03-0.18] and those whose age at first birth was (15-19 year) or (20-29 years) were associated with less likelihood of experiencing child marriage. Communities with a high percentage of women who gave birth at a young age [aOR = 1.36, 95% CI = 1.15-1.62] were more likely to experience child marriage. Individual and community-level characteristics accounted for 35% of the overall variations in communities' likelihood of experiencing early marriage. Even after controlling for both individual and community-level influences, the intra-class correlation revealed that around 4.5 percent of the overall variations remained unexplained.ConclusionPrevalence of child marriage has reduced over the years but is still high in Zambia. Both individual and community- level factors influenced child marriage in Zambia. There is a need to strengthen strategies that keep girls in school to delay their exposure to early sexual debut and child marriage. Designing of reproductive health interventions in the country should consider integration of community factors such as economic insecurity and access to reproductive health information.
| S-EPMC9843915 | biostudies-literature
Project description:Conditional cash transfers (CCTs) have become important components of social protection policies in Latin America. By establishing coresponsibilities tied to health and education, CCTs may reduce poverty and encourage human capital investment. While CCT programs can have unintended effects on sexual and reproductive health outcomes, such effects have been mixed and poorly documented in South America. This study examines the impact of Ecuador's CCT program, Bono de Desarrollo Humano, on contraceptive behavior among women of childbearing age who are sexually active and do not wish to become pregnant. We analyze nationally representative data in a regression-discontinuity quasi-experimental design. Using an instrumental variable approach and a set of robustness checks, our study finds no significant effects of the CCT program on contraceptive use. Our results offer important considerations for the ongoing policy debate in South America regarding the effects of cash transfer programs on beneficiaries.
| S-EPMC8011311 | biostudies-literature
Project description:BackgroundPreventing early marriage by increasing girls education has shown promise. We assessed the effects of a two-year cash plus program on marriage and fertility in a pastoralist setting in Northeastern Kenya, six years after it began.MethodsA prospective 80-cluster randomized trial followed 2,147 girls 11-14 years old starting in 2015, re-interviewing 94.2% in 2021. Interventions included community dialogues (violence prevention), a conditional cash transfer (education), health and life skills training (health), and financial literacy (wealth creation). Villages were randomized to one of four study arms: (1) violence prevention only (V-only); (2) + education (VE); (3) + health (VEH); or (4) + wealth creation (VEHW). We used analysis of covariance to estimate intent-to-treat impacts of each study arm with an education component, as well as a pooled (weighted average) study arm combining VE, VEH and VEHW, in reference to V-only, four years after the intervention ended when girls were 17-20 years old.FindingsBase specification estimates show reductions in the primary outcomes, though none statistically significant in the full sample. Estimates with extended controls are larger and the pooled study arm had significantly lower marriage and pregnancy. There are considerably larger statistically significant effects for the baseline out-ofschool subsample. Pooled estimates indicate 18.2 percentage point lower marriage compared to V-only and 15.1 percentage point lower pregnancy. For the same group pooled estimates indicate a 27.9 percentage point increase in current enrollment (compared to 7.1% in V-only) and a 1.8 grades increase (compared to 1.2 in V-only).ConclusionThis study shows the potential for interventions in early adolescence with an education component to delay marriage and fertility into late adolescence and early adulthood in a marginalized and socially conservative setting with low education and high rates of child marriage.
| S-EPMC10992718 | biostudies-literature