A few tried-and-true methods, such as anti-malarial medications, bed nets, and immunizations, can save the lives of newborns and young children in low- and middle-income nations. Another is cash, according to the findings of a large experiment conducted in rural Kenya.
According to a National Bureau of Economic Research analysis released Monday, children delivered to recipients of $1,000 in cash with no conditions were nearly half as likely to die as newborns born to recipients of no money. Researchers discovered that cash reduced mortality in children under five by roughly 45%, which is comparable to the effects of vaccinations and antimalarial drugs.
“This paper is really well done, and the result itself is pretty stunning,” says Heat Henderson, a Drake University economist who did not participate in the study. It has historically been “difficult to study the impacts of cash transfers on mortality with any sort of rigor,” he comments. He asserts, “This study is different,” and shows that money can assist people receive life-saving medical care.
The notion of merely providing cash to those living in poverty has gained popularity over the last ten or so years, partly due to evidence that it can be effective. Randomized controlled trials are the best source of data, according to academics. An experimental group receives cash in this setup, while a control group does not. Researchers then look for variations in quantifiable outcomes, such as income or savings, to determine the impact of the cash.
Cash transfers and economic well-being have been clearly linked in research, but health has been more difficult to determine, particularly for the most severe health outcomes.
Edward Miguel, a co-author of the study and an economist from the University of California Berkeley, states that infant and child mortality in rural Kenya is “an order of magnitude higher than it is in the U.S.” However, child death is still a somewhat uncommon occurrence. According to statistics, this indicates that in order to obtain accurate and trustworthy estimates of the impact of cash on child mortality, we need a very high sample size.
$1,000 to 10,000 families
The nonprofit GiveDirectly started a large-scale experiment in 2014. They distributed $1,000 to more than 10,000 low-income households in 653 Western Kenyan villages over the course of the following three years.
Miguel explains, “It was intended as a randomized control trial.” Thus, certain regions received greater funding. We can examine the effects of the money that certain people received less of.”
Miguel and his colleagues gathered a lot of information to investigate that influence. They filled out a sort of birth census for every kid born in the study area who had passed away before turning five during the preceding ten years. “In the end, we gathered information on more than 100,000 births. It was completed in a year.
They discovered that cash significantly reduced baby and toddler mortality, particularly when it was given shortly before delivery.
Infant mortality decreased by 48% as a result of cash transfers, from about 40 deaths per 1,000 births to about 21 deaths. Children under five died at a rate of 32 per 100,000 births, down from 57 in homes that received cash, a 45% decrease.
Cash significantly contributed to a 70% decrease in delivery and postpartum fatalities when compared to controls. “That really pointed toward a key role for access to health services right at the moment of delivery being very important,” Miguel explains.
Why cash cut deaths
It can be challenging for many people in rural sub-Saharan Africa to go to a medical facility and pay for care there, particularly if they are pregnant.
According to Miriam Laker-Oketta, senior research adviser at GiveDirectly, “one of the things that was really clear for pregnant women when I worked in rural parts of Uganda was they did not attend antenatal care, because it’s so difficult to get to a health care facility.”
Since women frequently have to take a day off work to visit the doctor, she says, “You’re making the decision between, should I go for antenatal care and have my family sleep hungry, or should I stay home and hope that my baby is fine because I’m not feeling sick and we can have a meal that day.” “Those are some of the decisions people have to make.”
As long as medical services are close by, having more money seems to make those decisions easier.
For families who live 30 minutes or fewer from a medical institution with doctors on site, cash made the biggest difference. The advantages of cash for babies begin to diminish, but do not completely vanish, with increasing distance.
Pregnant women who got cash had 45% more hospital deliveries than those who did not, according to the researchers. According to Laker-Oketta, giving birth in a hospital is frequently more costly than at a smaller clinic. “We’ve given people the means to access the care that they need and not to make some of these really difficult choices between getting care and feeding a family.”
Additionally, the additional money helped put more food on the table. According to the study, children in households that received cash had a 44% lower chance of going to bed hungry. In addition to working around 21 less hours per week throughout their third trimester and the months following delivery, women who received cash during their pregnancies also worked roughly half as much as those who did not. According to Laker-Oketta, working in these rural locations can frequently be physically demanding.
“That’s great for the mother’s health, but also gives time for her baby to develop well,” she adds. “She’s also available after the baby is born to take the child to any early health visits.”
A ‘very important’ data point
Overall, the findings impressed Aaron Richterman, a doctor who is not engaged in the study but studies poverty alleviation at the University of Pennsylvania.
It’s just one piece of information, but it’s a crucial one. In this instance, we can be absolutely positive that the money is the reason for the mortality benefits we are witnessing,” he says. He claims that cash could be a straightforward method of lowering infant mortality in a setting where foreign aid is decreasing.
How easily people in other places can use the additional funds to receive health care may determine just how much of an impact money could have.
Henderson, the Drake economist and author of Poor Relief: Why Giving People Money Is Not The Answer To Global Poverty, stated, “I think this paper underscores the point that it’s really adequate access to health care that’s making all the difference.””It just so happens that in this particular place, people needed cash to access health care.”
According to Laker-Oketta, such is probably the case in many, but not all, locations in sub-Saharan Africa following years of investment in strengthening health care systems.
“The answer is not we give cash alone, or we just focus on improving the health care system,” she states. “What’s obvious in this study is that you need both to be working together.”
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