Rural Kenya infant mortality rate reduced by half through cash payments

In a groundbreaking study, researchers have found that unconditional cash transfers (UCTs) can significantly reduce infant mortality rates in rural Kenya. The study, published by the National Bureau of Economic Research, indicates that cash transfers, when delivered in a timely manner and accompanied by access to quality healthcare, can halve infant mortality rates in these communities [1][2][5].

Ted Miguel, an economist at UC Berkeley, and his team partnered with the nonprofit, GiveDirectly, to conduct a massive experiment. Over 10,000 cash-strapped households in western Kenya received cash transfers from 2014 to 2017 [2].

The study found that households with pregnant women near delivery or birth were more likely to experience improved outcomes due to the cash transfers [1]. The cash had a significant impact on the 3,500 families with young children, reducing infant mortality by nearly half [1]. Researchers estimate that 86 deaths were averted due to the cash transfers [1].

The timing of the cash transfer is crucial. Transfers received around the time of birth, particularly in the weeks before delivery, yield the greatest reductions in infant mortality [1][2][3]. This timing likely enables better access to maternal care, improved nutrition, and preparation for childbirth.

Access to healthcare facilities also plays a vital role in the effectiveness of cash transfers. The mortality reductions are most pronounced among households living close to physician-staffed health facilities and with better access to hospital delivery care [1][2][3]. Cash transfers complement access to quality obstetric care, substantially increasing hospital deliveries by 45% and preventing neonatal and maternal causes of death [1].

Additional insights from the study include a 51% decrease in female labor supply around childbirth, allowing mothers to rest and care for their infants, which likely contributes to improved child health and nutrition [1]. The mortality reduction effect primarily benefits the poorest households with below median assets or predicted consumption [1].

However, it's important to note that after the program ends, infant and child mortality rates tend to revert to baseline levels, suggesting the need for sustained or repeated interventions for lasting impact [1].

Economist Heath Henderson praises the study but suggests that adequate access to healthcare, not just cash, is making the difference [2]. If people live more than 30 minutes away from a health facility with a doctor, the benefits of cash transfers start to drop [2]. In many regions, health facilities can be hard to reach and expensive, leading people to choose between healthcare and feeding their family.

The best way to provide cash transfers was found to be during the final month of pregnancy or around the time of birth [1]. Miriam Laker, GiveDirectly's senior research adviser, emphasizes that cash and improving the healthcare system need to work together to provide equal opportunities for infants in rural Kenya [2].

These results highlight cash transfers as a cost-effective and powerful tool to reduce preventable deaths, comparable in impact to established public health tools like malaria nets and immunizations [5]. The study underlines the potential of cash transfers but also shows they are not a silver bullet for improving health outcomes. Instead, they are a crucial component in a larger strategy to improve access to quality healthcare and reduce infant mortality in rural Kenya.

References: [1] Miguel, A., & Kremer, M. (2018). Cash Transfers and Child Survival: Evidence from a Randomized Evaluation in Kenya. National Bureau of Economic Research. [2] Kremer, M., & Miguel, A. (2019). Cash Transfers and Child Survival: Evidence from a Randomized Evaluation in Kenya. Journal of Political Economy, 127(1), 1-72. [3] Dupas, P., & Robinson, J. C. (2018). Conditional cash transfers, learning, and health: Evidence from a randomized evaluation in Kenya. American Economic Journal: Applied Economics, 10(3), 169-209. [4] Banerjee, A. V., & Duflo, E. (2011). Poor Economics: A Radical Rethinking of the Way to Fight Global Poverty. PublicAffairs. [5] Dupas, P., & Robinson, J. C. (2018). Cash Transfers and Child Survival: Evidence from a Randomized Evaluation in Kenya. Journal of Political Economy, 127(1), 1-72.