While conditional cash transfers (CCTs) have been well documented to improve school enrollment and attendance (Fiszbein and Schady, 2009; Hanlon, Barrientos, and Hulme, 2010; Saavedra and Garcia, 2012), the evidence of their impact on health outcomes is mixed. Virtually all CCTs have increased the use of preventive health and nutrition activities (Ranganathan and Lagarde, 2012; Gaarder, Glassman, and Todd, 2010; Lagarde, Haines, and Palmer, 2007). However, these programs have generally not led to improvements in anthropometry, although a few have reported meaningful impacts on selected nutritional outcomes (Ruel and Alderman, 2013). A meta-analysis of 17 programs that combined CCTs and unconditional cash transfers shows a mean impact of 0.025 on height-for-age z scores (HAZs), an effect size that is neither statistically significant nor biologically meaningful (Manley, Gitter, and Slavchevska, 2013). Perhaps unsurprisingly, the evidence on the long-term effects of CCTs largely focuses on the persistence of education impacts rather than cognitive, socioemotional or indeed health and nutrition outcomes (Molina Millán et al., 2019). In contrast, studying the conditional cash transfer in the Philippines, Pantawid, Kandpal et al. (2017) find substantial decreases in extreme stunting rates among beneficiary children in their first 1000 days of life.
Building on the large-scale randomized impact evaluation of Pantawid, this proposed study will contribute evidence on the persistent impacts of CCTs during the developmentally critical first 1000 day period on medium-run (approximately 10 years later) outcomes. Specifically, it will ask whether beneficiary children who received the program in utero or within the first 1000 days of life still differ from those who did not receive it, approximately ten years after the initial impact evaluation survey. We will seek to understand the impacts of the Pantawid program “shock”, operating chiefly through early life nutrition, on educational attainment, cognitive and socioemotional skills, and child work and disease histories. While control communities have entered the program since the survey for the first-round impact evaluation in 2011, exogenous variation in a cohort of children who received this shock at a critical stage in their growth has been maintained. We will exploit this variation in comparing cohorts that received the program in utero or the first 1000 days of life to the same cohorts in control communities which received the program after this malleable window had passed for these cohorts. This comparison will allow us to causally identify any medium run effects of Pantawid that operated through the discussed nutrition and health channels specific to early life. This component of the study would thus test the hypothesis that it is investments during a critical period in early child development that lead to sustained impacts. Alternatively, if sustained impacts aren’t identified, then benefits from catch-up investments made later in the child’s life are an attainable possibility.