The Health Impacts of Maternal Cash Transfers

Last registered on May 20, 2019

Pre-Trial

Trial Information

General Information

Title
The Health Impacts of Maternal Cash Transfers
RCT ID
AEARCTR-0004189
Initial registration date
May 14, 2019

Initial registration date is when the trial was registered.

It corresponds to when the registration was submitted to the Registry to be reviewed for publication.

First published
May 20, 2019, 2:28 PM EDT

First published corresponds to when the trial was first made public on the Registry after being reviewed.

Locations

Region

Primary Investigator

Affiliation
Duke University

Other Primary Investigator(s)

PI Affiliation
University of Michigan

Additional Trial Information

Status
Completed
Start date
2016-02-01
End date
2019-04-30
Secondary IDs
Abstract
In 2014, the Union Government of Myanmar launched a National Social Protection Strategy with the aim of improving social assistance for the most vulnerable populations. Among other programs, the social protection plan comprises a large-scale pilot of a maternity and cash transfer program, aimed to ensure universal coverage for pregnant women and their children under two years of age.

This study will evaluate the causal impact of the maternal cash transfer program pilot on child nutrition, health, knowledge and adoption of health and hygiene practices, consumption, and labor outcomes. The experimental design varies the provision of cash transfers alone, or cash transfers paired with health informational meetings (SBCC), on a sample of about 6000 women in three townships of Myanmar dry zone. In the control group (149 villages), no program activities will be conducted. In one treatment arm (146 villages), cash transfers worth USD6.5–10 will be delivered to eligible women on a monthly basis. In the other treatment arm (142 villages), the cash transfers will be paired with a social behavioral communication change intervention (SBCC), which encompasses monthly informational meetings on nutrition, health, hygiene, and spending.

The project aims to rigorously evaluate program impacts, and to support government partners to make informed decisions about cash delivery design. The study is funded by the Livelihoods and Food Security Fund and the International Growth Center, and it will be conducted in partnership with Save the Children.
External Link(s)

Registration Citation

Citation
Field, Erica and Elisa M. Maffioli. 2019. "The Health Impacts of Maternal Cash Transfers." AEA RCT Registry. May 20. https://doi.org/10.1257/rct.4189
Former Citation
Field, Erica and Elisa M. Maffioli. 2019. "The Health Impacts of Maternal Cash Transfers." AEA RCT Registry. May 20. https://www.socialscienceregistry.org/trials/4189/history/46888
Sponsors & Partners

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Experimental Details

Interventions

Intervention(s)
The intervention will be implemented according to the following scheme:

• Control group: No program activities will take place.
• Treatment group 1 – Cash+SBCC: Cash transfers and social behavioral communication change (SBCC) activities will be provided jointly.
• Treatment group 2 – Cash-only: only cash transfers will be provided, and minimal information about the main purpose of the cash transfers will be shared via pamphlet or poster advertisement.

In treated areas, all women in their second and third trimesters of pregnancy will be eligible to receive monthly cash transfers worth 10,000-15,000MMK (6.50–10USD) for the remainder of their pregnancy as well as for the first 23 months of their new born child’s life. The purpose of cash transfers is to facilitate the purchase of nutritious foods and enhance access to appropriate healthcare services. In addition to cash transfers, a subset of beneficiaries will also be invited to attend monthly informational community meetings (SBCC intervention) on various topics such as nutrition, health, hygiene, breastfeeding practices, and financial management, for the whole duration of the program.

The intervention will be implemented across three townships in Myanmar dry zone, in collaboration with local partners such as Save the Children International (SCI), the Myanmar Midwives and Nurses Association (MNMA), and Pact Global Microfinance (PGMF). PGMF will be responsible for cash delivery across study areas, and MNMA will be in charge of enrolling eligible mothers into the program and delivering health information during SBCC community gatherings.
Intervention Start Date
2016-05-01
Intervention End Date
2019-04-30

Primary Outcomes

Primary Outcomes (end points)
Children anthropometrics: Measures of wasting, stunting, and underweight in children 0-5yo.
Primary Outcomes (explanation)
Child nutrition is the primary focus of the evaluation. Anthropometrics of nutrition adequacy offer objective and direct measures of well-being, and will be measured by a team of experienced surveyors for all biological children aged 0-5 years living in the household of each survey respondent. We will then build standard indicators of wasting, stunting, and underweight according to the most updated FAO/WHO guidelines. Outliers that are anomalous according to biological standards will be excluded from the analysis.

Secondary Outcomes

Secondary Outcomes (end points)
Health behavior: Mother and child dietary diversity, knowledge and adoption of breastfeeding practices, adoption of hygiene practices, use of antenatal and postnatal care services.
Secondary Outcomes (explanation)
• Child dietary diversity score (DDS): Dietary diversity is a qualitative measure of food consumption that reflects access to a variety of foods, and is also a proxy for nutrient adequacy of the diet of individuals. In a one-to-one interview, we will ask mothers to report food consumption in the past 24 hours for their children aged 6–23 months. For each child, we will then build a DDS by adding up all food categories consumed in the previous day (e.g. beans, meat, vegetables, etc). Anomalous outliers (e.g. DDS with value 0) will be regularly counter-checked during data collection, and excluded from the analysis whenever auditing is not feasible.
• Women dietary diversity score (DDS): Dietary diversity is a qualitative measure of food consumption that reflects access to a variety of foods, and is also a proxy for nutrient adequacy of the diet of individuals. In a one-to-one interview, we will ask all mothers in the sample to report their own food consumption in the past 24 hours. For each woman, we will then build a DDS by adding up all food categories consumed in the previous day (e.g. meat, eggs, vegetables, etc). Anomalous outliers (e.g. DDS with value 0) will be constantly counter checked during data collection, and excluded from the analysis whenever auditing is not feasible.
• Knowledge of breastfeeding practices: In a one-to-one interview, all mothers will be asked to report the correct definition or optimal timing of various breastfeeding practices such as exclusive breastfeeding, early initiation of breastfeeding, and complementary feeding. We will create binary variables indicating whether mothers reported to know each practice correctly, or not. In this set of variables, we will limit the presence of missing values.
• Adoption of breastfeeding practices: In a one-to-one interview, all mothers will be asked to report about the feeding practices they are currently using with their youngest children, such as exclusive breastfeeding (children 0-5mo), early initiation of breastfeeding (children 0-23mo), and complementary feeding (children 6-9mo). In this set of variables, we will limit the presence of missing values.
• Adoption of hygiene practices: In a one-to-one interview, all mothers will be asked to report about various WASH indicators, such as water treatment, water storage, and hand-washing behavior. We will collect measures of safe water treatment used in the household (such as boiling, chlorination, filtration, etc), and water storage practices, which will not only be asked to study participants, but also verified by surveyors while administering the survey interview. Additionally, we will collect self-reported measures of hand-washing behavior in the past 24 hours in various situations, and will build a hand-washing index by adding up all hand-washing measures (e.g. washed hands after disposing baby feces, before preparing food, before feeding children, etc). In this set of variables, we will limit the presence of missing values.
• Antenatal and postnatal care: In a one-to-one interview, all mothers who had at least one pregnancy will be asked to report about their use of healthcare services before and up to 6 weeks after childbirth. We will collect measures of use of these services, such as frequency, type, and cost of chosen assistance. We will then build additional variables indicating the number of times each mother visited or used a specific health service (e.g. number of visits with skilled health personnel – such as doctors and midwives – during prenatal period, and up to 6 weeks after childbirth). In this set of variables, we will limit the presence of missing values and exclude anomalous outliers from the analysis.

Experimental Design

Experimental Design
This randomized controlled trial aims to measure the causal impact of a cash transfer pilot program, in combination with SBCC, on the health and nutrition of target beneficiaries in Myanmar. The randomization unit employed in this study is sub-rural healthcare catchment areas, and was chosen based on presence of healthcare infrastructure within study areas. In total, 102 catchment areas (henceforth referred to as “clusters”) across three townships were grouped into 34 triplets that serve as geographic strata. Within each triplet, each cluster was randomly assigned to either treatment group 1 (T1), treatment group 2 (T2), or a comparison group. Specifically, clusters were randomly assigned as follows:

• Control group: 34 sub-rural healthcare catchment areas, encompassing a total of 149 villages, where no LEGACY activity will take place.
• Treatment group 1 (T1 – Cash+SBCC): 34 sub-rural healthcare catchment areas, encompassing a total of 142 villages, where monthly cash transfers and SBCC activities will be provided jointly.
• Treatment group 2 (T2 – Cash-only): 34 sub-rural healthcare catchment areas, encompassing a total of 146 villages, where only monthly cash transfers will be provided; minimal information about the main purpose of the cash transfers will be communicated via pamphlet or poster advertisement.

Random assignment ensures that any potential changes or differences across study-groups can be directly attributed to the intervention. Therefore, the design will allow researchers to compare the outcomes of the comparison group to those of the treatment groups up to 30 months after the intervention, and to assess the impact of cash (T2) as well as the incremental impact of the informational meetings supplement (T1).
Experimental Design Details
This randomized controlled trial aims to measure the causal impact of a cash transfer pilot program, in combination with SBCC, on the health and nutrition of target beneficiaries in Myanmar. The randomization unit employed in this study is sub-rural healthcare catchment areas, and was chosen based on presence of healthcare infrastructure within study areas. In total, 102 catchment areas (henceforth referred to as “clusters”) across three townships were grouped into 34 triplets that serve as geographic strata. Within each triplet, each cluster was randomly assigned to either treatment group 1 (T1), treatment group 2 (T2), or a comparison group. Specifically, clusters were randomly assigned as follows:

• Control group: 34 sub-rural healthcare catchment areas, encompassing a total of 149 villages, where no LEGACY activity will take place.
• Treatment group 1 (T1 – Cash+SBCC): 34 sub-rural healthcare catchment areas, encompassing a total of 142 villages, where monthly cash transfers and SBCC activities will be provided jointly.
• Treatment group 2 (T2 – Cash-only): 34 sub-rural healthcare catchment areas, encompassing a total of 146 villages, where only monthly cash transfers will be provided; minimal information about the main purpose of the cash transfers will be communicated via pamphlet or poster advertisement.

Random assignment ensures that any potential changes or differences across study-groups can be directly attributed to the intervention. Therefore, the design will allow researchers to compare the outcomes of the comparison group to those of the treatment groups up to 30 months after the intervention, and to assess the impact of cash (T2) as well as the incremental impact of the informational meetings supplement (T1).
Randomization Method
A computer-based randomization was conducted by the Principal Investigators in Duke University offices, in March 2016.
Randomization Unit
The geographic unit of randomization is based on existing healthcare infrastructure: sub-rural healthcare center catchment areas. In total, 102 catchment areas (which we henceforth refer to as “clusters”) across three townships in Myanmar — located within two hours from an urban center or settlement – are grouped into 34 cluster triplets that serve as geographic strata. Within each triplet, each cluster is randomly assigned to either treatment group 1 (T1), treatment group 2 (T2), or the comparison group.
Was the treatment clustered?
Yes

Experiment Characteristics

Sample size: planned number of clusters
102 sub-rural catchment areas (selection based on presence of healthcare facilities).
Sample size: planned number of observations
Approximately 6000 women.
Sample size (or number of clusters) by treatment arms
• Control group: 34 sub-rural healthcare catchment areas, encompassing a total of 149 villages.
• Treatment group 1 (T1 – Cash+SBCC): 34 sub-rural healthcare catchment areas, encompassing a total of 142 villages.
• Treatment group 2 (T2 – Cash-only): 34 sub-rural healthcare catchment areas, encompassing a total of 146.
Minimum detectable effect size for main outcomes (accounting for sample design and clustering)
IRB

Institutional Review Boards (IRBs)

IRB Name
Duke Campus IRB
IRB Approval Date
2016-04-25
IRB Approval Number
D0465
IRB Name
Innovations for Poverty Action IRB
IRB Approval Date
2016-04-01
IRB Approval Number
12109
IRB Name
Department of Medical Research, Government of the Republic of the Union of Myanmar
IRB Approval Date
2016-07-15
IRB Approval Number
003916

Post-Trial

Post Trial Information

Study Withdrawal

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Intervention

Is the intervention completed?
Yes
Intervention Completion Date
April 30, 2019, 12:00 +00:00
Data Collection Complete
Yes
Data Collection Completion Date
March 31, 2019, 12:00 +00:00
Final Sample Size: Number of Clusters (Unit of Randomization)
102 sub-rural catchment areas (selection based on presence of healthcare facilities).
Was attrition correlated with treatment status?
No
Final Sample Size: Total Number of Observations
4972 women, 5000 U5 children.
Final Sample Size (or Number of Clusters) by Treatment Arms
• Control group: 34 sub-rural healthcare catchment areas, encompassing a total of 147 villages and 1458 mothers. • Treatment group 1 (T1 – Cash+SBCC): 34 sub-rural healthcare catchment areas, encompassing a total of 141 villages and 1811 mothers. • Treatment group 2 (T2 – Cash-only): 34 sub-rural healthcare catchment areas, encompassing a total of 141 villages and 1703 mothers.
Data Publication

Data Publication

Is public data available?
No

Program Files

Program Files
No
Reports, Papers & Other Materials

Relevant Paper(s)

Reports & Other Materials