Long Term Effects of an Intervention on maternal behavior, child health, and community influence

项目总结 在关键的产前和围产期未充分利用卫生保健被认为起着重要的作用 在解释发展中国家儿童健康状况不佳方面的作用。需求方的创新，通常 包括使用货币奖励措施，已被证明能促使更多人接受保健服务， 但一个关键的悬而未决的问题是，它们是否会改善健康状况。作为对此的回应 我们进行了有史以来最早的大规模随机分组试验之一 激励措施。在2,300多个人口普查统计地区有10,000多名孕妇 尼日利亚参加了这一试验。在随机分配到干预的组中，孕妇被 提供现金支付14美元，如果他们参加了至少三次产前检查，在健康状况下分娩 并参加了一次产后探视。在对照组中，孕妇收到了一份价值 参赛费用为0.43美元。我们发现，在干预中，手臂对产前和围产期护理的利用更多 超过一倍，妇女得到更高质量的护理，最终显著减少了胎儿损失 和死产，以及儿童死亡率总体下降。在接下来的R01中，我们建议返回到 研究社区在随机对照试验后大约5年。我们有三个主要目标：第一，我们想要 检查激励措施是否对母亲的行为产生了长期影响，第二，我们想衡量 对儿童健康的长期影响，最后我们想检查这些激励措施是否会产生 社区溢出效应。

PROJECT SUMMARY Under-utilization of health care during the critical pre- and perinatal periods is believed to play an important role in explaining poor child health outcomes in developing countries. Demand-side innovations, often involving the use of monetary incentives, have been shown to induce greater uptake of health services, but a key unanswered question has been whether they lead to improvements in health. In response to this evidence gap we conducted one of the first ever large-scale cluster randomized trials of conditional incentives. More than 10,000 pregnant women across more than 2,300 census enumeration areas in Nigeria participated in this trial. In clusters randomly assigned to the intervention, pregnant women were offered cash payments of $14 payable if they attended at least three prenatal visits, delivered in a health facility, and attended one postnatal visit. In control clusters, pregnant women received a small gift worth $0.43 for participation. We found that in the intervention arm utilization of pre- and perinatal care more than doubled and women received better quality care, culminating in a significant reduction in fetal losses and stillbirths, and an overall decrease in child mortality. In this follow-on R01 we propose to return to the study communities approximately 5 years after the RCT. We have three main objectives: first, we want to examine whether the incentives had long run effects on maternal behavior, second, we want to measure long run effects on child health, and finally we want to examine whether the incentives generated community spillovers.