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

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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.