Giving women a cash payment just before they give birth could halve infant mortality rates and provide a cost-effective way of saving lives in the face of shrinking aid budgets, a study in Kenya has suggested.
Households across 653 villages that were given a one-off, no-strings-attached payment of $1,000 dollars (£740) around the time of birth had 48 per cent fewer children die before the age of one and 45 per cent fewer die before the age of five.
The money, sent via a mobile phone money transfer, allowed women to access pre-natal care, give birth in hospital and work less in the six months surrounding the birth, the researchers from University of California, Berkeley and the non-profit GiveDirectly said.
Dr. Miriam Laker, an infectious diseases doctor in Uganda a senior research advisor at GiveDirectly said the charity was, “looking at the current funding climate,” including Donald Trump’s slashing of foreign aid, and saying: “A lot of health facilities were improved by the [US] funding in the past. They already exist, they are staffed, they have the resources. Can we use cash transfers to let whoever can access these services access them?”
That cash could come from other large donors or from individuals’ charitable giving, she suggested.
The timing was important though, with the cash having the biggest effects on infant survival if it was given in the month before birth. The biggest gains were among newborns, and mothers given the cash were 51 per cent more likely to deliver in hospital.
As well as paying for healthcare, women also used the money to work less in the three months before, and three months after, their babies arrived.
As aid cuts not just in the US but across Europe bite, health programs are, “all under so much pressure to do much more with less,” Dr Laker said.
Cash transfers can be given very quickly and easily, cutting out middlemen and so keeping costs down, she suggested.
She compared the deaths prevented to other things aid donors might spend money on: childhood vaccines (21 per cent); insecticide-treated bed nets (17 per cent) and preventative malaria pills (57 per cent).
While all important to fund, “they all tend to address one link in the chain,” she said. “Cash transfers work at many points in the chain,” for example allowing mothers to pay for transport to clinics, the healthcare itself and for nutrition for themselves and their children.
It also gives people more agency when it comes to their own health priorities, Dr Laker said. Once people get cash transfers, when, where and how they use it is up to them, she added.
“We're removing that power that cash would otherwise give us as the people [who are] giving. And so it is very respectful for the recipients.”
However, the study found cash transfers alone were not enough. The cash had a much bigger impact on babies’ survival in families that lived closer to a doctor.
“No matter how beautiful and well-resourced the health facility is, if the people for whom it is intended cannot access it…then there is no point in having that health facility,” Dr Laker said.
“One particular evening that I can't forget, I was just leaving my station. And this woman was brought into hospital. She’d been in labour for three days. Her baby was outside of the womb and was breech.
“And when I asked the family what happened, they didn't even live that far away,” Dr Laker explained. “They said, ‘You know, we could not afford to get any mode of transportation to get her here.’ And I said, ‘We have a practically world-class facility but the people who need to access it cannot come here.’”
Dr Clare Relton at Queen Mary University of London, who described the findings as “significant”, said there was, “quite a lot of fear about giving people money [directly]. There's a lot of prejudice.”
“We can keep on proving that actually offering these cash transfers or vouchers are a huge benefit to the different parts of society, very important parts of society: children, mothers, our future. But it's the how that is the million dollar question”.
She added that the study should be considered not just in the context of, “the UK giving to other countries [but] what can we learn from the study as a country,” when it came to the UK’s own “huge inequity in maternal and infant health”.
This article is part of The Independent’s Rethinking Global Aid project
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