Skip to main content
SpringerLink
Log in

Do Behavioral Interventions Enhance the Effects of Cash on Early Childhood Development and Its Determinants? Evidence from a Cluster-Randomized Trial in Madagascar

  • Original Article
  • Published:
The European Journal of Development Research Aims and scope Submit manuscript

Abstract

There is growing interest in how best to leverage cash transfers to foster positive impact on children in beneficiary households. We evaluate the effects of interventions based on behavioral science on measures of early childhood socio-cognitive development (and related household-level outcomes) for children from households receiving cash transfers in Madagascar using a multi-arm cluster-randomized trial, where communities were randomized into arms, with 77 communities in each arm and approximately 950 and 1200 households sampled at baseline and midline, respectively. Three behavioral interventions (a ‘Mother Leaders’ group, either by itself or augmented with a ‘self-affirmation’ or a ‘plan-making’ nudge) are layered onto a child-focused cash transfer program targeting the rural poor in Madagascar with children aged 0–6. Approximately 18 months into the implementation of these interventions, we find evidence that households in the behaviorally enhanced arms undertake more desirable parenting behaviors, interact more with their children, prepare more (and more diverse) meals at home, and report lower food insecurity than households that received only cash, and children in these arms perform better than children from households in the cash-only arm on several measures of socio-cognitive development including language learning and social skills. This is promising evidence that behavioral interventions can add significant value to cash transfer programs that aim to improve human development outcomes. (AEARCTR-0000957).

Résumé

Il y a un intérêt croissant pour savoir comment mieux exploiter les transferts d'argent pour favoriser un impact positif sur les enfants dans les ménages bénéficiaires. Nous évaluons les effets des interventions basées sur les sciences comportementales sur les mesures du développement socio-cognitif précoce (et les résultats connexes au niveau des ménages) pour les enfants des ménages recevant des transferts d'argent à Madagascar en utilisant un essai randomisé en grappes à plusieurs bras, où les communautés ont été randomisées en bras, avec 77 communautés dans chaque bras et environ 950 et 1 200 ménages échantillonnés à la ligne de base et à la mi-parcours, respectivement. Trois interventions comportementales (un groupe de 'Mères Leaders', soit par lui-même ou augmenté avec une 'auto-affirmation' ou une incitation à 'faire des plans') sont superposées à un programme de transfert d'argent axé sur l'enfant ciblant les pauvres ruraux à Madagascar avec des enfants âgés de 0 à 6 ans. Environ 18 mois après la mise en œuvre de ces interventions, nous trouvons des preuves que les ménages dans les bras améliorés comportementalement entreprennent des comportements parentaux plus souhaitables, interagissent davantage avec leurs enfants, préparent plus (et des repas plus divers) à la maison et signalent une insécurité alimentaire plus faible que les ménages qui n'ont reçu que de l'argent, et les enfants dans ces bras se comportent mieux que les enfants des ménages dans le bras uniquement en espèces sur plusieurs mesures du développement socio-cognitif, y compris l'apprentissage des langues et les compétences sociales. Ceci est une preuve prometteuse que les interventions comportementales peuvent ajouter une valeur significative aux programmes de transfert d'argent qui visent à améliorer les résultats du développement humain. (AEARCTR-0000957).

Resumen

Existe un creciente interés en cómo aprovechar mejor las transferencias de efectivo para fomentar un impacto positivo en los niños de los hogares beneficiarios. Evaluamos los efectos de las intervenciones basadas en la ciencia del comportamiento en medidas de desarrollo socio-cognitivo temprano en la infancia (y resultados relacionados a nivel del hogar) para niños de hogares que reciben transferencias de efectivo en Madagascar utilizando un ensayo de agrupación multi-brazo aleatorizado, donde las comunidades fueron aleatorizadas en brazos, con 77 comunidades en cada brazo y aproximadamente 950 y 1,200 hogares muestreados en la línea de base y en el punto medio, respectivamente. Tres intervenciones conductuales (un grupo de 'Madres Líderes', ya sea por sí solo o aumentado con un 'autoafirmación' o un 'estímulo para hacer planes') se superponen a un programa de transferencia de efectivo enfocado en los niños que apunta a los pobres rurales en Madagascar con niños de 0 a 6 años. Aproximadamente 18 meses después de la implementación de estas intervenciones, encontramos evidencia de que los hogares en los brazos mejorados conductualmente emprenden comportamientos parentales más deseables, interactúan más con sus hijos, preparan más (y más diversas) comidas en casa e informan una menor inseguridad alimentaria que los hogares que solo recibieron efectivo, y los niños en estos brazos se desempeñan mejor que los niños de hogares en el brazo solo de efectivo en varias medidas de desarrollo socio-cognitivo, incluyendo el aprendizaje del lenguaje y las habilidades sociales. Esta es una evidencia prometedora de que las intervenciones conductuales pueden agregar un valor significativo a los programas de transferencia de efectivo que buscan mejorar los resultados del desarrollo humano. (AEARCTR-0000957)

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

Data Availability

The data underlying this article will be shared on reasonable request to the corresponding author.

Notes

  1. The headcount measuring the percent of the population under the extreme poverty rate of US$1.90 (in PPP terms) was 76.2% in 2017 (http://www.worldbank.org/en/country/madagascar/overview).

  2. Chronic malnutrition affects 47.3% of children in Madagascar between 6 and 59 months (World Food Programme Country Brief, May 2018).

  3. Further details about the mother leader sessions and facilitators can be found here: http://www.womensworldbanking.org/wp-content/uploads/2019/06/CaseStudy-Madagascar.pdf.

  4. An inherent weakness of this pooling feature is that the design ignores the potential for within-commune spillovers between “enhanced” treatment conditions. This potential was judged to be low owing to the subtle nature of the differences in intervention types at the transfer payment point.

  5. This sample size was determined based on power calculations following standard economics assumptions of 5% significance and 80% power. We assumed a minimum detectable effect of 0.2 standard deviations, as is typically found for behavioral interventions, and assumed a standard intra-cluster correlation of 0.1.

  6. See https://www.instat.mg/ for more details.

  7. Pre-analysis plan registered at the American Economic Association and available at https://www.socialscienceregistry.org/trials/957/history/6111.

References

  • Adhvaryu, A., T. Molina, A. Nyshadham, and J. Tamayo. 2016. Helping children catch up: Early life shocks and the PROGRESA experiment.

  • Anderson, M.L. 2008. Multiple inference and gender differences in the effects of early intervention: A reevaluation of the Abecedarian, Perry Preschool, and Early Training Projects. Journal of the American Statistical Association 103 (484): 1481–1495.

    Article  MathSciNet  CAS  Google Scholar 

  • Arriagada, A.M., J. Perry, L. Rawlings, J. Trias, and M. Zumaeta. 2018. Promoting early childhood development through combining cash transfers and parenting programs. World Bank Working Paper Series, Washington, DC: World Bank Group.

  • Attanasio, O., C. Fernández, E. Fitzsimons, S. Grantham-McGregor, C. Meghir, and M. Rubio-Codina. 2014. Using the infrastructure of a conditional cash transfer program to deliver a scalable integrated early child development program in Colombia: Cluster randomized controlled trial. BMJ 349 (September): g5785.

    Article  PubMed  PubMed Central  Google Scholar 

  • Bastagli, F., J. Hagen-Zanker, L. Harman, V. Barca, G. Sturge, and T. Schmidt. 2016. Cash transfers: What does the evidence say? A rigorous review of programme impact and the role of design and implementation features. London: Overseas Development Institute.

    Google Scholar 

  • Baumeister, R.F., T.F. Heatherton, and D.M. Tice. 1994. Losing control: How and why people fail at self-regulation. San Diego: Academic Press.

    Google Scholar 

  • Benhassine, N., F. Devoto, E. Duflo, P. Dupas, and V. Pouliquen. 2015. Turning a shove into a nudge? A labeled cash transfer for education. American Economic Journal: Economic Policy 7 (3): 86–125.

    Google Scholar 

  • Black, M., S. Walker, L. Fernald, C. Andersen, A. DiGirolamo, C. Lu, and C. McCoy. 2017. Early childhood development coming of age: Science through the life course. The Lancet 389 (10064): 77–90.

    Article  Google Scholar 

  • Campos, F., M. Frese, M. Goldstein, L. Iacovone, H. Johnson, and D. McKenzie. 2017. Teaching personal initiative beats traditional training in boosting small business in West Africa. Science 357 (6357): 1287–1290. https://doi.org/10.1126/science.aan5329.

    Article  ADS  CAS  PubMed  Google Scholar 

  • Cohen J., Rothschield, C., Golub, G., Omundi, G.N., Kruk, M. E., & McConnell, M. (2017). Cash on delivery: Results of a randomized experiment to promote maternal health care in Kenya. Health Affairs 36(11). Global Health Policy.

  • Currie, J., and D. Almond. 2011. Chapter 15—Human capital development before age five. In Handbook of labor economics, vol. 4, ed. David Card and Orley Ashenfelter, 1315–1486. New York: Elsevier.

    Google Scholar 

  • Datta, S., and S. Mullainathan. 2012. Behavioral design: A new approach to development policy. Center for Global Development Policy Paper 016. Washington DC: Center for Global Development.

  • de Walque, D., L. Fernald, P. Gertler, and M. Hidrobo. 2017. Cash transfers and child and adolescent development. In: Disease control priorities (third edition): Volume 8, Child and adolescent health and development, ed. D. Bundy, N. de Silva, S. Horton, D. T. Jamison, and G. Patton. Washington, DC: World Bank Group.

  • Evans, D., B. Holtemeyer, and K. Kosec. 2016. Cash transfers and health: Evidence from Tanzania. World Bank Policy Research Working Paper 7882, Washington DC: World Bank Group.

  • Fiszbein, A., N. Schady, F.H.G. Ferreira, M. Grosh, N. Kelleher, P. Olinto, and E. Skoufias. 2009. Conditional cash transfers: Reducing present and future poverty. Washington, DC: World Bank.

    Book  Google Scholar 

  • Gennetian, L., M. Darling, and L. Aber. 2016. Behavioral economics and developmental science: A new framework to support early childhood interventions. Journal of Applied Research on Children 7(2).

  • Gertler, P., J. Heckman, R. Pinto, C. Vermeersch, S. Walker, S.M. Chang, and S. Grantham-McGregor. 2014. Labor market returns to an early childhood stimulation intervention in Jamaica. Science 344 (6187): 998–1001. https://doi.org/10.1126/science.1251178.

    Article  ADS  CAS  PubMed  PubMed Central  Google Scholar 

  • Ghosal, S., S. Jana, and A. Mani. 2013. Believing in oneself: Can psychological training overcome the effects of social exclusion? Working Paper Series, University of Warwick, 2013, No. 152.

  • Gladstone, M., G.A. Lancaster, E. Umar, M. Nyirenda, E. Kayira, N.R. Van den Broek, et al. 2010. The Malawi Developmental Assessment Tool (MDAT): The creation, validation, and reliability of a tool to assess child development in Rural African settings. PLoS Medicine 7 (5): e1000273.

    Article  PubMed  PubMed Central  Google Scholar 

  • Gollwitzer, P., and G. Moskowitz. 1996. Goal effects on action and cognition. In Social psychology: Handbook of basic principles, 361–399. New York: Guilford.

    Google Scholar 

  • Grantham-McGregor, S., Y. Cheung, S. Cueto, P. Glewwe, L. Richter, and B. Strupp. 2007. Developmental potential in the first 5 years for children in developing countries. The Lancet 369 (9555): 60–70.

    Article  Google Scholar 

  • Instat Madagascar. https://www.instat.mg/ Antananarivo, Madagascar.

  • Janmohamed, A., N. Sohani, Z.N. Lassi, and Z.A. Butta. 2020. The effects of community home visit and peer group nutrition intervention delivery platforms on nutrition outcomes in low and middle-income countries: A systematic review and meta-analysis. Nutrients 12 (12): 440.

    Article  PubMed  PubMed Central  Google Scholar 

  • Kabeer, N., and H. Waddington. 2015. Economic impacts of conditional cash transfer programmes: A systematic review and meta-analysis. Journal of Development Effectiveness 7 (3): 290–303.

    Article  Google Scholar 

  • Kuhl, J. 1984. Volitional aspects of achievement motivation and learned helplessness: Toward a comprehensive theory of action control. In Progress in experimental personality research, vol. 13, 99–171. Elsevier.

  • Lagarde, M., A. Haines, and N. Palmer. 2007. Conditional cash transfers for improving uptake of health interventions in low- and middle-income countries: A systematic review. Journal of the American Medical Association 298 (16): 1900.

    Article  CAS  PubMed  Google Scholar 

  • Little, M.T., K. Roelen, B.C.L. Lange, J.I. Steinert, A.R. Yakubovich, L. Cluver, and D.K. Humphreys. 2021. Effectiveness of cash-plus programmes on early childhood outcomes compared to cash transfers alone: A systematic review and meta-analysis in low- and middle-income countries. PLoS Medicine 18 (9): e1003698. https://doi.org/10.1371/journal.pmed.1003698.

    Article  PubMed  PubMed Central  Google Scholar 

  • Loewenstein, G. 1996. Out of control: Visceral influences on behavior. Organizational Behavior and Human Decision Processes 65 (3): 272–292.

    Article  Google Scholar 

  • Macours, K., N. Schady, and R. Vakis. 2012. Cash transfers, behavioral changes, and cognitive development in early childhood: Evidence from a randomized experiment. American Economic Journal: Applied Economics 4 (2): 247–273.

    Google Scholar 

  • Mani, A., S. Mullainathan, E. Shafir, and J. Zhao. 2013. Poverty impedes cognitive function. Science (new York, n.y.) 341: 976–980. https://doi.org/10.1126/science.1238041.

    Article  ADS  CAS  PubMed  Google Scholar 

  • Mischel, W., N. Cantor, and S. Feldman. 1996. Principles of self-regulation: The nature of willpower and self-control. In Social psychology: Handbook of basic principles, ed. E.T. Higgins and A.W. Kruglanski, 329–360. New York: Guilford Press.

    Google Scholar 

  • Moursi, M.M., M. Arimond, K.G. Dewey, S. Trèche, M.T. Ruel, and F. Delpeuch. 2008. Dietary diversity is a good predictor of the micronutrient density of the diet of 6- to 23-month-old children in Madagascar. The Journal of Nutrition 138 (12): 2448–2453. https://doi.org/10.3945/jn.108.09397.

    Article  CAS  PubMed  Google Scholar 

  • Mullainathan, S., and E. Shafir. 2013. Scarcity: Why having too little means so much, 1st ed. New York: Times Books, Henry Holt and Company.

    Google Scholar 

  • Oosterbeek, H., J. Ponce, and N. Schady. 2008. The impact of cash transfers on school enrollment: Evidence from Ecuador. Washington, DC: World Bank.

    Book  Google Scholar 

  • Rachlin, H. 1995. Self-control: Beyond commitment. Behavioral and Brain Sciences 18 (1): 109–159. https://doi.org/10.1017/S0140525X00037602.

    Article  Google Scholar 

  • Rasella, D., R. Aquino, C.A.T. Santos, R. Paes-Sousa, and M.L. Barreto. 2013. Effect of a conditional cash transfer programme on childhood mortality: A nationwide analysis of Brazilian municipalities. Lancet. https://doi.org/10.1016/S0140-6736(13)60715-1.

    Article  PubMed  Google Scholar 

  • Sedlmayr, R., A. Shah, and M. Sulaiman. 2018. Cash-plus: Poverty impacts of transfer-based intervention alternatives. Center for the Study of African Economics Working Paper WPS/2017-15-2. Oxford, United Kingdom.

  • Shah, A.K., S. Mullainathan, and E. Shafir. 2012. Some consequences of having too little. Science 338 (6107): 682–685. https://doi.org/10.1126/1222426.

    Article  ADS  CAS  PubMed  Google Scholar 

  • Tirivayi, N., J. Waidler, and F. Otchere. 2021. Cash transfers: Past, present and future: Evidence and lessons learned from the Transfer Project. Innocenti Research Brief 2021-07. UNICEF Office of Research-Innocenti, Florence.

  • Thaler, R. 1994. Psychology and savings policies. American Economic Review 84 (2): 186–192.

    Google Scholar 

  • Tsur, S. 2016. Liquidity constraints and human capital: The impact of child allowances on Arab families in Israel. Israel: Bank of Israel.

    Google Scholar 

  • Vargas-Barón, E. 2009. Going to scale: Early childhood development in Latin America. Washington: The RISE Institute.

    Google Scholar 

  • Wegner, D.M. 1994. Ironic processes of mental control. Psychological Review 101 (1): 34–52. https://doi.org/10.1037/0033-295X.101.1.34.

    Article  CAS  PubMed  Google Scholar 

  • World Bank. 2018a. World development report 2018: Learning to realize education’s promise. Washington, DC: World Bank.

    Book  Google Scholar 

  • World Bank. 2018b. The human capital project. World Bank, Washington, DC. https://openknowledge.worldbank.org/handle/10986/30498 License: CC BY 3.0 IGO.

  • World Bank. 2017. Early childhood development topic page. World Bank, Washington, DC. https://www.worldbank.org/en/topic/earlychildhooddevelopment.

  • World Bank Group. 2015. World development report: Mind, society, and behavior. Washington, DC: World Bank.

    Book  Google Scholar 

  • World Data Lab. https://worldpoverty.io/.

  • World Food Programme. 2018. WFP Madagascar country brief, May 2018. Rome, Italy. https://reliefweb.int/sites/reliefweb.int/files/resources/Madagascar%20Country%20Brief%20-%20May%202018.pdf.

  • World Health Organization. 2018. Nurturing care for early childhood development: A framework for helping children survive and thrive to transform health and human potential. Geneva, Switzerland. https://apps.who.int/iris/bitstream/handle/10665/272603/9789241514064-eng.pdf.

Download references

Acknowledgements

The trial was pre-registered at the American Economic Association’s RCT Registry as RCT ID AEARCTR-0000957. We gratefully acknowledge helpful comments and suggestions from Alaka Holla, Jeffrey Tanner, and Benedicte Leroy De La Briere at the World Bank; Keetie Roelen at the Institute of Development Studies (IDS) at the University of Sussex; and Lawrence Aber at New York University. Participants at the World Bank’s Social Protection and Jobs Seminar Series and IDS’s seminar on “Putting Children First” where earlier versions of this paper were presented gave helpful feedback and suggestions. We thank Attila Cidam for his help with analysis. Any remaining errors are ours. This work does not necessarily reflect the views of the World Bank, its Board of Executive Directors, or the governments they represent.

Funding

This work was supported by the Wellspring Philanthropic Fund and the Strategic Impact Evaluation Fund at the World Bank.

Author information

Authors and Affiliations

  1. ideas42, 80 Broad Street, New York, NY, 10004, USA

    Saugato Datta, Joshua Martin & Catherine MacLeod

  2. World Bank, 1818 H St NW, Washington, DC, 20009, USA

    Laura B. Rawlings & Andrea Vermehren

Authors
  1. Saugato Datta
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Joshua Martin
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Catherine MacLeod
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Laura B. Rawlings
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Andrea Vermehren
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Saugato Datta.

Ethics declarations

Conflict of interest

On behalf of all authors, the corresponding author states that there is no conflict of interest.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

This paper draws from a Working Paper previously submitted in the World Bank Working Paper Series (WPS9747), the working paper series of the institution of the authors.

Electronic supplementary material

Appendix

Appendix

See Tables

Table 6 Effects of cash on behaviors
Full size table

6,

Table 7 Effects of cash on proximate outcomes
Full size table

7, and

Table 8 Effects of cash on long-term outcomes
Full size table

8.

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Datta, S., Martin, J., MacLeod, C. et al. Do Behavioral Interventions Enhance the Effects of Cash on Early Childhood Development and Its Determinants? Evidence from a Cluster-Randomized Trial in Madagascar. Eur J Dev Res 36, 327–354 (2024). https://doi.org/10.1057/s41287-023-00603-y

Download citation

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1057/s41287-023-00603-y

Keywords

Search

Navigation