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Cash Transfers, Behavioral Changes, and the Cognitive Development of Young Children: Evidence from a Randomized Experiment. Karen Macours (Paris School of Economics) Norbert Schady (IADB) Renos Vakis (WB). Introduction.

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Cash Transfers, Behavioral Changes, and the Cognitive Development of Young Children: Evidence from a Randomized Experiment

Karen Macours (Paris School of Economics)

Norbert Schady (IADB)

Renos Vakis (WB)


Introduction l.jpg
Introduction Development of Young Children: Evidence from a Randomized Experiment

  • Food security and nutrition, in particular for young children, often motivated for it’s importance on cognitive development during early childhood

  • Yet, often early childhood cognitive development outcomes are not measured per se

  • Leads to extrapolation of nutrition (anthropometric) results to cognitive development

    • E.g. debate on critical ages (first 2-3 years of life) for childhood nutrition interventions

  • But we can obtain observable measures of ECD that are standardized (like anthro)


  • Motivation l.jpg
    Motivation Development of Young Children: Evidence from a Randomized Experiment

    • Cognitive development in early childhood is an important predictor of success throughout life

    • Literature on how nutritional supplements and early childhood stimulation programs affect early childhood development

    • Much less is known about programs that affect investments of parents directly


    Motivation4 l.jpg
    Motivation Development of Young Children: Evidence from a Randomized Experiment

    • Conditional cash transfer programs:

      • Are extremely popular in the developing world (29 countries and counting), especially in Latin America

      • Have been evaluated extensively to assess impacts on school enrollment and attendance, as well as on health service utilization, and nutritional and health status

      • But little evidence available on the impact of cash transfer programs on cognitive and emotional development in early childhood

      • Yet there is an open debate on longer-term returns to human capital acquired through CCTs (achievement, income, ….)

      • We analyzed the impact of the Atención a Crisis program, a conditional cash transfer (CCT) program, on cognitive development outcomes in early childhood in Nicaragua


    Outline l.jpg
    Outline Development of Young Children: Evidence from a Randomized Experiment

    • Intervention

    • Context, data, outcomes

    • Results on ECD outcomes

    • Persistence of effects

    • Transmission mechanisms

      • 3 risk factors for child development

      • Is transfer income used like other sources of income?


    Intervention l.jpg
    Intervention Development of Young Children: Evidence from a Randomized Experiment

    Atención a Crisis program

    • Cash payments to mothers: ~18 percent of pce for median household

    • Social marketing of program: intended to benefit children, encourage dietary diversity

    • Facilitates social interactions on human capital investments

    • Conditions:

      • Schooling

      • Health check-ups for preschool-aged children, but not monitored

    • Objectives:

      • Short-run safety net after a drought shock

      • Facilitate long-term risk management through income diversification

    • Three treatment packages:

      • CCT

      • CCT + vocational training program

      • CCT + productive investment grant


    Context data outcomes l.jpg
    Context, data, outcomes Development of Young Children: Evidence from a Randomized Experiment

    Where?

    6 municipalities in rural Nicaragua with high levels of extreme poverty and frequent droughts

    Who: Households in sample are very poor

    • Average years of schooling:

      • Fathers: 3.5 years

      • Mothers: 4 years

    • 27 percent of children stunted

    • 82 percent live on less than 1 US $ per capita per day


    Context data outcomes8 l.jpg
    Context, data, outcomes Development of Young Children: Evidence from a Randomized Experiment

    Experimental design

    • Random assignment of 56 communities to “treatment”, 50 “control”

    • Baseline survey: April-May 2005

      • Proxy means test: households above threshold ineligible (<10 percent of households)

      • 3,000 eligible households in treated communities, 1,000 potentially eligible households in control communities

    • No evidence of significant differences between treated and control households at baseline

    • Households started receiving payments in November 2005: Average household received payments for 9 months

    • Follow-up survey: July-August 2006

    • Program ended in December 2008

    • Second follow-up Survey in 2008/09


    Context data outcomes9 l.jpg
    Context, data, outcomes Development of Young Children: Evidence from a Randomized Experiment

    Attrition

    • Very low levels of attrition: 1.3 percent of households were not re-interviewed in 2006, about 3% in 2008/09

      • Uncorrelated with treatment

      • Very similar characteristics of full sample of households and households re-interviewed

        Compliance with experimental design

    • Very high levels of compliance with experimental assignment

      • 95 percent of households assigned to treatment group received transfers

      • Only 1 household in control communities received transfers

      • Of treated households, more than 95 percent received the full amount of the transfer for which they were eligible


    Context data outcomes10 l.jpg
    Context, data, outcomes Development of Young Children: Evidence from a Randomized Experiment

    • Denver Developmental Screening Test: Four subscales

      (a) Social-personal: social interactions, ability of child to dress and eat on her own, imitate others

      (b) Language: use of sounds, words, sentences

      (c) Fine motor skills: manual tasks such as drawing, playing with cubes, reaching for objects

      (d) Gross motor skills: crawling, walking, jumping, throwing

    • Test scaled based on number of tasks for which child is in the bottom quartile of the reference population distribution (or alternatively in the bottom decile)

    • Applied to children 0-83 months of age


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    Context, data, outcomes Development of Young Children: Evidence from a Randomized Experiment

    Additional tests applied to children 36-83 months of age

    • TVIP: Test of receptive language

      3. Memory for names: Visual memory from Woodcock-Munoz battery

      4. McCarthy:

      • Short-term memory: repeating strings of numbers

      • Leg-motor skills: walking on tiptoes, standing on one foot

        5. BPI: Behavioral Problem Index

        Incidence of behavioral problems

    • All were piloted in our population, and minor adjustments were made, as needed


    Choice of instruments l.jpg
    Choice of instruments Development of Young Children: Evidence from a Randomized Experiment

    • All outcomes (except BPI) can be age-standardized using “reference populations” (like anthropometrics z-scores)

    • All have been used extensively in the literature, including in developing countries

    • Standardized Spanish-language version of test existed (for tests involving language, i.e. Denver, TVIP, and the memory for names)

    • Ease of standardized administration of test

      • by non-experts,

      • in (often difficult) field conditions,

      • with children who are not familiar with (fancy) toys

    • Applicability of tests in population with potential large average delays

    • Duration of tests (~ limited attention spans)


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    Pre-testing process Development of Young Children: Evidence from a Randomized Experiment

    • Wider set of tests tried in pre-testing

      • Appropriateness of tasks and test items

      • Minimize scoring mistakes

      • Timing

      • Variation in population

      • Power to distinguish sufficiently between observations in the left tail

      • Establishing of trust with extremely shy children

      • Creation of optimal test environment, given field circumstances

        • And in particular: prevent interference and observation by other household members (~ minimize risk to human subjects)



    Context data outcomes15 l.jpg
    Context, data, outcomes to international norm

    In summary:

    • Children in our sample have very large delays in a variety of domains:

      • Especially large in language and in their social-personal skills

      • Much smaller for motor skills

    • Delays tend to increase with child age

    • Socioeconomic gradients in cognitive outcomes—even within our sample of very poor children

      • Gradients steepest for language, absent for the BPI

        => There may be potential for cash transfers to improve outcomes


    Main results l.jpg
    Main results to international norm

    1. Significant program effects on cognitive skills

    • Program effects concentrated on outcomes with largest delays, steepest gradients

    • Effects persist 2 years after the program ended

      4. No evidence of significant heterogeneity by gender

      5. Evidence of significant heterogeneity by child age

      • Program effects on language concentrated among older children, ages 5-6


    Main results robustness l.jpg
    Main results: Robustness to international norm

    5. Findings robust to a very large set of alternative specifications

    • With and without controls

    • Only children in household of main beneficiary

    • Only children of main beneficiary

    • Not removing age effects

    • Not standardizing

    • Not dropping 1 percent outliers

    • Using narrower age range for Denver (upto 6)

    • Not including children upto 10 months of age (in utero exposure)

    • Using tasks in bottom decile (instead of bottom quartile) for Denver

    • Using only observed (not reported) outcomes for Denver


    Transmission mechanisms l.jpg
    Transmission mechanisms to international norm

    (1) Focus on three risk factors for child development

    • Inadequate nutrition

    • Inadequate stimulation

    • Health status—including lack of micronutrients, exposure to infectious disease, caregivers’ mental health


    Transmission mechanisms20 l.jpg
    Transmission mechanisms to international norm

    (1) Focus on three risk factors for child development

    • Changes tend to be larger for older kids—often significantly so (for example, for child food intake, whether a child is read to, whether they have been taken to a growth check-up, have received micronutrients, or de-worming medication)

    • Pattern consistent with the observed improvements in final outcomes


    Transmission mechanisms21 l.jpg
    Transmission mechanisms to international norm

    (2) Is transfer income used like other sources of income?

    Maybe…

    • Money is fungible

      Maybe not…

    • Women received transfer

      • Women are thought to spend a higher fraction of the resources they control on children than men (for example, Lundberg et al. 1997)

    • Social marketing of program

      • Kooreman 2000 on child support income in Holland

      • Fraker et al. 1995 on food stamp “cashouts” in the US

    • Estimate changes in intermediate inputs among treated households in three critical “risk factors” identified in the literature

      • Food

      • Stimulation

      • Use of preventive health care


    Transmission mechanisms food engel curves at follow up l.jpg
    Transmission mechanisms: Food Engel curves to international normat follow-up






    Transmission mechanisms conclusions l.jpg
    Transmission mechanisms: Conclusions to international norm

    • Upwards shift in the Food Engel curve

    • Changes in the composition of food expenditures

      • Decrease in food share devoted to staples

      • Increases in food share devoted to animal proteins, and fruits & vegetables

    • Similar results for child food intake

    • Increase in stimulation:

      • Increase in proportion of children at a given expenditure level who have access to books, pen & paper

      • Significant increase in number of hours read to

    • Improvements in some measures of child health

    • Program effects on these “risk factors” tend to be larger among older children

    • Behavioral changes: At any level of expenditures, treated and control communities spend resources differently


    Conclusions l.jpg
    Conclusions to international norm

    • Cash transfers have modest but significant effects on some dimensions of child development after only 9 months

    • Impacts persist 2 years after the program ended

    • Evidence of program effects on risk factors for child development

      • Nutrition

      • Stimulation

      • Child health

    • Transfer income appears to have been used differently from other sources of income: suggests there were behavioral changes


    Implications l.jpg
    Implications to international norm

    • Large delays and the potential for catch-up indicate need for policy attention

    • Interventions that facilitate investments made by parents to reduce risk factors can result in ECD gains

    • Account for gains in ECD when considering gains from food security programs

    • This might put focus on other aspects of food security (~ quality of the diet)


    Next steps l.jpg
    Next steps to international norm

    • Next round of panel collected in 08-09

      • Different treatment groups have different income levels (though differences are small)

        => Further disentangle income effect from behavioral changes

    • Complementary ECD intervention focused on parental care

      • Role of information for changes in investment behavior in early childhood

      • Allocated randomly on Atencion a Crisis treatment and control

      • Role of mothers versus fathers

    • Related work

      • Medium/Long-term evaluation of the original CCT program in Nicaragua, taking advantage of randomized phase in

      • Do kids that benefitted in first 2 years of life have better cognitive and schooling outcomes 10 years later ?


    Thank you l.jpg
    Thank you ! to international norm

    [email protected]


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