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Impacts of Cash Transfers on Adolescents' & Young Women's Well-Being Globally: What do we know?


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Tia Palermo's presentation for the joint UNICEF & Gates Foundation Tanzania Adolescent Symposium in Dar es Salaam on 7 February 2018.

Using evidence from around the world, Tia outlines what we know about cash transfers impacts on youth and young women's well-being.

Published in: Government & Nonprofit
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Impacts of Cash Transfers on Adolescents' & Young Women's Well-Being Globally: What do we know?

  1. 1. unite for children Impacts of cash transfer programmes on adolescents’ and young women’s well-being globally: What do we know? Tia Palermo, Ph.D. UNICEF Office of Research – Innocenti The Transfer Project Symposium: “The Role of Cash Transfers in Programming for Adolescent Girls and Young Women: The State of the Evidence” February 7th, 2019 Dar es Salaam
  2. 2. Outline • Types of programming for adolescents Where do cash transfers fit in? • Cash directed to adolescents • National social protection programming • Why focus on adolescents? • Global evidence base • Gaps and new areas of research
  3. 3. Models Frameworks/key components Examples in ESAR Adolescent empowerment Livelihood/asset-building framework; life skills (plus); economic strengthening; ‘safe spaces’ • Stepping Stones/Creating Futures (SA) • IMAGE (SA) • Siayakha Nentsha (SA) • ELA (Tanzania & Uganda) • Safe & Smart savings for girls(Uganda/Kenya) • Tap & Reposition Youth (Kenya) • SHAZ (Zimbabwe) Household- level economic strengthening Cash transfers, public works, asset/livelihood strengthening, savings groups • Tanzania’s Productive Social Safety Net (PSSN) • Ethiopia’s Productive Safety Programme (PSNP) • Kenya’s CT for Orphans and Vulnerable Children • Malawi’s Social Cash Transfer (SCT) • Zimbabwe’s Harmonized Social CashTransfer (HSCT) • South Africa’s Child Support Grant (CSG) Parenting To foster positive parenting practices/ improve parent- child relationships, child behavior/outcomes • Sinovuyo Caring Families Teen Programme (SA) • Home visiting programme for children on child grant (SA) Community sensitisation/ social norms ‘Ecological model’; focus on social norms; can include other elements • Stepping Stones (SA) • Soul City (SA) • Sonke Gender Justice (SA) • SASA! (Uganda) • Berhan Hewan (Ethiopia) • KMG (Ethiopia) Adolescent programming types 3
  4. 4. (Fluid) classifications of cash transfers Objective Aims/examples Individual empowerment/wellbeing Often combination of life skills/ reproductive health info/economic strengthening Incentivize “positive” behaviors • education • STI/HIV prevention, • delay child marriage Humanitarian/emergency: • meet immediate needs in terms of food, shelter, clothing, or education (particularly in displacement settings) • conflict-specific objectives (eg, reunification of families, repatriation and reintegration) Social protection: • reduce poverty, smooth consumption, increase food security and resiliency, increase human capital (health and education) • By targeting household-level poverty, may help mitigate adverse outcomes among household members,including adolescents
  5. 5. 5 Type of cash transfers Objectives and beneficiaries Conditional cash transfers Regular income transfers to poor households conditional on particular actions and/or changes in behavior – most often to enhance education and health outcomes (build social capital). Unconditional cash transfers Regular income transfers without behavioural conditions, to help improve households’ income and thus meet basic needs Cash for work Cash payments in exchange for labor in public works projects, with the aim of increasing household income and often also reducing seasonal or temporary vulnerability . Child benefits/grants Cash grants- universal or targeted – for households with children to meet their basic nutrition, health and education needs. Disability grants Cash grants for people with disabilities to support access to services and basic needs; specially relevant for those who cannot work and/or generate income Pensions Regular income assistance to the elderly to help meet their subsistence needs – these may be contributory, non-contributory (social pensions funded by government revenue) or some combination UNICEF Framework Social Protection Framework, 2012 CTs as social protection programming
  6. 6. Motivation for focus on adolescents  Large increases in social protection programs globally, nearly half the world’s population covered by at least one benefit (45%) (ILO 2017) – key intervention for SDG 1 35% of children globally; 16% of children in Africa Non-contributory government programming tripled in Africa between 2000-2015  Positive impacts of cash transfers on consumption, food security, education, productive activities, and some evidence on ‘empowerment of women’ (Baird et al. 2013; Bastagli et al. 2016; Davis et al. 2016; etc.)  By reducing poverty, a risk factor for adverse outcomes, can cash transfers also facilitate safe and productive transitions to adulthood?
  7. 7. The Transfer Project Who: Community of research, donor and implementing partners – focus on coordination in efforts and uptake of results  UNICEF, FAO, UNC, National Governments, National researchers Mission: Provide rigorous evidence on government-run large-scale (largely unconditional) social cash transfers (SCTs) Motivation:  Income poverty has highly damaging impacts on human development  Cash empowers people living in poverty to make their own decisions on how to improve their lives Where: Ethiopia, Ghana, Kenya, Lesotho, Malawi, Mozambique, South Africa, Tanzania, Zambia & Zimbabwe
  8. 8. Social protection investments across the lifecycle of childhood Source: The TransferProject
  9. 9. What does the evidence say? Photo: Ivan Grifi, FAO
  10. 10. Overview of the evidence  Strong, positive across-the-board impacts:  Food security, household financial standing, and productive impacts  Material well-being  Increased school enrolment of secondary school-age children  Mixed evidence (varies by gender, country, sub-population, etc.)  Child work participation and hazardous labor Mental health, social support and networks Violence  Sexual debut, pregnancy, and sexual risk taking/HIV  Marriage  Few impacts to date: Health service utilization and morbidity
  11. 11. Breakdown of the evidence (1 of 2) Domain Evidence Education CTs increase school enrolment; no significant differences when comparing CCTs to UCTs, though degree of monitoring maymoderate impacts (Baird et al. 2014). Labor Most CTs have no effect or reduce child/adolescent labor; at least three programmes increase child/adolescent economic activities: Malawi and Zambia (increases in child work on household farm; de Hoop et al.2019); Philippines increased child participation in economic activities (de Hoop et al., 2017) Marriage Suggestive evidence that Ethiopia’s PSNP may delay early marriage (Hoddinott and Mekasha 2017); no impacts on delaying marriage in government programmes in Kenya, Malawi, Tanzania, Zambia, Zimbabwe (Transfer Project). Non-govt CT in Malawi delayed marriage and pregnancy (Baird et al. 2011). CCT in India delayed marriage until age 18 (Nanda et al. 2016) Mental health Mixed evidence: Govt CTs improved adolescent mental health in Kenya and Malawi (Angeles et al. 2019; Killburn et al. 2016), but not inTanzania, Zambia, Zimbabwe (Transfer Project). Mixed effects from non-govt programme (Baird et al. 2013).
  12. 12. Breakdown of evidence (2 of 2) Domain Evidence HIV Most studies find no effect of CTs on HIV incidence (Pettifor et al. 2016; CAPRISA 007; de Walque et al. 2014*; Kohler and Thornton 2012*). One study found CTs reduced HIV incidence (Baird et al. 2012), but effects only significant when weights used and small number ofinfections. Another study using a lottery & testing found reductionsin HIV (Björkman Nyqvist et al. 2015) Other STIs CCTs for STI prevention found to reduce risk of curable STIs (deWalque et al. 2014), mixed evidence on HSV-2: 2 studies find reductions (Abdool Karim, CAPRISA 007; Baird et al. 2012) others find no effect on HSV-2 or syphilis (de Walque et al. 2014; Pettifor et al. 2016;); Sexual debut, pregnancy, and sexual risk taking Government CTs delayed sexual debut and pregnancy among adolescents in Kenya and South Africa but not in Malawi or Zambia(Dake et al., 2018; S. Handa et al., 2014; S Handa et al., 2015; Heinrich, Hoddinott, & Samson, 2017). Also no delays found in Tanzania, Zimbabwe (Transfer Project). CTs reduce risk sexual behaviors in South Africa (Cluver et al. 2013) Violence Review of VAC showed that 19% of indicators showed protective effects of CTs, with most promising evidence in SSA related to sexual abuse & exploitation (Peterman et al. 2017); Among adult women, reviewindicated 73% of studies showed decreases in IPV, impacts stronger for physical/sexual (Buller et al. 2018)
  13. 13. Longer-term Impacts of Cash Transfers for Adolescents/Young Adults  Sub-Saharan Africa:  Non-governmental CT in Malawi led to improvements in school attainment and delayed marriage, childbearing among female adolescents who were out of school prior to the study (Baird, Chirwa, McIntosh, & Özler, 2015).  Latin America: Conditional cash transfer (CCTs) receipt to households in childhood increased subsequent educational attainment and labor market outcomes [with varying results by country and sometimes gender (Millán, Barham, Macours, Maluccio, & Stampini, 2018; Neidhofer & Nino-Zarazua, 2017; Parker & Vogl, 2018)], including increases in:  income,  hours worked,  probability of engaging in off-farm work
  14. 14. What underlies limitations of cash transfers? • Multiple drivers of poverty and exclusion • Cash can have impacts beyond direct income effects • BUT will not in itself address other structural drivers, barriers What are the drivers?
  15. 15. What underlies limitations of cash transfers? • Attitude towards risk, forward looking behaviour • information, knowledge Behavioral mediators • Exclusion from sectoral policies; • Quality, availability and access to supply side (e.g., schools, health facilities, access to extension services, access to inputs, access to markets); • Shocks, norms and prices. Moderators
  16. 16. Addressing vulnerabilities among adolescents  Case for integrated social protection/”cash plus”: Demand- and supply-side barriers simultaneously addressed.  Promising areas for linkages/integration:  Multi-faceted needs of adolescents addressed (i.e., strengthening economic and health capacities, including and especially as they relate to sexual and reproductive health).  SRH important to reduce gender disparities which influence trajectories of poverty.  Reproductive health rights are a significant source of social vulnerability for adolescents, as cultural attitudes, religious resistance, and health systems failures can limit access to services for girls (Holmes & Jones, 2013) (pp. 48-49).  Social protection programming can help expand girls’ options and capabilities, and this can be further leveraged if programming is designed with gender-related vulnerabilities in mind
  17. 17.  Overall, promising evidence that cash transfers can facilitate safe transitions for youth  Important considerations to interpret findings: programme objectives, delivery and targeting context: gender norms, quality of schools/health facilities; access to markets cash transfers are not a silver bullet; investment in infrastructure, supply- side for schools, health still needed  Long-term investment needed to achieve outcomes. Short-term, one-off, or one-sided interventions are unlikely to overcome years of exclusion, underinvestment in human capital, and structural constraints impeding access to productive assets, unequal power relations, and inequitable distribution systems (Dessallien, 1999; Holmes & Jones, 2013). Conclusion
  18. 18. Future research needs More testing of linkages/plus components to understand how they can boost the impacts of cash Rigorous study designs (quasi-experimental, experimental) needed More understanding of pathways and moderators that may impede impacts Longitudinal research needed to examine mid- and longer- term impacts, including impacts in early adulthood of investments made during childhood/adolescence
  19. 19. References (1 of 4)  Angeles G, de Hoop J, Handa S, Kilburn K, Milazzo A & A Peterman on behalf of the Malawi Social Cash Transfer Evaluation Team (2019). Government of Malawi’s Social Cash Transfer program increases youth mental health. Social Science & Medicine (in press).  Baird, S., et al. (2014). "Conditional, unconditional and everything in between: a systematic review of the effects of cash transfer programmes on schooling outcomes." Journal of Development Effectiveness 6(1): 1- 43.  Baird, S., et al. (2013). "Income shocks and adolescent mental health." Journal of Human Resources 48(2): 370-403  Baird, S., Chirwa, E., McIntosh, C., & Özler, B. (2015). What Happens Once the Intervention Ends? The Five- Year Impacts of a Cash Transfer Experiment in Malawi. Impact Evaluation Report,27.  Baird, S., McIntosh, C., & Özler, B. (2011). Cash or condition? Evidence from a cash transfer experiment. The Quarterly Journal of Economics, 126(4), 1709-1753.  Baird, S. J., Garfein, R. S., McIntosh, C. T., & Ozler, B. (2012). Effect of a cash transfer programme for schooling on prevalence of HIV and herpes simplex type 2 in Malawi: a cluster randomised trial. Lancet, 379(9823), 1320-1329.  Bastagli, Hagen-Zanker, Harman, Barca, Sturge, Schmidt, & Pellerano. (2016). “Cash transfers: What does the evidence say? A rigorous review of programme impact and of the role of design and implementation features.” 10.13140/RG.2.2.29336.39687.  Björkman-Nyqvist, M., Corno, L., De Walque, D., & Svensson, J. (2013). P4. 120 Evaluating the Impact of Short Term Financial Incentives on HIV and STI IncidenceAmong Youth in Lesotho:A Randomised Trial. Sex Transm Infect, 89(Suppl 1),A325-A325.  Buller,A., Peterman,A., Ranganathan, M., Bleile,A., Hidrobo, M., & Heise, L. (2018).A mixed-method review of cash transfers and intimate partner violence in low- and middle-income countries. World Bank Research Observer, 33(2).  Cincotta, R., & Madsen, E. L. The Four Dividends: TheAge-structural Timing of Transitions in Child Survival, Educational Attainment, Income, and PoliticalStability.
  20. 20. References (2 of 4) • Cluver, L., Boyes, M., Orkin, M., Pantelic, M., Molwena, T., & Sherr, L. (2013). Child-focused state cash transfers and adolescent risk of HIV infection in South Africa: a propensity-score-matched case-control study. The Lancet Global Health, 1(6), e362-e370. • Coast (2016). Gender and Adolescence: Capabilities, change strategies and contexts for well-being. • Dake, F., Natali, L., Angeles, G., De Hoop, J., Handa, S., & Peterman, A. (2018). Income transfers, early marriage and fertility in Malawi and Zambia. Studies in family planning, in press. • De Hoop, J., Groppo, V., & Handa, S. (2019). Cash Transfers, Microentrepreneurial Activity, and Child Work: Evidence from Malawi and Zambia. WBER, In press. • De Walque, D., Dow, W. H., Nathan, R., Abdul, R., Abilahi, F., Gong, E., . . . Krishnan, S. (2012). Incentivising safe sex: a randomised trial of conditional cash transfers for HIV and sexually transmitted infection prevention in rural Tanzania. BMJ open, 2(1), e000747. • Daidone S. Synergies between Social Protection and Agriculture: What is the evidence so far? Presentation to Public Policy and Human Development, Maastricht University, March 29, 2017. • De Groot R, Palermo T, Handa S, Ragno LP, Peterman A. (2017). Cash Transfers and Child Nutrition: WhatWe Know and What We Need to Know. Development Policy Review (online ahead of print). • Dammert, A., de Hoop, J., Mvukiyehe, E., and Rosati, F. C. 2018. “Effects of Public Policy on Child Labor: Current Knowledge, Gaps, and Implications for Program Design.” World Development 110:104–23. • De Hoop, J., Friedman, J., Kandpal, E., & Rosati, F. (2017). Child schooling and child work in the presence of a partial education subsidy. The World Bank. • de Walque, D., et al. (2017). "Cash Transfers and Child and Adolescent Development." Disease Control Priorities. • Holmes, R., & Jones, N. (2013). Gender and social protection in the developing world: beyond mothers andsafety nets: Zed Books Ltd.
  21. 21. References (3 of 4) • Handa, S. et al. 2018. "Mythbusting: Confronting six common perceptions about cash transfer programs insub- Saharan Africa", in World Bank Research Observer 33,259–298. • Handa, S., Halpern, C. T., Pettifor, A., & Thirumurthy, H. (2014). The government of Kenya's cash transfer program reduces the risk of sexual debut among young people age 15-25. PLoS One, 9(1),e85473-e85473. • Handa, S., Peterman, A., Huang, C., Halpern, C. T., Pettifor, A., & Thirumurthy, H. (2015). Impact of the Kenya Cash Transfer for Orphans and Vulnerable Children on Early Pregnancy and Marriage of Adolescent Girls. Social Science & Medicine, 141, 36-45. • Heinrich, C. J., Hoddinott, J., & Samson, M. (2017). Reducing adolescent risky behaviors in a high-risk context: the effects of unconditional cash transfers in South Africa. Economic Development and Cultural Change, 65(4), 619-652. • Hoddinott, J. F., & Mekasha, T. J. (2017). Social protection, household size and its determinants: Evidence from Ethiopia. Washington, DC: IFPRI. • Kohler, H.-P., & Thornton, R. L. (2011). Conditional cash transfers and HIV/AIDS prevention: unconditionally promising? The World Bank Economic Review, 26(2), 165-190. • Millán, T. M., Barham, T., Macours, K., Maluccio, J. A., & Stampini, M. (2018). Long-Term Impacts of Conditional Cash Transfers: Review of the Evidence. World Bank Research Observer, inpress. • Neidhöfer, G., & Niño‐Zarazúa, M. (2017). The long (er)-term impacts of Chile Solidario on human capital and labour income. • Nanda P, Nitin Datta, Elina Pradhan, Priya Das, and Sneha Lamba. 2016. Making Change with Cash? Impact of a Conditional Cash Transfer Program on Age of Marriage in India: Findings on Marriage. Washington, DC: International Center for Research on Women(ICRW). • Palermo T. (2018). Social Protection and Adolescence: Evidence, Promise, and Gaps. Policy in Focus on Children and social protection: understanding and responding to children’s needs. International Policy Centre for Inclusive Growth (IPC-IG). UNDP.
  22. 22. References (4 of 4) • Parker, S. W., & Vogl, T. (2018). Do Conditional Cash Transfers Improve Economic Outcomes in the Next Generation? Evidence from Mexico. • Kilburn, K., et al. (2016). "Effects of a large-scale unconditional cash transfer program on mental health outcomes of young people in Kenya: a cluster randomized trial." Journal of Adolescent Health 58(2):223-229. • Pettifor, A., et al. (2016). "The effect of a conditional cash transfer on HIV incidence in young women in rural South Africa (HPTN 068): a phase 3, randomised controlled trial." The Lancet Global Health 4(12): e978-e988. • Peterman A, Neijhoft AN, Cook S, Palermo T. (2017). Understanding the linkages between social protectionand childhood violence: A review of the evidence. Health Policy and Planning 32(7):1049-1071. • Roelen K, Devereux S, Abdulai AG, Martorano B, Palermo T, Ragno LP. (2017). “How to make ‘cash plus’ work in social protection: linking services and sectors.” UNICEF Office of Research – Innocenti Working Paper. Florence, Italy. • Sabates-Wheeler R, Devereux S. Transformative social protection: the currency of social justice. Social Protection for the Poor and Poorest: Springer; 2008. p. 64-84. UNICEF. • The Transfer Project. • UNICEF (2012). Integrated social protection systems: Enhancing equity for children. UNICEF SocialProtection Framework. New York: UNICEF.
  23. 23. Ahsentani! Ghana LEAP 1000 (© Michelle Mills)Photo: Valeria
  24. 24. Transfer Project is a multi-organizational initiative of the United Nations Children’s Fund (UNICEF) the UN Food and Agriculture Organization (FAO), Save the Children-United Kingdom (SC-UK), and the University of North Carolina at Chapel Hill (UNC-CH) in collaboration with national governments, and other national and international researchers. Current core funding (2014-2020) for the Transfer Project comes from the Swedish International Development Cooperation Agency (Sida) to UNICEF Office of Research, as well as from staff time provided by UNICEF, FAO and UNC-CH. Past core funding also came from DFID - UK Department of International Development to support the Transfer Project at UNICEF Office of Research – Innocenti (2014-2018). Evaluation design, implementations and analysis are all funded in country by government and development partners. Top-up funds for extra survey rounds have been provided by: 3IE - International Initiative for Impact Evaluation (Ghana, Malawi, Zimbabwe); DFID - UK Department of International Development (Ghana, Lesotho, Ethiopia, Malawi, Kenya, Zambia, Zimbabwe); EU - European Union (Lesotho, Malawi, Zimbabwe); Irish Aid (Malawi, Zambia); KfW Development Bank (Malawi); NIH - The United States National Institute of Health (Kenya); Sida (Zimbabwe); and the SDC - Swiss Development Cooperation (Zimbabwe); USAID – United States Agency for International Development (Ghana, Malawi); US Department of Labor (Malawi, Zambia). The body of research here has benefited from the intellectual input of a large number of individuals. For full research teams by country, see: Acknowledgements
  25. 25. • Transfer Project website: • Briefs: • Facebook: • Twitter: @TransferProjct • Email: For more information Ghana, credit: Ivan Griffi