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Journal Articles

UNICEF Innocenti's complete catalogue of international peer reviewed journals

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Poverty and perceived stress: Evidence from two unconditional cash transfer programs in Zambia

Jacobus de Hoop, Tia Palermo, Lisa Hjelm, Sudhanshu Handa

Published: 2017


Poverty is a chronic stressor that can lead to poor physical and mental health. This study examines whether two similar government poverty alleviation programs reduced the levels of perceived stress and poverty among poor households in Zambia.


Secondary data from two cluster randomized controlled trials were used to evaluate the impacts of two unconditional cash transfer programs in Zambia. Participants were interviewed at baseline and followed over 36 months. Perceived stress among female caregivers was assessed using the Cohen Perceived Stress Scale (PSS). Poverty indicators assessed included per capita expenditure, household food security, and (nonproductive) asset ownership. Fixed effects and ordinary least squares regressions were run, controlling for age, education, marital status, household demographics, location, and poverty status at baseline.


Cash transfers did not reduce perceived stress but improved economic security (per capita consumption expenditure, food insecurity, and asset ownership). Among these poverty indicators, only food insecurity was associated with perceived stress. Age and education showed no consistent association with stress, whereas death of a household member was associated with higher stress levels.


In this setting, perceived stress was not reduced by a positive income shock but was correlated with food insecurity and household deaths, suggesting that food security is an important stressor in this context. Although the program did reduce food insecurity, the size of the reduction was not enough to generate a statistically significant change in stress levels. The measure used in this study appears not to be correlated with characteristics to which it has been linked in other settings, and thus, further research is needed to examine whether this widely used perceived stress measure appropriately captures the concept of perceived stress in this population.

Cite this publication | No. of pages: 110-117 | Tags: cash transfers, child poverty
Impact of cash transfer programs on food security and nutrition in sub-Saharan Africa: A cross-country analysis

Smriti Tiwaria, Silvio Daidone, Maria Angelita Ruvalcaba, Ervin Prifti, Sudhanshu Handa, Benjamin Davis, Ousmane Niang, Luca Pellerano, Paul Quarles van Ufford, David Seidenfeld

Published: 2016
This paper explores the extent to which government-run cash transfer programs in four sub-Saharan countries affect food security and nutritional outcomes. These programs include Ghana's Livelihood Empowerment Against Poverty, Kenya's Cash Transfer for Orphans and Vulnerable Children, Lesotho's Child Grants Program and Zambia's Child Grant model of the Social Cash Transfer program. Our cross-country analysis highlights the importance of robust program design and implementation to achieve the intended results. We find that a relatively generous and regular and predictable transfer increases the quantity and quality of food and reduces the prevalence of food insecurity. On the other hand, a smaller, lumpy and irregular transfer does not lead to impacts on food expenditures. We complement binary treatment analysis with continuous treatment analysis to understand not only the impact of being in the program but also the variability in impacts by the extent of treatment.
Unconditional government social cash transfer in Africa does not increase fertility

Tia Palermo, Sudhanshu Handa, Amber Peterman, Leah Prencipe, David Seidenfeld

Published: 2016
Among policymakers, a common perception surrounding the effects of cash transfer programmes, particularly unconditional programmes targeted to families with children, is that they induce increased fertility. We evaluate the Zambian Child Grant Programme, a government unconditional cash transfer targeted to families with a child under the age of 5 and examine impacts on fertility and household composition. The evaluation was a cluster randomized control trial, with data collected over 4 years from 2010 to 2014. Our results indicate that there are no programme impacts on overall fertility. Our results contribute to a small evidence base demonstrating that there are no unintended incentives related to fertility due to cash transfers.
Cite this publication | No. of pages: 1083-1111 | Tags: cash transfers, fertility
The Effect of Cash, Vouchers and Food Transfers on Intimate Partner Violence: Evidence from a randomized experiment in Northern Ecuador

M. Hidrobo, Amber Peterman, L. Heise

Published: 2016
Using a randomized experiment in Ecuador, this study provides evidence on whether cash, vouchers, and food transfers targeted to women and intended to reduce poverty and food insecurity also affected intimate partner violence. Results indicate that transfers reduce controlling behaviors and physical and/or sexual violence by 6 to 7 percentage points. Impacts do not vary by transfer modality, which provides evidence that transfers not only have the potential to decrease violence in the short-term, but also that cash is just as effective as in-kind transfers.
Cite this publication | No. of pages: 284–303 | Tags: cash transfers, gender based violence
The impact of Zambia’s unconditional child grant on schooling and work: results from a large-scale social experiment

Sudhanshu Handa, Luisa Natali, David Seidenfeld, Gelson Tembo

Published: 2016
This article reports on the impact on child schooling and work of the Government of Zambia’s Child Grant Program (CGP), an unconditional cash transfer programme targeted to households with children under age 3 years in three districts of the country. Although the CGP’s focus is on very young children, we look to see if the programme has impacts on older children who are not the explicit target group. We use data from a large-scale social experiment involving 2519 households, half of whom were randomised out to a delayed-entry control group, that was implemented to assess the impact of the programme. We find that the CGP has no discernible impact on school enrolment of children age 7–14. However, when we break the sample by older (11–14) and younger (7–10) children – based on the grade structure of the Zambian schooling system – we find a significant impact among children age 11–14, which coincides with the exact age range where a sharp drop-out begins to occur in Zambia with point estimates in the range of 7–8 percentage points. Finally, we provide evidence on the potential pathways through which the unconditional cash transfer impacts on enrolment. Households in the CGP spend more on education, and in particular on uniforms and shoes, two items cited as key barriers to school enrolment in study areas.
Cite this publication | No. of pages: 346-367 | Tags: cash transfers, schooling, child labour
The Way to a Man’s Heart is through his Stomach?: A mixed methods study on the causal mechanisms through which cash and in-kind food transfers decreased intimate partner violence

A. M. Buller, M. Hidrobo, Amber Peterman, L. Heise

Published: 2016


Intimate partner violence (IPV) is highly prevalent and has detrimental effects on the physical and mental health of women across the world. Despite emerging evidence on the impacts of cash transfers on intimate partner violence, the pathways through which reductions in violence occur remain under-explored. A randomised controlled trial of a cash and in-kind food transfer programme on the northern border of Ecuador showed that transfers reduced physical or sexual violence by 30 %. This mixed methods study aimed to understand the pathways that led to this reduction.


We conducted a mixed methods study that combined secondary analysis from a randomised controlled trial relating to the impact of a transfer programme on IPV with in-depth interviews and focus group discussions with male and female beneficiaries. A sequential analysis strategy was followed, whereby qualitative results guided the choice of variables for the quantitative analysis and qualitative insights were used to help interpret the quantitative findings.


We found qualitative and quantitative evidence that the intervention led to reductions in IPV through three pathways operating at the couple, household and individual level: i) reduced day-to-day conflict and stress in the couple; ii) improved household well-being and happiness; and iii) increased women’s decision making, self-confidence and freedom of movement. We found little evidence that any type of IPV increased as a result of the transfers.


While cash and in-kind transfers can be important programmatic tools for decreasing IPV, the positive effects observed in this study seem to depend on circumstances that may not exist in all settings or programmes, such as the inclusion of a training component. Moreover, the programme built upon rather than challenged traditional gender roles by targeting women as transfer beneficiaries and framing the intervention under the umbrella of food security and nutrition – domains traditionally ascribed to women.


Transfers destined for food consumption combined with nutrition training reduced IPV among marginalised households in northern Ecuador. Evidence suggests that these reductions were realised by decreasing stress and conflict, improving household well-being, and enhancing women’s decision making, self-confidence and freedom of movement.

Time Discounting and Credit Market Access in a Large-Scale Cash Transfer Programme

Sudhanshu Handa, Bruno Martorano, Carolyn T. Halpern, Audrey Pettifor, Harsha Thirumurthy

Published: 2016
Time discounting is thought to influence decision-making in almost every sphere of life, including personal finances, diet, exercise and sexual behaviour. In this article, we provide evidence on whether a national poverty alleviation programme in Kenya can affect inter-temporal decisions. We administered a preferences module as part of a large-scale impact evaluation of the Kenyan Government's Cash Transfer for Orphans and Vulnerable Children. Four years into the programme, we find that individuals in the treatment group are only marginally more likely to wait for future money, due in part to the erosion of the value of the transfer by inflation. However, among the poorest households for whom the value of transfer is still relatively large we find significant programme effects on the propensity to wait. We also find strong programme effects among those who have access to credit markets though the programme itself does not improve access to credit.
The Social and Economic Impacts of Zambia's Child Grant Program

Sudhanshu Handa, D. Seidenfeld, B. David, G. Tembo, Zambia Evaluation Cash Transfer Team

Published: 2016

Accumulated evidence from dozens of cash transfer (CT) programs across the world suggests that there are few interventions that can match the range of impacts and cost-effectiveness of a small, predictable monetary transfer to poor families in developing countries. However, individual published impact assessments typically focus on only one program and one outcome. This article presents two-year impacts of the Zambian Government's Child Grant, an unconditional CT to families with children under age 5, across a wide range of domains including consumption, productive activity, and women and children's outcomes, making this one of the first studies to assess both protective and productive impacts of a national unconditional CT program. We show strong impacts on consumption, food security, savings, and productive activity. However, impacts in areas such as child nutritional status and schooling depend on initial conditions of the household, suggesting that cash alone is not enough to solve all constraints faced by these poor, rural households. Nevertheless, the apparent transformative effects of this program suggest that unconditional transfers in very poor settings can contribute to both protection and development outcomes.

Cite this publication | No. of pages: 357-387 | Tags: cash transfers, child well-being
How does a national poverty programme influence sexual debut among Kenyan adolescents?

Sudhanshu Handa, Tia Palermo, Molly Rosenberg, Audrey Pettifor, Carolyn Tucker Halpern, Harsha Thirumurthy

Published: 2016
Cash transfer programmes have recently emerged as promising interventions for HIV prevention among adolescents in Africa. However, the pathways through which risk reduction occurs are not well understood. We examine data on 1429 adolescents and youth from the Kenya Cash Transfer for Orphans and Vulnerable Children, which has been shown to result in delayed sexual debut among adolescents. We explored three potential mediating pathways: schooling, socio-economic status and psycho-social status. None of these hypothesised mediators greatly altered the main effect. However, school attendance had a larger protective effect on sexual debut among females but was only increased by the programme among males. This gendered pattern of effects may explain why we did not see a mediating effect of the cash transfer through schooling, despite schooling's protective effects against early sexual debut. Results also suggest that cash transfer programmes in Africa can contribute to the reduction of HIV related risk behaviours.
Income Transfers and Maternal Health: Evidence from a National Randomized Social Cash Transfer Program in Zambia

Sudhanshu Handa, Amber Peterman, D. Seidenfeld, G. Tembo

Published: 2016
There is promising recent evidence that poverty-targeted social cash transfers have potential to improve maternal health outcomes; however, questions remain surrounding design features responsible for impacts. In addition, virtually no evidence exists from the African region. This study explores the impact of Zambia's Child Grant Program on a range of maternal health utilization outcomes using a randomized design and difference-in-differences multivariate regression from data collected over 24 months from 2010 to 2012. Results indicate that while there are no measurable program impacts among the main sample, there are heterogeneous impacts on skilled attendance at birth among a sample of women residing in households having better access to maternal health services. The latter result is particularly interesting because of the overall low level of health care availability in program areas suggesting that dedicated program design or matching supply-side interventions may be necessary to leverage unconditional cash transfers in similar settings to impact maternal health.
Cite this publication | No. of pages: 225-236 | Tags: cash transfers, maternal health
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