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Relationship between Receipt of a Social Protection Grant for a Child and Second Pregnancy Rates among South African Women: A Cohort Study

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  • Molly Rosenberg
  • Audrey Pettifor
  • Nadia Nguyen
  • Daniel Westreich
  • Jacob Bor
  • Till Bärnighausen
  • Paul Mee
  • Rhian Twine
  • Stephen Tollman
  • Kathleen Kahn

Abstract

Background: Social protection programs issuing cash grants to caregivers of young children may influence fertility. Grant-related income could foster economic independence and/or increase access to job prospects, education, and health services, resulting in lower pregnancy rates. In the other direction, these programs may motivate family expansion in order to receive larger grants. Here, we estimate the net effect of these countervailing mechanisms among rural South African women. Methods: We constructed a retrospective cohort of 4845 women who first became eligible for the Child Support Grant with the birth of their first child between 1998 and 2008, with data originally collected by the Agincourt Health and Socio-Demographic Surveillance System in Mpumalanga province, South Africa. We fit Cox regression models to estimate the hazard of second pregnancy in women who reported grant receipt after birth of first child, relative to non-recipients. As a secondary analysis to explore the potential for grant loss to incentivize second pregnancy, we exploited a natural experiment created by a 2003 expansion of the program’s age eligibility criterion from age seven to nine. We compared second pregnancy rates between (i) women with children age seven or eight in 2002 (recently aged out of grant eligibility) to (ii) women with children age seven or eight in 2003 (remained grant-eligible). Results: The adjusted hazard ratio for the association between grant exposure and second pregnancy was 0.66 (95% CI: 0.58, 0.75). Women with first children who aged out of grant eligibility in 2002 had similar second pregnancy rates to women with first children who remained grant-eligible in 2003 [IRR (95% CI): 0.9 (0.5, 1.4)]. Conclusions: Across both primary and secondary analyses, we found no evidence that the Child Support Grant incentivizes pregnancy. In harmony with South African population policy, receipt of the Child Support Grant may result in longer spacing between pregnancies.

Suggested Citation

  • Molly Rosenberg & Audrey Pettifor & Nadia Nguyen & Daniel Westreich & Jacob Bor & Till Bärnighausen & Paul Mee & Rhian Twine & Stephen Tollman & Kathleen Kahn, 2015. "Relationship between Receipt of a Social Protection Grant for a Child and Second Pregnancy Rates among South African Women: A Cohort Study," PLOS ONE, Public Library of Science, vol. 10(9), pages 1-12, September.
    • Handle: RePEc:plo:pone00:0137352
    DOI: 10.1371/journal.pone.0137352
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    References listed on IDEAS

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    1. Eric Udjo, 2009. "Trends in the age pattern of fertility, 1995-2005, in the context of the child support grant in South Africa," Development Southern Africa, Taylor & Francis Journals, vol. 26(2), pages 289-299.
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    2. Sonia Laszlo & Muhammad Farhan Majid & Laëtitia Renée, 2024. "Conditional cash transfers and women's reproductive choices," Health Economics, John Wiley & Sons, Ltd., vol. 33(2), February.
    3. Tia Palermo & Sudhanshu Handa & Amber Peterman & Leah Prencipe & David Seidenfeld, 2016. "Unconditional government social cash transfer in Africa does not increase fertility," Journal of Population Economics, Springer;European Society for Population Economics, vol. 29(4), pages 1083-1111, October.
    4. Zohra S. Lassi & Sophie G. E. Kedzior & Wajeeha Tariq & Yamna Jadoon & Jai K. Das & Zulfiqar A. Bhutta, 2021. "Effects of preconception care and periconception interventions on maternal nutritional status and birth outcomes in low‐ and middle‐income countries: A systematic review," Campbell Systematic Reviews, John Wiley & Sons, vol. 17(2), June.
    5. Hajdu, Flora & Granlund, Stefan & Neves, David & Hochfeld, Tessa & Amuakwa-Mensah, Franklin & Sandström, Emil, 2020. "Cash transfers for sustainable rural livelihoods? Examining the long-term productive effects of the Child Support Grant in South Africa," World Development Perspectives, Elsevier, vol. 19(C).
    6. Oyenubi, Adeola & Kollamparambil, Umakrishnan, 2022. "Does the child support grant incentivise childbirth in South Africa?," Economic Analysis and Policy, Elsevier, vol. 73(C), pages 812-825.

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