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Can cash transfers improve determinants of maternal mortality? Evidence from the household and community programs in Indonesia

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  • Kusuma, Dian
  • Cohen, Jessica
  • McConnell, Margaret
  • Berman, Peter

Abstract

Despite global efforts in maternal health, 303,000 maternal deaths still occurred globally in 2015. One explanation is a considerable inequality in maternal mortality and the sources such as nutritional status and health utilization. One strategy to fight health inequality due to poverty is conditional cash transfer (CCT). Taking advantage of two large clustered-randomized trials in Indonesia from 2007 to 2009, this paper provides evidence on the effects of household cash transfers (PKH) and community cash transfers (Generasi) on determinants of maternal mortality. The sample sizes are 14,000 households for PKH and 12,000 households for Generasi. After two years of implementation, difference-in-differences (DID) analyses show that the two programs can improve determinants of maternal mortality with Generasi provides positive impact in some aspects of determinants, but PKH does not. Generasi improves maternal health knowledge, reduces financial barriers to accessing health services and improves utilization of health services, increases utilization among higher-risk women, improves posyandu equipment, and increases nutritional intake. As for PKH, evidence shows its strongest effects only on utilization of health services. Both programs, however, are unlikely to have a large effect on maternal mortality due to design and implementation issues that might significantly reduce program effectiveness. While the programs improved utilization, they did so at community-based facilities not equipped with emergency obstetric care. In the midst of popularity of household cash transfer, our results show that community cash transfer offers a viable policy alternative to improve the determinants of maternal mortality by allowing more flexibility in activities and at lower cost by monitoring at community level.

Suggested Citation

  • Kusuma, Dian & Cohen, Jessica & McConnell, Margaret & Berman, Peter, 2016. "Can cash transfers improve determinants of maternal mortality? Evidence from the household and community programs in Indonesia," Social Science & Medicine, Elsevier, vol. 163(C), pages 10-20.
    • Handle: RePEc:eee:socmed:v:163:y:2016:i:c:p:10-20
    DOI: 10.1016/j.socscimed.2016.06.020
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    6. Cooper, Jan E. & Benmarhnia, Tarik & Koski, Alissa & King, Nicholas B., 2020. "Cash transfer programs have differential effects on health: A review of the literature from low and middle-income countries," Social Science & Medicine, Elsevier, vol. 247(C).
    7. Lenel, Friederike & Priebe, Jan & Satriawan, Elan & Syamsulhakim, Ekki, 2022. "Can mHealth campaigns improve CCT outcomes? Experimental evidence from sms-nudges in Indonesia," Journal of Health Economics, Elsevier, vol. 86(C).
    8. Barnish, Maxwell S. & Tan, Si Ying & Robinson, Sophie & Taeihagh, Araz & Melendez-Torres, G.J., 2023. "A realist synthesis to develop an explanatory model of how policy instruments impact child and maternal health outcomes," Social Science & Medicine, Elsevier, vol. 339(C).
    9. Grépin, Karen A. & Habyarimana, James & Jack, William, 2019. "Cash on delivery: Results of a randomized experiment to promote maternal health care in Kenya," Journal of Health Economics, Elsevier, vol. 65(C), pages 15-30.
    10. Ila Rocha Falcão & Rita de Cássia Ribeiro-Silva & Flávia Jôse Oliveira Alves & Naiá Ortelan & Natanael J Silva & Rosemeire L Fiaccone & Marcia Furquim de Almeida & Júlia M Pescarini & Cinthia Soares L, 2022. "Evaluating the effect of Bolsa Familia, Brazil’s conditional cash transfer programme, on maternal and child health: A study protocol," PLOS ONE, Public Library of Science, vol. 17(5), pages 1-14, May.
    11. Kusuma, Dian & Thabrany, Hasbullah & Hidayat, Budi & McConnell, Margaret & Berman, Peter & Cohen, Jessica, 2017. "New Evidence on the Impact of Large-scale Conditional Cash Transfers on Child Vaccination Rates: The Case of a Clustered-Randomized Trial in Indonesia," World Development, Elsevier, vol. 98(C), pages 497-505.

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