Can Cash Transfers Save Lives? Evidence from a Large-Scale Experiment in Kenya

We estimate the impacts of large-scale unconditional cash transfers on child survival. One-time transfers of USD 1000 were provided to over 10,500 poor households across 653 randomized villages in Kenya. We collected census data on over 100,000 births, including on mortality and cause of death, and detailed data on household health behaviours. Unconditional cash transfers (accounting for spillovers) lead to 48% fewer infant deaths before age one and 45% fewer child deaths before age five. Detailed data on cause of death, transfer timing relative to birth, and the location of health facilities indicate that unconditional cash transfers and access to delivery care are complements in generating mortality reductions: the largest gains are estimated in neonatal and maternal causes of death largely preventable by appropriate obstetric care and among households living close to physician-staffed facilities and those who receive the transfer around the time of birth, and treatment leads to a large increase in hospital deliveries (by 45%). The infant and child mortality declines are concentrated among poorer households with below median assets or predicted consumption. The transfers also result in a substantial decline of 51% in female labour supply in the three months before and the three months after a birth, and improved child nutrition. Infant and child mortality largely revert to pre-program levels after cash transfers end. Despite not being the main aim of the original program, we show that unconditional cash transfers in this setting may be a cost-effective way to reduce infant and child deaths.