Effects of unconditional and conditional cash transfers on child health and development in Zimbabwe: a cluster-randomised trial Wealth differentials in the impact of conditional and unconditional cash transfers on education: findings from a community-randomised controlled trial in Zimbabwe Role of cash in conditional cash transfer programmes for child health, growth, and development: an analysis of Mexico's Oportunidades Incentivising safe sex: a randomised trial of conditional cash transfers for HIV and sexually transmitted infection prevention in rural Tanzania Unconditional government social cash transfer in Africa does not increase fertility The impact of Mexico's conditional cash transfer programme, Oportunidades, on birthweight. Conditional cash transfers to improve education and health: an ex ante evaluation of Red de Protección Social, Nicaragua. Empowering women to obtain high quality care: evidence from an evaluation of Mexico's conditional cash transfer programme. 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. Conditional cash transfers and uptake of and retention in prevention of mother-to-child HIV transmission care: a randomised controlled trial. Effects of cash transfers on Children’s health and social protection in Sub-Saharan Africa: differences in outcomes based on orphan status and household assets HPTN 068: A Randomized Control Trial of a Conditional Cash Transfer to Reduce HIV Infection in Young Women in South Africa—Study Design and Baseline Results Conditional Cash Transfers to Increase Retention in PMTCT Care, Antiretroviral Adherence, and Postpartum Virological Suppression: A Randomized Controlled Trial The impact of cash transfers on social determinants of health and health inequalities in Sub-Saharan Africa: a systematic review protocol Income Transfers and Maternal Health: Evidence from a National Randomized Social Cash Transfer Program in Zambia. The Short-Term Impacts of a Schooling Conditional Cash Transfer Program on the Sexual Behavior of Young Women Cash component of conditional cash transfer program is associated with higher body mass index and blood pressure in adults.
Summary Background Cash-transfer programmes can improve the wellbeing of vulnerable children , but few studies have rigorously assessed their effectiveness in sub-Saharan Africa . We investigated the effects of unconditional cash transfers ( UCTs ) and conditional cash transfers ( CCTs ) on birth registration , vaccination uptake , and school attendance in children in Zimbabwe . Methods We did a matched , cluster-r and omised controlled trial in ten sites in Manical and , Zimbabwe . We divided each study site into three clusters . After a baseline survey between July , and September , 2009 , clusters in each site were r and omly assigned to UCT , CCT , or control , by drawing of lots from a hat . Eligible households contained children younger than 18 years and satisfied at least one other criteria : head of household was younger than 18 years ; household cared for at least one orphan younger than 18 years , a disabled person , or an individual who was chronically ill ; or household was in poorest wealth quintile . Between January , 2010 , and January , 2011 , households in UCT clusters collected payments every 2 months . Households in CCT clusters could receive the same amount but were monitored for compliance with several conditions related to child wellbeing . Eligible households in all clusters , including control clusters , had access to parenting skills classes and received maize seed and fertiliser in December , 2009 , and August , 2010 . Households and individuals delivering the intervention were not masked , but data analysts were . The primary endpoints were proportion of children younger than 5 years with a birth certificate , proportion younger than 5 years with up-to- date vaccinations , and proportion aged 6–12 years attending school at least 80 % of the time . This trial is registered with Clinical Trials.gov , number NCT00966849 . Findings 1199 eligible households were allocated to the control group , 1525 to the UCT group , and 1319 to the CCT group . Compared with control clusters , the proportion of children aged 0–4 years with birth certificates had increased by 1·5 % ( 95 % CI −7·1 to 10·1 ) in the UCT group and by 16·4 % ( 7·8–25·0 ) in the CCT group by the end of the intervention period . The proportions of children aged 0–4 years with complete vaccination records was 3·1 % ( −3·8 to 9·9 ) greater in the UCT group and 1·8 % ( −5·0 to 8·7 ) greater in the CCT group than in the control group . The proportions of children aged 6–12 years who attended school at least 80 % of the time was 7·2 % ( 0·8–13·7 ) higher in the UCT group and 7·6 % ( 1·2–14·1 ) in the CCT group than in the control group . Interpretation Our results support strategies to integrate cash transfers into social welfare programming in sub-Saharan Africa , but further evidence is needed for the comparative effectiveness of UCT and CCT programmes in this region . Funding Wellcome Trust , the World Bank through the Partnership for Child Development , and the Programme of Support for the Zimbabwe National Action Plan for Orphans and Vulnerable Children Abstract We investigated ( 1 ) how household wealth affected the relationship between conditional cash transfers ( CCT ) and unconditional cash transfers ( UCT ) and school attendance , ( 2 ) whether CCT and UCT affected educational outcomes ( repeating a year of school ) , ( 3 ) if baseline school attendance and transfer conditions affected how much of the transfers participants spent on education and ( 4 ) if CCT or UCT reduced child labour in recipient households . Data were analysed from a cluster-r and omized controlled trial of  CCT and UCT in 4043 households from 2009 to 2010 . Recipient households received $ 18 dollars per month plus $ 4 per child . CCT were conditioned on above 80 % school attendance , a full vaccination record and a birth certificate . In the poorest quintile , the odds ratio of above 80 % school attendance at follow-up for those with below 80 % school attendance at baseline was 1.06 ( p = .67 ) for UCT vs. CCT . UCT recipients reported spending slightly more ( 46.1 % ( 45.4–46.7 ) ) of the transfer on school expenses than did CCT recipients ( 44.8 % ( 44.1–45.5 ) ) . Amongst those with baseline school attendance of below 80 % , there was no statistically significant difference between CCT and UCT participants in the proportion of the transfer spent on school expenses ( p = .63 ) . Amongst those with above 80 % baseline school attendance , CCT participants spent 3.5 % less ( p = .001 ) on school expenses than UCT participants . UCT participants were no less likely than those in the control group to repeat a grade of school .  CCT participants had .69 ( .60–.79 ) lower odds vs. control of repeating the previous school grade . Children in CCT recipient households spent an average of .31 fewer hours in paid work than those in the control group ( p < .001 ) and children in the UCT arm spent an average of .15 fewer hours in paid work each week than those in the control arm ( p = .06 ) BACKGROUND Many governments have implemented conditional cash transfer ( CCT ) programmes with the goal of improving options for poor families through interventions in health , nutrition , and education . Families enrolled in CCT programmes  receive cash in exchange for complying with certain conditions : preventive health requirements and nutrition supplementation , education , and monitoring design ed to improve health outcomes and promote positive behaviour change . Our aim was to disaggregate the effects of cash transfer from those of other programme components . METHODS In an intervention that began in 1998 in Mexico , low-income communities ( n=506 ) were r and omly assigned to be enrolled in a CCT programme  ( Oportunidades , formerly Progresa ) immediately or 18 months later . In 2003 , children ( n=2449 ) aged 24 - 68 months who had been enrolled in the programme their entire lives were assessed for a wide variety of outcomes . We used linear and logistic regression to determine the effect size for each outcome that is associated with a doubling of cash transfers while controlling for a wide range of covariates , including measures of household socioeconomic status . FINDINGS A doubling of cash transfers was associated with higher height-for-age Z score ( beta 0.20 , 95 % CI 0.09 - 0.30 ; p<0.0001 ) , lower prevalence of stunting ( -0.10 , -0.16 to -0.05 ; p<0.0001 ) , lower body-mass index for age percentile ( -2.85 , -5.54 to -0.15 ; p=0.04 ) , and lower prevalence of being overweight ( -0.08 , -0.13 to -0.03 ; p=0.001 ) . A doubling of cash transfers was also associated with children doing better on a scale of motor development , three scales of cognitive development , and with receptive language . INTERPRETATION Our results suggest that the cash transfer component of Oportunidades is associated with better outcomes in child health , growth , and development Objective The authors evaluated the use of conditional cash transfers as an HIV and sexually transmitted infection prevention strategy to incentivise safe sex . Design An unblinded , individually r and omised and controlled trial . Setting 10 villages within the Kilombero/Ulanga districts of the Ifakara Health and Demographic Surveillance System in rural south-west Tanzania . Participants The authors enrolled 2399 participants , aged 18–30 years , including adult spouses . Interventions Participants were r and omly assigned to either a control arm ( n=1124 ) or one of two intervention arms : low-value conditional cash transfer ( eligible for $ 10 per testing round , n=660 ) and high-value conditional cash transfer ( eligible for $ 20 per testing round , n=615 ) . The authors tested participants every 4 months over a 12-month period for the presence of common sexually transmitted infections . In the intervention arms , conditional cash transfer payments were tied to negative sexually transmitted infection test results . Anyone testing positive for a sexually transmitted infection was offered free treatment , and all received counselling . Main outcome measures The primary study end point was combined prevalence of the four sexually transmitted infections , which were tested and reported to subjects every 4 months : Chlamydia trachomatis , Neisseria gonorrhoeae , Trichomonas vaginalis and Mycoplasma genitalium . The authors also tested for HIV , herpes simplex virus 2 and syphilis at baseline and month 12 . Results At the end of the 12-month period , for the combined prevalence of any of the four sexually transmitted infections , which were tested and reported every 4 months ( C trachomatis , N gonorrhoeae , T vaginalis and M genitalium ) , unadjusted RR for the high-value conditional cash transfer arm compared to controls was 0.80 ( 95 % CI 0.54 to 1.06 ) and the adjusted RR was 0.73 ( 95 % CI 0.47 to 0.99 ) . Unadjusted RR for the high-value conditional cash transfer arm compared to the low-value conditional cash transfer arm was 0.76 ( 95 % CI 0.49 to 1.03 ) and the adjusted RR was 0.69 ( 95 % CI 0.45 to 0.92 ) . No harm was reported . Conclusions Conditional cash transfers used to incentivise safer sexual practice s are a potentially promising new tool in HIV and sexually transmitted infections prevention . Additional larger study would be useful to clarify the effect size , to calibrate the size of the incentive and to determine whether the intervention can be delivered cost effectively . Trial registration number NCT00922038 Clinical Trials.gov 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 r and omized 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 OBJECTIVES To evaluate the impact of Oportunidades , a large-scale , conditional cash transfer programme in Mexico , on  birthweight .  The programme provides cash transfers to low-income , rural households in Mexico , conditional on accepting nutritional supplements health education , and health care . METHODS The primary analyses used retrospective reports from 840 women in poor rural communities participating in an effectiveness study and r and omly assigned to incorporation into the programme in 1998 or 1999 across seven Mexican states . Pregnant women in participating households received nutrition supplements and health care , and accepted cash transfers . Using multivariate and instrumental variable analyses , we estimated the impact of the programme on birthweight in grams and low birthweight ( < 2500 g ) , receipt of any pre-natal care , and number of pre-natal visits . RESULTS Oportunidades beneficiary status was associated with 127.3 g higher birthweight among participating women and a 4.6 percentage point reduction in low birthweight . CONCLUSION The Oportunidades conditional cash transfer programme improved birthweight outcomes . This finding is relevant to countries implementing conditional cash transfer programmes Using baseline data from a r and omized experiment , this article extends and tests in the context of health , the feasibility of a recently proposed reduced form approach to ex ante evaluations of social programs with an application to a  conditional cash transfer program in Nicaragua . It uses a behavioural model to estimate the impact on preventive care utilization outcomes for children younger than 3 years . It vali date s the model with the results of the experiment and then simulates two alternate policy scenarios . The model performs well in predicting the health related outcomes and shows different results for the two sets of policy scenarios . In addition , simulations are also carried out for the school component of the cash transfer program OBJECTIVES To evaluate the impact of Mexico 's conditional cash transfer programme on the quality of health care received by poor women . Quality is measured by maternal reports of prenatal care procedures received that correspond with clinical guidelines . METHODS The data describe retrospective reports of care received from 892 women in poor rural communities in seven Mexican states . The women were participating in an effectiveness study and r and omly assigned to incorporation into the programme in 1998 or 1999 . Eligible women accepted cash transfers conditional on obtaining health care and nutritional supplements , and participated in health education sessions . RESULTS Oportunidades beneficiaries received 12.2 % more prenatal procedures compared with non-beneficiaries ( adjusted mean 78.9 , 95 % Confidence Interval ( CI ) : 77.5 - 80.3 ; P < 0.001 ) . CONCLUSION The Oportunidades conditional cash transfer programme is associated with better quality of prenatal care for low-income , rural women in Mexico . This result is probably a manifestation of the programme 's empowerment goal , by encouraging beneficiaries to be informed and active health consumers BACKGROUND Cash transfers have been proposed as an intervention to reduce HIV-infection risk for young women in sub-Saharan Africa . However , scarce evidence is available about their effect on reducing HIV acquisition . We aim ed to assess the effect of a conditional cash transfer on HIV incidence among young women in rural South Africa . METHODS We did a phase 3 , r and omised controlled trial ( HPTN 068 ) in the rural Bushbuckridge subdistrict in Mpumalanga province , South Africa . We included girls aged 13 - 20 years if they were enrolled in school grade s 8 - 11 , not married or pregnant , able to read , they and their parent or guardian both had the necessary documentation necessary to open a bank account , and were residing in the study area and intending to remain until trial completion . Young women ( and their parents or guardians ) were r and omly assigned ( 1:1 ) , by use of numbered sealed envelopes containing a r and omisation assignment card which were numerically ordered with block r and omisation , to receive a monthly cash transfer conditional on school attendance ( ≥80 % of school days per month ) versus no cash transfer . Participants completed an Audio Computer-Assisted Self-Interview ( ACASI ) , before test HIV counselling , HIV and herpes simplex virus (HSV)-2 testing , and post-test counselling at baseline , then at annual follow-up visits at 12 , 24 , and 36 months . Parents or guardians completed a Computer-Assisted Personal Interview at baseline and each follow-up visit . A stratified proportional hazards model was used in an intention-to-treat analysis of the primary outcome , HIV incidence , to compare the intervention and control groups . This study is registered at Clinical Trials.gov ( NCT01233531 ) . FINDINGS Between March 5 , 2011 , and Dec 17 , 2012 , we recruited 10 134 young women and enrolled 2537 and their parents or guardians to receive a cash transfer programme ( n=1225 ) or not ( control group ; n=1223 ) . At baseline , the median age of girls was 15 years ( IQR 14 - 17 ) and 672 ( 27 % ) had reported to have ever had sex . 107 incident HIV infections were recorded during the study : 59 cases in 3048 person-years in the intervention group and 48 cases in 2830 person-years in the control group . HIV incidence was not significantly different between those who received a cash transfer ( 1·94 % per person-years ) and those who did not ( 1·70 % per person-years ; hazard ratio 1·17 , 95 % CI 0·80 - 1·72 , p=0·42 ) . INTERPRETATION Cash transfers conditional on school attendance did not reduce HIV incidence in young women . School attendance significantly reduced risk of HIV acquisition , irrespective of study group . Keeping girls in school is important to reduce their HIV-infection risk . FUNDING National Institute of Allergy and Infectious Diseases , National Institute of Mental Health of the National Institutes of Health BACKGROUND Novel strategies are needed to increase retention in and uptake of prevention of mother-to-child HIV transmission ( PMTCT ) services in sub-Saharan Africa . We aim ed to determine whether small , increasing cash payments , which were conditional on attendance at scheduled clinic visits and receipt of proposed services can increase the proportions of HIV-infected pregnant women who accept available PMTCT services and remain in care . METHODS In this r and omised controlled trial , we recruited newly diagnosed HIV-infected women , who were 32 or less weeks pregnant , from 89 antenatal care clinics in Kinshasa , Democratic Republic of Congo , and r and omly assigned ( 1:1 ) them to either the intervention group or the control group using computer-based r and omisation with varying block sizes of four , six , and eight . The intervention group received compensation on the condition that they attended scheduled clinic visits and accepted offered PMTCT services ( US$ 5 , plus US$ 1 increment at every subsequent visit ) , whereas the control group received usual care . Outcomes assessed included retention in care at 6 weeks ' post partum and uptake of PMTCT services , measured by attendance of all scheduled clinic visits and acceptance of proposed services up to 6 weeks ' post partum . Analyses were by intention to treat . This trial is registered with Clinical Trials.org , number NCT01838005 . FINDINGS Between April 18 , 2013 , and Aug 30 , 2014 , 612 potential participants were identified , 545 were screened , and 433 were enrolled and r and omly assigned ; 217 to the control group and 216 to the intervention group . At 6 weeks ' post partum , 174 participants in the intervention group ( 81 % ) and 157 in the control group ( 72 % ) were retained in care ( risk ratio [ RR ] 1·11 ; 95 % CI 1·00 - 1·24 ) . 146 participants in the intervention group ( 68 % ) and 116 in the control group ( 54 % ) attended all clinic visits and accepted proposed services ( RR 1·26 ; 95 % CI 1·08 - 1·48 ) . Results were similar after adjustment for marital status , age , and education . INTERPRETATION Among women with newly diagnosed HIV , small , incremental cash incentives result ed in increased retention along the PMTCT cascade and uptake of available services . The cost-effectiveness of these incentives and their effect on HIV-free survival warrant further investigation . FUNDING President 's Emergency Plan for AIDS Relief and the National Institute of Health and Child Development Background Unconditional and conditional cash transfer programmes ( UCT and CCT ) show potential to improve the well-being of orphans and other children made vulnerable by HIV/AIDS ( OVC ) . We address the gap in current underst and ing about the extent to which household-based cash transfers differentially impact individual children ’s outcomes , according to risk or protective factors such as orphan status and household assets . Methods Data were obtained from a cluster-r and omised controlled trial in eastern Zimbabwe , with r and om assignment to three study arms – UCT , CCT or control . The sample included 5,331 children ages 6 - 17 from 1,697 households . Generalized linear mixed models were specified to predict OVC health vulnerability ( child chronic illness and disability ) and social protection ( birth registration and 90 % school attendance ) . Models included child-level risk factors ( age , orphan status ) ; household risk factors ( adults with chronic illnesses and disabilities , greater household size ) ; and household protective factors ( including asset-holding ) . Interactions were systematic ally tested . Results Orphan status was associated with decreased likelihood for birth registration , and paternal orphans and children for whom both parents ’ survival status was unknown were less likely to attend school . In the UCT arm , paternal orphans fared better in likelihood of birth registration compared with non-paternal orphans . Effects of study arms on outcomes were not moderated by any other risk or protective factors . High household asset-holding was associated with decreased likelihood of child ’s chronic illness and increased birth registration and school attendance , but household assets did not moderate the effects of cash transfers on risk or protective factors . Conclusion Orphaned children are at higher risk for poor social protection outcomes even when cared for in family-based setting s. UCT and CCT each produced direct effects on children ’s social protection which are not moderated by other child- and household-level risk factors , but orphans are less likely to attend school or obtain birth registration . The effects of UCT and CCT are not moderated by asset-holding , but greater household assets predict greater social protection outcomes . Intervention efforts need to focus on ameliorating the additional risk burden carried by orphaned children . These efforts might include caregiver education , and additional incentives based on efforts made specifically for orphaned children Abstract Young women in South Africa are at high risk for HIV infection . Cash transfers offer promise to reduce HIV risk . We present the design and baseline results from HPTN 068 , a phase III , individually r and omized trial to assess the effect of a conditional cash transfer on HIV acquisition among South African young women . A total of 2533 young women were r and omized to receive a monthly cash transfer conditional on school attendance or to a control group . A number of individual- , partner- , household- and school-level factors were associated with HIV and HSV-2 infection . After adjusting for age , all levels were associated with an increased odds of HIV infection with partner-level factors conveying the strongest association ( aOR 3.05 95 % CI 1.84–5.06 ) . Interventions like cash transfers that address structural factors such as schooling and poverty have the potential to reduce HIV risk in young women in South Africa Background : Novel strategies are needed to increase retention in prevention of mother-to-child HIV transmission ( PMTCT ) services . We have recently shown that small , incremental cash transfers conditional on attending clinic result ed in increased retention along the PMTCT cascade . However , whether women who receive incentives to attend clinic visits are as adherent to antiretrovirals ( ARV ) as those who do not was unknown . Objective : To determine whether HIV-infected women who received incentives to remain in care were as adherent to antiretroviral treatment and achieved the same level of viral suppression at 6 weeks postpartum as those who did not receive incentives but also remained in care . Methods : Newly diagnosed HIV-infected women at ⩽32 weeks gestational age were recruited at antenatal care clinics in Kinshasa , Democratic Republic of Congo . Women were r and omized in a 1:1 ratio to an intervention or control group . The intervention group received compensation ( $ 5 , plus $ 1 increment at each subsequent visit ) conditional on attending scheduled clinic visits and accepting offered PMTCT services , whereas the control group received usual care . The proportion of participants who remained in care , were fully adherent ( took all their pills at each visit ) or with undetectable viral load at 6 weeks postpartum were compared across group . Results : Among 433 women r and omized ( 216 in intervention group and 217 in control group ) , 332 ( 76.7 % ) remained in care at 6 weeks postpartum , including 174 ( 80.6 % ) in the intervention group and 158 ( 72.8 % ) in the control group , ( P = 0.04 ) . Data on pill count were available for 297 participants ( 89.5 % ) , including 156 ( 89.7 % ) and 141 ( 89.2 % ) in the intervention and control groups , respectively ; 69.9 % ( 109/156 ) and 68.1 % ( 96/141 ) in the intervention and control groups had perfect adherence [ risk difference , 0.02 ; 95 % CI : −0.06 to 0.09 ] . Viral load results were available for 171 ( 98.3 % ) and 155 ( 98.7 % ) women in the intervention and control groups , respectively ; 66.1 % ( 113/171 ) in the intervention group and 69.7 % ( 108/155 ) in the control group had an undetectable viral load ( risk difference , −0.04 ; 95 % CI : −0.14 to 0.07 ) . Results were similar after adjusting for marital status , age , education , baseline CD4 count , viral load , gestational age , and initial ARV regimen . Conclusions : Although the provision of cash incentives to HIV-infected pregnant women led to higher retention in care at 6 weeks postpartum , among those retained in care , adherence to ARVs and virologic suppression did not differ by study group Background There is increasing pressure to address the social determinants of health ( SDoH ) and health inequities through the implementation of culturally acceptable interventions particularly in Sub-Saharan Africa ( SSA ) where health outcomes are generally poor . Available evaluation research on cash transfers ( CTs ) suggests that the programs may influence the wider determinants of health in SSA ; yet , there has been no attempt to synthesize the evidence regarding their contribution to tackling the SDoH and health inequalities . To date , nearly all the review s on CTs ' impact on health have predominantly featured evidence from Latin America with limited transferability to the social , cultural , and political environments in SSA . Therefore , the aim of this study is to undertake a systematic review to assess the role of CTs in tackling the wider determinants of health and health inequalities in SSA . Methods / design A systematic review of published and unpublished literature on CTs ’ impact on health and health determinants covering the period 2000–2016 will be undertaken . Studies will be considered for inclusion if they present quantitative or qualitative data , including all relevant study design s. The SDoH conceptual framework will be used to guide the data extraction process . EPPI Review er software will be used for data management and analysis . Studies included in the review will be analyzed by narrative synthesis and /or meta- analysis as appropriate for the nature of the data retrieved . Discussion This review will provide empirical evidence on the impact of CTs on SDoH to inform CT policy , implementation , and research in SSA . The protocol follows the Preferred Reporting Items for Systematic Review and Meta- Analysis Protocol s ( PRISMA -P ) . Systematic review registration This protocol has been registered with the PROSPERO international prospect i ve register of systematic review s , reference CRD42015025015 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 r and omized 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 setting s to impact maternal health Recent evidence suggests that conditional cash transfer programs for schooling are effective in raising school enrollment and attendance . However , there is also reason to believe that such programs can affect other outcomes , such as the sexual behavior of their young beneficiaries .  Zomba Cash Transfer Program is a r and omized , ongoing conditional cash transfer intervention targeting young women in Malawi that provides incentives ( in the form of school fees and cash transfers ) to current schoolgirls and recent dropouts to stay in or return to school . An average offer of US$ 10/month conditional on satisfactory school attendance – plus direct payment of secondary school fees – led to significant declines in early marriage , teenage pregnancy , and self-reported sexual activity among program beneficiaries after just one year of program implementation . For program beneficiaries who were out of school at baseline , the probability of getting married and becoming pregnant declined by more than 40 percent and 30 percent , respectively . In addition , the incidence of the onset of sexual activity was 38 percent lower among all program beneficiaries than the control group . Overall , these results suggest that conditional cash transfer programs not only serve as useful tools for improving school attendance , but may also reduce sexual activity , teen pregnancy , and early marriage The cash component of Oportunidades , a large conditional cash transfer ( CCT ) program in Mexico , has previously been shown to be associated with better outcomes for child growth and development . The objective of this analysis was to determine whether the cash transfers were also associated with positive outcomes for adult health .  Oportunidades  was originally r and omized across 506 rural ( < 2500 inhabitants ) communities assigned to immediate incorporation into the program in 1997 or incorporation 18 mo later . Adults ( n = 1649 early , n = 2039 late intervention ) aged 18 - 65 y were then assessed in 2003 . All of the households included in the analysis reported here complied with Oportunidades 's requirements for the entire period , but some received higher cumulative cash transfers because they were living in communities r and omized to begin receiving transfers earlier and /or they accumulated cash at a faster rate because they had more school-aged children at baseline . Our primary findings were that a doubling of cumulative cash transfers to the household was associated with higher BMI ( beta = + 0.83 , 95 % CI 0.46 , 1.20 ; P < 0.0001 ) , higher diastolic blood pressure ( beta = + 1.19 , 95 % CI 0.09 , 2.29 ; P = 0.03 ) , and higher prevalence of overweight [ odds ratio ( OR ) = 1.41 , 95 % CI 1.18 , 1.67 ; P < 0.0001 ) , grade I obesity ( OR = 1.41 , 95 % CI 1.14 , 1.75 ; P = 0.002 ) , and grade II obesity ( OR = 1.57 , 95 % CI 1.05 , 2.36 ; P = 0.03 ) , while controlling for a wide range of covariates , including household composition at baseline . Oportunidades has been portrayed as a model for CCT programs worldwide , but the results reported here support the notion that the cash component of Oportunidades may be negatively associated with some adult health outcomes
The available evidence on impact of CCT and UCT on contraception is inconclusive due to the limited number of studies , varying outcome measures , and lack of intervention specifically for contraception
This systematic review synthesizes evidence on the impact of conditional and unconditional cash transfers ( CCT and UCT ) on contraception in low- and middle-income countries .