Monetary Incentives and Early Initiation of Antenatal Care: A Matched-Pair, Parallel-Cluster Randomized Trial in Zambia

Forthcoming at Studies in Family Planning

Working paper version (here)

Monetary incentives are often used to increase the motivation and output of health service providers. However, the focus has generally been on frontline health service providers. Using a cluster randomized trial, we evaluate the effect of monetary incentives provided to community-based volunteers on early initiation of antenatal care visits and deliveries in health facilities in communities in Zambia. Monetary incentives were assigned to community-based volunteers in treatment sites, and payments were made for every woman referred or accompanied in the first trimester of pregnancy during January-June 2020. We found a significant increase of about thirty-two percentage points in the number of women seeking antenatal care visits in the first trimester but no effect on coverage rates (the percentage of women who deliver at a health facility and are assisted by skilled birth attendants). The number of women accompanied by community-based volunteers for antenatal care in the first trimester increased by thirty-three percentage points. Deliveries in health facilities also increased by twenty-two percentage points. These findings suggest that the use of health facilities during the first trimester of pregnancy can be improved by providing community- based volunteers with monetary incentives and that such incentives can also increase deliveries in health facilities, which are key to improving the survival of women and newborns.

Working Papers

Mental Health Effects of an Old Age Pension: Experimental Evidence for Ekiti State in Nigeria

With Maria Laura Alzua, Ana Dammert and Damilola Olajide

Revisions requested at Journal of African Studies

Many countries in the developing world have implemented old-age pensions. Evidence of the impact of such policies on the elderly in sub-Saharan Africa, however, is scarce. We provide the first evidence from a randomized evaluation of an unconditional old-age pension targeted at the elderly in Ekiti State, Nigeria. Our findings show that treated beneficiaries self-report better quality of life and a more stable mental health. We also provide evidence of spillover effects on the labor outcomes of other household members and of household savings patterns as well as support for interventions aimed at improving the welfare of elderly poor citizens and other household members.

Does maternal schooling lead to improvements in child health? Evidence from Ethiopia

Under review at Economics of Education Review

You may find it here

This paper examines the role of women’s education on child health by analyzing the second-generation impact of a nationwide reform that eliminated primary school fees in Ethiopia in 1995. I exploit the timing of the implementation of Universal Primary Education (UPE) policy in Ethiopia, as well as regional differences in implementation, as a natural experiment and a Two Stage Least Square analysis of the effect of schooling on their children's health. Analysis of key health outcomes among children whose mothers were educated at the time of the reforms’ implementation shows better long-run health outcomes among the children of women who received more schooling. The children of women with more schooling are 4 percentage points less likely to be chronically malnourished, and they display 0.190 and 0.177 standard deviations better weight-for-age and height-for-age Z-scores, respectively.

Is there school discrimination against children of same-sex households? Experimental evidence from Colombia

with Brian Feld and Mónica Hernández-Florez

Workin g paper (Draft)

We measure the extent of discrimination against same-sex couples by schools in Colombia using a correspondence study. We send requests to visit private and public schools from several couples of different sexual orientation as conveyed by the names of the parents. We track the response rate from schools, the time to reply and the "quality" of the reply. We find that schools are 11.7 percentage points (21.9%) less likely to respond to a request sent by a homosexual couple with respect to one sent by a heterosexual one. When no information about sexual orientation is provided, the response rate decreases by 20pp. (37%) versus an explicitly heterosexual couple. Conditional on replying, we find no difference in the time schools take to respond or the quality of the reply across couples, a result plausibly driven by selection into responding. Our findings suggest that, despite a strong legal framework that protects LGBTQ+ rights, discrimination against same-sex couples is pervasive and can have intergenerational consequences.

Gender and Value of Decision-making Within the Household: Experimental Evidence from Colombia

with Tatiana Orozco, Marcela Ibanez and Gerhard Riener

Freedom of choice is a fundamental aspect of individuals' social, economic, and political lives, and it is considered the ultimate goal of development. However, one paradoxical aspect is that men are the primary decision-makers in many cultures at the household and community levels. We use a two-stage field experiment to examine whether men's and women's underlying motivations to exert agency differ. In the first stage, participants make a donation decision on an individual and a joint endowment. In the second stage, and without previous announcements, participants can delegate the decision to either a random device, their spouses, or a stranger. This stage allows us to identify whether men and women value agency equally. Similar to Neri and Rommeswinkel (2017), the treatment conditions vary the control individuals exert on others' payoff to disentangle the role of preferences for independence, power, or self-reliance as mechanisms explaining agency. We find gender differences regarding the preferences to keep the decision rights. Our findings imply that men strongly prefer freedom, while similar behaviour is not found in women paired with their spouses.

The Effect of Teenage Pregnancy on Schooling and Labor Force Participation: Evidence From Urban South Africa

Working paper (here)

Policy makers often express concerns over the lasting implications of teenage pregnancy, due to the observation that young mothers have worse health, less schooling, and poorer job market performance in adulthood. However, because there is selection into early motherhood, the causal impact of teenage pregnancy on human capital investments is difficult to estimate. Additionally, the majority of the literature has focused on high income settings. I examine the impact of teenage pregnancy in Cape Town, South Africa, on educational outcomes and future labor force participation using two main identification strategies. I use an instrumental variable strategy which relies on the number of teenage fertile years as an instrument for teenage pregnancy and exploit differences among a subsample of sisters where one sister reported a teenage pregnancy and at least one who did not. I find an increase in the likelihood of failing a grade by approximately 50 percentage points and dropping out of school of 27 percent (10 percentage points). As for overall school attainment, teenagers who report a pregnancy are, on average, 1.8 less years less educated. Finally, I find that the negative effects of teenage pregnancy is mitigated by strong kinship networks and by lowering its social costs. My findings suggest that the presence of the mother

How can sports events alter public opinion on politics? Evidence from Colombia

with Andres Ochoa and Juan Camilo Madrid

Human behavior is the result of a wide array of variables. One of them is culture. In the case of Colombia, football constitutes a major cultural element, together with all the activities derived from it. Therefore, we have sought to explore how high-profile sports events can alter individual economic and political views. To do that, we have estimated the impact of the elimination of the national football team from the Russia 2018 World Cup. Our main findings suggest an 8.6 to 10.2 percentage-point decrease in confidence as measured by the governance index from the football match, based on a difference-in-differences analysis. On the other hand, an event study points to signs of a change in satisfaction regarding economic performance. We conclude that these variables do have a significant weight on public opinion regarding policy decision-making.

Do women-led ventures set different target margins? Evidence from emerging markets

with Brian Feld and Estefany Peña

You may find the working paper here (Draft)

In recent decades, the number of female entrepreneurs has grown substantially, particularly in low- and middle-income countries. Despite the high rate of involvement of women in entrepreneurial activity, the characteristics and performance of female-led ventures differ significantly from those of ventures led by men. A potential reason for this is the lack of clearly defined venture goals, including the profit margin that ventures target. We study the relationship between gender and target margins using a large dataset of ventures located in Latin America and the Caribbean and Sub-Saharan Africa. We find that ventures led only by women are almost five percentage points less likely than male-led ventures to establish target margins, even after observable characteristics of the venture and the founders are controlled for. In addition, in most cases, ventures with only female founders set lower target margins than those with only male founders. These results suggest that policymakers, as well as accelerators and incubators, can play a major role in supporting female entrepreneurs as they grow their businesses by encouraging women to set clear and realistic target margins to be more successful at raising funds for their ventures.

Financial incentives for maternal and child care: Impact of a national program in Bolivia

with Leonardo Orihuela

Financial incentives have been used as an effective means of encouraging health behaviours. The study explores the impact of a national program in Bolivia that provides small cash incentives to women. Conditional on antenatal care visits and deliveries assisted by skilled health personnel. We show positive effects of the program on prenatal care and delivery and use of health services in never married women. If never married women are enrolled in the program increases the probability of being attended by a doctor in a delivery care by 69.4 percentage points. Also, increase the probability of taking their children to the doctor during the first 30 days after birth by 57.4 percentage points. A pathway analysis shows that the results of such programs effects may be related to the empowerment of women and their effect on decision-making in the demand for medical care.

Premarital Fertility in Liberia: Exploring Predictors of Early Sexual Debut and Pregnancy Among Adolescent Girls in Monrovia

with Shelley Clark, Tricia Koroknay-Palicz, and Michelle Poulin

Works in Progress

The effects of mining on wellbeing in rural remote communities with Laura Quintero

The Covid vaccine take up in rural remote areas with Juan Carlos Muñoz and Laura Quintero

Schools during the Colombian Social Economic Crisis with Leonardo Orihuela and Daniel Cañizares

Community participation on school management, with Clara Delavallade, Alan Griffith, and Rebecca Thornton