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

Molly S. Rosenberg · Audrey E. Pettifor · Nadia Nguyen · Daniel J. Westreich · Jacob H. Bor · Till Bärnighausen +4 more

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Poverty, Education, and Child Welfare Reproductive Health and Contraception Gender, Labor, and Family Dynamics

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.

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References

2006The Impact of Unconditional Cash Transfers on Nutrition: The South African Child Support Grant 2007Research into health, population and social transitions in rural South Africa: Data and methods of the Agincourt Health and Demographic Surveillance System1 2009Social protection to support vulnerable children and families: the potential of cash transfers to protect education, health and nutrition 2006Is the child support grant associated with an increase in teenage fertility in South Africa?: evidence from national surveys and administrative data 2007Unintended effects of poverty programmes on childbearing in less developed countries: Experimental evidence from Latin America 2001The Effect of Welfare Payments on the Marriage and Fertility Behavior of Unwed Mothers: Results from a Twins Experiment 2005Population mobility and household dynamics in rural South Africa: implications for demographic and health research.2007Evaluating access to a child-oriented poverty alleviation intervention in rural South Africa1

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