Cash Transfers, Young Women’s Economic Well-Being, and HIV Risk: Evidence from HPTN 068

Abstract

Despite the large interest in economic interventions to reduce HIV risk, little research has been done to show whether there are economic gains of these interventions for younger women and what intermediary role economic resources play in changing participants' sexual behavior. This paper contributes to this gap by examining the impacts of a conditional cash transfer (CCT) for young women in South Africa on young women's economic resources and the extent to which they play a role in young women's health and behavior. We used data from HIV Prevention Trials Network 068 study, which provided transfers to young women (in addition to their parents) conditional on the young woman attending at least 80% of school days in the previous month. We found that the CCT increased young women's economic wellbeing in terms of having savings, spending money, being unindebted, and food secure. We also investigated heterogeneous effects of the program by household economic status at baseline because the program was not specifically poverty targeted and found that the results were driven by young women from the poorest families. From these results, we examined heterogeneity by baseline poverty for other outcomes related to HIV risk including sexual behavior and psychosocial well-being. We found psychosocial well-being benefits in young women from the poorest families and that economic wellbeing gains explained much these impacts.

Government of Malawi's unconditional cash transfer improves youth mental health

“…First, our findings further underline the potential of unconditional cash grants, which are increasingly used as part of national social protection systems in SSA, to improve youth mental wellbeing when implemented at scale. As mentioned in the introduction, our findings are in line with three other studies examining the effects of cash transfers on youth mental health in Kenya, Malawi and South Africa (Baird et al, 2013; Kilburn et al, 2016, 2018a). All three programs resulted in improvements in mental health (Kilburn et al, 2018a only for the poorest households), despite differences in the targeting criteria, program features such as transfer amounts, and length of exposure to the program.…”

“…Although the program substantially increased school enrollment, changes in school participation do not appear to explain the improvement in mental wellbeing. Finally, Kilburn et al (2018a) find that an NGO-run cash transfer conditional on school attendance in South Africa had no average impact on the CES-D scale among female youth aged 13–20 at baseline, yet improved both mental health and hope among girls in the poorest households at baseline. Taken together, these results show promise for similar income support programs to improve youth mental health.…”

The Impact of a Conditional Cash Transfer on Multidimensional Deprivation of Young Women: Evidence from South Africa’s HTPN 068

“…Household consumption of our sample is also much lower compared to the rest of South Africa and most households would be defined as poor by government standards. At the start of baseline data collection in 2011, the official poverty line in South Africa was 620 Rand per capita/month while the average per capita monthly expenditure among our study sample at baseline was only 460 Rand, demonstrating consumption rates well below the poverty line (Stats SA 2014 ; Kilburn et al 2019 ). Food expenditures among our sample also makes up around half of total expenditures signifying that most consumption was for basic needs.…”

“…Food expenditures among our sample also makes up around half of total expenditures signifying that most consumption was for basic needs. Moreover, the young women participants reported high levels of food insecurity at baseline with around a third reporting having been worried about having enough food in the past 12 months (Kilburn et al 2019 ). Comparatively, across South Africa, 36% of households were considered poor and 23% were food-poor according to official poverty lines at the time of baseline data collection in 2011 (Stats SA 2017 ).…”

The effect of cash transfers on mental health: Opening the black box – A study from South Africa

“…This makes South Africa a particularly important country for the analysis of cash transfer effects on mental health. Few studies have analysed the effects of cash transfers on mental health outcomes and most of these studies look at the direct effects of cash transfers on adolescent, child and maternal mental health and find mixed evidence ( Ozer et al, 2011 ; Baird et al, 2013 ; Haushofer and Shapiro, 2013 ; Kilburn et al, 2016 , 2019 ; Angeles et al, 2019 ; Ohrnberger et al, 2020 ). Whilst understanding the general direction and magnitude of the effect is important, it is also vital for mental health policies that focus on the poor populations in LMICs to understand the underlying mechanisms (mediators) through which cash transfer programmes affect mental health.…”