Cash transfer programs improve health outcomes across low- and middle-income countries

Large-scale, government-led cash transfer programs drove significant improvements in health outcomes across low- and middle-income countries (LMICs), according to a major new study in The Lancet from researchers at the University of Pennsylvania Perelman School of Medicine. More women received health care early in their pregnancies, more babies were born in health facilities, and more births were attended by trained health workers when governments gave money through cash transfer programs. 

Giving cash leads to massive health improvements 

Researchers analyzed data from more than two million live births and nearly one million children under the age of five, spanning 37 LMICs, such as Haiti, Malawi, and Cambodia, between 2000 and 2019, 20 of which introduced large-scale cash transfer programs. 

The study found that, when governments give people money through cash transfer programs, women were more likely to plan pregnancies as they wished, and more women were also able to get and use birth control when they needed it. Cash transfer programs that reached a greater share of the population had the strongest effects. The study builds on prior research by the same team, published in Nature, showing that these same cash transfer programs led to large declines in mortality rates among women and children. 

As many countries consider the future of their cash transfer programs-including approaches such as basic or guaranteed incomes-this research highlights the broad health benefits these programs can deliver."

Aaron Richterman, MD, MPH, assistant professor of Infectious Diseases and one of the study's lead authors

Children benefit across the board 

The study also found that in countries with cash transfer programs, babies were more likely to be fed only breast milk, more young children got enough healthy food, and more children overall were vaccinated against measles. These programs also helped to lower the number of children who got diarrhea or were reported as underweight. 

While previous research has shown favorable impacts of cash transfers on beneficiaries' schooling, nutrition, and well-being, this study is among the first to demonstrate population-wide health improvements, including among non-beneficiaries. 

The authors combined national survey data with a comprehensive database of government-led cash transfer programs to evaluate seventeen outcomes related to maternal health service use, fertility and reproductive decision-making, caregiver health behaviors, and child health and nutrition. 

Why it matters 

More than 20 percent of the world's population live on less than $3.65 a day, and 700 million survive on less than $2.15 per day. The trend has only worsened since the COVID-19 pandemic, which some estimates say will have plunged nearly 50 million people worldwide into extreme poverty by the year 2030. 

"Unfortunately, that gap has likely only widened since," added Richterman. 

This research also has relevance for ongoing debates about cash transfers and other forms of economic support in the U.S. The new study appears amidst a reduction of social safety net programs like Supplemental Needy Assistance Program (SNAP) benefits, which saw significant federal cuts beginning this month. The same research team, in 2023, found that rollbacks to temporary SNAP benefits led to significant increases in food insufficiency. 

Some cities, like Flint, Michigan, have considered cash transfers and similar programs, such as guaranteed income. Flint's Rx Kids program promised $1,500 for all expectant mothers during pregnancy and $500 per month for the first year of their baby's life regardless of income. 

Taken together, the research gives policymakers new data to consider when outlining how best to support families in low- and middle-income countries-as well as potentially here at home. 

"The evidence from this study strengthens the case for countries to expand the coverage of cash transfers," added Harsha Thirumurthy, PhD, Professor and Chief of the Division of Health Policy and co-author. "Cash transfer programs impacted not only mothers, but their children, and led to a broad array of health improvements." 

This research was supported by the Eunice Kennedy Shriver National Institute of Child Health and Development and the National Institute of Mental Health.