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Precommitment, Cash Transfers, and Timely Arrival for Birth: Evidence from a Randomized Controlled Trial in Nairobi Kenya
Jessica Cohen, Katherine Lofgren, and Margaret McConnell
American Economic Review. May 2017, Vol. 107, No. 5: Pages 501-505

Precommitment, Cash Transfers, and Timely Arrival for Birth: Evidence from a Randomized Controlled Trial in Nairobi Kenya†

Jessica Cohen1, Katherine Lofgren2 and Margaret McConnell3

1Harvard T. H. Chan School of Public Health, Building 1, Room 1209, 665 Huntington Avenue, Boston, MA 02115 (e-mail: )

2Harvard Center for Health Decision Science, 718 Huntington Avenue, 2nd Floor, Boston, MA 02115 (e-mail: )

3Harvard T. H. Chan School of Public Health, Building 1, Room 1217, 677 Huntington Avenue, Boston, MA 02115 (e-mail: )

Abstract

Maternal and neonatal mortality rates in the slums of Nairobi, Kenya are among the highest in the world. Mounting evidence suggests that delivering in a facility is not enough to ensure mortality reductions: women must deliver in high-quality facilities and arrive early enough for appropriate care if complications arise. We designed an RCT combining labeled cash transfers and pre-commitment incentives to encourage earlier and more effective delivery facility choice and to promote earlier facility arrival. We find that the intervention improves planning, increases delivery at the desired facility, and encourages more timely arrival at delivery facilities.