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Pre-commitment Devices and Delivery Facility Choice

Health & Psychology Kenya

Complications in the period around childbirth take the lives of 1.25 million mothers and babies each year in sub-Saharan Africa. This study conducts a randomized evaluation with pregnant women in informal settlements of Nairobi, Kenya, where maternal and neonatal mortality rates remain high despite nearly universal delivery in facilities. Researchers analyze whether cash transfers, coupled with behavioral “nudges,” lead women to deliver in higher-quality facilities that are consistent with their preferences. The first intervention tested was a labeled cash transfer (LCT), which explained that the cash was to help women deliver where they want. The second combined an LCT with a commitment by the recipient to deliver in a pre-specified desired facility as a condition of receiving the final payment (L-CCT). While the LCT had fewer measured benefits, results found the L-CCT leading to improved quality of interpersonal care, but not technical care, according to the patients. In addition, the L-CCT led to more women delivering in facilities meeting standards for newborn care but not obstetric care. However, many women still used poor-quality facilities. A larger study is necessary to test whether the L-CCT can improve maternal and newborn outcomes.

All PIS on Project
  • Margaret McConnell
  • Jessica Cohen
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