Relationship between Receipt of a Social Protection Grant for a Child and Second Pregnancy Rates among South African Women: A Cohort Study
Year: 2015
Type: article
Study design: Observational Study
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.
Source: PLoS ONE
Institutions: Harvard University, University of North Carolina at Chapel Hill, University of the Witwatersrand, Agincourt Health and Socio-Demographic Surveillance System, Boston University, Wellcome Trust, London School of Hygiene & Tropical Medicine, Faculty of Public Health, Umeå University, Indepth Network
Language: English
Subfield: Safety Research
Field: Social Sciences
Domain: Social Sciences
Open Access status: gold
Estimated APC paid: $2,382
Awards: Strengthening and stabilising a demographic and health surveillance in Agincourt: foundation for a health and population research programme in South Africa's rural northeast, G1112674395, Carolina Population Center, HIV acquisition and transmission: Multi-level longitudinal analysis, South Africa, G1789099407, G2270545241, Health, population and social transitions in rural Southern Africa: Elucidating pathways and testing interventions., G339783423, Preventing cardiometabolic diseases in Africa: life-course and multi-sector approaches., G3511106470, G387396141, G4029150292, Investigating and responding to health, population and social transitions in rural Southern Africa., Causal Pathways to population health impact of HIV antiretroviral treatment, Africa Centre for Health and Population Studies: Core Award, G666894910, Carolina Population Center, G8186070293, G8276714428, G9000006923, G9000042165, Population Research Training
OpenAlex ID: W1804378147