Effects of a Mexican Conditional Cash Transfer Program on Health and Demography

Abstract

Progresa, a Mexican conditional cash transfer program (CCT), was introduced in 1997 to alleviate poverty. The program provided cash payments to low-income households conditional on the children’s regular attendance at school and household members’ regularly visits to health clinics. Progresa also offered nutritional supplements, principally to young children and pregnant women. This anti-poverty program was one of the oldest and best-known CCT programs, supporting 7 million low-income families. However, in Spring 2019, the Mexican government officially dismantled Progresa. This dissertation evaluated the impacts of implementing and terminating of Progresa on Mexican health and demographic outcomes using nationwide vital statistics. As vital events were frequently under-reported in rural areas of Mexico where Progresa was mainly implemented, the first chapter examined the validity of vital statistics using the Brass method. I found that births and child deaths were under-reported in Mexico, and under-reporting was more severe in poorer areas. However, for births, there was little evidence of under-reporting once late-registered births were taken into account. The second chapter evaluated the effects of Progresa on fertility, child mortality, and maternal health. Using variations in the beneficiaries of Progresa across municipalities and time, I found that Progresa significantly reduced 0.4-0.5 births during a woman’s lifetime, while adolescent pregnancy was decreased by 13-18%. The program reduced child mortality by 19%, but the effect was temporary. Progresa also enhanced maternal health: it significantly increased institutional deliveries and birth attendance by physician, while decreasing childbirth at home and birth attendance by nurse or midwife. The third chapter assessed the effects of the recent sudden termination of Progresa: it immediately increased in infant mortality due to infectious and parasitic diseases, whereas it reduced deliveries at private clinic and marginally increased deliveries with midwives’ attendance. This dissertation makes significant contributions to social policy and public health by estimating the effects of the CCT program on understudied demographic and health outcomes and the effects of its sudden termination on maternal and child health. This research has crucial public health and policy implications, particularly for several middle- and low-income countries where similar CCT programs are implemented