Healthcare at the Beginning of Life and Child Survival: Evidence from a Cash Transfer Experiment in Nigeria

Households in poor countries are encouraged (and sometimes coerced) to increase investments in formal health care during pregnancy and childbirth. Is this good policy? The answer to a large extent depends on its effects on child welfare. In this large-scale randomized trial designed to shed light on this question, households in Nigeria were randomly assigned to receive a cash transfer of $14 conditioned on uptake of a package of health services by pregnant women in the household or to a control group that received a small gift worth $0.43 for participating in the trial. We show that women in treated households were substantially more likely to use healthcare services. We then show that this led to a large and significant increase in child survival (about 7% relative to the control group mean). We explore causal mechanisms and present evidence suggesting that the key driver is prenatal health investments and not health care at birth.