Impact of the Child Support Grant on fertility among rural South African women

Background: Poverty reduction programs issuing cash stipends to parents/guardians of young children may influence future fertility decisions of the recipients. Methods: The authors constructed a closed, retrospective cohort of 7415 women eligible to receive the Child Support Grant (CSG) for a biological child living in the Agincourt sub-district of Bushbuckridge in rural Mpumalanga, South Africa between 1998 and 2008. The cohort was constructed using data originally collected by the Agincourt Health and Socio-Demographic Surveillance System. The main outcome was defined as a new pregnancy occurring after CSG receipt for women who received the CSG, and as pregnancy occurring after 2002 (median year of CSG receipt) for women who never received the CSG. Log-binomial models were constructed to estimate the relative risk of these pregnancies among women exposed to the CSG compared to unexposed women, controlling for the confounding effects of SES and refugee status. Results: Overall, 95% of women in the study received the CSG at some point during the ten-year follow-up and 29% experienced a pregnancy subsequent to their receipt of the CSG or the median CSG receipt year. Women who received the CSG were approximately 30% less likely to have a subsequent pregnancy compared to those not receiving the CSG (aRR: 0.69; 95% CI: 0.61, 0.78), adjusting for socio-economic status and refugee status. Conclusions: The CSG appears to provide no perverse incentive for pregnancy among this cohort of rural, South African women. However, the fertility consequences of such cash transfer programs should be considered prior to implementation.