268186 Impact of the Child Support Grant on fertility among rural South African women

Monday, October 29, 2012

Molly Rosenberg, MPH , Epidemiology, UNC Gillings School of Global Public Health, Chapel Hill, NC
Nadia Nguyen , Epidemiology, UNC Gillings School of Global Public Health, Chapel Hill, NC
Paul Mee , MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), University of Witwatersrand, Johannesburg, South Africa
Rhian Twine, MPH , MRC/Wits Rural Public Health and Health Transitions Research Unit, University of the Witwatersrand, Johannesburg, Johannesburg, South Africa
Kathleen Kahn, PhD , MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt); School of Public Health, Faculty of Health Sci, University of the Witwatersrand, Johannesburg, South Africa
Audrey Pettifor, MPH, PhD , Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel HIll, Chapel Hill, NC
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.

Learning Areas:
Planning of health education strategies, interventions, and programs

Learning Objectives:
1. Identify two potential ways poverty reduction programs issuing cash transfers may influence fertility decisions of female recipients 2. Describe the unique analytical challenges in research involving cash transfers and fertility

Keywords: Family Planning, Poverty

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I have experience researching the impact of poverty reduction programs on sexual health outcomes, including micro-finance and cash transfers. I personally developed the research question and performed the analyses presented here.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.

Back to: 3198.0: PRSH Posters: Contraception