Study: Giving cash to mothers cut infant deaths in half

By GiveDirectly @ 2025-08-18T13:40 (+98)

Summary

• 🤰🏽 A randomized study in Kenya found that giving families a $1,000 GiveDirectly cash transfer immediately cut infant deaths by 48%. →
• 🏥 Deaths dropped most for mothers living near physician-staffed health facilities and those who received cash in the weeks before they gave birth. →
• 🩺 GiveDirectly is launching a new program to maximize these life-saving impacts, partnering with a Kenyan community health provider to get cash to more expectant mothers. →

In rural Kenya, giving poor families a one-time $1,000 transfer cut infant deaths nearly in half, one of the largest reductions ever recorded for a poverty program. With global aid budgets shrinking and funders under pressure to do more with less, the findings point to cash as a powerful, underused tool to reduce preventable deaths.

Cash cut infant deaths by 48%

The study, led by researchers at UC Berkeley and Oxford, tracked over 100,000 births and found that infant mortality fell by 48% in the years families received a one-time $1,000 transfer from GiveDirectly.

It’s a striking result, reinforcing what decades of research have already shown: poverty itself is one of the biggest risk factors for a child’s survival. As the researchers note, “infant and child mortality appears highly sensitive to economic conditions.”

Cash saved lives by helping new moms rest, eat, and deliver safely

The biggest gains were among newborns: deaths within the first 30 days of a baby’s life fell by 63%, with drops in maternal and newborn causes of death accounting for more than half of the overall decline in infant deaths. 

This drop was driven by a 45% increase in hospital deliveries and a 51% drop in work (often physically strenuous) during the third trimester and postpartum. Less work in late pregnancy coincided with fewer deaths from complications at birth. 

When mothers have cash, they get care, proving that sometimes, the best way to save a child’s life is to simply give their mom money.

Cash had the largest impact when timed near birth and paired with access to healthcare

🗓️ Timing was critical. Researchers note that “gains in child survival are concentrated among women who received cash in the month they gave birth or shortly beforehand.” Transfers that came earlier or later had smaller impacts.

🏥 Access to healthcare was just as critical. Infant deaths fell more in villages closer to physician-staffed health facilities, where mothers could more easily access and afford existing high-quality health services. 

The authors note that this pattern suggests “cash transfers can complement rather than substitute for investments in rural health infrastructure.”

Cash ranks among the best tools we have to save children’s lives

📊 Unconditional cash had impacts on par with top global health interventions. Our program reduced child deaths as much as giving out vaccines and anti-malarials, even though it wasn’t specifically designed to do so. This suggests direct cash should be a tool in the public health toolkit, working in complement with well-supported healthcare systems.^[1]

While the broad cash program in this study is certainly more expensive per family than other global health programs, the researchers note that if the cash was targeted to pregnant women in their third trimester, it could be “comparably cost effective to a number of WHO-recommended maternal and child health interventions, even without taking into account other possible benefits of unconditional cash transfers (such as consumption gains).”

We’re launching a pilot this fall in Kenya specifically for pregnant women to learn just how much more cost-effectively cash can improve infant and maternal health, one of our many tests to improve our programs for specific outcomes.

💵 Cash also boosts many economic measures. Beyond saving lives, large lump sum transfers are proven to improve many dimensions of extreme poverty. An earlier study of the same Kenya program found this $1,000 directly reduced poverty and grew the local economy:

We’re building on this evidence with new maternal and newborn health programs

Building on these results, we’re piloting a new program sending cash to pregnant women in rural Kenya, in partnership with local government actors and Lwala Community Alliance.

GiveDirectly will provide cash alongside existing health services to help women cover critical costs during pregnancy, childbirth, and postpartum recovery to maximize our impact.

We’ll be testing this model in two countries, with a similar program launching in the DRC with Panzi.

Cash is an underused tool to end preventable child deaths

This study adds to growing evidence that getting cash to the right households at the right time can prevent suffering before it happens. 

With global aid budgets shrinking by $21 billion this year, health systems are under pressure to do more with less, and leaders are rethinking how to protect the most vulnerable.

As Bill Gates recently put it, we need new ways to “put the world on a path to ending preventable deaths of moms and babies.” This new study shows that cash has huge potential to accomplish that goal.

Appendix: How we know cash saved lives (Methods FAQs)

Cash is well-studied. Why haven’t we seen this impact before?

This is the first randomized controlled trial (RCT) large enough to reliably measure whether cash reduces child mortality. Previous studies have shown that cash likely helps, but most used non-randomized methods that can’t fully rule out other explanations or were smaller in scale, making it harder to draw firm conclusions. 

This is because studying mortality takes: 

• Enormous sample sizes: Deaths are typically measured per 1,000 births, so even meaningful changes are hard to detect without surveying tens of thousands of people.
• Accurate birth data: Many places with high child mortality don’t have birth records, making it impossible to study changes in mortality over time.

Then how was this study able to measure the link between mortality and cash?

Two rare conditions came together: 

1. Large, randomized cash program: Between 2014 and 2017, GiveDirectly delivered $1,000 to over 10,500 households across 653 villages in rural Siaya, Kenya. Villages were randomly assigned to receive cash or not, allowing researchers to measure effects on both recipients and their neighbors.
2. Accurate, long-term birth survey: Like most places facing extreme poverty, Siaya, Kenya had no reliable birth records. To fill the gap, researchers supported by GiveWell ran a full census in 2023, surveying 107,000 women and recording over 100,000 births going back to 2011.

With these conditions, researchers could finally isolate the impact of cash on mortality at a sufficient scale.

Explore the map below to see the study area, including treatment and control villages. Proximity helped researchers measure both individual impacts and broader effects across communities.

How do they track 100,000 births with no hospital records?

To fill the gap of incomplete birth and death records, researchers used verbal autopsies: structured, in-person interviews with caregivers. This method is standardized, endorsed by the World Health Organization, and widely used when medical records aren’t available.

Teams went door-to-door across the study area to collect these histories, building the most complete picture possible of births and child survival over the study period.

1. ^{^}

   Our goal with this comparative table is to show that the effect size of cash was large -- comparable to other very effective global health interventions. This means unconditional cash is a promising tool for public health, which is not currently a commonly held belief.