For young women in Malawi, the possibility of contracting HIV is ever-present. As of 2016, over 14% of women in their late 20s lived with the condition, a rate three times greater that of men; prevalence in some other sub-Saharan African countries is even higher.
A growing body of research supports one surprisingly effective solution: To help young women stay healthy, try giving them cash.
Cash transfer programs have emerged as one of the most influential global development policies of the last few decades, with programs rolling out in countries from Mexico to Kenya to India to the United States. Around one billion people now receive cash transfers, which typically come from governments, across 130 countries, according to the World Bank (pdf).
Research suggests giving poor people money outright really does work. Cash transfers are cheaper to administer than programs that focus on education or job training, and they allow people to make decisions about what the best investment might be based on their specific circumstances.
Mounting evidence suggests that cash transfers don’t just fight poverty—they also give poor women in particular a major boost. Studies in Malawi, South Africa, Mexico, and beyond show that with cash comes financial independence for women—a change that both empowers girls and young women to make more far-sighted choices in love and education and decreases domestic violence among adults, which gives their daughters a chance to flourish.
Avoiding the wrong sexual partners
In 2008, the World Bank funded a study that sought to find out whether cash transfers could have an impact on young women’s sexual health in Malawi. The idea was that some extra cash might allow young women to stay in school and get married later—factors associated with a lower chance of getting HIV.
For two years, the researchers randomly selected 800 girls between the ages of 13 and 22 in the Zomba district of Malawi to receive between $1-5 a month, and their parents an additional $4-10 a month. On average, a family received a total of $10 a month, about 10% of the typical Malawian family’s monthly income.
Eighteen months after the start of the program, researchers compared the women who’d received cash to a control group about 500 women who were not enrolled in the program. The results? The women who received the cash were healthier. While 3% of the women in the control group tested positive for HIV, only 1.2% of the women in the program tested positive. Three percent of the women in the control group had herpes, compared to less than 1% of the young women who’d received cash. Survey data also showed that women who did not receive cash were far more likely to lose their virginity and have sex regularly.
Clearly, the cash made a big difference. But why?
Economist Sarah Baird, one of the researchers on the study, has a surprising explanation about why the cash transfers worked: Basically, the cash allowed girls and young women to go out with younger guys.
“A little more pocket money can make a big difference about who these young women date,” Baird says. “They relied on [older] sexual partners for basic support like uniforms and school fees. As soon as the girls got the cash transfers from us, they were like, We are not going to date you anymore. Now I can date my classmate.”
Baird cautions that we shouldn’t necessarily think of the older guys in question as exploiting the young women. It’s just that they happened to be older, and so they were more likely to expect sex and have sexually transmitted diseases. She also notes that this explanation is mostly based on interviews with participants in the study, rather than quantitative evidence—although the data do show more of the women in the control group say they had a sexual partner over 25.
One participant explained the impact of the program in an interview: “[A]fter the program, I had money, and if the time came for me to date a boy, I would look for the one who is pleasing me, not just choosing someone who does whatever … provided he is giving me money.”
It’s not the only study to find such an effect. A similar experiment, conducted in the Mpumalanga district of South Africa from 2010 to 2011, also found that cash had important impacts on dating. This experiment, funded by the US National Institute of Health, involved giving girls between the ages of 13-20 and their parents $10-20 a month under the condition that the girl went to school. The researchers found that, on average, the girls selected for the program started having sex later and had fewer sexual partners. They also faced less physical violence within those relationships.
The South Africa study’s researchers hoped to find that young women would be less likely to contract HIV than a control group. They found no effect. But the lack of impacts in this case is not damning to the idea that cash transfers can be good for women’s sexual health. As the World Bank economist Berk Ozler points out, this program was not targeted at a group of women particularly vulnerable to contracting sexually transmitted diseases.
Regardless of the health outcomes, giving a young woman a small amount of cash appears to allow her to date the way she wants to—not as she deems necessary. This seems like an excellent investment in women’s futures.
Decreasing domestic violence in marriages
One feature of most cash transfer programs today is that the cash is directed towards the mother in a household. Policymakers figured women would be more likely to spend it on their children’s education and health, while a man might be more likely to blow it on drugs and gambling—what researchers call temptation goods. Studies have shown, that indeed, women are more likely to spend cash transfers on their kids (pdf). Thankfully, there is no evidence that men spend the money frivolously—they just tend to spend it on housing and other physical assets.
In addition to allowing empowering women to direct money towards their priorities, programs that give the cash to mothers also have had a surprising, and very welcome, secondary effect: They reduce intimate partner violence.
Globally, one in three women have experienced intimate partner violence. Women with fewer financial resources are particularly likely to experience this brutality.
Domestic violence has profound effects on the next generation. Children raised in violent households are more likely to experience developmental delays and high rates of anxiety and depression. Young girls particularly suffer emotionally. A 2014 study in the US found that while exposure to domestic violence increased physical aggression in boys, for girls, it often led to worse social skill development.
Decreasing intimate partner violence was not the original aim of cash transfer programs. In fact, initially, program designers worried that concern that cash transfers directed to women could actually make things worse: Perhaps quarrels between couples over how to spend the money would lead to even more domestic violence.
A forthcoming paper in the World Bank Research Observer, shared with Quartz by the researchers, examined the 14 major studies across the world that assessed the impact of cash transfers on intimate partner violence. The women who were part of these studies typically range from their early 20s to their 40s. The researchers show that eleven of these studies found a reduction in domestic violence, two found no change, and only one found an increase. That’s a miraculous finding.
It’s difficult to say exactly how much cash transfers reduce intimate partner violence. Transfers differ in the amount of cash given and in terms of the prevalence of intimate partner violence in the program’s location. In Ecuador, for example, monthly transfers of $40, or about 35% of that family’s typical spending, led to about a 25% reduction in intimate partner violence during the program. This was a fairly typical case.
So what happened?
Melissa Hidrobo, an economist at the International Food Policy Research Institute and one of the authors of the World Bank Research Observer study, tells Quartz that there are two main reasons cash reduces violence: Women get more power in their relationships, and life gets less stressful.
In her research examining the impact of cash transfer programs in Ecuador and Bangladesh, women who received cash often tell Hidrobo that it gives them more control in their relationship. Many husbands, accustomed to being the sole breadwinner in a household, adjust their behavior toward wives who suddenly have means of their own. Women can also use their cash as a way of sending a warning: If the husbands don’t change, women have the means to leave.
“When I got that [transfer], it was both of us [who were head of the household],” one Ecuadorian woman told Hidrobo in an interview. “With what I got, I could buy food and all, and he could pay for other things.”
An even bigger factor in reducing intimate partner violence, it seems, is that the extra money reduced stress. Globally, studies find that financial stress makes intimate partner violence more likely. According to Hidrobo’s research, cash transfers lead to fewer arguments about how to allocate money. An extra $10 a month might mean each partner gets the minimum they need to spend on their priorities—whether that be housing, a new business, on their children’s education. Hibdrobo says cash recipients she has interviewed often report more amicable relationships when it comes to finances.
The best quantitative evidence that reductions in stress from cash transfers is key to reducing intimate partner violence, is that, even when the money was given to men, researchers still found a significant reduction in violence. A program in Mali where cash transfers were targeted at men saw intimated partner violence reduced by around 20%.
The bad news (sort of)
The effect of cash transfers on young women’s relationships, sexual health, and intimate partner violence is very good news. Yet there is one important caveat. When the cash transfers go away, it appears that so too do the important effects on women.
Two years after the cash transfers ended, the researchers who conducted the program for young women in Malawi returned to measure the long-term impact. The results were incredibly disappointing. Nearly all the impacts on the program had disappeared. The women who received cash were just as likely to have HIV and be married.
Basically, as soon as the young women lost the cash support, they immediately went back to making the same choices they had before the cash was there. This shouldn’t be surprising, according to Sarah Baird. Nothing had really fundamentally changed for these women. The cash helped, but it was not enough to change their lives. Perhaps a larger sum, which would have allowed them to invest in education, would have made a bigger difference.
Melissa Hidrobo says that the evidence also suggests that when cash programs go away, the level of intimate partner violence in families receiving the support ticks right back to where it was. In fact, this appears to be a problem with cash transfer programs more generally. While they are good for poverty reduction while people receive them, more and more studies are showing that the effects don’t last.
This makes sense. Cash transfers should only have long-term impacts if people are able to use them to make investments that will help them after the transfer ends—by launching a business, say, or getting a degree. But good investments options don’t exist for many of the people receiving transfers, and if they do, recipients often don’t have the skills to make those investments. In effect, cash transfers are a palliative solution, not a transformative one.
This doesn’t mean that cash transfers are a bad idea. Most of the largest-scale cash transfer programs are run by governments, and sustained over long periods of time. The dissipation of impacts is a bigger deal for short-term programs run by NGOs. A recent World Bank report (pdf) on the state of cash transfer programs shows government-run cash transfers dwarf those of NGOs.
Still, it would be ideal if short-term cash transfer programs can create long-term positive change. Hidrobo says that one promising option is to have complementary education programs that go along with the cash. For an experiment that Hidrobo conducted in Bangladesh, some women were given cash conditional on their attending a nutritional education program, while others were just given cash. Hidrobo’s analysis suggests that while the effect on intimate partner violence dissipated for those only given cash once it went away, the impact has stuck around for those who also received the nutrition program.
Because of cultural norms, many women in rural Bangladesh mostly stay in their homes, with little social interaction with those out of their family. The training program gave these women opportunities to build new relationships—a program they might not have attended without the cash incentive. It is through these relationships, Hidrobo thinks, that the decrease in intimate partner violence is sustained. Even after the program ends, these women are more likely to visit other women in the community, and those women will see physical evidence that they were abused. This may shame men into changing their behavior.
Here’s the thing to remember about these programs: A cash transfer is not a silver bullet. It won’t change society; a woman given a modest amount of cash will not magically find her job prospects improved, or a sexist society transformed. Tackling women’s sexual health issues and intimate partner violence means improving women’s economic opportunities and reducing the gender pay gap, which in turn makes it easier for women to form healthier relationships, and leave bad ones—for their own good and their children.
Still, cash programs are a promising and simple way to dramatically improve the lives of the most vulnerable women. They also offer a reminder that the world is often too quick to blame young people for their circumstances—particularly young women from low-income backgrounds. Often, all these women need to advance in life are the privileges that come from having a little extra money.