Effect of Ecuador's cash transfer program (Bono de Desarrollo Humano) on child development in infants and toddlers: a randomized effectiveness trial.

We examined the effects of Ecuador's Bono de Desarrollo Humano (BDH)--an unconditional cash transfer program that was rolled-out using a randomized design--on health and development outcomes in very young children. Communities that were randomly assigned to the treatment group began receiving the BDH in 2004 and those randomly assigned to the comparison group began receiving benefits two years later. Families enrolled in the BDH received a monthly cash stipend ($15USD) representing an approximate 6-10% increase in household income. Participants analyzed in this study are children aged 12-35 months from treatment (n = 797) and comparison (n = 399) communities in rural and urban Ecuador. Main outcomes measured were language skills (the Fundación MacArthur Inventorio del Desarollo de Habilidades Comunicativas-Breve), height-for-age z-score, and hemoglobin concentration. Results indicate that in rural areas, being randomized to receive the BDH in very early childhood led to significantly better performance on the number of words a child was saying, and on the probability that the child was combining two or more words. There were no significant effects on language development for children in urban areas and there were no effects on height-for-age z-score or hemoglobin concentration in rural or urban areas. A limited number of potential pathways with respect to cognitive/language stimulation, health behaviors, and parenting quality were also explored. Findings indicate that compared to children in comparison areas, rural children in treatment areas were more likely to have received vitamin A or iron supplementation and have been bought a toy in the past six months. This study provides evidence for significant benefits of an unconditional cash transfer program for language development in very young children in rural areas.