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ticks or carrots? Conditional cashransfers and their effect on childbuse and neglect

eetie Roelen ∗

nstitute of Development Studies, UK

n recent years, conditional cash transfer(CCT) programs have gained unprece-dented popularity in the fight against

overty, and can now be found across thelobe. Experience is most long-standing andidespread in Latin America, with almost

very country in the region running a CCT pro-ram.CCT programs aim to break the intergen-

rational cycle of poverty by making cashransfers conditional upon certain requirementshat promote human capital development. Con-itions largely pertain to education, health, andutrition for children and include school enroll-ent and attendance, immunization and regular

ealth check-ups, and weight monitoring.Programs have been widely applauded for

heir positive effects on various outcomes forhildren and short- to medium-term poverty.hey are considered particularly appropriate

n a context with demand barriers that limit

An overwhelming and growing body of evi-dence supports claims that CCT programs doindeed positively benefit households and chil-dren. In their paper from 2009, Ariel Fiszbeinand Norbert Schady show that CCT programsin Latin America increase household consump-tion and reduce poverty, particularly whentransfers are generous. In a systematic reviewof CCT programs in low- and middle-incomecountries, Mylene Lagarde, Andy Haines, andNatasha Palmer point to the positive effectsof CCTs on care-seeking behavior, immuniza-tion coverage, anthropometric measures, andhealth status. Cash transfers (including condi-tional transfers) in Malawi were found to havehelped reduce rates of early marriage and HIVinfection, and a CCT program in Honduras hada positive effect on routine pediatric examina-tions and growth-monitoring visits for children.

Evidence with respect to linkages betweenCCT programs and child protection outcomes

r provide unequal access to services such asducation and health care.

∗ Correspondence to: Institute of Development Studies, LibrE-mail address: k.roelen@ids.ac.uk

145-2134/$ – see front matter © 2014 Elsevier Ltd. All rightttp://dx.doi.org/10.1016/j.chiabu.2014.01.014

ary Road, Brighton, England BN1 9RE, UK.

is most widely available with respect to theissue of child labor. A 2012 review by Marco

s reserved.

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Sanfillipo, Chris de Neubourg, and Bruno Mar-torano reported a reduction of the incidence ofchild labor numbers of hours worked for bothboys and girls, often going hand-in-hand withan increase in primary and secondary schoolenrollment and attendance rates.

CCT programs also hold promising potentialfor other areas of child protection, includingimprovement in quality of care, preventionof loss of parental care, and reductionsin early marriage. As such, CCT programsare often considered an important interven-tion in the toolkit for child-sensitive socialprotection.

Notwithstanding the rigor of evaluations thathighlight the benefits of CCT programs, fewattempts have been made to think “outside thebox” and investigate negative side effects orperverse incentives that may negatively affectchildren or adults. It is a common feature ofimpact evaluations – they assess the antici-pated impact of programs but hardly ever allowfor considering what goes on outside of thetheory of change to investigate unintended side-effects, either good or bad. Because issues ofchild protection, with the exception of childlabor, tend not to feature in theories of changeof CCT programs, the potential effect on childabuse and neglect – and child protection morebroadly – is rarely considered.

A recent review undertaken by ArmandoBarrientos, Jasmina Byrne, Juan Miguel Villa,and Paolo Pena from the Brooks World PovertyInstitute and the United Nations Children’sFund (UNICEF) Office of Research confirmedthe need for more information. According totheir report, of 79 impact evaluation reports onsocial transfer programs, 58 were found to con-sider the impact on child labor, 36 assessed the

effect on schooling outcomes, five assessed theimpact on child marriage, and three consideredfamily separation.

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Three elements of CCT programs are keywith respect to their potential impact in termsof child protection, namely (1) conditions, (2)cash, and (3) supply of services.

Conditions: Putting theCart Before the Horse?

Conditionality is the defining feature of CCTprograms and is a debated topic when it comesto designing and implementing social protec-tion programs. Arguments in favor and againstrest not only upon evidence as to what worksbut also upon ideological, political, and moralconsiderations.

Conditions in CCT programs essentiallyserve to nudge recipients to behave in a cer-tain way because they are not trusted to behavethat way if the cash was provided to them with-out such conditions. The evidence that this isindeed the case – that recipients behave moredesirably when the cash is conditioned – is fewand far between.

Both conditional and unconditional (cash)transfer programs have been found to improveoutcomes for children and families, but there islittle research that shows that such effects canbe attributed to the element of conditionality inparticular. The imposition of conditions may ormay not amplify the transfers’ positive effects.For example, although CCTs in Malawi weremore effective than unconditional cash trans-fers in keeping adolescent girls in school, therewas no difference in rates of school enrollment,early marriage, and HIV infection.

Notwithstanding the potential positiveeffects, the imposition of conditions can alsolead to unforeseen negative side effects and

perverse incentives with repercussions interms of child protection. For example, a 2004paper by Saul Morris, Rafael Floris Pedro

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linto and Juan Manuel Medina of Brazil’solsa Alimentacao (Feeding Allowance) pro-ram indicated that the program led to somehildren being kept underweight to guaranteeualification for benefits that were tied tohildren being below a particular weight.imilar concerns were raised in an evaluationf a food voucher program in Dabaab refugeeamp in Kenya in which the receipt of benefitsepended on the number of children in theousehold being malnourished.

These experiences point toward the risk ofssociating the receipt of benefits with negativeutcomes for children (e.g., having your childlassified as underweight or malnourished).n evaluation of Nicaragua’s CCT program,owever, found that conditions based on pos-tive outcomes (e.g. the child having gainednough weight) can equally give rise to per-erse incentives. Some children were overfedn a last-minute attempt to avert suspensionf benefits due to children not having gainednough weight.

This creation of perverse incentives is notxclusive to conditions related to nutritionalutcomes. A program in Hungary with casheing conditional upon school attendance com-elled mothers to send their children to schoolven when they are ill. In Romania, thentroduction of a condition in the country’shild benefit program led to hidden dropout:hildren would only attend school intermit-ently but were not reported as absent byhe teachers because the teachers’ salariesere, in part, tied to the number of children

nrolled.Concerns have also been raised about the

otential substitution effect that conditionsimed at promoting gender equality may cause;

hat is, if a condition specifies that girls are toe enrolled in or attending school, boys may beaken out of school to fulfill the domestic chores

or work outside of the household previouslyundertaken by girls.

Another type of condition placed on thereceipt of transfers involves work. Public workprograms in particular have grown in popu-larity in recent years, in part because theyare believed to counteract dependency syn-drome and the notion of beneficiaries gettingsomething-for-nothing. This work requirementcan have quite distinct positive and negativeeffects for children.

Work requirements for adults in public workprograms can also have adverse impacts oncare for children. Results from many studiespoint towards increased school enrollment andattendance rates and a decrease in hours workedin different types of paid and unpaid work bychildren. However, there is also evidence thatsuggests an increase in the hours of work forchildren, particularly girls, to substitute forthe adult that is now working outside of thehousehold. For example, studies of Ethiopia’sProductive Safety Net Program (PSNP) byScelo Zibagwe, Themba Nduna and GiftDafuleya in 2013 and John Hoddinott, DanielGilligan and Alemayehu Seyoum Taffesse in2010 find a substantial degree of substituta-bility, with school attendance rates for youngergirls (aged 6–10) dropping and the numbersof hours spent on domestic work going up.

Other productivity-enhancing programs,such as microcredit or microfinance schemes,led to similar effects with children beingrequired to take on more domestic choresto compensate for their parents’ increasedabsence from the household. Findings froma cash-for-work emergency relief program inEthiopia suggest that the creation of assetsassociated with the receipt of cash requires chil-

dren to provide labor supply for the utilizationof those assets, most notably livestock and land.Some studies have found this increase to go

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Child Abuse & Neglect xxx (2014) xxx–xxx

at the expense of school enrollment and atten-dance, but more often a child sacrifices his orher leisure time. When caregivers go to work,children may go without adult supervision forhours each day. Such impacts can be counter-acted through appropriate child care arrange-ments at the public works location. Guidelinesfor such arrangements have been formulatedfor large public works schemes, includingEthiopia’s Productive Safety Net Programand India’s Mahatma Gandhi National RuralEmployment Guarantee Scheme (actual imple-mentation, however, has been limited to date).

Most programs are more successful in opera-tionalizing provisions for pregnant women andlactating mothers that exempt them from workfor a fixed period of time. For example, a cash-for-work program in Ethiopia allows mothersto continue receiving their allowance whilestaying at home with their newborn childrenfor up to 10 months. The program has resultedin increased breastfeeding and more time spentwith children. By comparison, women in neigh-boring areas without the program were forcedto separate from their newborns soon after giv-ing birth to go to work.

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People’s own preferences in terms of receiv-ing transfers with or without the attachment ofconditions are also far from evident. Althoughsome researchers and practitioners emphasizethat recipients of cash transfers perceive con-ditions as being empowering and as providingopportunities for improved livelihoods, othersraise concerns about CCT programs encourag-ing paternalism, reinforcing inequalities, andlimiting people’s freedom to choose.

Indeed, the imposition of conditions impliesa power transfer that can put children and theircaregivers in a vulnerable position. Someonehas to attest that conditions were met (e.g. ateacher must confirm school attendance; a doc-tor must sign a vaccination card). Althoughthere is no evidence of systematic abuse of suchpower, the potential implications of such powertransfers when imposing conditions should beconsidered, particularly with respect to chil-dren. Their lack of autonomy and relativevoicelessness make them particularly vulner-able to the abuse of power, and conditions mayreinforce and perpetuate their vulnerable posi-tion rather than lessen it.

Cash: A Wolf in Sheep’sClothing?

The positive effects of providing regular andreliable cash payments have now been widelydocumented (see, for example, the 2010 book,Just Give Money to the Poor, by Joseph Han-lon, Armando Barrientos, and David Hulme).Cash transfers are seen to help reduce povertyand inequality, improve educational and healthoutcomes for children, and lift demand-sidebarriers to access to services. The role of cash

transfers is also increasingly being consideredin relation to children’s care issues, notably, inrelation to the quality of care, prevention of loss

Child Abuse & Neglect xxx (2014) xxx–xxx

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f parental care, and incentivizing of kinship oroster care.

Indeed, poverty and lack of resources canreatly undermine carers’ abilities to provideuality care to children. It is widely recognizedhat economic hardship leads to high stress lev-ls, which can negatively affect the quality ofare children receive. It is also likely to limit themount of time a parent or carer can spend withis or her children, often forcing older childreno supervise and care for younger siblings. Thenability to make ends meet may also requirehildren to engage in household production orork outside of the household at the expense of

heir schooling or other developmental activi-ies.

Cash transfers can work toward amelio-ating that stress and reduce the need foregative coping strategies. For example, asighlighted by Armando Barrientos and col-eagues, the receipt of cash through CCTrograms allowed mothers in Mexico andolombia to reduce their hours of paid workutside of the house, thereby avoiding having toeave their children unsupervised at home androviding opportunities to spend time with theirhildren.

Monetary incentives or other transfers arelso thought to influence children’s care byreventing the loss of parental care and sup-orting preferred options for alternative care,ost notably foster or kinship care. Poverty is

n important factor in children losing parentalare. Parents migrating in search of employ-ent opportunities leads to family separation,

nd the inability to make ends meet may causeamilies to take desperate measures such asending their child to be raised in an institu-ion. Poverty may also cause children to leave

he house in search of better care or work else-here. Cash transfers might prevent families

rom adopting such strategies.

When loss of parental care cannot be avertedor reversed, it is widely acknowledged that kin-ship support, foster care and formal adoptionare more appropriate and preferable options toresidential care. However, potential kin, foster,or adoptive caregivers may lack the resourcesnecessary to care for an additional child(ren).The overextension of already poor host house-holds is considered one of the major constraintsin terms of the provision of informal care forchildren, and the lack of proper financial sup-port is a reason for a dearth of foster carersin many regions. A Save the Children cashtransfer program in Goma in the DemocraticRepublic of Congo that was directed at sup-porting foster families in caring for separatedand unaccompanied children – many of whomwere previously members of armed groups –was successful in providing many of such chil-dren with family-based care. Many countriesfaced with large number of orphans are con-templating the option of cash transfer paymentsto providers of informal kinship or foster care.

Despite cash transfers’ potentially positiveeffects, on various aspects of children’s care,evidence is slowly emerging that these mech-anisms may also lead to unforeseen perverseincentives. One notable concern is the so-calledcommodification of children. Although thepromise of cash in return for care can providethe necessary support to families allowing themto provide kinship or foster care, it may alsoresult in poor care or abuse of neglect of chil-dren. In Botswana, for example, social workersindicated that in some cases carers are moti-vated by monetary incentives only and have nointrinsic or actual interest in caring for a child.

Experiences with Save the Children’s cashtransfer program in the Democratic Republic

of the Congo suggested that an important ele-ment to success was the training of carers andthe explicit agreement to a code of conduct by

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families. A description of program outcomesin a 2012 review by the Cash Learning Partner-ship (CaLP) on how cash transfers can protectchildren from violence, abuse, and exploitationindicated that in settings where such additionalmeasures were not taken, children were farmore likely to become the victim of abuse andexploitation. The use of a written code of con-duct was thus considered an important tool inensuring an adequate level of care and commit-ment.

More generally, the notion that placementin a (extended) family environment is in achild’s best interest should not be taken forgranted. Although the level of relatedness canplay an important role in a person’s willingnessto care for a child, with stronger blood rela-tionships being linked to greater willingnessto and higher quality of care, the motivationfor and nature of care provided to children isby no means self-evident. For example, prop-erty grabbing – whereby orphans lose theirinherited property to other family members,including to those members acting as their car-ers – is not an uncommon phenomenon inAfrica. Experiences in Mozambique have indi-cated that if foster carers are not adequatelyselected or prepared, children are more likelyto experience abuse and neglect.

The size and nature of the effect of trans-fers on children’s care also depends on programdesign and context. Although the prospect ofregular receipt of cash may instill confidencein carers, the requirement to comply with con-ditions or be an active program participantmay compound rather than reduce stress. Thiscompounding of stress holds particularly truefor female carers because the responsibilityfor complying with education- and health-

related conditions is often borne by women.The ways in which CCT programs build on andperpetuate women’s roles as main caregivers

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can reinforce gender inequalities rather thanimprove women’s empowerment, as argued byRebecca Holmes and Nicola Jones in their 2013book on gender-sensitive social protection.

Even if caregiver stress is reduced, it mightnot automatically translate into higher qualityof care and better outcomes for children. Theimplementation of a Village Savings and LoansAssociation scheme in Burundi, for example,showed that the reduction of household povertyin and of itself did not lead to better outcomesfor children and that awareness and sensitiza-tion was crucial.

Services: Lifting Barriers orCreating Unmet Needs?

Lack of Availability of Services

The supply of services is a key componentof any CCT program because a basic require-ment for the receipt of benefits is for programparticipants to make use of particular services(e.g., education, health). As most studies haveshown, much of a CCT program’s successhinges on the availability of and access tohigh-quality services. For this reason, it iswidely recognized that CCT programs are not asuitable option in supply-constrained contexts,and therefore, CCT programs are less com-monly implemented in Sub-Saharan Africa.

Nevertheless, the appeal of CCT programssometimes overrides such supply constraints.In reference to South Africa’s Child SupportGrant (CSG), for example, draft regulationssuggested making receipt of the grant condi-tional upon school attendance despite the fact

that poor school attendance in South Africa wasthe result of a lack of schools and limited spacein classrooms.

Child Abuse & Neglect xxx (2014) xxx–xxx

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The imposition of conditions in a supply-onstrained context does not only underminehe programs’ ability to break the intergenera-ional transmission of poverty, it can also havear-reaching negative effects in terms of childrotection. In Mexico, for example, compli-nce with school- and health-related conditionsoses a great problem for indigenous people aservices are often not available in the remotereas that they live in. Households in ruralreas in Mexico were required to move to urbanenters in order to comply with the conditionf secondary school enrollment. Beneficiariesf CCT programs in such supply-constrainedontexts can be said to experience a double dis-dvantage; not only do they have few or weakervices to their disposal, they are also beingunished for their inability to use such services.

ack of Quality Services

In addition to concerns about availabilityf services, concern has also been raisedegarding the quality of services. Qualityervices are imperative to ensure that pro-rams have the desired impacts in both thehort- and long-term. The focus on improvingvailability of and access to services has notlways resulted in improving quality of thoseervices. Examples from different contextshow that a rapid expansion of services haseen given higher priority than developmentnd capacity building among those imple-enting the services. Volunteers in Childrotection Community Committees (CPCCs)

n Mozambique, for example, struggle withdentifying and addressing complex problemsf child protection that go beyond the denial ofasic needs. More complex problems remain

ndetected or are not appropriately addressed.his capacity gap is confounded by the lackf resources in the statutory social workforce

to provide the required administrative andtechnical support to the CPCCs.

In terms of CCT programs making receipt oftransfers conditional on school attendance, Fer-nando Reimers, Carol DeShano da Silva andErnesto Trevino argue in a 2006 working paperthat an assessment of the impact of such pro-grams should look beyond school attendanceand rather pay attention to schooling outcomes.They point to the perverse political economyof CCT programs, whereby the promotion ofschool attendance diverts attention away fromnecessary educational reforms. In many con-texts, it is not school attendance that is requiredto improve children’s educational outcome butrather an improvement in educational services,including teacher training, selection, and pro-motion.

Beyond the lack of desired impact, poorquality services can also lead to child pro-tection violations. Limited training of serviceproviders (e.g., teachers, social workers, com-munity volunteers), may inadvertently lead toharmful practice. In addition, stress caused byheavy workloads and shortage of staff can haverepercussions in terms of child protection. Lowteacher-pupil ratios in schools, for example,may lead teachers to engage in harsher formsof child disciplining.

Lack of Availability ofComplementary Services

Complementary services over and abovethose on which receipt of transfers has beenmade conditional (e.g., coaching, awarenessraising, social support) can form the key inaddressing household power dynamics, genderinequality and care for children. The need for

complementary services that promote genderequity is a pertinent illustration of the value-added of complementary services. The direct

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provision of cash to women is often thoughtto lead to empowerment and reduce genderinequality. Despite positive effects, evidenceshows that much more needs to be done to breakentrenched patterns of gender inequality. Manyprograms target women in their role as mothersand primary caregivers, which has been toutedas empowering for women and disparagedfor reinforcing and perpetuating patterns ofgender inequality. Indeed, very few socialprotection programs make explicit provisionsfor informal care, with even fewer programsaddressing engendered patterns of care.

Experiences with transfer programs acrossthe globe suggest that cash in and of itselfcannot change the power dynamics within ahousehold or change traditional gender pat-terns. Evaluations of the Child Support Grant(CSG) in South Africa and a CCT programin Indonesia, for example, have shown thatalthough the receipt of the transfer by womencan be empowering, entrenched gender pat-terns prevent any alleviation of women’s careburden or improvement of income-earningactivities outside of the home. A direct transferof cash to women in Mexico and Nicaragua waseven found to increase domestic violence, asevidenced by Manuela Angelucci and by SarahBradshaw and Ana Quiroz Viquez in 2008.Although findings hold particularly true in theshort term and when transfers consist of largeramounts, there is no solid evidence suggestingthat this effect reverses in the longer run.

The need for complementary services toaddress engrained patterns of inequality anddisadvantage also extends to children. Manyevaluations have shown that although cashtransfers, both conditional and unconditional,can increase school attendance, decrease child

labor, and improve health seeking behav-ior for children, they have limited effect inaddressing underlying attitudes and beliefs

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regarding harmful practice for children in thefuture. In contexts where early marriage andchild labor are strongly entrenched in localtradition, for example, a (conditional) cashtransfer program is more likely to have a posi-tive impact in the long-run when coupled withsensitization and awareness raising.

Complementary social services can also playan important role in counteracting discrimi-nation. For example, experiences with a cashtransfer scheme in Goma showed that childrenin foster families were less likely to be sub-jected to abuse and neglect if transfers werecomplemented by a code of conduct that wasdiscussed and developed together with a socialworker. Also, participants in the Village Sav-ings and Loans Associations in Burundi wereless likely to subject their children to harshforms of physical and verbal disciplining whentaking part in discussion modules comple-menting the program.

Discussion

Despite the wealth of knowledge on CCTprograms, there is little evidence about theimpact of such programs on child abuse andneglect and child protection more generally.The consideration of CCT programs and othersocial protection programs in terms of theelements of conditions, cash, and supply ofservices do, however, allow for a number ofassertions.

For one, the imposition of conditions shouldundergo far more scrutiny than it has thus far,particularly in terms of the potential effectson children. The current discourse on con-

ditionality of programs largely emphasizespositive effects. It often fails to acknowledgethe potentially damaging consequences, which

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ay outweigh the supposed benefits of condi-ionality.

Indeed, the imposition of conditions can leado unintended consequences following parents’ctions to ensure compliance and avoid losingenefits. Strategies such as overfeeding chil-ren prior to weight assessments and sendingick children to school to meet attendance crite-ia counteract the positive benefits that the veryonditions aim to achieve.

Also, conditions can be a cause of con-iderable stress for parents and caregivers.ayments as part of CCT programs often con-titute a considerable part of family’s income,nd households will go to great length to securehat income. Lack of available services to com-ly with such conditions or misunderstandingsbout the actual conditions in place can rein-orce and exacerbate stress levels. A clearnderstanding of CCT programs’ criteria androcesses and their potential side effects byoth program implementers and recipients isrucial for reducing any negative side effectsr perverse incentives.

The provision of cash or other forms of trans-ers holds promising potential for children’sare. Indeed, supporting families’ abilities toake ends meet can prevent the loss of parental

are, improve quality of care, and encouragereferential care options. It is imperative, how-ver, not to turn a blind eye to the potentialerverse incentives. For example, in the situa-ion of using transfers to motivate participationn kinship or foster care, although the provisionf material support might present the necessarydditional means for families to care for a childhat is not their own, it might also constituten income-earning strategy with detrimentalffects for children. Thus, such efforts should

e administered with caution.Finally, the availability of and access to high-

uality services is imperative for the success

of CCT programs, particularly given that thetheory of change is built on the use of ser-vices like education and health care. In termsof child protection, services are crucial for tworeasons. First, the provision of high-quality ser-vices by skilled professionals and volunteerswill prevent child protection violations thatresult from lack of awareness and poor training.Second, complementary services – above andbeyond those that are part of CCT programs –have the potential to tackle structural causes ofchild protection violations by addressing harm-ful attitudes, behavior, and beliefs. Althoughthe strong focus on rapid expansion of ser-vices seems to undermine quality assurance,the establishment of the infrastructure can beconsidered a positive starting point.

Conclusion

In sum, there is no doubt that CCTs, alongwith unconditional cash transfers and othersocial protection programs hold great potentialfor improving children’s lives. Such opportu-nities should be taken advantage of to their fullpotential. However, the current debate aroundCCT programs is in danger of being roman-ticized, whereby the potential for perverseincentives or negative side effects is ignored.It has been argued that child-sensitive socialprotection needs a nuanced perspective, ratherthan being based on assumptions about whatwe think works and does not work for children.This includes the link between social protectionand child protection outcomes. What is neededis an injection of a healthy dose of realism.

A crucial step in gaining better insightinto the links between CCT programs and

child protection outcomes is not merely to domore research, but rather to do research thatgoes beyond the parameters as set by CCT

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programs’ theories of change and that crit-ically assesses the pathways through whichconditions are adhered to and program out-comes are reached. Such research requiresan acknowledgment that child protection out-comes are not only shaped by the interventionsdirectly (i.e., the provision of cash or the con-dition of school attendance or regular healthcheck-ups) but also, or maybe primarily, by thedesign and implementation features of those

Suggestion for Further Reading

Angelucci, M. (2008). Love on the rocks: Domestic violence and alcohol abuse in rural Mexico. Journal ofEconomic Analysis & Policy, 8(1), 43.

Barrientos, A., Byrne, J., Villa, J. M., & Pena, P. (2013). Social transfers and child protection (Working PaperNo. 2013-05). Florence, Italy: United Nations Children’s Fund, Office of Research.

Bradshaw, S., & Viquez, A. Q. (2008). Women beneficiaries or women bearing the cost: A gendered analysis ofthe Red de Proteccion Social in Nicaragua. Development and Change, 39, 823–844.

Fiszbein, A., & Schady, N. (2009). Conditional cash transfers: Reducing present and future poverty (World BankPolicy Research Report). Washington, DC: World Bank.

Hanlon, J., Barrientos, A., & Hulme, D. (2010). Just give money to the poor. Sterling, VA: Kumarian Press.Holmes, R., & Jones, N. (2013). Gender and Social Protection in the Developing World. Beyond Mothers and

Safety Nets. London: Zed Books.Hoddinott, J., Gilligan, D., & Taffesse, A. S. (2010). The impact of Ethiopia’s Productive Safety Net Program on

schooling and child labor. In S. Handa, S. Devereux, & D. Webb (Eds.), Social protection for Africa’s children.London, England: Routledge.

Lagarde, M., Haines, A., & Palmer, N. (2007). Conditional cash transfers for improving uptake ofhealth interventions in low- and middle-income countries: A systematic review. JAMA, 298, 1900–1910.http://dx.doi.org/10.1001/jama.298.16.1900

Morris, S. S., Flores, R., Olinto, P., & Medina, J. M. (2004). Monetary incentives in primary health care andeffects on use and coverage of preventive health care interventions in rural Honduras: cluster randomised trial.Lancet no., 364(9450), 2030–2037. http://dx.doi.org/10.1016/s0140-6736(04)17515-6

Reimers, F., C. DeShano da Silva, & Trevino, E. (2006). Where is the “Education” in Conditional Cash Transfersin Education? Quebec: UNESCO Institute for Statistics.

Sanfilippo, M., De Neubourg, C., & Martorano, B. (2012). The impact of social protection on children (WorkingPaper 2012-06). Florence, Italy: United Nations Children’s Fund, Office of Research.

interventions. As long as the potential effect,foreseen and unforeseen, of these features is notadequately considered, the picture regardingthe link between CCT programs and childabuse and neglect will remain partial, and pro-grams run the risk of causing as much harm tochildren as they do good.

Keywords: conditional cash transfers; childabuse and neglect; social protection programs

Zibagwe, S., Nduna, T., & Dafuleya, G. (2013). Are sociaSouthern Africa, 30, 111–120. http://dx.doi.org/10.1080

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l protection programs child-sensitive? Development/0376835X.2012.756100