Amber Peterman, Elsa Valli and Tia Palermo UNICEF Office of Research – Innocenti On Behalf of the LEAP 1000 Evaluation Team CSAE Conference 2019, Oxford March 17, 2019

1. unite for
children
Government Anti-Poverty Programming
and Intimate Partner Violence in Ghana
Amber Peterman, Elsa Valli and Tia Palermo
UNICEF Office of Research – Innocenti
On Behalf of the LEAP 1000 Evaluation Team
CSAE Conference 2019, Oxford
March 17, 2019

2. 2
Background & motivation
 1 in 3 women globally experienced physical and/or sexual
violence by an intimate partner (Devries et al. 2013)
 In SSA: 37% lifetime IPV (Southern SSA 30% - Central SSA 66%)
 In Ghana: 28-35% experienced IPV in last 12 months (GDHS 2009)
 Large increases in social protection programmes globally, nearly
half the worlds population covered by at least one benefit (45%)
(ILO 2017) – key intervention for SDG 1
 In SSA: Average country has 15 SSNs, average coverage 10%
(Beegle et al. 2018)
 Can social protection also reduce intimate partner violence (IPV)?
 If so, through what mechanisms?
 Under which circumstances (for which populations, due to which
design features)?

3. 3
Global review: Cash transfers decrease
women’s experience of IPV
0
2
4
6
8
10
12
14
16
18
Decrease Mixed Increase No
relationship
identified
Quantiative Qualitative
• Majority of studies (73%) showed decreases, impacts stronger for physical/sexual
Overall impacts on IPV
[22 studies]
Gaps identified in that review:
• Little evidence on frequency
& severity of IPV
• Few studies examine
pathways
• Large regional gaps,
including Sub-Saharan
Africa and Western/Central
Africa in particular
Source: Buller A, Peterman A, Ranganathan M, Bleile A, Hidrobo M, & Heise L. (2018). A
Mixed Method Review of Cash Transfers and Intimate Partner Violence in Low- and Middle
Income Countries. World Bank Research Observer 33(2).

4. 4
Existing quantitative studies from SSA
1. Mali (Health et al., 2018): National programme given to male heads of
households on a quarterly basis + monthly BCC sessions. Impact: large
decreases in controlling behaviors, emotional and physical IPV (7 – 16 pps)
driven by polygamous sample (~40% of the sample). Mechanism: due to
increases in male emotional wellbeing, decrease in stress and anxiety.
2. Kenya (Haushofer et al. 2018): NGO (GiveDirectly) gave approximately
two years’ worth pc expend transfers. Impact: decreased physical IPV
(0.26-0.18 DS), decreased sexual IPV (0.22 SD). Also spillover effect:
reduction in physical violence (0.16 SD). Mechanism: change in woman’s
tolerance & men’s distaste for IPV.
3. South Africa (Pettifor et al. 2016; Kilburn et al., 2018): NGO CCT
targeting females in secondary school (conditional on attendance). Impact:
reduced past-year physical IPV (RR: 0.66; 0.56-0.74). Mechanism: young
women engaged in fewer partnerships (decreased sexual debut and
number of past year partners).

5. 5
Program theory & Mechanisms
Source: Buller A, Peterman A, Ranganathan M, Bleile A, Hidrobo M, & Heise L. (2018). A Mixed
Method Review of Cash Transfers and Intimate Partner Violence in Low- and Middle Income Countries.
World Bank Research Observer 33(2).

6. 6
Study aims
 Examine whether a
government social protection
programme targeted to
extremely poor, rural
households with pregnant and
recently pregnant women in
Ghana had an impact on past-
year prevalence and frequency
of IPV;
 Through which pathways;
 Assess if family structure
matters (polygamous v.
monogamous)

7. 7
LEAP 1000 programme
 Part of government-led, nationwide unconditional cash
transfer programme: Livelihood Empowerment Against
Poverty (LEAP) programme
 Program objectives: 1) Alleviate short-term poverty and 2)
Encourage long-term human capital development
 LEAP 1000 specific focus on nutrition and stunting
 Targets pregnant women or women with a child <1 year
 Bi-monthly cash transfer [approx. GH₵76 (EUR14)] and
health insurance (NHIS) premium waiver
 Initial coverage of LEAP 1000: 6,220 households in 10
districts in Northern Ghana

8. 8
Methods: Evaluation Design and sample
 2-year mixed method, quasi-
experimental, longitudinal study
 8,058 households applied for LEAP
1000 and 3,619 deemed eligible
 Baseline (Jul-Sept 2015), Endline
(Jul-Sept 2017)
 BL evaluation sample N=2,497
households (1,262 T and 1,235 C)
 Final analysis sample: N=2,083
women (1,060 T & 1,023 C)
Districts: Yendi, Karaga, East
Mamprusi, Bongo Garu Tempane

9. 9
Measures: IPV Outcomes
 Based on modified Conflict Tactics Scale
 Female enumerators, interviews conducted in privacy
 Any experience in prior 12 months
 Frequency in prior 12 months (0=never, 1=sometimes, 2=often for
each item; standardized)
 Controlling behaviors, 7 questions (any; frequency 0 – 7)
 Emotional IPV, 4 questions (any; frequency range 0 – 8)
 Physical IPV, 7 questions (any; frequency range 0 – 14)
 Sexual IPV, 2 questions (any; frequency range 0 – 4)
 Emotional/Physical/Sexual IPV, 13 questions (any; frequency
range 0 – 26)

10. 10
Measures: Pathways
1. Economic strengthening and overall emotional wellbeing
• household-level poverty and extreme poverty
• household adult equivalent monthly total & food expenditures (cedis)
• woman’s perceived stress (Cohen perceived stress scale)
• women’s life satisfaction
2. Intra-household conflict
• partner often drunk
• partner sometimes/often drunk
• household monthly expenditure on alcohol (cedis)
3. Women’s empowerment
• agency index
• locus of control
• decision-making ability
• saving money (binary) & amount saved last month (cedis)
• social support score
• valid NHIS (binary),
• sought care for illness/injury – 2 weeks

11. 11
Statistical analysis
• Inspired by Regression Discontinuity Design approach: exploits
cutoff threshold applied to a continuous proxy means test
• Difference-in-difference (DID) to estimate program impacts
𝑌𝑖𝑗𝑡 = 𝛽0 + 𝛽1 𝑃𝑖𝑗 + 𝛽2 𝑇𝑡 + 𝛽3 𝑃𝑖𝑗 ∗ 𝑇𝑡 + 𝛽4 𝑿𝑖𝑗𝑡 + 𝜆𝑗 + 𝜀𝑖𝑗𝑡
• 𝑌𝑖𝑗𝑡 is the IPV or pathway outcome of interest for woman 𝑖 who lives in
community 𝑗 at time 𝑡.
• 𝑃𝑖𝑗 is program participation
• 𝑇𝑡 is time
• 𝑃𝑖𝑗 ∙ 𝑇𝑡 is the interaction term of the program and the time dummy
• 𝑿𝑖𝑗𝑡 represents a set of observed individual, spouse, and household
characteristics including polygamous marriage, PMT score
• 𝜆𝑗 represents a full set of community fixed effects
• 𝜀𝑖𝑗𝑡 is error term

12. 12
Results: Baseline Balance, IPV indicators
 Baseline balance: Across 36 control, pathway & outcome variables,
3 are significant different at p<0.10 level or higher
 Attrition: 10%, across 36, 2 show signs of differential attrition

13. 13
Background characteristics
Full sample
(1)
Monogamous sample
(2)
Polygamous sample
(3)
P-value of diff.
(2) = (3)
Woman’s age (years) 29.74 28.66 32.08 0.00
Woman any formal education (0,1) 0.19 0.24 0.09 0.00
Partner's age (years) 36.71 34.26 41.98 0.00
Partner any formal education (0,1) 0.28 0.33 0.18 0.00
Age difference (partner-woman) 6.96 5.60 9.90 0.00
Difference in spouse-woman any education 0.09 0.09 0.09 0.81
Household size 6.71 5.93 8.41 0.00
Pathway indicators
Poverty status (0,1) 0.87 0.87 0.88 0.58
Household monthly AE expenditure (cedis) 120.41 122.31 116.31 0.18
Cohen perceived stress scale 31.72 31.66 31.86 0.45
Satisfied with life (some of the time or more, 0,1) 0.58 0.60 0.55 0.05
Partner sometimes or often drunk (0,1) 0.15 0.15 0.17 0.38
Household monthly expenditure on alcohol (cedis) 1.27 1.51 0.74 0.15
Women’s agency index (z-score) 0.00 0.02 -0.03 0.32
Women saving any money (0,1) 0.08 0.08 0.10 0.08
Amount of money saved last month (cedis) 4.52 3.83 6.00 0.15
Social support score (standardized) 52.85 52.51 53.58 0.28
Sought care for illness in last 2 weeks (0,1) 0.52 0.51 0.53 0.25
IPV in the last 12 months
Experienced controlling behaviors (0,1) 0.82 0.79 0.88 0.00
Frequency controlling behaviors (sum; range: 0-7) 2.44 2.29 2.75 0.00
Experienced emotional IPV (0,1) 0.60 0.57 0.67 0.00
Frequency emotional IPV (sum; range: 0-8) 1.18 1.07 1.41 0.00
Experienced physical IPV (0,1) 0.36 0.32 0.44 0.00
Frequency physical IPV (sum; range: 0-14) 1.17 1.01 1.52 0.00
Experienced sexual IPV (0,1) 0.19 0.17 0.23 0.00
Frequency sexual IPV (sum; range: 0-4) 0.20 0.18 0.26 0.00
Experienced emotional/physical/sexual IPV (0,1) 0.66 0.63 0.73 0.00
Frequency emotional/physical/sexual IPV (sum; range: 0-26) 2.55 2.26 3.19 0.00
N 2,083 1,423 660
Descriptive statistics by family structure

14. 14
Results: Impacts on Experience of IPV
Controlling behavior Emotional IPV Physical IPV Sexual IPV
Emotional,
physical or sexual
IPV
(1) (2) (3) (4) (5) (6) (7) (8) (9) (10)
Impact -0.02 -0.03 -0.03 -0.06 -0.04 -0.05 -0.01 -0.03 -0.03 -0.08
(0.02) (0.03) (0.02) (0.03)** (0.03) (0.03)* (0.02) (0.03) (0.03) (0.03)**
Polygamous 0.05 0.07 0.09 0.14 0.07 0.14 0.05 0.12 0.08 0.18
(0.01)*** (0.02)*** (0.02)*** (0.04)*** (0.02)*** (0.03)*** (0.01)*** (0.03)*** (0.02)*** (0.04)***
Impact X Polygamous 0.04 0.10 0.05 0.06 0.15
(0.04) (0.06)* (0.05) (0.05) (0.06)***
R2 0.14 0.14 0.09 0.09 0.11 0.12 0.08 0.08 0.09 0.10
Endline comparison means 0.834 0.834 0.566 0.566 0.278 0.278 0.211 0.211 0.624 0.624
Net treatment polygamous 0.00 0.04 -0.00 0.03 0.08
(0.03) (0.05) (0.04) (0.03) (0.05)
 No impacts in full sample
 5-8 pp decreases among monogamous sample only (emotional, physical &
combined)
 Polygamous union associated with 5 pp – 18 pp increase across all measures
Standard errors in parenthesis clustered at the community level. * p<0.1 ** p<0.05; *** p<0.01. All regressions include the following covariates at baseline: Women's age, dummy
for having any formal education (0,1), dummy for polygamous marriage (0,1), partner's age and dummy for having any formal education (0,1); PMT score, household size;
community fixed effects.

15. 15
Results: Impacts on Frequency of IPV
Controlling behavior Emotional IPV Physical IPV Sexual IPV
Emotional,
physical or sexual
IPV
(1) (2) (3) (4) (5) (6) (7) (8) (9) (10)
Impact -0.04 -0.07 -0.11 -0.11 -0.09 -0.11 -0.05 -0.06 -0.11 -0.12
(0.06) (0.07) (0.05)* (0.07)* (0.05)* (0.06)* (0.05) (0.06) (0.05)** (0.06)**
Polygamous 0.15 0.22 0.22 0.23 0.14 0.25 0.14 0.18 0.19 0.27
(0.04)*** (0.07)*** (0.04)*** (0.08)*** (0.05)*** (0.08)*** (0.04)*** (0.06)*** (0.05)*** (0.08)***
Impact X Polygamous 0.10 0.02 0.07 0.03 0.06
(0.12) (0.13) (0.11) (0.12) (0.11)
R2 0.18 0.18 0.14 0.14 0.09 0.10 0.08 0.08 0.12 0.12
Endline comparison means -0.000 -0.000 0.000 0.000 0.000 0.000 0.000 0.000 -0.000 -0.000
Net treatment polygamous 0.03 -0.09 -0.04 -0.03 -0.07
(0.10) (0.10) (0.10) (0.10) (0.09)
 Small impacts in full sample (0.09 – 0.11 SD decreases)
 No difference by polygamous status
 Polygamous union associated with 0.14 - 0.27 SD increase across all measures
Standard errors in parenthesis clustered at the community level. * p<0.1 ** p<0.05; *** p<0.01. All regressions include the following covariates at baseline: Women's age, dummy
for having any formal education (0,1), dummy for polygamous marriage (0,1), partner's age and dummy for having any formal education (0,1); PMT score, household size;
community fixed effects.

16. 16
Results: Summary of pathway impacts
 Positive impacts on:
 Economic security (less likely to be poor
and extremely poor; 3-5 pp)
 Monthly expenditures (~ 7 Cedis AE)
 Monthly food expenditures (~ 5-6 Cedis
AE)
 Locus of control (monogamous women)
 Savings
 Social support
 Valid NHIS card; health seeking behavior
 No impacts on:
 Self perceived stress
 Life satisfaction
 Partner drinking
 Expenditures on alcohol
 Women’s decision-making
 Agency

17. 17
Discussion & conclusion
 LEAP 1000 reduced frequency of emotional, physical, any IPV
measures in the full sample
 Any experience of IPV only reduced in the monogamous sample
 No impacts on experience among polygamous sample, which is at
highest risk of IPV
 Pathways include economic standing/emotional wellbeing and
women’s empowerment
 Limitations: Local average treatment effects, underreporting possible
 Results underscore that cash transfers can improve wellbeing beyond
primary program objectives
 Findings indicate that family structure matters in designing programs
– yet we know little about why or how (more research needed +
qualitative inquiry)

18. 18
References
• Beegle, Kathleen, Aline Coudouel, and Emma Monsalve (2018). Realizing the Full Potential of Social Safety Nets in
Africa. Africa Development Forum series. Washington, DC: World Bank. doi:10.1596/978-1-4648-1164-7
• Buller A, Peterman A, Ranganathan M, Bleile A, Hidrobo M, & Heise L. (2018). A Mixed Method Review of Cash
Transfers and Intimate Partner Violence in Low- and Middle Income Countries. World Bank Research Observer
33(2): 218-258.
• Devries et al. (2013). The Global Prevalence of Intimate Partner Violence Against Women. Global Health, 340.
• GDHS, and ICF Macro (2009). Ghana Demographic and Health Survey 2008. Calverton, Maryland, USA: GSS,
GHS, and ICF Macro.
• Haushofer, Johannes, Ringdal, Charlotte, and Shapiro, Jeremy (2018). Income changes and intimate partner
violence: Evidence from unconditional cash transfers in Kenya (working paper).
• Health, R., Hidrobo, M. & Roy, S. (2018). Cash transfers, polygamy and intimate partner violence: Experimental
evidence from Mali (working paper).
• ILO (2017). World Social Protection Report 2017–19: Universal social protection to achieve the Sustainable
Development Goals International Labour Office – Geneva.
• Kilburn, K., Pettifor, A., Edwards, J.K., Selin, A., Twine, R., MacPhail, C. et al. (2018). The effect of a conditional
cash transfer for HIV prevention on the experience of partner violence for young women: Evidence from a
randomized experiment in South Africa HPTN 068. Journal of International AIDS Society (in press).
• Pettifor, A., MacPhail C, Hughes, JP, Selin A, Wang J, Gomez-Olive FX et al. (2016). The effect of a conditional
cash transfer on HIV incidence in young women in rural South Africa (HPTN 068): a phase 3, randomized controlled
trial. The Lancet Global Health 4(12): e978-e988.

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Acknowledgements
We are grateful for the support of the Government of Ghana for the implementation
of this evaluation, in particular William Niyuni, Mawutor Ablo and Richard Adjetey
from the Ministry of Gender, Children and Social Protection. In addition, the
UNICEF Ghana team was instrumental to the success of this report: Sara
Abdoulayi, Luigi Peter Ragno, Jennifer Yablonski, Sarah Hague, Maxwell Yiryele
Kuunyem, Tayllor Spadafora, Christiana Gbedemah and Jonathan Nasonaa
Zakaria.
We would also like to acknowledge the hard-working field teams of ISSER and
NHRC, who conducted the data collection for this study to the highest standards.
Funding for the evaluation was generously provided by the United States Agency
for International Development (USAID) and the Canadian International
Development Agency (CIDA). Additional funding to include intimate partner violence
modules in the evaluation and to produce this paper was received from an
Anonymous donor and the American World Jewish Services by the UNICEF Office
of Research—Innocenti via the US Fund for UNICEF. We thank Laura Meucci and
Michelle Kate Godwin for grant administrative support.

20. 20
LEAP 1000 Evaluation Team
UNICEF Office of Research – Innocenti: Tia Palermo (co-Principal
Investigator), Richard de Groot, Elsa Valli;
Institute of Statistical, Social and Economic Research (ISSER), University
of Ghana: Isaac Osei-Akoto (co-Principal Investigator), Clement Adamba,
Joseph K. Darko, Robert Darko Osei, Francis Dompae and Nana Yaw;
Carolina Population Center, University of North Carolina at Chapel Hill:
Clare Barrington (co-Principal Investigator), Gustavo Angeles, Sudhanshu
Handa (co-Principal Investigator), Frank Otchere, Marlous de Miliano;
Navrongo Health Research Centre (NHRC): Akalpa J. Akaligaung (co-
Principal Investigator) and Raymond Aborigo.

21. 21
Meda ase
Asante
Zikomo
Thank you
Grazie!
Ghana LEAP 1000
(© Michelle Mills)

22. 22
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