Unjust Conditions: Women's Work and the Hidden Cost of Cash Transfer Programs

Tara Patricia Cookson

204 pages, University of California Press, 2018

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Last year, World Bank President Jim Kim offered financing to any country willing to implement conditional cash transfers (CCTs), which he termed “a great thing to do.” He particularly praised the Peruvian CCT, Juntos, for its apparent role in reducing child malnutrition. Kim isn’t alone in his enthusiasm; a decade ago, the Centre for Global Development claimed that CCTs were “as close as you can come to a magic bullet in development.” Today, CCTs are implemented in over 67 countries, reaching over 135 million people in Latin America alone.

The first part of this book reviews the evidence in support of CCTs – and there’s a lot of it. Hundreds of quantitative studies have shown them to be effective, efficient mechanisms for changing poor people’s health and education seeking behavior. But this book departs from the realm of RCTs and survey data, instead centring the perspectives of the women who are responsible for the care work necessary to meet program conditions.

Care encompasses all of the paid and unpaid labor required to sustain healthy, productive human beings. Most of it is done by women—a critical factor in the persistence of gender inequality. Caring can be deeply time intensive, depending on the quality of social supports available in houses, clinics and schools, and on the availability of infrastructure like potable water and public transportation. —Tara Patricia Cookson

When witty, twenty-six-year-old Josepa was pregnant with the second of two children, she was abandoned by her husband for a younger woman. Faced with few options, pregnant Josepa left her philandering husband and moved back in with her parents in a village some three hours away. Like other families in the village, Josepa’s parents were subsistence farmers, and on their property was a great granadilla tree that produced a sour-sweet fruit that her children devoured. One afternoon as we sat in the yard, Josepa explained to me that she had been receiving the Juntos payments for nearly eight months. When she moved back to the village, her sister had been enrolled in the program, and Josepa had hoped for the day that the census takers would come by and register her details. Sure enough, one day they arrived, and in due course she was summoned to a community meeting and asked to provide the required documentation so that she could enroll in the program.

Given that there was no other paid work available, Josepa was grateful for the “little bit of help” that the cash payment provided. In order to receive Juntos’s monthly payment of one hundred soles ($35 US dollars), mothers like Josepa were required to meet a standard set of seemingly reasonable conditions. These included attendance at prenatal exams, children’s regular growth-and-nutrition checkups until the age of five, and school attendance with fewer than three absences per month until eighteen years of age or graduation. Program implementation and compliance with conditions was monitored by frontline program staff called local managers. Given that one of Josepa’s children was under five, and the other just over, she was required to meet both the health- and education-related conditions. The local managers would record Josepa’s compliance, and if she did as required, she would join the majority of her neighbors, who received monthly cash payments.

Over the course of my ethnographic fieldwork with women in the Andes, I discovered that the practice of providing and earning a cash incentive did not play out exactly as policy makers intended. Juntos recipients like Josepa were made to believe that their coresponsibilities extended far beyond the reasonable set of conditions laid out in official policy documents. In the villages where I conducted research, responsible motherhood involved much more than the use of basic health and education services on behalf of one’s children. It also required participation in a whole host of activities deriving from more powerful people’s ideas about what it takes for rural families to overcome their poverty—or in more sinister cases, activities that helped authorities maintain and acquire more power. When I asked Josepa what she had to do to receive the “little bit of help” that Juntos provided, she responded, “Whatever the local manager tells me to.” Josepa, like all of the other Juntos mothers I spoke with, did not have a clear picture of what was officially required of her, because she was not provided one by the authorities entrusted with implementing the antipoverty program. In fact, the system of imposing conditions in the rural countryside was so distorted by program staff and other local authorities that none of the Juntos mothers I met knew what the program conditions “officially” entailed.

In addition to the requirement that children attend school and health appointments, women in my interviews cited a variable combination of activities. I call these shadow conditions. These activities included having hospital births rather than home births; growing a garden; keeping hygiene instruments (toothbrush, soap) organized; cooking for the school lunch program; having a latrine; leaving babies at the state day-care center; participating in parades; painting the Juntos flag on the outside of one’s house; marching to demonstrate support for a politician’s reelection campaign; contributing toward the medical costs incurred when a neighbor breaks a leg; having a cocina mejorada (smokeless stove); contributing funds for school parties; participating in a regional cooking fair; and attending literacy workshops. None of these were official policy requirements, and, at first, I thought that these women were simply wrong. However, after months of these conversations I began to see that this was a systematic tendency; in all of the interviews I conducted, women named at least two of these tasks; typically, they named four or five. In practice, Juntos mothers often found these other tasks indistinguishable from official conditions. This was through no fault of their own, as shadow conditions were often organized by local program managers, teachers, health clinic staff, and local government authorities, who used threats of expulsion from the program in order to get women to participate.

Toward a More Caring Society

Twenty years after the first large-scale conditional cash transfer programs were rolled out in Mexico and Brazil, imposing conditions is no longer the exclusive terrain of governments, and children’s health and education are no longer the only targets for improvement. Thanks to the wonders of mobile money and the popularity of conditional aid among a growing range of nongovernmental organizations, social enterprises, research institutes, and philanthropists, you, too, can reform the misguided behaviors of a poor person. For instance, the award-winning social enterprise New Incentives offers you the opportunity to motivate a woman in rural Nigeria to give birth in a health clinic—which you can do from the comfort of your armchair. And you can trust that your incentive will have the desired effect, because New Incentives will disburse the cash only after they have verified with clinic staff that the mother gave birth as required. (New Incentives originally incentivized pregnant women who were HIV positive, or who met other criteria associated with risky pregnancies, to give birth in specific health clinics. Shortly before publication of this book, the nonprofit organization changed its model and now incentivizes mothers to vaccinate their children.) Or, if sanitation strikes your fancy, you can incentivize a man in India to install a toilet. Reproductive health? A pilot program in Tanzania incentivizes youth to remain free of sexually transmitted infections. My hope is that, having read this book, you will think twice about the apparent simplicity of making aid conditional.

In undertaking the long and trying ethnographic work of comprehending conditional aid programs from the perspective of poor mothers, I have traveled from an interest in cash transfers, to the more skeptical stance of “thinking twice,” and finally to the view that the contemporary practice of conditional aid is unjust. In the preceding chapters I have offered analytical contributions related to blind spots in our measurement of program impacts, the ironic conditions of clinics and schools, the unpaid work of walking and waiting, and the wild proliferation of shadow conditions. The broader arc of this book’s argument is as much about speaking truth to power as it is as analytical; I have argued that these conditions are unjust.

To the development experts who boldly proclaim that CCTs “are a great thing to do,” this book stands as a rebuke and a plea for humility. One of the appeals of conditional aid is its alleged efficiency, but in practice CCTs are efficient only if women’s time and unpaid labor is worth nothing. When we account for all of the work that rural women are required to do to implement a CCT program, we inevitably uncover a number of hidden costs. CCTs are often rolled out in places where poor people have a difficult time accessing quality services. In Peru, rural mothers do a lot of walking and waiting. In the absence of safe and reliable transportation, and sometimes even roads, pregnant women walk to deliver their babies in clinics, and mothers walk to deliver their children to health appointments and school. They walk back and forth between home and the clinic until they encounter it open and staffed for service. They walk up and down the Andes mountains in the sun and the rain and the cold and the fog. Between journeys, women wait. They wait for attention from school staff, nurses, and bureaucrats in government offices. They wait for politicians to fulfill promises, and they wait for the state to deliver what wealthier, urban regions already have: teachers, doctors, water, jobs, and a sanitation system. They wait as long as the authorities ask them to wait, and in my observations, they wait patiently.

In the case of Juntos, women bore the cost of poor-quality services, and they also bore the cost of an inadequately staffed program. The state employed a cadre of hardworking frontline bureaucrats called local managers to enforce and monitor conditions, but they were responsible for an unrealistic number of households. The only way that local managers could meet their professional responsibilities was to rely on the help of the women they managed. Juntos mothers were required to “manage up.” They attended meetings to save local managers travel time, and they walked and waited to make sure that Juntos maintained an updated database and an accurate list of who had complied with the program conditions. Managing up had a cost for women, who expended their time in service of Juntos rather than on any number of other productive, caring, or leisurely tasks.

In addition to the work of ordinary mothers required to manage up, local managers also relied on the organized labor of a group of “exemplary” Juntos recipients called Mother Leaders. Local managers referred to these women as “the local managers in their communities.” The work of Mother Leaders bore a surprising resemblance to the job descriptions that program headquarters had written for local managers. The Mother Leaders, however, were not paid for their contributions. Here was yet another gendered cost, hidden between the line items of Juntos’s administrative budget. If not for Mother Leaders, the state would have been required to hire many, many more local managers. The unpaid labor of these women subsidized the cost of implementing Peru’s largest social program, which development experts hold up as a “model for the world.”

On paper, conditionality seems like a simple technical arrangement. Yet in the real world of unequal resources and social hierarchies, a well-intended incentive can unravel into a coercive exercise of authority. Once Juntos arrived in the places it was meant to improve, conditionality became a tool for more authoritative groups to exercise power over subordinate groups. Experts in Lima intended for Juntos mothers to meet a strict schedule of health and education conditions, and they did. But they also complied with a host of additional directives put in place by Juntos’s frontline staff and other local authorities. These “shadow conditions” were enforced through threats of suspension and accusations of irresponsible motherhood.

Although undoubtedly well-intentioned, Juntos was an example of development by susto (fear). Local managers yelled at mothers, telling them they had to take their children to school or the state would take Juntos away from them— and to an extent, this threat was based on official policy. But they also demanded that mothers use the state-run day care, keep tidier houses, participate in parades, and give birth in clinics. In theory, these were not things for which women could rightfully be suspended. In practice, there were no substantive checks on abuse of power. And so women bore the cost. They went running from one appointment to another, unsure of what was actually required of them. Shadow conditions were a manifestation of the coercive power of incentives; the limits of this power were unclear, its effects practically immeasurable. This is perhaps the most striking of the reasons that I call conditioning aid unjust.

Nearly a year after the fieldwork for this book took place, news broke that a group of local managers, in collusion with two cashiers from the National Bank, had stolen approximately one million soles from Juntos recipients’ savings accounts. This systematically organized heist took place over the course of two years and affected an unaccounted-for number of program beneficiaries. According to reports, local managers simply informed the mothers that they would not receive the cash transfer for a given period of time, and subsequently the bank cashiers siphoned the money from the agreed-upon accounts. Media coverage of this scandal generally treated it as a rare and extreme event. However, I offer an alternative interpretation. The fact that local managers could withhold transfers from hundreds of Juntos women for months at a time with no explanation, knowing that these women had no recourse whatsoever, tells of a broader pattern. In the communities where I conducted fieldwork, the prevalence of shadow conditions stands as evidence that frontline workers seldom face repercussions when they use conditions for purposes that policy makers should be loath to condone. This theft surfaced unequal power dynamics that are widespread and routinely implicated in more ordinary and invisible forms of injustice. Imposing conditions on aid facilitates such abuses. Conditional incentives in the context of deep social and political inequities are not merely “powerful tools” but tools that give the more dominant groups unchecked power over subordinate groups.

Incentives are effective insofar as they change behaviors. Yet mothers’ accounts of their everyday lives revealed that their children’s poverty was less an issue of the women’s misguided individual choices, and more an issue of the difficult conditions in which they cared for their families. Instead of focusing our good intentions and resources on motivating poor women to change their behavior, we might instead seek to change the persistent inequities that shape people’s broader life conditions. By all accounts, this would require us to ask the challenging “political-economic questions” that simpler, technical fixes so often sideline. A nuanced and substantive way of refocusing on the broader conditions of people’s lives is through a focus on care.

Author Note: “Data driven development” rarely includes measurement of women’s care work, nor the quality of supporting services – but it can and should. This is particularly true when we impose conditions on aid, but the insight applies more broadly to social innovation. It led me to co-found a feminist research consultancy called Ladysmith, where we believe that the “gender data gap” is also qualitative, that gender equality is an important goal in and of itself, and that a more just world requires attention to women’s everyday lives.