The Seen and the Unseen : Unintended Impact of a Conditional Cash Transfer Program on Prenatal Sex-Selection

How can prenatal sex-selective behaviour be changed in a son preference culture? We answer this question in the context of a conditional cash transfer program in India called Janani Suraksha Yojna. By providing access to prenatal sex detection technology and simultaneously providing cash incentives to both households and community health workers, this program unintentionally altered the existing trends in prenatal sex selection. Using difference-in-differences and triple difference estimators we find that the program led to an increase in female births. However, this improvement comes at a cost, as it increased under-5 mortality for girls, indicating a shift in discrimination against girls from prenatal to postnatal. The net effect of the program is that nearly 300,000 girls survived in treatment states between 2006 and 2015. Finally, we find that the role played by community health workers in facilitating the program is a key driver of the decline in prenatal sex selection