Child health and nutrition in rural Mexico: Did Progresa improve the life chances of the very poor?

It is well established that poverty during early childhood can have deleterious consequences. Unfavourable childhood conditions are likely to be transmitted over the life course and across generations, thereby perpetuating the "vicious circle" of poverty. Progresa - Mexico's main anti-poverty programme - aims to shift the odds of disadvantage by promoting and supporting parents' investments in children's education, health and nutrition. The Programme is based on the philosophy that investing in human capital can set the grounds for breaking the intergenerational transmission of poverty in which poor families find themselves. Progresa provides benefits in three areas that are closely linked to each other: education, health, and nutrition. It gives a set of monetary and in-kind benefits that vary according to the demographic characteristics of each family. These benefits are conditional on children's attendance to school and on regular health check ups. The aim of this thesis is to investigate whether this Programme did indeed improve children's life chances during its first three years of intervention. The specific outcomes we examined include family-level food security (measures of both caloric availability and dietary diversity), children's early feeding patterns (breastfeeding and exclusive breastfeeding), the incidence of infectious diseases (diarrhoea and respiratory infections), and anthropometric indicators (stunting and underweight). For each outcome, models were constructed to test whether there are differential Programme effects over time and according to households' severity of poverty. The analyses were carried out using longitudinal data from a unique data set that contained randomised treatment and control groups. The results indicate that, over a three year period, the Programme had a modest effect on young children's outcomes. Estimates suggest that the Programme contributed a reduction in the incidence of diarrhoea among children and to an improvement in their weight for age, but only for a selected group of the population: those aged 0 to 23 months at baseline. Estimates also show a modest, but positive effect on household food security (an increase of 7 percent on caloric availability and of 7.3 percent on dietary diversity), but it is not clear whether the increased access to food is large enough to meet the families' nutritional needs. Moreover, Progresa's positive effect on caloric availability was largely protective because caloric availability fell substantially over the period of study in both treatment and control localities. Finally, Progresa's intervention had a modest impact on extending the duration of overall breastfeeding (already long at baseline) but no impact at all on exclusive breastfeeding (rarely practised before the intervention). Although the programme effects are somewhat small, one positive finding is worth emphasising. The results clearly and consistently demonstrate that it is children living in families with fewer resources that benefit most from the Programme's intervention. The findings aim to provide useful recommendations for child poverty alleviation strategies in developing countries and to point out lessons learned so that programmes like Progresa can be more effectively replicated in other countries.