Measures

As noted above, our primary interest is in whether the intervention affects measures of women’s economic and social empowerment, and on the health and nutrition of their children. Here we provide a summary of the rationale for the choice of primary and secondary study outcomes for mothers and children.

Outcomes for mothers

Primary outcomes
The primary outcomes for women include women’s employment, income and savings, and measures of empowerment. Based on prior literature suggesting that access to daycare increases women’s labor force attachment \cite{Attanasio:2004zm,Berlinski:2009bv,Barros:2011qr,Berlinski:2011fe,Angeles:2014bh}and income \cite{Deutsch:1998lr,Nakahara:2010ye}, we hypothesize that women living in treated hamlets will be more likely to engage in non-domestic work after the intervention. We collected information on the type of work that women were performing (examples?), and will investigate the program impact for specific categories of work. Opportunities for paid employment in Rajasthan are limited, as indicated by the small fraction (~10%) of women who reported that they worked for cash in the past week at baseline, so we anticipate a modest increase in paid employment.
To the extent that child care relief may provide women with additional opportunities for work, we will also examine whether the treatment affects women’s income and savings. We collected detailed information on the household income received in the past 12 months from various categories (e.g., agricultural income, business income, rents, remittances, government payments), in addition to savings accounts held by household members, including for each account the type of account, its purpose, the total value, and whether the respondent can use the account to make purchases. We will also assess whether the intervention reduces the probably of a household reporting that they have a Below Poverty Line (BPL) card, India’s scheme that identifies households in need of government assistance and aid.
India’s National Rural Employment Guarantee Act (NREGA) provides at least 100 days of wage employment to rural adults that volunteer to do unskilled manual work and provides work opportunities to our participants. Access to daycare should provide increased opportunities to take advantage of NREGA so we will also assess whether the treatment influenced the probability of NREGA participation. The treatment could affect household income and savings independently of women’s formal labor force participation if access to daycare influences husband’s earning opportunities. Table 1 shows the primary outcomes and how they will be measured.
Secondary outcomes
Secondary study outcomes for women include their use of time, self-rated mental health, and experience of intimate partner violence. Time use is one of the mechanisms by which access to daycare might influence the primary outcomes of interest, including women’s economic empowerment. We asked respondents whether they spent any time in the past 24 hours on specific activities (e.g., gathering firewood, laundry), how much time they spent on each activity, and whether that was the usual amount of time for that activity. We will assess the intervention impact on specific categories of time allocation: paid work, unpaid household work (e.g., caring for children), and unpaid non-household work (e.g., farming).
By reducing childcare demands, we also expect that the treatment has the potential to reduce women’s levels of mental distress. Focus group discussions prior to the study suggested that mothers felt particular distress related to the safety of their children while conducting routine household activities. We used the Hindi version of the 12-item General Health Questionnaire (GHQ-12), translated by Gautam et al. \cite{Gautam:1987kq}, to measure symptoms of mental distress (e.g., “Have you recently been able to concentrate on what you’re doing?”). Responses for each of the 12 questions range from 1 to 4 on a Likert scale.
We also will assess the program’s impact on intimate partner violence. There are reasons to expect that daycare might have either positive or negative effects on intimate partner violence. If access to daycare improves household dynamics and interpersonal relationships it could reduce a husband’s controlling behaviors and perpetration of physical and emotional abuse. A few studies, however, have examined the impact of women’s empowerment programs on intimate partner violence \cite{Vyas:2009mi}; there are mixed results, with some literature indicating that these programs might actually exacerbate domestic violence \cite{Weitzman:2014ff}. If daycare were to empower women to assert themselves in decision-making processes that threaten the husband’s authority, then it could result in the increased incidence of intimate partner violence. Measures of secondary outcomes for women are provided in Table 2.

Outcomes for children

Primary outcomes
The main outcomes for children included their nutritional status, the incidence of specific illnesses and use of healthcare, and vaccination status. We anticipated that the treatment, by providing access to a daycare program that includes healthy meals, would improve children’s nutritional status, including shorter and longer-term indicators. The treatment could influence the incidence of illness in either direction. If the treatment induced mothers to join the labor force, for example, then they might be less available to take their children to see a health professional in the case of illness. Conversely, if access to daycare improved household economic conditions then families may be able to afford out-of-pocket health expenditures, which may have been a barrier to accessing care. The program is also intended to track children’s vaccination status and refer children for vaccination services so we hypothesized that the treatment would increase immunization coverage. Primary outcomes and measures for children are listed in greater detail in Table 3.
Secondary outcomes
Secondary outcomes among children include schooling and literacy. For all children (not just those who enroll in daycare) we will track their school attendance, including the average number of days attended per week and average number of hours per day on the days attended. Young children (especially young girls) often spend time helping to care for their younger siblings, and this may be one reason why young girls are more likely than boys to drop out of school. We hypothesize that daycare provision may help relieve the burden on younger siblings and could lead to increased attendance and duration of schooling. Because the balwadi program also includes a consistent educational curriculum, we also hypothesize that children in treated areas may achieve higher levels of literacy and numeracy, which will be measured by mother’s self-reports of whether the child can read or write.