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.