Florencia Lopez Boo

This study aimed to evaluate the impact of the Survive and Thrive program on neonatal mortality and child development in Boa Vista, Brazil. Between November 2017 and May 2021, the program to support pregnant women as well as mothers of children under age 3 was rolled out in three phases. Neighborhoods were selected either for home visits or for group meetings held at Social Assistance Reference Centers. To allow for an evaluation of the program, the timing of the rollout was randomized at the neighborhood level. To assess the impact of the program on neonatal mortality, we used complete vital registration data from the period 2010 to 2010, and estimated differences in child mortality before and after the program were launched. Impact on child development was assessed through a detailed assessment of 744 children born in 2019 using the Caregiver Reported Early Child Development Index and Regional Project on Child Development Indicators instruments. Home visits resulted in a significant improvement in child development [d = 0.28, 95% Confidence Interval (CI) (−0.013, 0.57), P-value of .06] and reduction of neonatal mortality [Risk Ratio (RR) 0.58, 95% CI (0.36, 0.93), P-value of .02]. No impacts were found for the group meetings. The findings indicate that a home visiting program beginning in pregnancy can significantly reduce neonatal mortality and improve child development in poor urban neighborhoods of Brazil.

This study experimentally evaluates the impact of a large-scale, government-implemented Home Visit Program in Nicaragua, finding positive effects of home visits on a composite indicator of child development, preschool completion, and one parenting behavior: cognitive stimulation. The intent-to-treat estimates show that assignment to home visits increased child development scores by 0.11 standard deviations (SD), with a local average treatment effect of 0.26 SD, and raised the likelihood of preschool completion by 7 percentage points (18 percentage points for those who received home visits), making the program highly cost-effective. The study also provides novel evidence regarding the importance of implementation quality in explaining these effects, addressing a key challenge in the literature on scale-up: how to ensure quality. Leveraging random assignment to institutional (centralized) monitoring versus structured, community-led (decentralized) monitoring, the study provides causal evidence that community monitoring improves home-visit quality across four domains: home visitor–caregiver relationship, use of materials and preparation, visit content, and focus on caregiver. In turn, each of these quality domains (except focus on caregiver) is linked to improved child development.

Over the past decade, migration flows in Latin America and the Caribbean (LAC) have grown significantly, characterized by complex patterns of origin, transit, destination, and return migration. This has deeply impacted families, particularly young children (aged 0 to 5). Parental migration has mixed effects on children left behind: while increased family income can provide benefits, the absence of parents may harm their emotional and cognitive development. For children who migrate, evidence indicates poorer cognitive and socio-emotional development, often due to a lack of stimulation and the stress associated with both the journey and the adjustment process. Children born in destination countries face a mix of opportunities and challenges, such as limited access to healthcare and education, and the stress of living under the threat of deportation. This paper reviews global evidence on the relationship between migration and early childhood, with a specific focus on the LAC region. It highlights the challenges faced by these children and offers policy recommendations tailored to their varied needs. Among the most promising interventions discussed in the literature are family-centered approaches, center-based services, and mental health support for caregiversall aimed at improving the cognitive and socio-emotional development of migrant children.

We investigate the impact of non-invasive anemia screening on treatment adherence in El Salvador. Anemia is a common childhood condition in low-income countries, due mainly to iron-deficiency, which if left untreated during critical development periods can have lasting health consequences. While effective treatments exist, adherence to treatment is often challenging, since the symptoms of mild to moderate anemia such as lack of energy or paleness can be easily overlooked. We test whether making anemia risks salient through screening during child-well visits can improve treatment adherence, using a cluster-randomized trial in high-poverty areas in El Salvador. Preliminary results indicate that screening enhances treatment adherence and there is suggestive evidence of a reduction of anemia among children 6 to 23 months old. Our results highlight the potential of screening in making anemia risks salient and motivating caregivers to follow treatment plans.

This brief outlines the challenges of noncommunicable diseases (NCDs) and the pivotal role of individual decision-making in healthcare. It highlights behavioral biases influencing decisions and proposes a user's journey methodology rooted in behavioral economics to identify biases at key decision points, including the decision to be screened, appointment setting, attendance, and habit formation. By showcasing examples and research conducted by the IDB and other institutions, this note demonstrates how behavioral interventions can sometimes overcome these biases and bolster health programs by, for example, increasing risk saliency, reducing hassles, and addressing cognitive limitations. In conclusion, the brief underscores the potential of behavioral economics to shape scalable and cost-effective health policies, ultimately improving health outcomes regionally and globally.

Some evidence suggests that there are significant gender gaps in early child development in low- and middle-income countries, with girls generally outperforming boys. However, few studies have tested for the existence of such gaps at a large scale. Our objective is to examine gender disparities in early child development in Brazil, Chile, Colombia, India, Indonesia, Nicaragua, Peru, Senegal, and Uruguay, with 26,055 children aged 7 to 48 months. We estimate gaps using cross-sectional studies with language, socioemotional, and motor skills development assessments. Consistent with small-sample findings, the data shows girls consistently outperformed boys on language tests (0.14 standard deviations) and socioemotional development (0.17 standard deviations), with differences consistent across all nine countries. There were no systematic differences by gender for motor development. We explored how family characteristics, health investments, or parent–child interactions influenced the gap. We did not find evidence that variation on these characteristics across children explained the gap. Our findings suggest that gender gaps in language and socioemotional development emerge very early in life.

Gaps in child development by socioeconomic status (SES) start early in life, are large and can increase inequalities later in life. We use recent national-level, cross-sectional and longitudinal data to examine inequalities in child development (namely, language, cognition, and socio-emotional skills) of children 0-5 in five Latin American countries (Chile, Colombia, Mexico, Peru and Uruguay). In the cross-section analysis, we find statistically significant gaps with inequality patterns that widely differ across countries. For instance, gaps in language and cognition for Uruguay and Chile are much smaller than those for Colombia and Peru. When turning to the longitudinal data, average SES gaps are similar to those of the cross-section in language but differ substantially in cognition, mainly in Uruguay where they emerge as more unequal when cohort effects do not operate. Importantly, we also find that the ECD gaps found at early ages (0-5), still manifest 6-12 years later in almost all locations and realms in which we have measures of early child development, but they do not increase with age. Results are robust to using different measures of inequality (income and maternal education). Gaps are smaller but generally remain when adjusting for possible explanatory factors (e.g., family structure, parental education, geographic fixed effects). To reduce ECD inequality and promote equality in later life outcomes, policymakers should look to implementing evidence-based interventions at scale to improve developmental outcomes of the most disadvantaged children in society.

Los detalles muchas veces son tan imperceptibles como poderosos. A quién votamos (o si votamos), cuánto ahorramos, la frecuencia con la que hacemos ejercicio, ir (o no) al médico, vacunarnos, tomar esa pastilla diaria que nos puede salvar la vida. Todas son decisiones importantes y, a veces, de vida o muerte. Y, aunque no nos demos cuenta, dependen de pequeños detalles. Los detalles importan y esa es una buena noticia, porque significa que lograr cambios de comportamiento puede ser más fácil y menos costoso de lo que pensábamos. Algo que se vuelve fundamental, no solo para nuestro bienestar individual, sino para el de nuestra comunidad y hasta el de nuestros países. Pero también es peligroso, porque significa que, si queremos tomar buenas decisiones, tenemos que prestar mucha más atención a las pequeñas sutilezas que inciden en cada paso que damos. Esto es lo que hace la Economía del Comportamiento y es lo que vienen haciendo muchos expertos (incluidos los autores de este libro): identificar esos detalles y usarlos para mejorar la forma en que tomamos decisiones. La ciencia de los detalles no es solamente un libro científico. Lleva las enseñanzas de años de investigación a la vida real, del laboratorio a la pista de baile de las decisiones.

Understanding health-seeking behaviors and their drivers is key for governments to manage health policies. There is a growing literature on the role of cognitive biases and heuristics in health and care-seeking behaviors, but little is known of how they might be influenced during a context of heightened anxiety and uncertainty. This study analyzes the relationship between four behavioral predictors the internal locus of control, impatience, optimism bias, and aspirations and healthcare decisions among low-income women in El Salvador. We find positive associations between internal locus of control and preventive health behaviors during the COVID-19 pandemic (use of masks, distance, hand washing, and COVID-19 vaccination) and in general (prenatal checkups, iron-rich diets for children and hypertension tests). Measures of impatience negatively correlate with COVID-19 prevention behaviors and mothers micronutrient treatment adherence for children, and optimism bias and educational aspirations with healthcare-seeking behaviors during the COVID-19 pandemic. Some associations were more robust during the pandemic, suggesting that feelings of uncertainty and stress could enhance behavioral drivers influence on health-related behaviors, a novel and relevant finding in the literature relevant for the design of policy responses for future shocks.

Background: Increasing vaccine take-up has been key to curb the COVID-19 pandemic globally. However, vaccine acceptance and take-up has been a challenge in some regions such as the Caribbean countries. This paper analyzes the performance of different behaviorally informed social media campaigns on people’s engagement with information about the vaccination process and vaccine take-up in Belize, a country where despite of enough vaccine supply take-up was very low. Methods: Using Belize’s Facebook platform (>230,000 users) and national administrative vaccination data at the district level, we conduct three types of analyses. First, we run linear regression models to analyze which of five behaviorally informed and sequentially displayed Facebook campaigns were better at predicting i) social media engagement with COVID-19 vaccination; and ii) COVID-19 vaccination uptake. Then, within one of the campaigns (e.g. the side-effects one) we conduct a randomized experiment to measure the effect on social media engagement of exposure to either positively (“Majority did not report discomfort”) or negatively framed messages, using words (“Few persons reported discomfort”) or numerical proportions (“3 out of 100 reported discomfort”). Social media engagement is measured by the number of people that clicked on the respective Facebook ad and visited the official vaccination site (“Clicks”) and the number of people that interacted with the ad through likes and different emojis (“Engagements”). Results: Campaigns highlighting COVID-19 vaccine safety best predicted vaccination uptake (second and booster doses) and social media engagement. Emphasizing the vaccine´s effectiveness was associated with a higher uptake of first doses. These results match previous research showing that safety was one of the main concerns among Belizean citizens and that efficacy beliefs were important to increase the likelihood of uptake among the unvaccinated. Finally, informational messages related to side effects that were framed positively (“Majority did not report discomfort”) and using words (“Few persons reported discomfort”) were better at generating "Clicks” compared to those negatively framed and using numbers (“3 out of 100 reported discomforts”). Conclusions: Highlighting COVID-19 vaccines´ safety and framing side-effect information positively (i.e., focusing on those who will not get them) with words might increase vaccination uptake and interest in low-uptake regions like the Caribbean.