Summary

• 💸 We’ve sent cash to nearly 1,500 pregnant women in rural Kenya to support safer pregnancies and newborn care since September 2025.
• 📊 Early data show women prioritizing food, baby supplies, and healthcare spending (6x what we see in our general poverty relief programs).
• 🏥 Cash is helping women cover specific costs to access healthcare: insurance fees, transportation, and clinic bills.
• 🌍 We’re expanding to reach more women in Kenya and piloting a similar model in DRC to learn what works across different contexts.

Seven months ago, we launched a pilot giving cash to pregnant women in rural Kenya, building on a landmark study showing that unconditional cash during pregnancy saved babies’ lives when healthcare was accessible.

Mothers living near health services receive ~$860 starting around 20 weeks of pregnancy, delivered either via large payments or in smaller installments.

The pilot is helping us refine how to deliver cash during pregnancy and track early signs of success. We’re partnering with Lwala Community Alliance and the Ministry of Health to measure success and share lessons learned as we prepare to expand to more areas.

Mothers are 6x more likely to spend cash on healthcare than other GiveDirectly recipients

More than half of mothers (60%) report spending part of their transfer on healthcare, including insurance, medical fees, or transport to clinics. That’s six times higher than what we typically see in our poverty relief programs, where only about 9% of recipients report spending on healthcare. 

Because unconditional cash arrives during pregnancy, many mothers end up using money to pay for medical care and prepare for their babies. This tracks with what researchers observed in the earlier Kenya study.

We’re testing two payment structures: larger lump-sum transfers and smaller, more frequent installments.

Across both groups, mothers most often spend on food, healthcare, and preparing for a new baby.  

Mothers who receive a lump sum tend to spend on these essentials and then some — housing, building a business, education, and livestock. Mothers who receive smaller payments focus more narrowly on food first, then healthcare and baby supplies, and much less on other areas.

This mirrors what we’ve seen in our landmark UBI study: larger, less frequent transfers unlock bigger investments, while smaller, more frequent payments tend to cover only day-to-day needs and not much more.

Installments are still ongoing, so spending patterns may shift as flow payments continue. We’ll continue tracking how payment schedules shape birth preparation and care.

Cash is arriving as mothers navigate a more costly health system

We launched this pilot roughly a year after Kenya replaced a program that covered delivery costs even for women without registration documents. The new system requires families to register for national health insurance and pay 2.75% of their monthly income (at least ~$2.50 per month).

Women told us that costs like insurance enrollment, transport, and clinic fees can push families toward home delivery, even when they know hospital births are safer. But they also cited barriers cash alone can’t fix, including difficulty reaching facilities and challenging experiences at certain clinics.

But early spending data suggest cash is helping mothers overcome some of the new cost barriers: more than 1 in 4 report using part of their transfer to pay insurance fees under the new system, and we expect a clearer picture of how cash is influencing health outcomes after our midline survey in May.

We’re tracking three signals to understand whether the program is working as expected

While the cash is unconditional, the goal is better health outcomes for mothers and babies. Early spending patterns are one aspect of three key questions we’re tracking:

1️⃣ Are mothers using cash to get care? Women report how they’re spending and if it helps cover costs like clinic visits, insurance registration, medicines, or transport.

2️⃣ Are they better able to prepare for birth? Women report on their food security, stress levels, and whether they feel able to make decisions about their health and their baby’s.

3️⃣ Are they getting more care during and after pregnancy? Surveys and data from health authorities help track rates of prenatal visits, facility deliveries, birth weights, and postpartum care.

Over time, we’ll have clearer answers. Early spending data (1️⃣) are promising, and upcoming midline results will show how mothers are preparing for birth (2️⃣). Health outcome data (3️⃣) are just beginning to come in, though it will take time before we can make any strong conclusions.

So far, we’re not seeing signs that giving cash to mothers is creating conflict at home

Some supporters have asked whether sending cash to pregnant women could cause arguments at home about how the money is used. So far, we see little evidence of this: men have generally been supportive during enrollment, and reports of conflict related to how cash is spent have been rare (just two cases to date).

We’re also monitoring whether the program influences future pregnancy decisions and expect clearer insight in the coming months. Encouragingly, studies of cash programs in similar places find no evidence that cash leads to more pregnancies.

We’re expanding the pilot in Kenya and launching in other countries

In partnership with county health leaders, we’re expanding the program to more communities across Kenya, with a goal of reaching 5,300 women by the end of 2026.

We’re also launching the program in the Democratic Republic of Congo with Panzi Hospital and exploring expanding to other countries where this approach could be effective.

Later this year, we expect to share early findings on maternal and newborn health from the Kenya pilot as more mothers give birth and follow-up surveys roll out in May.

The program is growing, and so is our understanding of what works best to support healthier mothers and babies. We’ll keep learning out loud as we go.