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make rational choices. Rather than reflectingnegligence on the part of beneficiaries, failureto comply with programme requirements maybe due to the lack of accessible services, theirinadequate quality or—in the case of indigenouspopulations— language barriers. 60 Evidence fromthe Plurinational State of Bolivia and Peru, forexample, suggests that distant health facilities,long waiting times and mistreatment by staff ledwomen to forgo maternal health services evenwhere conditionalities encouraged their use. 61Whether conditionalities are necessary toachieve improvements in child nutrition, healthand education has become a subject of intensedebate among experts and practitioners. 62Support remains strong among donors andinternational financial institutions, but emergingresearch suggests that the injection of additionalcash into the household might well be enoughto generate positive results. 63 The South AfricanChild Support Grant, for example— one of the fewchild-related transfer schemes that, until recently,was unconditional—achieved poverty reductionoutcomes and improvements in children’s schoolenrolment and attendance without the use ofconditionalities. 64 A randomized cash transferintervention in Malawi also found that conditionaland unconditional transfers resulted in the samegains with regards to higher school enrolment andlower drop-out rates. 65Monitoring and enforcement of conditions aswell as proof of compliance have significant costsfor both governments and beneficiaries. If, inpractice, conditionalities have no or little bearingon child development, government budgetsmight be better used to invest in more and betterschools and primary health care centres. Thedesired impact of conditionalities on child wellbeingcould also be achieved by other meansincluding, for example, subsidized or free schoolmeals, school-based health checks and localfamily health programmes that actively reach outto the poor, as is the case in Brazil. 66RecommendationsUniversal child allowances are an importantpart of social protection floors and can helpfamilies shoulder some of the costs associatedwith childrearing. In order to contribute to theachievement of substantive equality, childrelatedcash transfer programmes need to:• Make women’s empowerment an explicitgoal rather than an accidental side effect byenhancing their income security and accessto decent work opportunities• Provide adequate benefit levels and moreand better services—including healthcare, education and training, credit andchildcare—to address women’s needs headonand bolster their income security in thelong term• Work towards universal rather than meanstestedprogrammes to avoid stigma andexclusion errors and reduce administrativecosts• Reconsider the use of conditionalities; wheretheir contribution to social developmentoutcomes, such as child health and survival,is questionable, these should be eliminated• Sensitize beneficiary households,programme managers and service providersabout harmful social norms and equalsharing of responsibilities.To achieve these changes, women beneficiariesand gender equality advocates must be involvedin the design, implementation and monitoringof cash transfer schemes. Recent experiencesin Brazil and Egypt, for example, show that theactive involvement of women’s rights advocatescan be a catalyst for transformation. In bothcases, cash transfers were explicitly designedwith women’s rights in mind, tackling thelimitations of existing schemes (see also Box 3.3).141