The effect of affordable daycare on health and well-being over the life-course

The primary outcomes are being measured at three timepoints over the course of the study: a baseline survey, which occurred in early-mid 2015; a first post-intervention, or midline, survey that will be fielded in mid 2016; and a final post-intervention, or endline, survey that will be fielded in mid 2017.

We assessed health, social, and economic outcomes. The primary health outcomes are child nutrition and women's mental health. We measured child length/height and weight using standardized techniques and this information will be used to derive children’s length/height-for-age, weight-for-age, weight-for-length/height, and body mass index (BMI)-for-age using the World Health Organization Child Growth Standards. Symptoms of common mental disorders (CMD) are being assessed using the 12-item General Health Questionnaire (GHQ-12). The GHQ-12 produces results that are similar to the longer version of the GHQ and has been found to be a valid screening instrument for CMD in diverse settings. To the best of our knowledge, validation studies have not been conducted among women living in Rajasthan.

The primary social outcome is women's economic empowerment. We adopted a conceptual approach that incorporates both the personal and political dimensions of empowerment, and developed indicators that captured women’s sense of self‐worth and identity, their willingness to question their own subordinate status, their control over their own lives and their voice and influence within the family. We constructed indicators of empowerment, adapted from the Indian National Family Health Survey whenever possible to facilitate comparability, which encompassed four domains:
1. Decision making within the family and control over income (e.g., who decides how the money you earn will be used: mainly you, mainly your husband, or you and your husband jointly?)
2. Freedom of movement in the public domain (e.g., are you usually permitted to go to the following places—for example, a market within the village—to buy things: on your own, only if someone accompanies you, or not at all?)
3. Participation in community and public life (e.g., are you a member of any type of association, group or club which holds regular meetings?)
4. Views and attitudes on critical gender issues (e.g., please tell me if you agree or disagree with each statement: A married woman should be allowed to work outside the home if she wants to). We plan to test the reliability of empowerment measures during the second survey wave.

The primary economic endpoint is women's labor force participation. We asked about employment experiences, including whether respondents work, their occupation, the type of work, the quantity of work, whether they are paid for their work in cash or in-kind, and what they do with their children while working.

The secondary outcomes are being measured at three timepoints over the course of the study: a baseline survey, which occurred in early-mid 2015; a first post-intervention, or midline, survey that will be fielded in mid 2016; and a final post-intervention, or endline, survey that will be fielded in mid 2017.

Secondary outcomes included mechanisms hypothesized to link access to daycare to the primary outcomes described above, including women's time use and economic status.

Use of time was measured using a structured questionnaire that asked respondents whether they spent any time in the past 24 hours on specific activities (e.g., gathering fuel or firewood), how much time they spent on each activity, and whether this amount reflected the usual amount of time spent on the activity. The questionnaire also asks whether respondents were paid in cash or in-kind for the activities they engaged in.

Economic status is measured by household income and wealth. Respondents reported the household income received in the past 12 months from various categories (e.g., agricultural income, business income, rents, remittances, government payments). Household wealth is measured using a series of questions about ownership of specific assets (e.g., telephone, bicycle, radio), environmental conditions (e.g., type of water source, sanitation facilities), and housing characteristics, (e.g., number of rooms, materials used for housing construction). Additionally, respondents are asked about 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.