Casino-based cash transfers and fertility among the Eastern Band of Cherokee Indians in North Carolina: A time-series analysis.

Fertility decline remains a key concern among high-income countries. Prior research indicates that income supplementation through unconditional cash transfers (UCT) may correspond with increased fertility. We examine whether a casino-based UCT, in the form of per capita (percap) payments to members of the Eastern Band of Cherokee Indians (EBCI) corresponds with an acute increase in fertility. We use North Carolina vital statistics datasets from 1990 to 2006 and apply time-series analysis methods to examine the relation between specific months of percap payments (exposure) and monthly number of conceptions that result in live births (outcome) among the EBCI. We control for autocorrelation and monthly counts of births (arrayed by conception cohorts) among white women (ineligible for UCT receipt) in the study region. Results indicate an increase in conceptions that result in live births at 1 and 3 months after percap receipt among EBCI women aged ≥20 years (exposure month lag 1 coefficient = 1.74, p = 0.03; exposure month lag 3 coefficient = 1.60, p = 0.04). Exploratory analyses indicate that the observed fertility increase concentrates among primiparae EBCI women. We do not find any association between percap payment timing and births to EBCI women aged <20 years.