Biography: Anne Karing’s research focuses on the economics of healthcare delivery and health-seeking behaviors in low-income countries, applying insights from psychology. Her core work examines how social signaling motives can change behaviors, in ways that benefit individual health and society. She has implemented large-scale field experiments that examine the effectiveness of social signaling incentives in increasing the demand for childhood immunization and deworming treatment in Sierra Leone and Kenya. As part of this research, Anne also conducts follow-up surveys with cohorts previously exposed to incentives to assess their potential crowd-out effects on motivation. Other branches of her work include markets of medicines, including how formal and illegal markets interact, and the relevance of social preferences and competition in taming market failures among formal providers. Karing earned a BA with honors in Philosophy, Politics, and Economics as well as an MPhil in Economics from the University of Oxford. She completed a PhD in Economics at University of California, Berkeley and a postdoctoral fellowship at Princeton University.

Abstract: We investigate the impact of incentives and their withdrawal on parents’ decisions to vaccinate subsequent children. We follow up with parents three years after exposure to a bracelet incentive given to children for timely vaccination in Sierra Leone. Our analysis leverages the design of an experiment in which clinics were randomly assigned to offer incentives or not. Since only parents with a newborn at the time of the experiment were eligible for the incentive, we can exploit individual variation in exposure within clinics. First, we find that eligibility for an incentive for an earlier child reduces parents’ motivation to vaccinate their subsequent child on time, with reductions of 5 to 11 percent in the number of timely visits compared to unexposed parents. There are no effects on vaccination rates by 15 months of age, suggesting that parents delay vaccination rather than abstaining altogether. Second, parents living in communities where incentives were offered but who were ineligible for them show no effects, ruling out the possibility that changes in community norms or clinic practices drive the results. Third, incentives that signaled being a caring parent do not lead to adverse effects. Using causal forest analysis and testing for differences in knowledge and practices around immunization, we rule out that negative effects are due to learning from the removal of incentives. Instead, we conclude that the exposure to incentives crowded out parents’ intrinsic motivation by altering their self-perception or relationship with vaccination.

An audio recording of Dr. Karing’s presentation may be accessed here.

The slides of the presentation may be accessed here.