Long-term impact of a conditional cash transfer programme on maternal mortality: a nationwide analysis of Brazilian longitudinal data
Abstract Background Reducing poverty and improving access to health care are two of the most effective actions to decrease maternal mortality, and conditional cash transfer (CCT) programmes act on both. The aim of this study was to evaluate the effects of one of the world’s largest CCT (the Brazilia...
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doaj-2b646d2f8f7043848500ee8efa7020282021-06-06T11:32:07ZengBMCBMC Medicine1741-70152021-06-011911910.1186/s12916-021-01994-7Long-term impact of a conditional cash transfer programme on maternal mortality: a nationwide analysis of Brazilian longitudinal dataDavide Rasella0Flávia Jôse Oliveira Alves1Poliana Rebouças2Gabriela Santos de Jesus3Maurício L. Barreto4Tereza Campello5Enny S. Paixao6ISGlobal, Hospital Clínic - Universitat de BarcelonaInstitute of Collective Health, Federal University of Bahia (UFBA)Institute of Collective Health, Federal University of Bahia (UFBA)School of Nutrition, Federal University of Bahia (UFBA)Institute of Collective Health, Federal University of Bahia (UFBA)Center of Data and Knowledge Integration for Health (CIDACS), Instituto Gonçalo Muniz, Fundação Oswaldo Cruz (FIOCRUZ)Center of Data and Knowledge Integration for Health (CIDACS), Instituto Gonçalo Muniz, Fundação Oswaldo Cruz (FIOCRUZ)Abstract Background Reducing poverty and improving access to health care are two of the most effective actions to decrease maternal mortality, and conditional cash transfer (CCT) programmes act on both. The aim of this study was to evaluate the effects of one of the world’s largest CCT (the Brazilian Bolsa Familia Programme (BFP)) on maternal mortality during a period of 11 years. Methods The study had an ecological longitudinal design and used all 2548 Brazilian municipalities with vital statistics of adequate quality during 2004–2014. BFP municipal coverage was classified into four levels, from low to consolidated, and its duration effects were measured using the average municipal coverage of previous years. We used negative binomial multivariable regression models with fixed-effects specifications, adjusted for all relevant demographic, socioeconomic, and healthcare variables. Results BFP was significantly associated with reductions of maternal mortality proportionally to its levels of coverage and years of implementation, with a rate ratio (RR) reaching 0.88 (95%CI 0.81–0.95), 0.84 (0.75–0.96) and 0.83 (0.71–0.99) for intermediate, high and consolidated BFP coverage over the previous 11 years. The BFP duration effect was stronger among young mothers (RR 0.77; 95%CI 0.67–0.96). BFP was also associated with reductions in the proportion of pregnant women with no prenatal visits (RR 0.73; 95%CI 0.69–0.77), reductions in hospital case-fatality rate for delivery (RR 0.78; 95%CI 0.66–0.94) and increases in the proportion of deliveries in hospital (RR 1.05; 95%CI 1.04–1.07). Conclusion Our findings show that a consolidated and durable CCT coverage could decrease maternal mortality, and these long-term effects are stronger among poor mothers exposed to CCT during their childhood and adolescence, suggesting a CCT inter-generational effect. Sustained CCT coverage could reduce health inequalities and contribute to the achievement of the Sustainable Development Goal 3.1, and should be preserved during the current global economic crisis due to the COVID-19 pandemic.https://doi.org/10.1186/s12916-021-01994-7Conditional cash transferBolsa Família ProgrammeMaternal mortality |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Davide Rasella Flávia Jôse Oliveira Alves Poliana Rebouças Gabriela Santos de Jesus Maurício L. Barreto Tereza Campello Enny S. Paixao |
spellingShingle |
Davide Rasella Flávia Jôse Oliveira Alves Poliana Rebouças Gabriela Santos de Jesus Maurício L. Barreto Tereza Campello Enny S. Paixao Long-term impact of a conditional cash transfer programme on maternal mortality: a nationwide analysis of Brazilian longitudinal data BMC Medicine Conditional cash transfer Bolsa Família Programme Maternal mortality |
author_facet |
Davide Rasella Flávia Jôse Oliveira Alves Poliana Rebouças Gabriela Santos de Jesus Maurício L. Barreto Tereza Campello Enny S. Paixao |
author_sort |
Davide Rasella |
title |
Long-term impact of a conditional cash transfer programme on maternal mortality: a nationwide analysis of Brazilian longitudinal data |
title_short |
Long-term impact of a conditional cash transfer programme on maternal mortality: a nationwide analysis of Brazilian longitudinal data |
title_full |
Long-term impact of a conditional cash transfer programme on maternal mortality: a nationwide analysis of Brazilian longitudinal data |
title_fullStr |
Long-term impact of a conditional cash transfer programme on maternal mortality: a nationwide analysis of Brazilian longitudinal data |
title_full_unstemmed |
Long-term impact of a conditional cash transfer programme on maternal mortality: a nationwide analysis of Brazilian longitudinal data |
title_sort |
long-term impact of a conditional cash transfer programme on maternal mortality: a nationwide analysis of brazilian longitudinal data |
publisher |
BMC |
series |
BMC Medicine |
issn |
1741-7015 |
publishDate |
2021-06-01 |
description |
Abstract Background Reducing poverty and improving access to health care are two of the most effective actions to decrease maternal mortality, and conditional cash transfer (CCT) programmes act on both. The aim of this study was to evaluate the effects of one of the world’s largest CCT (the Brazilian Bolsa Familia Programme (BFP)) on maternal mortality during a period of 11 years. Methods The study had an ecological longitudinal design and used all 2548 Brazilian municipalities with vital statistics of adequate quality during 2004–2014. BFP municipal coverage was classified into four levels, from low to consolidated, and its duration effects were measured using the average municipal coverage of previous years. We used negative binomial multivariable regression models with fixed-effects specifications, adjusted for all relevant demographic, socioeconomic, and healthcare variables. Results BFP was significantly associated with reductions of maternal mortality proportionally to its levels of coverage and years of implementation, with a rate ratio (RR) reaching 0.88 (95%CI 0.81–0.95), 0.84 (0.75–0.96) and 0.83 (0.71–0.99) for intermediate, high and consolidated BFP coverage over the previous 11 years. The BFP duration effect was stronger among young mothers (RR 0.77; 95%CI 0.67–0.96). BFP was also associated with reductions in the proportion of pregnant women with no prenatal visits (RR 0.73; 95%CI 0.69–0.77), reductions in hospital case-fatality rate for delivery (RR 0.78; 95%CI 0.66–0.94) and increases in the proportion of deliveries in hospital (RR 1.05; 95%CI 1.04–1.07). Conclusion Our findings show that a consolidated and durable CCT coverage could decrease maternal mortality, and these long-term effects are stronger among poor mothers exposed to CCT during their childhood and adolescence, suggesting a CCT inter-generational effect. Sustained CCT coverage could reduce health inequalities and contribute to the achievement of the Sustainable Development Goal 3.1, and should be preserved during the current global economic crisis due to the COVID-19 pandemic. |
topic |
Conditional cash transfer Bolsa Família Programme Maternal mortality |
url |
https://doi.org/10.1186/s12916-021-01994-7 |
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