Evaluating the effect of Bolsa Familia, Brazil’s conditional cash transfer programme, on maternal and child health: A study protocol

Falcão, Ila Rocha; Silva, Rita de Cássia Ribeiro; Alves, Flávia Jôse Oliveira; Ortelan, Naiá; Silva, Natanael J; Fiaccone, Rosemeire Leovigildo; Almeida, Márcia Furquim de; Pescarini, Júlia Moreira; Lisboa, Cinthia Soares; Júnior, Elzo Pereira Pinto; Paixão, Enny S.; Ferreira, Antônio G. P.; Teixeira, Camila Silveira Silva; Rocha, Aline dos Santos; Katikireddi, Srinivasa Vittal; Ali, M Sanni; Dundas, Ruth; Leyland, Alastair H.; Rodrigues, Laura C.; Ichihara, Maria Yury; Barreto, Maurício L.

doi:10.1371/journal.pone.0268500

Cited by 8 publications

(15 citation statements)

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“…Two-sided P < .05 indicated statistical significance. In line with the published research protocol 10 and previous quasi-experimental studies using the Cadastro Único data set and the 100 Million Brazilian Cohort, [20][21][22] the association between BFP and maternal mortality was estimated based on the propensity score-based method. First, we used logistic regression to JAMA Network Open | Public Health estimate the conditional probability of receiving treatment (being a BFP beneficiary or not), given the set of observable characteristics using the propensity score (eFigures 1 and 2 and eTable 2 in Supplement 1).…”

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

“…All of the methods and analyses were described in the previously published research protocol . We conducted a cross-sectional analysis nested within the 100 Million Brazilian Cohort, a retrospective dynamic cohort resulting from linkage of national administrative, social, and health data sets .…”

Section: Methodsmentioning

confidence: 99%

“…All of the methods and analyses were described in the previously published research protocol. 10 We conducted a cross-sectional analysis nested within the 100 Million Brazilian Cohort, a retrospective dynamic cohort resulting from linkage of national administrative, social, and health data sets. 12 The cohort baseline includes records from over 114 million individuals in the Unified Registry for Social programs (Cadastro Único), an administrative system with detailed information on the poor and extremely poor in Brazil (families with a monthly income Յ3 minimum…”

Section: Methodsmentioning

confidence: 99%

“…The association increased with the increment in coverage levels and years of implementation. 9 The mechanisms through which the program can affect maternal mortality were proposed and described in the research protocol 10 and a previous study. 9 Like other CCTs, BFP can affect maternal health both through receipt of the benefit and conditionalities.…”

Section: Introductionmentioning

confidence: 99%

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Association of Conditional Cash Transfers With Maternal Mortality Using the 100 Million Brazilian Cohort

et al. 2023

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ImportanceConditional cash transfers (CCTs) have been consistently associated with improvements to the determinants of maternal health, but there have been insufficient investigations regarding their effects on maternal mortality.ObjectiveTo evaluate the association between being a Bolsa Família program (BFP) beneficiary and maternal mortality and to examine how this association differs by duration of BFP receipt, maternal race, living in rural or urban areas, the Municipal Human Development Index (MHDI), and municipal primary health care coverage.Design, Setting, and ParticipantsThis cross-sectional analysis was nested within the 100 Million Brazilian Cohort. Girls and women aged 10 to 49 years (hereinafter referred to as women) who had at least 1 live birth were included, using data from Brazilian national health databases linked to the 100 Million Brazilian Cohort (January 1, 2004, to December 31, 2015). Propensity score kernel weighting was applied to control for sociodemographic and economic confounders in the association between BFP receipt and maternal mortality, overall and stratified by different subgroups (race, urban or rural area, and MHDI), and duration of BFP receipt. Data were analyzed from July 12, 2019, to December 31, 2022.Main Outcome(s) and MeasuresMaternal death.ResultsA total of 6 677 273 women aged 10 to 49 years were included in the analysis, 4056 of whom had died from pregnancy-related causes. The risk of maternal death was 18% lower in women who received BFP (weighted odds ratio [OR], 0.82 [95% CI, 0.71-0.93]). A longer duration receiving BFP was associated with an increased reduction in maternal mortality (OR for 1-4 years, 0.85 [95% CI, 0.75-0.97]; OR for 5-8 years, 0.70 [95% CI, 0.60-0.82]; OR for ≥9 years, 0.69 [95% CI, 0.53-0.88]). Receiving BFP was also associated with substantial increases in the number of prenatal appointments and interbirth intervals. The reduction was more pronounced in the most vulnerable groups.Conclusions and RelevanceThis cross-sectional analysis nested within the 100 Million Brazilian Cohort found an association between BFP receipt and maternal mortality. This association was of greater magnitude in women with longer exposure to BFP and in the most vulnerable groups. These findings reinforce evidence that programs such as BFP, which have already proven effective in poverty reduction, have great potential to improve maternal survival.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Association of Conditional Cash Transfers With Maternal Mortality Using the 100 Million Brazilian Cohort

et al. 2023

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Participation in Conditional Cash Transfer Program During Pregnancy and Birth Weight–Related Outcomes

Falcão,

Ribeiro-Silva,

Fiaccone

et al. 2023

JAMA Netw Open

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ImportanceThere is limited evidence of the association of conditional cash transfers, an important strategy to reduce poverty, with prevention of adverse birth-related outcomes.ObjectiveTo investigate the association between receiving benefits from the Bolsa Família Program (BFP) and birth weight indicators.Design, Setting, and ParticipantsThis cohort study used a linked data resource, the Centro de Integracao de Dados e Conhecimentos Para Saude (CIDACS) birth cohort. All live-born singleton infants born to mothers registered in the cohort between January 2012 and December 2015 were included. Each analysis was conducted for the overall population and separately by level of education, self-reported maternal race, and number of prenatal appointments. Data were analyzed from January 3 to April 24, 2023.ExposureLive births of mothers who had received BFP until delivery (for a minimum of 9 months) were classified as exposed and compared with live births from mothers who did not receive the benefit prior to delivery.Main Outcomes and MeasuresLow birth weight (LBW), birth weight in grams, and small for gestational age (SGA) were evaluated. Analytical methods used included propensity score estimation, kernel matching, and weighted logistic and linear regressions. Race categories included Parda, which translates from Portuguese as “brown” and is used to denote individuals whose racial background is predominantly Black and those with multiracial or multiethnic ancestry, including European, African, and Indigenous origins.ResultsA total of 4 277 523 live births (2 085 737 females [48.8%]; 15 207 among Asian [0.4%], 334 225 among Black [7.8%], 29 115 among Indigenous [0.7%], 2 588 363 among Parda [60.5%], and 1 310 613 among White [30.6%] mothers) were assessed. BFP was associated with an increase of 17.76 g (95% CI, 16.52-19.01 g) in birth weight. Beneficiaries had an 11% lower chance of LBW (odds ratio [OR], 0.89; 95% CI, 0.88-0.90). BFP was associated with a greater decrease in odds of LBW among subgroups of mothers who attended fewer than 7 appointments (OR, 0.85; 95% CI, 0.84-0.87), were Indigenous (OR, 0.73; 95% CI, 0.61-0.88), and had 3 or less years of education (OR, 0.76; 95% CI, 0.72-0.81). There was no association between BFP and SGA, except among less educated mothers, who had a reduced risk of SGA (OR, 0.83; 95% CI, 0.79-0.88).Conclusions and RelevanceThis study found that BFP was associated with increased birth weight and reduced odds of LBW, with a greater decrease in odds of LBW among higher-risk groups. These findings suggest the importance of maintaining financial support for mothers at increased risk of birth weight–related outcomes.

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Early Life Interventions for Intergenerational Prosperity

Rahman,

Pingali

2024

Palgrave Studies in Agricultural Economics and Food Policy

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Investing in early childhood development is paramount to building development resilience. Children born to poor parents are less likely to be well nourished, finish school, earn less, and live in poverty, and give birth to malnourished children. Early life interventions—in utero, and in childhood—therefore provide a suitable window of opportunity to stem disparities in human development and intergenerational persistence of poverty. Through a range of programs with multiple scope—institutional birth delivery, nutritional assistance for pregnant and lactating mothers, and reducing classroom hunger—and an explicit focus on children and women, Indian government attempts to address inequalities which develop early in life. While these programs have been effective in achieving the purported goals, there is a significant room of improvement to achieve transformational gains. In this chapter, we argue for further strengthening of these programs through better implementation of the program, enhancements in the quality of services offered, greater synergy across programs, and a sustained commitment to improving maternal and child healthcare.

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Evaluating the effect of Bolsa Familia, Brazil’s conditional cash transfer programme, on maternal and child health: A study protocol

Cited by 8 publications

References 58 publications

Association of Conditional Cash Transfers With Maternal Mortality Using the 100 Million Brazilian Cohort

Association of Conditional Cash Transfers With Maternal Mortality Using the 100 Million Brazilian Cohort

Participation in Conditional Cash Transfer Program During Pregnancy and Birth Weight–Related Outcomes

Early Life Interventions for Intergenerational Prosperity

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