Perceptions of beneficiaries and health professionals regarding a conditional cash transfer program to improve pregnancy follow-up: a qualitative analysis of the NAITRE randomized controlled study

Abstract

Background: Economic incentives have been used in several countries to improve pregnancy follow-up, to encourage families to bring their infants to see a doctor, and to promote school attendance. However, these conditional cash transfer programs (CCTs) are often subject to criticism. The NAITRE study, which is currently underway in France, assesses the use of CCT to promote prenatal care in women with low socioeconomic backgrounds and has also been the focus of such criticism. The objective of the qualitative study was to analyse how the CCT is perceived by the women and health professionals involved in the project. These data are essential for in-depth understanding of the elements that could encourage or deter a generalization of the process. Methods: A multicentre, cross-sectional, qualitative study was conducted among 26 women included in the NAITRE trial and 8 health professionals (physicians and midwives). All data were collected through semi-structured individual interviews and transcribed in their entirety. A thematic content analysis was then used to generate the results. Results: In the interviews, the women expressed surprise regarding the offer of a cash incentive. However, they did not perceive the CCT negatively, but saw it rather as a significant source of aid for women with limited financial resources. Some even expressed feeling as though they were supported far beyond the financial support. The health professionals were much less positive. Still, though they all stressed the ethical considerations related to the premise of the trial, they recognized the need for such an evaluation. Conclusions: In a country where access to health care is facilitated by a nationalized health insurance system, the use of a CCT to improve medical follow-up during pregnancy raises ethical questions for the health professionals involved. However, an analysis of the interviews conducted with the women who received compensation showed that they did not feel stigmatized. While the women generally reported that the CCT money allowed them to better prepare for the birth, none indicated that they changed their behaviour relative to medical follow-up during the pregnancy.