The intergenerational relationship between conditional cash transfers and newborn health

Abstract

Background Lack of nutrition, inadequate housing, low education and limited access to quality care can negatively affect children’s health over their lifetime. Implemented in 2003, the Bolsa Familia (“Family Stipend”) Program (PBF) is a conditional cash transfer program targeting poor households in Brazil. This study investigates the long-term benefits of cash transfers through intergenerational transmission of health and poverty by assessing the early life exposure of the mother to the PBF. Methods We used data from the 100M SINASC-SIM cohort compiled and managed by the Center for Data and Knowledge Integration for Health (CIDACS), containing information about participation in the PBF and socioeconomic and health indicators. We analyzed five measures of newborn health: low (less than 2,500 g) and very low (less than 1,500 g) birth weight, premature (less than 37 weeks of gestation) and very premature (less than 28 weeks of gestation) birth, and the presence of some type of malformation (according to ICD-10 codes). Furthermore, we measured the early life exposure to the PBF of the mother as PBF coverage in the previous decade in the city where the mother was born. We applied multilevel logistic regression models to assess the associations between birth outcomes and PBF exposures. Results Results showed that children born in a household where the mother received BF were less likely to have low birth weight (OR 0.93, CI; 0.92-0.94), very low birth weight (0.87, CI; 0.84-0.89), as well as to be born after 37 weeks of gestation (OR 0.98, CI; 0.97-0.99) or 28 weeks of gestation (OR 0.93, CI; 0.88-0.97). There were no significant associations between households where the mother received BF and congenital malformation. On average, the higher the early life exposure to the PBF of the mother, the lower was the prevalence of low birth weight, very low birth weight and congenital malformation of the newborn. No trend was noted for preterm birth. Conclusion The PBF might have indirect intergenerational effects on children’s health. These results provide important implications for policymakers who have to decide how to effectively allocate resources to improve child health.

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

“…First, CTs enable the family to diversify the food purchased (consuming more vegetables, fruit, and meat, which are sources of minerals and vitamins), which is associated with family food security indicators, psychosocial health, increased social capital, and female decision-making power . The second is the association of conditionalities with outcomes and the benefits provided by integrated, health-related actions …”

Income Segregation, Conditional Cash Transfers, and Breast Cancer Mortality Among Women in Brazil

“…13 Aimed at reducing poverty and inequality, improving nutritional status, and increasing access to preventive health services and education, the BFP requires beneficiaries to comply with conditions, such as prenatal visits for pregnant women, vaccination for children, and minimum school attendance by children. [13][14][15] Nearly 90% of BFP beneficiary families have women as recipients. 16 Evidence shows that conditional cash-transfer programs are effective, associated with increases in women's use of preventive health care services (eg, Papanicolaou test tests), 14 improved health status, 17 and enhanced empowerment among women upon increasing familial income.…”

“…16 Evidence shows that conditional cash-transfer programs are effective, associated with increases in women's use of preventive health care services (eg, Papanicolaou test tests), 14 improved health status, 17 and enhanced empowerment among women upon increasing familial income. 15 Individual-level income may attenuate the association between area-level socioeconomic disadvantage and breast cancer mortality. 7 Therefore, we hypothesized that the BFP would be associated with improved access among women to community resources and preventive cancer care services, such as clinical breast examinations and mammographic screening, and thus early detection and treatment and ultimately reductions in the breast cancer mortality associated with income segregation.…”

“…First, it examines the association of a structural contextual factor, income segregation, with breast cancer mortality rather than focusing on individual attributes, which may provide a more comprehensive range of intervention strategies beyond the individual. Second, studies on the association of the BFP with health inequities have been focused on child health outcomes, 15,18,19 and women's health has been less explored. Using individual data from a large-scale, population-based cohort in Brazil, which includes more than half of the…”

“…Implemented in 2004, Brazil’s Bolsa Família program (BFP) is the world’s largest conditional cash-transfer program, targeting low and extremely low income households . Aimed at reducing poverty and inequality, improving nutritional status, and increasing access to preventive health services and education, the BFP requires beneficiaries to comply with conditions, such as prenatal visits for pregnant women, vaccination for children, and minimum school attendance by children . Nearly 90% of BFP beneficiary families have women as recipients .…”