Journal
BMC MEDICINE
Volume 19, Issue 1, Pages -Publisher
BMC
DOI: 10.1186/s12916-021-01994-7
Keywords
Conditional cash transfer; Bolsa Familia Programme; Maternal mortality
Categories
Funding
- Wellcome Trust Training Fellowships in Public Health and Tropical Medicine scheme [109949/Z/15/Z]
- Wellcome Trust [213589/Z/18/Z]
- Foundation for Research Support of the State of Bahia (FAPESB)
- Wellcome Trust [109949/Z/15/Z] Funding Source: Wellcome Trust
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The Brazilian Bolsa Familia Programme (BFP) has been shown to significantly reduce maternal mortality and improve access to healthcare, with stronger effects observed among poor mothers who were exposed to the programme during their childhood and adolescence. This indicates a potential inter-generational effect of conditional cash transfer (CCT) programmes in reducing health inequalities and contributing to the achievement of Sustainable Development Goal 3.1. During the current global economic crisis caused by the COVID-19 pandemic, it is crucial to preserve sustained CCT coverage to continue reducing maternal mortality and improving healthcare access.
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.
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