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 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.

Sociodemographic inequalities in the trends of different types of leisure-time physical activity among Brazilian adults between 2006 and 2019

“…Higher poverty rates can lead to less access to private structures for physical activity, such as gyms. These findings demonstrate the urgent need for public policies to improve income distribution, giving greater autonomy for individuals to engage in LTPA, as well as enhance other health conditions [ 26 , 27 ].…”

Spatial-temporal distribution of incidence, mortality, and case-fatality ratios of coronavirus disease 2019 and its social determinants in Brazilian municipalities

“…SIR, SMR, and SCFR were inversely associated with both the per capita Bolsa Família Programme bene ts distributed in the municipality and the PMR. Several authors have demonstrated the positive impact of Bolsa Família, a cash transfer programme for vulnerable sectors of the Brazilian population, on the decreasing child mortality, 19 the incidence of leprosy in families living in municipalities with a high burden of the disease, 20 and maternal mortality, 21 and increasing the number of people recovering from tuberculosis. 22 In this context, cash transfer programmes for socially vulnerable individuals, such as the Bolsa Família Programme, play a key role in protecting the most basic needs of people, including nutritional security.…”

Global disease burden and trends of leukemia attributable to occupational risk from 1990 to 2019: An observational trend study

“…The marked increase in leukemia attributable to occupational risk in Latin America in terms of deaths and DALYs can be partially explained by the fact that humans in these countries and regions are mostly engaged in physical labor and have more opportunities to come into contact with toxic substances such as formaldehyde and benzene. Besides, long-term poverty, poor access to healthcare, a lower awareness regarding occupational risk, inadequate prevention measures and screening, and a lower proportion of treatment together make low-income countries more susceptible to leukemia attributable to occupational risk than high-income countries ( 36 – 38 ). Therefore, in the subsequent campaign to eliminate leukemia attributable to occupational risk, more attention and health resources were warranted in developing countries and low-income regions.…”