Paying Patients for Prenatal Care: The Effect of a Small Cash Transfer on Stillbirths and Survival

Abstract

work is licensed under a Creative Commons IGO 3.0 AttributionNonCommercial-NoDerivatives (CC-IGO BY-NC-ND 3.0 IGO) license (http://creativecommons.org/licenses/by-nc-nd/3.0/igo/ legalcode) and may be reproduced with attribution to the IDB and for any non-commercial purpose, as provided below. No derivative work is allowed.Any dispute related to the use of the works of the IDB that cannot be settled amicably shall be submitted to arbitration pursuant to the UNCITRAL rules. The use of the IDB's name for any purpose other than for attribution, and the use of IDB's logo shall be subject to a separate written license agreement between the IDB and the user and is not authorized as part of this CC-IGO license.Following a peer review process, and with previous written consent by the Inter-American Development Bank (IDB), a revised version of this work may also be reproduced in any academic journal, including those indexed by the American Economic Association's EconLit, provided that the IDB is credited and that the author(s) receive no income from the publication. Therefore, the restriction to receive income from such publication shall only extend to the publication's author(s). With regard to such restriction, in case of any inconsistency between the Creative Commons IGO 3.0 Attribution-NonCommercial-NoDerivatives license and these statements, the latter shall prevail.Note that link provided above includes additional terms and conditions of the license.The opinions expressed in this publication are those of the authors and do not necessarily reflect the views of the Inter-American Development Bank, its Board of Directors, or the countries they represent. Abstract:We study the effects of conditional cash transfers to pregnant women on stillbirths and child survival in Bolivia. Payments are conditional on compliance with medically recommended prenatal care and skilled birth attendance. At a value equivalent to just 1% of monthly household consumption, the payments are the smallest amongst national cash transfer programs in Latin America. Using multiple data sources and empirical methods, we show that the intervention reduced the average rate of stillbirths by 9.5% to 22.3%, and increased the survival rates of birth cohorts exposed to the program by 3.5% to 16.8%. The causal pathways of these effects are consistent with evidence of increased utilization of recommended health care services, including early initiation of prenatal care (17%), at least four prenatal visits (16%), and skilled birth attendance (15%). Given the modest transfer amounts and considerable effects on health care utilization, we posit that final health outcomes are likely driven by the health care conditionality, rather than an income effect. The intervention is highly cost-effective, at $184.54 per DALY averted, making the program's pay-per-compliance design a promising policy alternative.JEL codes: H51, I12, I38, J18, O15.

Effects of women’s economic empowerment interventions on antenatal care outcomes: a systematic review

“…Sixteen studies evaluated an intervention in Asia,37–52 13 studies in Africa,53–65 7 in South America66–72 and 1 study evaluated interventions in multiple countries in South America and Asia 73. The most studied country in this review was India (n=10).…”

“…The most studied country in this review was India (n=10). Eight studies sampled households,37 41 47 49 59 67 72 8 studies sampled currently pregnant women44 53–55 58 61 63 64 and 23 studies sampled women with previous pregnancy experience 38–40 42 44–48 50 51 57 59 62 64–66 68–71. Of those 23 studies, 4 studies were limited to married women 42 45 46 52.…”

“…Thirty-five studies used a quantitative methodology,38–44 46–73 while two studies were mixed methods 37 51. Seven studies used an experimental study design: four studies were cluster-randomised trials,45–47 55 and three were randomised controlled trials 53 60 63.…”

Changing Behavioral Patterns Related to Maternity and Childbirth in Rural and Poor Populations: A Critical Review

“…However, although the use of non-monetary incentives seem to have more potential in terms of cost-effectiveness than traditional CCTs we should remark that the use of monetary incentives can be refined: there is evidence that providing small, immediate payments after specific health behaviors are performed leads to greater impact as shown in a recent study by Celhay et al (2017). 12,13 Discussion and Conclusion…”

Public Policies for Promotion of Maternal-Infant Health in Brazil: Some Experiences with Adolescent Mothers in São Paulo

“…We know that proper accompaniment during the prenatal period and delivery is fundamental for ensuring adequate conditions of survival for mothers and their babies [25]. The São Paulo Municipal Secretariat of Health, in accordance with federal policies, establishes that pregnant women should have monthly consultations (or at least 7), lab and ultrasound exams, free transportation vouchers to and from the exams and consultations, and visits before delivery.…”