Women and health professionals’ perspectives on a conditional cash transfer program to improve pregnancy follow-up: a qualitative analysis of the NAITRE randomized controlled study

Abstract

Objectives. Many types of conditional cash transfer (CCTs) programs have been developed and their effects demonstrated, including programs to improve prenatal care, but ethical critiques have included paternalism and lack of informed choice. These criticisms were levelled at the French NAITRE randomized clinical trial, which is assessing a CCT program that promotes prenatal care among women of low socioeconomic backgrounds. We conducted qualitative research to determine if women in the study and health professionals (HP) shared these concerns.Study design. We conducted a multicenter, cross-sectional, qualitative study of 26 participating post-delivery women and 8 HP (physicians and midwives, participants and non-participants) to assess their perspectives on CCT, purposively selecting a sample of women with diverse experiences. We excluded women who had miscarried or whose babies had died, or whose new-born suffered from a severe medical condition. We invited health professionals to participate even if they or their center had not participated in the trial. Participants agreed to semi-structured face-to-face or phone interviews, which we recorded as audio and transcribed. Our approach to identifying patterns was inductive; we highlighted topics that repeatedly emerged, characterized them, and organized them into themes.Results. Women expressed surprise that the CCT was offered, but did not perceived it negatively. They never mentioning feeling stigmatized. They described CCT as a significant source of aid for women with limited financial resources. HP described the CCT in less positive terms, e.g., expressing concern about discussing cash transfer at their first medical encounter with women. Though they emphasized ethical concerns about the basis of the trial, they recognized that CCT needed to be evaluated.Conclusion. In France, a high-income country where prenatal follow-up is free, health professionals were concerned that the CCT program would change their relationship with patients and wondered if it was the best use of funding, but women who received a cash incentive said they did not feel stigmatized and indicated that these payments helped them prepare for their baby’s birth. Trial registration: NCT02402855- Clinical Trial – first registration 30 march 2015 -