Sarah L Barber1. 1. Institute of Business and Economic Research, University of California, Berkeley, CA, USA. barbers@wpro.who.int
Abstract
BACKGROUND: Caesarean section rates are increasing in Mexico and Latin America. This study evaluates the impact of a large-scale, conditional cash transfer programme in Mexico on caesarean section rates. The programme provides cash transfers to participating low income, rural households in Mexico conditional on accepting health care and nutrition supplements. METHODS: The primary analyses uses retrospective reports from 979 women in poor rural communities participating in an effectiveness study and randomly assigned to incorporation into the programme in 1998 or 1999 across seven Mexican states. Using multivariate and instrumental variable analyses, we estimate the impact of the programme on caesarean sections and predict the adjusted mean rates by clinical setting. Programme participation is measured by beneficiary status, programme months and cash transfers. RESULTS: More than two-thirds of poor rural women delivered in a health facility. Beneficiary status is associated with a 5.1 percentage point increase in caesarean rates; this impact increases to 7.5 percentage points for beneficiaries enrolled in the programme for >or=6 months before delivery. Beneficiaries had significantly higher caesarean delivery rates in social security facilities (24.0 compared with 5.6% among non-beneficiaries) and in other government facilities (19.3 compared with 9.5%). CONCLUSION: The Oportunidades conditional cash transfer programme is associated with higher caesarean section rates in social security and government health facilities. This effect appears to be driven by the increases in disposable income from the cash transfer. These findings are relevant to other countries implementing conditional cash transfer programmes and health care requirements.
BACKGROUND: Caesarean section rates are increasing in Mexico and Latin America. This study evaluates the impact of a large-scale, conditional cash transfer programme in Mexico on caesarean section rates. The programme provides cash transfers to participating low income, rural households in Mexico conditional on accepting health care and nutrition supplements. METHODS: The primary analyses uses retrospective reports from 979 women in poor rural communities participating in an effectiveness study and randomly assigned to incorporation into the programme in 1998 or 1999 across seven Mexican states. Using multivariate and instrumental variable analyses, we estimate the impact of the programme on caesarean sections and predict the adjusted mean rates by clinical setting. Programme participation is measured by beneficiary status, programme months and cash transfers. RESULTS: More than two-thirds of poor rural women delivered in a health facility. Beneficiary status is associated with a 5.1 percentage point increase in caesarean rates; this impact increases to 7.5 percentage points for beneficiaries enrolled in the programme for >or=6 months before delivery. Beneficiaries had significantly higher caesarean delivery rates in social security facilities (24.0 compared with 5.6% among non-beneficiaries) and in other government facilities (19.3 compared with 9.5%). CONCLUSION: The Oportunidades conditional cash transfer programme is associated with higher caesarean section rates in social security and government health facilities. This effect appears to be driven by the increases in disposable income from the cash transfer. These findings are relevant to other countries implementing conditional cash transfer programmes and health care requirements.
Authors: Béatrice Blondel; Michael D Kogan; Greg R Alexander; Nirupa Dattani; Michael S Kramer; Alison Macfarlane; Shi Wu Wen Journal: Am J Public Health Date: 2002-08 Impact factor: 9.308
Authors: Carl Reddy-Jacobs; Martha Ma Téllez-Rojo; Fernando Meneses-González; Julio Campuzano-Rincón; Mauricio Hernández-Avila Journal: Salud Publica Mex Date: 2006
Authors: Blair G Darney; Marcia R Weaver; Sandra G Sosa-Rubi; Dilys Walker; Edson Servan-Mori; Sarah Prager; Emmanuela Gakidou Journal: Int Perspect Sex Reprod Health Date: 2013-12
Authors: Christie Y Jeon; Peter Muennig; E Yoko Furuya; Bevin Cohen; Denis Nash; Elaine L Larson Journal: Am J Infect Control Date: 2014-11-25 Impact factor: 2.918
Authors: William Massavon; Calistus Wilunda; Maria Nannini; Robert Kaos Majwala; Caroline Agaro; Emanuela De Vivo; Peter Lochoro; Giovanni Putoto; Bart Criel Journal: BMC Pregnancy Childbirth Date: 2017-12-19 Impact factor: 3.007
Authors: Susan F Murray; Benjamin M Hunter; Ramila Bisht; Tim Ensor; Debra Bick Journal: BMC Pregnancy Childbirth Date: 2014-01-17 Impact factor: 3.007