2021 REPORT (SHORT VERSION)

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Brazil’s conditional cash transfer programme, Bolsa Família, significantly reduced maternal mortality, particularly among young women

In 2017, around 300,000 women died due to complications from pregnancy or childbirth. Most of these deaths were in low- and middle-income countries.

In 2017, around 300,000 women died due to complications from pregnancy or childbirth. Most of these deaths were in low- and middle-income countries.

Why do so many women in the world still die before, during or after giving birth? One of the reasons, in short, is poverty and poverty-related factors such as poor access to healthcare services, unsanitary living conditions, illiteracy, social exclusion and food insecurity. Therefore, some countries have established cash transfer programmes to improve access to healthcare and reduce poverty—two key actions to reduce maternal mortality. “However, up to now it was not clear whether these programmes were effectively reducing maternal deaths,” explains Davide Rasella, who leads the Health Impact Assessment Group at ISGlobal. So, in collaboration with colleagues from Fiocruz in Brazil, his team used a state-of-the-art methodology to evaluate the impact of Brazil’s Bolsa Família programme over 11 years. The conditional cash transfer programme, one of the world’s largest, gives money to beneficiary families when certain conditions—such as scheduled medical visits—are met.

Change takes time, but is far-reaching

Using data from 2,548 Brazilian municipalities between 2004 and 2014, the study found that Bolsa Família was significantly associated with a reduction in maternal mortality (i.e. women who died during pregnancy or within 42 days after giving birth): up to a 17% decrease in those municipalities where the programme was implemented for the longest or reached the most families. The effect was strongest in young mothers (aged under 30 years), suggesting that the programme was having an intergenerational effect and helping to break the cycle of poverty.

“Several factors may contribute to this impact,” says Rasella. Women have to attend antenatal healthcare services as a condition for receiving the cash transfer, which improves birth outcomes and also helps to detect and treat chronic conditions or infections the mother may have. Also, the cash allowance could help them eat better and have access to nutritional supplements. “In any case, the change is not immediate,” underlines Rasella. “We observed that it takes some time before the programme’s impact becomes evident.” This means that these programmes should be preserved even during economic crises such as the one generated by the COVID-19 pandemic.

Rasella D, Alves FJO, Rebouças P, et al. Long-term impact of a conditional cash transfer programme on maternal mortality: a nationwide analysis of Brazilian longitudinal data. BMC Med 19, 127 (2021). doi: 10.1186/s12916-021-01994-7

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