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Sustainable Development Goals
01 Erradicação da pobreza03 Saúde e Bem-Estar
08 Trabalho decente e crescimento econômico
10 Redução das desigualdades
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LONG-TERM IMPACT OF A CONDITIONAL CASH TRANSFER PROGRAMME ON MATERNAL MORTALITY: A NATIONWIDE ANALYSIS OF BRAZILIAN LONGITUDINAL DATA
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Instituto de Salud Global de Barcelona. Barcelona, España / Universitat de Barcelona. Hospital Clínico y Provincial de Barcelona. Barcelona, España.
Universidade Federal da Bahia. Instituto de Saúde Coletiva. Salvador, BA, Brasil / Fundação Oswaldo Cruz. Instituto Gonçalo Moniz. Centro de Integração de Dados e Conhecimentos para Saúde. Salvador, BA, Brasil.
Universidade Federal da Bahia. Instituto de Saúde Coletiva. Salvador, BA, Brasil / Fundação Oswaldo Cruz. Instituto Gonçalo Moniz. Centro de Integração de Dados e Conhecimentos para Saúde. Salvador, BA, Brasil.
Universidade Federal da Bahia. Escola de Nutrição. Salvador, BA, Brasil.
Universidade Federal da Bahia. Instituto de Saúde Coletiva. Salvador, BA, Brasil / Fundação Oswaldo Cruz. Instituto Gonçalo Moniz. Centro de Integração de Dados e Conhecimentos para Saúde. Salvador, BA, Brasil.
Fundação Oswaldo Cruz. Instituto Gonçalo Moniz. Centro de Integração de Dados e Conhecimentos para Saúde. Salvador, BA, Brasil / University of Nottingham. School of Biosciences. Centre for Research in Race and Rights. Future Food Beacon of Excellence. Nottingham, United Kingdom.
Fundação Oswaldo Cruz. Instituto Gonçalo Moniz. Centro de Integração de Dados e Conhecimentos para Saúde. Salvador, BA, Brasil / London School of Hygiene and Tropical Medicine. Faculty of Epidemiology and Population Health. London, United Kingdom.
Universidade Federal da Bahia. Instituto de Saúde Coletiva. Salvador, BA, Brasil / Fundação Oswaldo Cruz. Instituto Gonçalo Moniz. Centro de Integração de Dados e Conhecimentos para Saúde. Salvador, BA, Brasil.
Universidade Federal da Bahia. Instituto de Saúde Coletiva. Salvador, BA, Brasil / Fundação Oswaldo Cruz. Instituto Gonçalo Moniz. Centro de Integração de Dados e Conhecimentos para Saúde. Salvador, BA, Brasil.
Universidade Federal da Bahia. Escola de Nutrição. Salvador, BA, Brasil.
Universidade Federal da Bahia. Instituto de Saúde Coletiva. Salvador, BA, Brasil / Fundação Oswaldo Cruz. Instituto Gonçalo Moniz. Centro de Integração de Dados e Conhecimentos para Saúde. Salvador, BA, Brasil.
Fundação Oswaldo Cruz. Instituto Gonçalo Moniz. Centro de Integração de Dados e Conhecimentos para Saúde. Salvador, BA, Brasil / University of Nottingham. School of Biosciences. Centre for Research in Race and Rights. Future Food Beacon of Excellence. Nottingham, United Kingdom.
Fundação Oswaldo Cruz. Instituto Gonçalo Moniz. Centro de Integração de Dados e Conhecimentos para Saúde. Salvador, BA, Brasil / London School of Hygiene and Tropical Medicine. Faculty of Epidemiology and Population Health. London, United Kingdom.
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.
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