The impact of conditional cash transfer programmes on antenatal care service uptake in low- and middle-income countries: a systematic review
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Published version
Author(s)
Jacobs, Ward
Downey, Laura
Type
Journal Article
Abstract
Objective:
Antenatal care (ANC) is crucial to protecting the health of pregnant women and their unborn children, however the uptake of ANC amongst pregnant women in low- and middle-income countries (LMICs) is sub-optimal. One popular strategy to increase the uptake of health services, including ANC visits, are conditional cash transfer (CCT) programmes. CCT programmes require beneficiaries to comply with certain conditionalities in order to receive a financial sum. A systematic review was carried out to determine whether CCT programmes have a positive impact on ANC uptake in LMIC populations.
Methods:
Electronic databases CENTRAL, MEDLINE, Embase, Maternity and Infant Care and Global Health were searched from database inception to 21 January 2022. Reference checking and grey literature searches were also applied. Eligible study designs were randomized controlled trials, controlled before-after studies and interrupted time series analysis. Risk of bias assessments were undertaken for each study by applying the ROB-2 and ROBINS-I tools.
Results:
Out of 1534 identified articles, 18 publications were included for analysis. Eight studies reported statistically non-significant results on all reported outcomes. Seven studies demonstrated statistically significant positive effects ranging from 5.5% to 45% increase in ANC service uptake. A further three studies reported small but statistically significant impact of CCT on the use of ANC services in both positive (2.5% increase) and negative (3.7% decrease) directions. Sub-analysis of results disaggregated by socioeconomic status (SES) indicated that ANC attendance may be more markedly improved by CCT programs in low SES populations, however results were inconclusive.
Conclusion:
Our evidence synthesis presented here demonstrated a highly heterogeneous evidence base pertaining to the impact of CCTs on ANC attendance. More high-powered studies are required to elucidate the true impact of CCT programmes on ANC uptake, with particular focus on the barriers and enablers of such programs in achieving intended outcomes.
Antenatal care (ANC) is crucial to protecting the health of pregnant women and their unborn children, however the uptake of ANC amongst pregnant women in low- and middle-income countries (LMICs) is sub-optimal. One popular strategy to increase the uptake of health services, including ANC visits, are conditional cash transfer (CCT) programmes. CCT programmes require beneficiaries to comply with certain conditionalities in order to receive a financial sum. A systematic review was carried out to determine whether CCT programmes have a positive impact on ANC uptake in LMIC populations.
Methods:
Electronic databases CENTRAL, MEDLINE, Embase, Maternity and Infant Care and Global Health were searched from database inception to 21 January 2022. Reference checking and grey literature searches were also applied. Eligible study designs were randomized controlled trials, controlled before-after studies and interrupted time series analysis. Risk of bias assessments were undertaken for each study by applying the ROB-2 and ROBINS-I tools.
Results:
Out of 1534 identified articles, 18 publications were included for analysis. Eight studies reported statistically non-significant results on all reported outcomes. Seven studies demonstrated statistically significant positive effects ranging from 5.5% to 45% increase in ANC service uptake. A further three studies reported small but statistically significant impact of CCT on the use of ANC services in both positive (2.5% increase) and negative (3.7% decrease) directions. Sub-analysis of results disaggregated by socioeconomic status (SES) indicated that ANC attendance may be more markedly improved by CCT programs in low SES populations, however results were inconclusive.
Conclusion:
Our evidence synthesis presented here demonstrated a highly heterogeneous evidence base pertaining to the impact of CCTs on ANC attendance. More high-powered studies are required to elucidate the true impact of CCT programmes on ANC uptake, with particular focus on the barriers and enablers of such programs in achieving intended outcomes.
Date Issued
2022-11-25
Date Acceptance
2022-09-30
Citation
BMJ Open, 2022, 12 (11), pp.1-14
ISSN
2044-6055
Publisher
BMJ Journals
Start Page
1
End Page
14
Journal / Book Title
BMJ Open
Volume
12
Issue
11
Copyright Statement
© Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. http://creativecommons.org/licenses/by-nc/4.0/
This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.
This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.
Identifier
https://bmjopen.bmj.com/content/12/11/e064673.info
Publication Status
Published
Date Publish Online
2022-11-25