Impact of cash transfer programs on birth and child growth outcomes: systematic review

Lisboa, Cinthia Soares; Guimarães, Nathalia Sernizon; Ferreira, Andrêa Jacqueline Fortes; Silva, Karine Brito Beck da; Alves, Flávia Jôse Oliveira; Rocha, Aline dos Santos; Ortelan, Naiá; Texeira, Camila Silveira Silva; Falcão, Ila Rocha; Silva, Natanael de Jesus; Ribeiro-Silva, Rita de Cássia; Barbosa, Djanilson; Barreto, Mauricio Lima

doi:10.1590/1413-81232023288.14082022

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REVIEW • Ciênc. saúde coletiva 28 (8) • Aug 2023 • https://doi.org/10.1590/1413-81232023288.14082022 copy

Impact of cash transfer programs on birth and child growth outcomes: systematic review

Impacto dos programas de transferência de renda nos desfechos de nascimento e crescimento infantil: revisão sistemática

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

To investigate the impact of cash transfer (CTs) on birth outcomes, including birth weight, low birth weight and prematurity, as well as child physical growth were included, as assessed by anthropometric indices in children under five years of age. Searching was performed using the PubMed/Medline, Embase, LILACS, Cochrane Library, Scopus and Web of Science databases. Quantitative observational, experimental and quasi-experimental. Eleven studies were included in the review. The majority (81.8%) were carried out in low-and middle-income countries and most involved conditional CTs (63.6%). Four were clinical trials and seven were observational studies. Conditional CTs were found to be associated with a reduction in height-for-age (-0.14; 95%CI -0.27, -0.02); (OR 0.85; 95%CI 0.77-0.94); (OR = 0.44; 95%CI 0.19-0.98), a significantly reduced chance of low weight-for-age (OR = 0.16; 95%CI -0.11-0.43), low weight-for-height (OR = -0.68; 95%CI -1.14, -0.21), and low weight-for-age (OR = 0.27; 95%CI 0.10; 0.71). Unconditional CTs were associated with reduced birth weight (RR = 0.71; 95%CI 0.63-0.81; p < 0.0001) and preterm births (RR = 0.76; 95%CI 0.69-0.84; p < 0.0001). Conditional CTs can positively influence birth outcomes and child growth.

Key words:
Infant; Nutritional status; Public policy

Components	Definitions
Population	Children under 5 years whose families were beneficiaries of conditional or unconditional cash transfer programs
Intervention	Conditional or unconditional cash transfers
Comparison	Children belonging to non-beneficiary families (i.e., those who did not receive conditional or unconditional cash transfers)
Outcomes	Child growth assessed by anthropometry [weight-for-height (W/H), weight-for-age (W/A), height-for-age (H/A), body mass index-for-age (BMI/A)] and birth outcomes (birth weight, low birth weight and preterm birth)

Author(s)/year	Country	Study				Nutritional indicators
Author(s)/year	Country	Cash transfer program (type)	Intervention period	Design	Population
Hamad R, Rehkopf DH, 2015³⁴	USA	Earned income tax credit (EITC)	168 months	Retrospective cohort; quasi-experimental	Sample consisted of 2,985 women and 4,683 children. Exposures: term pregnancy (1,799) and birth weight (1,803); non-exposed group: term pregnancy (2,884) and birth weight (2,880)	Birth weight
Brownell M. et al., 2016³⁵	Canada	(UCT)	84 months	Retrospective cohort; quasi-experimental	Sample consisted of 14,591 women: 10,738 were exposed and 3,853 were not exposed	Birth weight
Kandpal E et al., 2016³³	Philippines	Healthy Baby Prenatal Benefit (HBPB)	3 months	Randomized clinical trial	Sample of 1,418 families randomly assigned to treatment (714 poor families) or control (704 poor families).	H/A W/A
Lopez-Arana S et al., 2016³²	Colombia	(UCT)	48 months	Quasi-experimental	Sample consisted of 2,874 children under 7 years of age. The study was divided into 2 segments: 1st follow-up period: 2002 (N = 1,814 exposed; 2,283 controls) 2nd follow-up period: 2006 (N = 1,290 exposed; 1,584 controls)	H/A BMI/A
Labrecque J et al., 2018²⁶	Brazil	Pantawid Pamilya (CCT)	16 months out of 24 months post-childbirth	Cohort	1,703 families eligible for cohort inclusion, divided into 3 groups according to household income level: 1- No Bolsa Família (N = 110) at 12 months and (N = 291) at 24 months 2- Low Bolsa Família (< 1,000 reais) (N = 110) at 12 months and (N = 291) at 24 months 3- High Bolsa Família (> 1,000 reais household) (N = 319) at 12 meses and (N = 355) at 24 meses	H/A W/A
Adubra L et al., 2019	Mali	Santé Nutritionnelle à Assise communautaire dans la région de Kayes (SNACK-CNA) (CCT)	Minimum 18 months; maximum 30 months	Controlled, randomized clinical trial	Sample consisted of 4,970 children for H/A assessment N = 1,202 in study group of interest.	H/A
Briaux J et al., 2020⁹	Togo	Cash Plus (UCT)	24 to 30 months	Controlled, randomized clinical trial	Study divided into 2 segments: Follow-up 1 (2014) Treated: 1,357 Controls: 1,301 Follow-up 2 (2016) Treated: 1,035 Controls: 996	H/A W/A
Sudfeld C et al., 2021²⁸	Tanzania	CCT	18 months	Cluster-controlled, randomized clinical trial	Study divided into 3 groups for anthropometric assessments: Group 1- Only exposed to community actions (N = 185) Group 2- Exposed to community actions and cash transfers (N = 188) Group 3- Control (N = 174)	H/A W/A W/H
Chakrabarti S, Pan A, Singh P, 2021²⁹	India	Mamata Scheme (CCT)	60 months	Retrospective cohort; quasi-experimental	Sample size: 200,000 mothers & children, divided as follows: Group CG1: all Indian states except Uttar Pradesh, Bihar, Jharkhand and Uttarakhand CG2: Odisha neighboring states (West Bengal, Chhattisgarh, Jharkhand and Andhra Pradesh) Odisha N = 11,558 CG1 N = 168,580 CG2 N = 35,702	H/A
González L, Trommlerová S., 2022³⁰	Spain	Universal Benefit for Children (UCT)	16 weeks	Retrospective cohort; quasi-experimental	The sample was made up of 147.913 people: 57.998 poor people (40%) and 89.900 non-poor people (60%); 36.267 poor people (25%) and 111.631 poor people (75%).	Birth weight
Lucas A, 2022³¹	Brazil	Programa Bolsa Família (CCT)	48 months	Retrospective cohort	The sample was made up of children born between 2011 and 2015 (n = 5,246,874).	Birth weight

Cash transfer programs
Author(s)/year	Objective(s)	Monthly value (US$)	Main results
Observational studies
Hamad R, Rehkopf DH, 201534	Reduce poverty for low-income families.	Amount received varied between US$ 500 and US$ 2,000.	Birthweight: EITC payments were not statistically significant regarding increased birth weight at family income level of $1,000 [β=65.1 (95%CI-0.46,130.6) p<0.05]. Family income did not affect perinatal health in association with EITC: Term pregnancy [β= 0.0056 (95%CI -0.013,0.024) p>0.05]; Birthweight [β= 18.0 (95%CI -17.8,53.8) p>0.05].
Brownell M et al., 201635	Improve prenatal health and birth outcomes.	HBPB provided prenatal income support (up to $63.91 per month) for low-income women during the second and third trimesters	Gestational age: HBPB was associated with a reduction in preterm birth [RR=0.76 (95%CI 0.69-0.84) p<0.0001] and small-for-gestational age [RR= 0.90 (95%CI 0.81-0.99) p=0.05], as well as increased large-for-gestational age [RR= 1.13 (95%CI 1.05-1.23) p=0.001]. Birthweight: The program was associated with reduced birth weight [RR=0.71 (95%CI 0.63-0.81) p<0.0001].
Labrecque J et al., 201826	Combat poverty through cash transfers to low-income and very low-income families.	US$ 2.68 to US$ 16.97 monthly, depending on family income level per capita and number of children.	Anthropometric outcomes: a difference of β= -0.14 [95%CI -0.27, -0.02] was identified in the H/A index among children aged up to 2 years with income < 1,000 reais, and β= -0.20 [95%CI -0.33, -0.88] among those with income > 1,000 reais. Regarding W/A, differences were β= -0.04 [95%CI -0.17-0.08] for the group with < 1,000 reais in income and β= -0.18 [95%CI -0.30, -0.05] for those with > 1,000 reais.
Chakrabarti S, Pan A, Singh P, 202129	Improve maternal and child health outcomes through the promotion of health care utilization.	Financial incentive of US$66.60 offered to women who met specified conditions regarding the use of maternal and childcare services.	Anthropometric outcomes: the chance of stunting in Odisha was lower following the implementation of Mamata compared to other Indian states. CG1: All Indian states except Uttar Pradesh, Bihar, Jharkhand and Uttarakhand [OR=0.89 (95%CI 0.81-0.98)] poor and [OR=1.17 (95%CI 1.04-1.32)] not poor. CG2: Odisha neighboring states (West Bengal, Chhattisgarh, Jharkhand and Andhra Pradesh) [OR=0.85 (95%CI 0.77-0.94)] poor and [OR=1.15 (95%CI 0.86-1.53)] not poor.
Lucas A, 202231	Assess the long-term benefits of cash transfers through intergenerational transmission of health and poverty, by assessing the relationship between program aid received by the mother during childhood and newborn health, controlling for a set of socioeconomic and health variables.	US$ 17 e US$34, limit of values 2020.	Birthweight: that children born in a household where the mother received program were less likely to have low birth weight [OR= 0.93 (CI95% 0.92-0.94)], very low birth weight [OR=0.87 (CI95% 0.84-0.89)], as well as to be born after 37 weeks of gestation [OR= 0.98 CI95% 0.97-0.99)] or 28 weeks of gestation [OR=0.93 CI95% 0.88-0.97)].
Intervention Studies
Kandpal E et al., 201633	Eradicate extreme poverty in the Philippines, promote healthy practices, improve child nutrition and increase use of health services.	Maximum monthly cash transfer value: $27.80, targeting poor families with children aged between 0 to 14 years and/or pregnant women	Anthropometric outcomes: with each additional amount of income, increases in H/A [β= 0.284 (95%CI -0.034; 0.600) p=0.08] and W/A [β= 0.140 (95% CI -0.161; 0.438) p>0.05] were observed, yet without statistical significance. However, the program was associated with a significant reduction in severe short stature [β = -10,189 (95%CI -18,769; -1,607) p<0.05].
Lopez-Arana S et al., 201632	Provide subsidies for investments in education, nutrition and health in poor areas.	US$ 32-US$ 38 for each child.	Anthropometric outcomes: FA was associated with a reduction in thinness [OR=0.21 (95%CI 0.05-0.82)] and increased BMI [β= 0.12; (95%CI -0.05-0.29) p <0.05], but also impacted H/A [β=0.00 (95%CI -0.09; 0.10)], short stature [OR= 1.0 (95%CI 0.82-1.23)], overweight [OR=1.39 (95%CI 0.86-2.25)] and obesity [OR=0.31 (95%CI 0.09- 1.06)] among children aged 2 to 5 years.
Adubra L et al., 201927	Improve nutrition during the first 1000 days of life.	US$ 4.30 monthly	Anthropometric outcomes: no associations were observed among any of the treatment groups regarding W/A or delayed growth (SNACK + CASH: [β=0.03 (95%CI -0.15.0.2) p=0.75]. Similarly, compared to the SNACK group, changes in stunting prevalence over time were not statistically significant in the intervention groups (SNACK + MONEY: [OR=0.87 (95%CI 0.66-1.14) p=0.32]. Birthweight: no impact on birth weight [β= -180.1 (95%CI -559, 199)] or low birth weight [OR=1.58 (95%CI 0.29-8.50)].
Briaux J et al., 20209	Improve child nutrition and offer community activities (sensitization meetings and home visits targeting child health, nutrition and social protection, as well as integrated community case management of childhood illness and acute malnutrition targeting mother-child pairs during the “first 1,000 days”.	Approximately US$ 8.40/month.	Anthropometric outcomes: the program exerted a protective effect on H/A among children aged 6-29 months [DiD= 0.25 (95%CI 0.01-0.50) p= 0.039]. H/A remained stable prior to intervention in 2014 compared to after intervention in 2016 [β=0.03 (95%CI -0.14-0.21) p=0.728]. Birthweight: Women receiving benefits were less likely to have children with low birth weight (<2,500g) [DiD= -11.8; 95%CI 0.10-0.82) p=0.020].
Sudfeld C et al., 202128	Increase access to and utilization of prenatal and child health services, including monitoring child growth, treating health conditions, and other interventions not provided by community health workers.	US$ 4.34 per prenatal care visit, or US$2.17 per routine visit to monitor child growth and health.	Anthropometric outcomes: no significant effects of CHW + CCT intervention on HAZ [β=1.16 (95%CI 0.59-1.93)]. Significant effects were found on short stature [β=0.44 (95%CI 0.19-0.98)], W/A [β=0.16 (95%CI -0.11 - 0.43)]; W/H [β=-0.68 (95%CI -1.14, -0.21)]. CHW + CCT reduced the risk of overweight [β= 0.27 (95%CI 0.10-0.71)].
González L, Trommlerová S, 202230	Assessing the impact of a wage transfer directed toward me on the outcomes of my children's birth.	Families received a fixed payment of US$ 2.623,45 for each child born or adopted	Birthweight and gestacional age: the women who received the benefit had a much lower chance of having low-weight children in the future, while their proclivity to have another child (or the time of birth) remained unchanged. The effect is generally fueled by disfavored families (poor women, unmarried women, and women with low education. The transfer of earnings resulted in a drop of 0.9% and 0.7% in the category of children born with less than 2.000 and 1.500 g in low-income households over the next five years, representing a reduction of 49% and 83%, respectively. The effect on birth weight is pushed by premature babies, but there is no effect on the fracture of premature children.

Number	Author(s)/year	Selection Bias	Study design	Confounders	Blinding	Data collection methods	Withdrawals and drop-outs	Global study rating*
1	Kandpal E et al., 2016³³	1	1	1	3	3	1	3
2	Lopez-Arana S et al., 2016³²	1	1	3	3	1	1	3
3	Brownell M et al., 2016³⁵	1	2	3	1	1	1	3
4	Labrecque J et al., 2018²⁶	1	2	3	1	1	1	2
5	Adubra L et al., 2019²⁷	1	1	3	1	1	2	2
6	Hamada R, Rehkopf DH, 2015³⁴	1	2	3	3	1	3	3
7	Briaux J et al., 2020⁹	1	1	1	1	1	1	1
8	Sudfeld C et al., 2021²⁸	1	1	1	1	1	1	1
9	Chakrabarti S, Pan A, Singh P, 2021²⁹	1	2	2	1	1	1	1
10	González L, Trommlerová S. 2022³⁰	1	1	3	1	1	2	2
11	Lucas A, 2022³¹	3	2	3	1	1	1	3

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[1] Chief editors:

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