It seeks to understand the impacts of the Bolsa Família conditional cash transfer on birth outcomes (e.g., birth weight, gestational weeks, etc). It will disentangle the measured effects into one component that is associated to the cash transfer and another related to prenatal care assistance. The strategy will allow researchers to determine the window of opportunity where cash transfer interventions exhibit its highest impacts, recognizing heterogeneous benefits according to how early in the pregnancy it starts.
The study design focused on analyzing small subsets of extensive registry data to examine the causal impact of additional income transfers during pregnancy on birth outcomes, informed by experimental variations in program rules. The analysis used detailed information about family characteristics and compositions, as well as the transfers received by each mother through Bolsa Família during pregnancy.
A dataset was created by linking various databases containing sensitive information and individual identifiers, which were not accessible by other means. Access was granted to our team under confidentiality agreements, in collaboration with local health administrations (LHAs), the Ministry of Health (MS), and the Ministry of Citizenship (MC). The linkages were carried out through a five-step process. LHAs provided access to identified birth and mortality records, while the MS performed linkages in step 2 using nationwide birth data. The project team developed linkage algorithms based on experiments with LHA data.
The deterministic linkage algorithm successfully recovered 70-75% of births among women of reproductive age found in the Cadastro Único or Bolsa Família. The positive predictive value of this linkage procedure ranged from 96.8% to 98.7%, indicating that nearly all linked pairs are genuine mother-baby matches. The analysis reveals that approximately two-thirds of births in Brazil occur in families registered in Cadastro Único, highlighting significant vulnerabilities affecting newborns nationwide. The team created a longitudinal dataset tracking children born into low-income families in Brazil, including monthly information on all Bolsa Família transfers received by the family before and after birth, as well as family composition and characteristics during pregnancy.
The project revealed significant variation in extra financial transfers received by babies from both treatment and control families. The maximum income variation at 9 months ranged from R$15 to R$406 (in 2010 values), which corresponds to 5-29% of the transfers typically received by these families and 8-74% of their monthly income. Overall, the results indicate that additional funds do not have a measurable impact on birth outcomes, nor do they lead to significant changes in maternal health conditions or prenatal care. However, extra income transfers to women who are receiving adequate prenatal care do reduce the incidence of preterm birth. Furthermore, these financial benefits tend to be more effective for less vulnerable women.
Research on Bolsa Família indicates a positive link between the program’s geographic expansion and health outcomes, such as mortality rates under 5. However, the mechanisms and pathways that explain these findings remain poorly understood.
Understanding the social and environmental determinants of poverty has enormous potential to reduce inequalities from birth and throughout life.
Plans include expanding the dedicated server for storing and handling sensitive data and continuing and establishing new partnerships for data integration. Because linkage algorithms are scalable, plans are to expand them to include new variables. These data will be used in four new research projects related to this current one: (a) the long-term effects of intrauterine transfers of conditional cash transfers (CCT) on maternal and child nutrition and morbidity throughout life and after birth; (b) the impact of CCT on all family members and children beyond the newborn, as our methodology also applies to them; (c) the differential impacts of benefits from alternative safety nets, such as social security for the elderly and their families (Continuous Cash Benefit) and benefits for pregnant women (Pregnancy Benefit); (d) the importance of housing and sanitation for child health and infant mortality, based on geocoding addresses in the Social Security Registry.