Utilization, Health Care, Birth Outcomes
Conditions
Brief summary
It has been estimated that increasing the use of skilled care during childbirth could prevent up to 1.5 million maternal and newborn deaths and stillbirths by 2025. Conditional cash transfer programs, in which women receive cash payments conditioned on the use of maternal health services, are increasingly being used as a mechanism to increase uptake. In this study, the investigators randomly assign households to receive varying cash amounts conditioned on uptake of recommended pregnancy and delivery care. The investigators crosscut this with an intervention in which pregnant women receive information about their risk type. This randomized trial will provide new evidence about the potential efficacy of targeting cash transfers by pregnancy risk. This study will take place in 288 primary health service areas (HSAs) in Nigeria.
Interventions
BEHAVIORALConditional cash transfer
Pregnant women receive cash payments conditioned on their use of prenatal services and use of a health facility for child birth.
BEHAVIORALRisk information provision
Pregnant women who exhibit characteristics associated with a greater risk of a poor birth outcome - these will be identified from the medical and epidemiological literature - will be informed that they possess these characteristics.
Sponsors
RAND
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
HEALTH_SERVICES_RESEARCH
Masking
NONE
Eligibility
Sex/Gender
FEMALE
Age
15 Years to 49 Years
Healthy volunteers
Yes
Inclusion criteria
* Pregnant women ages 15-49 who reside in the participating health service areas
Exclusion criteria
* none
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Child mortality - early infant death | 3-4 months after anticipated childbirth/delivery date | Child mortality - early infant death |
| Child mortality - stillbirths | 3-4 months after anticipated childbirth/delivery date | Child mortality - stillbirths |
| Probability of prenatal care | 3-4 months after anticipated childbirth/delivery date | the probability of receiving prenatal care |
| Uptake of prenatal care | 3-4 months after anticipated childbirth/delivery date | the number of prenatal visits completed |
| Uptake of health facility birth | 3-4 months after anticipated childbirth/delivery date | probability of giving birth at a health facility |
| Child mortality - fetal loss | 3-4 months after anticipated childbirth/delivery date | Child mortality - fetal loss |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Child vaccination | 3-4 months after anticipated childbirth/delivery date | Probability of receiving recommended child immunizations |
| Maternal beliefs | 3-4 months after anticipated childbirth/delivery date | Risk perceptions and beliefs assessed using a questionnaire |
| Pregnancy behavior - tetanus vaccination | 3-4 months after anticipated childbirth/delivery date | Probability of receiving tetanus vaccination |
| Pregnancy behavior - malaria prophylaxis | 3-4 months after anticipated childbirth/delivery date | Probability of receiving malaria prophylaxis |
| Pregnancy behavior - dietary consumption | 3-4 months after anticipated childbirth/delivery date | Probability of consuming nutrient-rich foods assessed using questionnaire |
| Quality of perinatal care | 3-4 months after anticipated childbirth/delivery date | Quality score assessed using a questionnaire |
| Timely initiation of prenatal care | 3-4 months after anticipated childbirth/delivery date | Probability of initiating prenatal care in the first trimester of pregnancy |
| Maternal work | 3-4 months after enrollment | Hours worked in the last seven days |
| Pregnancy behavior - blood building products | 3-4 months after anticipated childbirth/delivery date | Probability of receiving blood building products |
| Maternal health | 3-4 months after anticipated childbirth/delivery date | delivery complications |
| Maternal mortality | 3-4 months after anticipated childbirth/delivery date | maternal death |
| Child weight | 3-4 months after anticipated childbirth/delivery date | Child weight |
| Child length | 3-4 months after anticipated childbirth/delivery date | Child length |
| Uptake of postnatal care | 3-4 months after anticipated childbirth/delivery date | Probability of using postnatal care |
Other
| Measure | Time frame | Description |
|---|---|---|
| Maternal depression | 3-4 months after anticipated childbirth/delivery date | Depression assessed using the Edinburgh Postnatal Depression Scale |
| Health facility choice | 3-4 months after anticipated childbirth/delivery date | Probability of receiving care at a government or private hospital |
Countries
Nigeria
Outcome results
None listed