Conditional cash transfers, uptake of maternal and child health services, and health outcomes in western rural China

Huan Zhou,Chang Sun,Yuju Wu,Alexis Medina,Linxiu Zhang,Yaojiang Shi,Chengfang Liu,Scott Rozelle

doi:10.1186/s12889-020-08996-9

Abstract

BackgroundEmpirical evidence suggests that the uptake of maternal and child health (MCH) services is still low in poor rural areas of China. There is concern that this low uptake may detrimentally affect child health outcomes. Previous studies have not yet identified the exact nature of the impact that a conditional cash transfer (CCT) has on the uptake of MCH services and, ultimately, on child health outcomes. The objective of this study is to examine the relationship between CCT, uptake of MCH services, and health outcomes among children in poor rural areas of western China.MethodsWe designated two different sets of villages and households that were used as comparisons against which outcomes of the treated households could be assessed. In 2014, we conducted a large-scale survey of 1522 households in 75 villages (including 25 treatment and 50 comparison) from nine nationally designated poverty counties in two provinces of China. In each village, 21 households were selected based on their eligibility status for the CCT program. Difference-in-difference analyses were used to assess the impact of CCT on outcomes in terms of both intention-to-treat (ITT) and average-treatment-effects-on-the-treated (ATT).ResultsOverall, the uptake of MCH services in the sample households were low, especially in terms of postpartum care visits, early breastfeeding, exclusive breastfeeding, and physical examination of the baby. The uptake of the seven types of MCH services in the CCT treatment villages were significantly higher than that in the comparison villages. The results from both the ITT and ATT analyses showed that the CCT program had a positive, although small, impact on the uptake of MCH services and the knowledge of mothers of MCH health issues. Nonetheless, the CCT program had no noticeable effect on child health outcomes.ConclusionsThe CCT program generated modest improvements in the uptake of MCH services and mothers’ knowledge of MCH services in poor rural areas of Western China. These improvements, however, did not translate into substantial improvements in child health outcomes for two potential reasons: poor CCT implementation and the low quality of rural health facilities.

Highlights

Empirical evidence suggests that the uptake of maternal and child health (MCH) services is still low in poor rural areas of China
In this paper, we utilized rigorous impact evaluation approaches on a large sample of women who participated in a pilot conditional cash transfer (CCT) program that sought to incentivize new mothers in two poor regions in Western China to improve their utilization of MCH services, enhance their knowledge, and, improve health outcomes
As our study focuses primarily on MCH service uptake, we believe that the tracking of such outcomes does provide sufficient information to be able to evaluate the impact of this CCT program on the uptake of MCH services

Summary

Introduction

Empirical evidence suggests that the uptake of maternal and child health (MCH) services is still low in poor rural areas of China. There is concern that this low uptake may detrimentally affect child health outcomes. Previous studies have not yet identified the exact nature of the impact that a conditional cash transfer (CCT) has on the uptake of MCH services and, on child health outcomes. The objective of this study is to examine the relationship between CCT, uptake of MCH services, and health outcomes among children in poor rural areas of western China. The Chinese government has made great progress in improving MCH across large parts of the country in recent years by aggressively expanding the coverage of rural health insurance and promoting maternal delivery in hospitals [2–6]. There are concerns about the status of MCH in Western China’s poor rural areas. When compared with eastern and central regions of China, these western regions had the highest under-5 mortality rates and neonatal mortality rates in 2015— an estimated under-5 mortality rate of 18.5 deaths per 1000 live births and neonatal mortality rate of 9.5 per 1000 live births [9]

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