Abstract
BackgroundExpanding social protection programme is a major target of the Sustainable Development Goals. Previous studies provided evidence for the relationship of social protection programme to greater use of health services and some improved health outcomes for children. Yet, its impact on child mortality has not been clearly revealed. In this study, we examined the association between social protection programmes and child mortality.MethodsWe obtained child mortality data from 379 nationally representative surveys involving 101 low- and middle-income countries (LMICs). We included five child mortality outcomes in the study, which were neonatal mortality rate (NMR), post-neonatal mortality rate (PMR), childhood mortality rate (CMR), infant mortality rate (IMR), and under-5 mortality rate (U5MR). We extracted data on social protection programmes from multiple data sources (eg, Atlas of Social Protection Indicators of Resilience and Equity). Social protection and labour programme (SPL) was the major type of social protection we included. We also included four subtypes of SPL - social assistance, cash transfer, social insurance, and labour market protection. Both unadjusted and adjusted regressions were conducted to measure the associations between characteristics of social protection programmes and child mortality, as well as inequalities in child mortality.ResultsAmong the 101 countries, the median coverage rate of SPL was 28.5%, with an interquartile range between 6.5% and 55.2%. Using the adjusted model, we found a one-percentage-point increase in SPL coverage is associated with a reduction of 0.09 (95% confidence interval (CI) = 0.04, 0.14) per 1000 live births in NMR, 0.11 (95% CI = 0.04, 0.18) in PMR, and 0.25 (95% CI = 0.11, 0.38) in CMR. Social assistance programme was the only subtype of SPL to be significantly associated with lower mortality rates. A higher SPL coverage was associated with better equity in child mortality – as the coverage of SPL increased by one percentage point, the concentration index of CMR would increase by 0.08 (95% CI = 0.03, 0.13) in the adjusted model, suggesting an improvement in equity.ConclusionsThe strong association between social protection programme and child mortality suggests that to achieve the SDG targets of universal social protection and to reduce child mortality, LMICs shall consider prioritizing the expansion of social protection programmes.
Highlights
Expanding social protection programme is a major target of the Sustainable Development Goals
Among the 101 countries involved in the study, the median of the NMR was 24.1 per 1000 live births (interquartile range (IQR) = 14.9, 29.7); the median of PMR was 16.7 per 1000 live births (IQR = 8.2, 23.4); the median of CMR was 13.4 per 1000 live births (IQR = 4.5, 26.3)
Our result on the strong association between the coverage of social protection programmes and child mortality provided evidence to the SDG target of moving towards universal social protection. It shed light on a long-existing dilemma that social programme designers faced, in LMICs - given the scarcity of resources, whether the policymakers should expand the coverage of social protection programmes or provide higher benefit levels to the most disadvantaged population [50,51]
Summary
Our aim was to investigate the association between social protection programmes and the level and equity status of child mortality
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