Glassman Amanda, Duran Denizhan, Fleisher Lisa, Singer Daniel, Sturke Rachel, Angeles Gustavo, Charles Jodi, Emrey Bob, Gleason Joanne, Mwebsa Winnie, Saldana Kelly, Yarrow Kristina, Koblinsky Marge
J Health Popul Nutr. 2013 Dec;31(4 Suppl 2):48-66.
Maternal and newborn health (MNH) is a high priority for global health and is included among the Millennium Development Goals (MDGs). However, the slow decline in maternal and newborn mortality jeopardizes achievements of the targets of MDGs. According to UNICEF, 60 million women give birth outside of health facilities, and family planning needs are satisfied for only 50%. Further, skilled birth attendance and the use of antenatal care are most inequitably distributed in maternal and newborn health interventions in low- and middle-income countries. Conditional cash transfer (CCT) programmes have been shown to increase health service utilization among the poorest but little is written on the effects of such programmes on maternal and newborn health. We carried out a systematic review of studies on CCT that report maternal and newborn health outcomes, including studies from 8 countries. The CCT programmes have increased antenatal visits, skilled attendance at birth, delivery at a health facility, and tetanus toxoid vaccination for mothers and reduced the incidence of low birthweight. The programmes have not had a significant impact on fertility while the impact on maternal and newborn mortality has not been well-documented thus far. Given these positive effects, we make the case for further investment in CCT programmes for maternal and newborn health, noting gaps in knowledge and providing recommendations for better design and evaluation of such programmes. We recommend more rigorous impact evaluations that document impact pathways and take factors, such as cost-effectiveness, into account.
孕产妇和新生儿健康是全球卫生的高度优先事项，并被纳入千年发展目标（MDGs）之中。然而，孕产妇和新生儿死亡率下降缓慢危及千年发展目标各项指标的实现。据联合国儿童基金会称，6000万妇女在医疗机构之外分娩，且只有50%的计划生育需求得到满足。此外，在低收入和中等收入国家的孕产妇和新生儿健康干预措施中，熟练接生和产前护理的使用分布最不均衡。有条件现金转移支付（CCT）计划已被证明能提高最贫困人群对卫生服务的利用率，但关于此类计划对孕产妇和新生儿健康影响的文献却很少。我们对报告孕产妇和新生儿健康结果的CCT研究进行了系统综述，包括来自8个国家的研究。CCT计划增加了产前检查、熟练接生、在医疗机构分娩以及母亲的破伤风类毒素疫苗接种，并降低了低体重儿的发生率。这些计划对生育率没有显著影响，而对孕产妇和新生儿死亡率的影响迄今尚未得到充分记录。鉴于这些积极影响，我们主张进一步投资于针对孕产妇和新生儿健康的CCT计划，指出知识空白并为更好地设计和评估此类计划提供建议。我们建议进行更严格的影响评估，记录影响路径并考虑成本效益等因素。
