Chakrabarti Suman, Pan Anwesha, Singh Parvati
Department of Health Metrics Sciences, Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA.
Department of Anthropology, University of Washington, Seattle, WA, USA.
J Nutr. 2021 Aug 7;151(8):2271-2281. doi: 10.1093/jn/nxab129.
Conditional cash transfers (CCTs) are demand-side interventions that link cash receipt to fulfilment of health-promoting conditions such as regular health check-ups and investment in human capital. In 2011, the Indian state of Odisha, implemented a statewide CCT program-the Mamata Scheme-towards improving maternal/child health outcomes and promoting health-seeking behavior. Mamata targets pregnant and lactating women aged ≥19 y, and provides a sizable financial incentive relative to household income levels.
We aimed to longitudinally examine whether, and to what extent, initiation of the Mamata scheme corresponded with changes in health and nutrition outcomes in Odisha, relative to comparison states in India.
Outcomes included maternal health service utilization [antenatal care (ANC), iron-folic acid supplementation, breastfeeding counseling, full child immunization, tetanus vaccination, vitamin A supplementation] and nutrition [anemia during pregnancy and stunting, anemia in children <5 y old (U5)]. Data on outcomes and covariates were obtained from 3 waves of India's National Family Health Surveys corresponding to the years 1999, 2006, and 2016. We used difference-in-differences (DID) estimation strategy to estimate the impact of the program.
The pooled sampled size comprised >200,000 mother-child dyads. Tests of parallel trends indicated that preintervention trends were similar across all outcomes in Odisha with the exception of anemia. When comparing Odisha with other states for health services, DID models indicated that exposure to Mamata corresponded with increased odds of counseling for breastfeeding (OR: 2.74; 95% CI: 1.97, 3.80), ANC receipt (OR: 1.51; 95% CI: 1.15, 1.99), and full immunization (OR: 1.69; 95% CI: 1.37, 2.08). DID models also indicated decline in stunting (OR: 0.92; 95% CI: 0.84, 1.02) and anemia (OR: 0.62; 95% CI: 0.54, 0.71) among U5 children in Odisha following Mamata, relative to comparison states. Models comparing poor with nonpoor groups indicated the presence of heterogeneous effects.
This study provides proof-of-concept for potential improvements in maternal and child nutrition outcomes following CCTs that incentivize health care utilization in India.
有条件现金转移支付（CCTs）是一种需求侧干预措施，将现金领取与诸如定期健康检查和人力资本投资等促进健康条件的实现相挂钩。2011年，印度奥里萨邦实施了一项全州范围的CCT计划——玛玛塔计划，旨在改善母婴健康结果并促进就医行为。玛玛塔计划的目标人群是年龄≥19岁的孕妇和哺乳期妇女，并根据家庭收入水平提供可观的经济激励。
我们旨在纵向研究玛玛塔计划的启动是否以及在多大程度上与奥里萨邦相对于印度其他对照邦的健康和营养结果变化相对应。
结果指标包括孕产妇保健服务利用情况[产前保健（ANC）、铁叶酸补充、母乳喂养咨询、儿童全程免疫接种、破伤风疫苗接种、维生素A补充]和营养状况[孕期贫血和发育迟缓、5岁以下儿童（U5）贫血]。结果指标和协变量的数据来自印度全国家庭健康调查的三轮调查，对应年份分别为1999年、2006年和2016年。我们使用双重差分（DID）估计策略来评估该计划的影响。
汇总样本量包括超过20万个母婴对子。平行趋势检验表明，除贫血外，奥里萨邦所有结果指标的干预前趋势相似。在比较奥里萨邦与其他邦的医疗服务时，DID模型表明，参与玛玛塔计划与接受母乳喂养咨询的几率增加相关（比值比：2.74；95%置信区间：1.97，3.80）、接受产前保健的几率增加相关（比值比：1.51；95%置信区间：1.15，1.99）以及全程免疫接种的几率增加相关（比值比：1.69；95%置信区间：1.37，2.08）。DID模型还表明相对于对照邦，奥里萨邦5岁以下儿童的发育迟缓（比值比：0.92；95%置信区间：0.84，1.02）和贫血（比值比：0.62；95%置信区间：0.54，0.71）有所下降。比较贫困与非贫困组的模型表明存在异质性效应。
本研究为印度通过激励医疗服务利用的有条件现金转移支付来改善母婴营养结果的潜在效果提供了概念验证。
