Improving Perinatal Outcomes Using Conditional and Targeted Transfers

Study Overview
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Brief Summary
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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.

Official Title
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Improving Perinatal Outcomes Using Conditional and Targeted Transfers

Conditions
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Utilization, Health Care, Birth Outcomes

Intervention / Treatment
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* Behavioral: Conditional cash transfer
* Behavioral: Risk information provision


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Pregnant women ages 15-49 who reside in the participating health service areas Exclusion Criteria: none

Ages Eligible for Study
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Minimum Age: 15 Years
Maximum Age: 49 Years

Sexes Eligible for Study
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Female

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Health Services Research
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| No Intervention: Control<br>Women in the control arm will complete the baseline and follow up surveys but will not receive any intervention. | |
| Active Comparator: Risk information only<br>Women in the risk only arm who exhibit characteristics associated with a greater risk of a poor birth outcome will be informed that they possess these characteristics. Risk characteristics (identified from the medical and epidemiological literature) include age, prior pregnancy and birth history (e.g., previous stillbirth). | Behavioral: Risk information provision<br>* 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.<br>|
| Active Comparator: Conditional Cash Transfer only<br>Women in this arm will be eligible to receive conditional cash transfers. To receive the transfer, pregnant women must attend prenatal care and give birth in a health facility. | Behavioral: Conditional cash transfer<br>* Pregnant women receive cash payments conditioned on their use of prenatal services and use of a health facility for child birth.<br>|
| Active Comparator: Conditional Cash Transfer and risk information<br>Women in this arm will be provided with risk information at the time of baseline survey administration AND be eligible to receive conditional cash transfers, pending attendance at prenatal care and delivery at a health facility. | Behavioral: Conditional cash transfer<br>* Pregnant women receive cash payments conditioned on their use of prenatal services and use of a health facility for child birth.<br>Behavioral: Risk information provision<br>* 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.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Probability of prenatal care | the probability of receiving prenatal care | 3-4 months after anticipated childbirth/delivery date | 
| Uptake of prenatal care | the number of prenatal visits completed | 3-4 months after anticipated childbirth/delivery date | 
| Uptake of health facility birth | probability of giving birth at a health facility | 3-4 months after anticipated childbirth/delivery date | 
| Child mortality - fetal loss | Child mortality - fetal loss | 3-4 months after anticipated childbirth/delivery date | 
| Child mortality - stillbirths | Child mortality - stillbirths | 3-4 months after anticipated childbirth/delivery date | 
| Child mortality - early infant death | Child mortality - early infant death | 3-4 months after anticipated childbirth/delivery date | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Maternal health | delivery complications | 3-4 months after anticipated childbirth/delivery date | 
| Maternal mortality | maternal death | 3-4 months after anticipated childbirth/delivery date | 
| Child weight | Child weight | 3-4 months after anticipated childbirth/delivery date | 
| Child length | Child length | 3-4 months after anticipated childbirth/delivery date | 
| Uptake of postnatal care | Probability of using postnatal care | 3-4 months after anticipated childbirth/delivery date | 
| Child vaccination | Probability of receiving recommended child immunizations | 3-4 months after anticipated childbirth/delivery date | 
| Maternal beliefs | Risk perceptions and beliefs assessed using a questionnaire | 3-4 months after anticipated childbirth/delivery date | 
| Pregnancy behavior - tetanus vaccination | Probability of receiving tetanus vaccination | 3-4 months after anticipated childbirth/delivery date | 
| Pregnancy behavior - malaria prophylaxis | Probability of receiving malaria prophylaxis | 3-4 months after anticipated childbirth/delivery date | 
| Pregnancy behavior - blood building products | Probability of receiving blood building products | 3-4 months after anticipated childbirth/delivery date | 
| Pregnancy behavior - dietary consumption | Probability of consuming nutrient-rich foods assessed using questionnaire | 3-4 months after anticipated childbirth/delivery date | 
| Quality of perinatal care | Quality score assessed using a questionnaire | 3-4 months after anticipated childbirth/delivery date | 
| Timely initiation of prenatal care | Probability of initiating prenatal care in the first trimester of pregnancy | 3-4 months after anticipated childbirth/delivery date | 
| Maternal work | Hours worked in the last seven days | 3-4 months after enrollment |