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The European Journal of Public Health Advance Access published online on November 23, 2009
The European Journal of Public Health, doi:10.1093/eurpub/ckp184
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© The Author 2009. Published by Oxford University Press on behalf of the European Public Health Association. All rights reserved.

Mexico’s conditional cash transfer programme increases cesarean section rates among the rural poor

Sarah L. Barber

Institute of Business and Economic Research, University of California, Berkeley, CA, USA

Correspondence: Sarah L. Barber, World Health Organization, 401 Dongwai Diplomatic Office Building, 23 Dongzhimenwai Dajie Avenue, Chaoyang District, Beijing 100 600, China, tel: +86-10-6532-7189, fax: +86-10-6532-2359, e-mail: barbers{at}wpro.who.int

Received March 11, 2009 , revised June 13, 2009 , accepted October 14, 2009

Background: Caesarean section rates are increasing in Mexico and Latin America. This study evaluates the impact of a large-scale, conditional cash transfer programme in Mexico on caesarean section rates. The programme provides cash transfers to participating low income, rural households in Mexico conditional on accepting health care and nutrition supplements. Methods: The primary analyses uses retrospective reports from 979 women in poor rural communities participating in an effectiveness study and randomly assigned to incorporation into the programme in 1998 or 1999 across seven Mexican states. Using multivariate and instrumental variable analyses, we estimate the impact of the programme on caesarean sections and predict the adjusted mean rates by clinical setting. Programme participation is measured by beneficiary status, programme months and cash transfers. Results: More than two-thirds of poor rural women delivered in a health facility. Beneficiary status is associated with a 5.1 percentage point increase in caesarean rates; this impact increases to 7.5 percentage points for beneficiaries enrolled in the programme for ≥6 months before delivery. Beneficiaries had significantly higher caesarean delivery rates in social security facilities (24.0 compared with 5.6% among non-beneficiaries) and in other government facilities (19.3 compared with 9.5%). Conclusion: The Oportunidades conditional cash transfer programme is associated with higher caesarean section rates in social security and government health facilities. This effect appears to be driven by the increases in disposable income from the cash transfer. These findings are relevant to other countries implementing conditional cash transfer programmes and health care requirements.

Keywords: poverty, social welfare, public policy, health care delivery, caesarean section.


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