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

Area of Science:

• Public Health
• Health Economics
• Maternal Health

Background:

• Caesarean section rates are rising in Mexico and Latin America.
• This study examines the effect of a large-scale conditional cash transfer program in Mexico on caesarean section rates.
• The program provides financial aid to low-income, rural households conditioned on healthcare and nutrition supplement uptake.

Purpose of the Study:

• To evaluate the impact of the Oportunidades conditional cash transfer program on caesarean section rates in Mexico.
• To analyze how program participation and duration influence caesarean delivery rates.
• To assess differences in caesarean rates across various healthcare facility types.

Main Methods:

• Retrospective analysis of 979 women in poor rural communities in Mexico.
• Random assignment to the program in 1998 or 1999 across seven states.
• Multivariate and instrumental variable analyses to estimate program impact on caesarean sections, predicting adjusted mean rates by clinical setting.

Main Results:

• Over two-thirds of women delivered in health facilities.
• Program beneficiaries showed a 5.1 percentage point increase in caesarean rates, rising to 7.5 percentage points for those enrolled for ≥6 months.
• Beneficiaries had significantly higher caesarean delivery rates in social security (24.0% vs 5.6%) and other government facilities (19.3% vs 9.5%).

Conclusions:

• The Oportunidades program is associated with elevated caesarean section rates in public health facilities.
• Increased disposable income from cash transfers appears to be a driving factor.
• Findings offer insights for other countries implementing similar conditional cash transfer and healthcare programs.