Improving Perinatal Outcomes Using Conditional and Targeted Transfers

NCT04090762 | Completed

• 1 other identifier: R01HD090231
• Study Type: interventional
• Target: 36,607
• Locations: 1 country
• Sites: 1

Brief Summary

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.

Conditions

Utilization, Health Care; Birth Outcomes

Outcome Measures

Primary Outcomes (6)

• 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 Outcomes (14)

• Maternal health

  3-4 months after anticipated childbirth/delivery date

• Maternal mortality

  3-4 months after anticipated childbirth/delivery date

• Child weight

  3-4 months after anticipated childbirth/delivery date

• Child length

  3-4 months after anticipated childbirth/delivery date

• Uptake of postnatal care

  3-4 months after anticipated childbirth/delivery date

Other Outcomes (2)

• Maternal depression

  3-4 months after anticipated childbirth/delivery date

• Health facility choice

  3-4 months after anticipated childbirth/delivery date

Study Arms (4)

Control

NO INTERVENTION

Women in the control arm will complete the baseline and follow up surveys but will not receive any intervention.

Risk information only

ACTIVE COMPARATOR

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

Conditional Cash Transfer only

ACTIVE COMPARATOR

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

Conditional Cash Transfer and risk information

ACTIVE COMPARATOR

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; Behavioral: Risk information provision

Interventions

Risk information provision BEHAVIORAL

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.

Conditional Cash Transfer and risk information; Risk information only

Conditional cash transfer BEHAVIORAL

Pregnant women receive cash payments conditioned on their use of prenatal services and use of a health facility for child birth.

Conditional Cash Transfer and risk information; Conditional Cash Transfer only

Eligibility Criteria

• Age: 15 Years - 49 Years
• Sex: female
• Healthy Volunteers: Yes
• Age Groups: Child (0-17), Adult (18-64)

You may qualify if:

• Pregnant women ages 15-49 who reside in the participating health service areas

You may not qualify if:

• none

Sponsors & Collaborators

• RAND: lead

Study Sites (1)

Aminu Kano Teaching Hospital

Kano, Kano State, Nigeria

Location

Related Publications (2)

• Okeke EN, Abubakar IS, De Guttry R. In Nigeria, Stillbirths And Newborn Deaths Increased During The COVID-19 Pandemic. Health Aff (Millwood). 2021 Nov;40(11):1797-1805. doi: 10.1377/hlthaff.2021.00659. Epub 2021 Oct 20.

  PMID: 34669501 BACKGROUND

• Okeke EN. Playing defense? Health care in the era of Covid. J Health Econ. 2022 Sep;85:102665. doi: 10.1016/j.jhealeco.2022.102665. Epub 2022 Jul 25.

  PMID: 35952443 BACKGROUND

MeSH Terms

Conditions

Patient Acceptance of Health Care

Condition Hierarchy (Ancestors)

Treatment Adherence and Compliance; Health Behavior; Behavior

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: RANDOMIZED
• Masking: NONE
• Purpose: HEALTH SERVICES RESEARCH
• Intervention Model: PARALLEL
• Sponsor Type: OTHER
• Responsible Party: PRINCIPAL INVESTIGATOR
• PI Title: Senior Economist

Study Record Dates

• First Submitted: June 28, 2019
• First Posted: September 16, 2019
• Study Start: July 8, 2019
• Primary Completion: June 30, 2021
• Study Completion: April 30, 2025
• Last Updated: January 13, 2026

Record last verified: 2026-01

Data Sharing

• IPD Sharing: Will not share

Locations

NG (1)