The Oportunidades conditional cash transfer program: effects on pregnancy and contraceptive use among young rural women in Mexico.

CONTEXT: Oportunidades is a large conditional cash transfer program in Mexico. It is important to examine whether the program has any direct effect on pregnancy experience and contraceptive use among young rural women, apart from those through education. METHODS: Data from the 1992, 2006 and 2009 waves of a nationally representative, population-based survey were used to describe trends in pregnancy experience, contraceptive use and education among rural adolescent (15-19) and young adult (20-24) women in Mexico. To examine differences in pregnancy experience and current modern contraceptive use among young women, multivariable logistic regression analyses were conducted between matched 2006 samples of women with and without exposure to Oportunidades, predicted probabilities were calculated and indirect effects were estimated. RESULTS: Over the three survey waves, the proportion of adolescent and young adult women reporting ever being pregnant stayed flat (33-36%) and contraceptive use increased steadily (from 13% in 1992 to 19% in 2009). Educational attainment rose dramatically: The proportion of women with a secondary education increased from 28% in 1992 to 46% in 2009. In multivariable analyses, exposure to Oportunidades was not associated with pregnancy experience among adolescents. Educational attainment, marital status, pregnancy experience and access to health insurance--but not exposure to Oportunidades--were positively associated with current modern contraceptive use among adolescent and young adult women. CONCLUSION: Through its effect on education, Oportunidades indirectly influences fertility among adolescents. It is important for Mexico to focus on strategies to increase contraceptive use among young rural nulliparous women, regardless of whether they are enrolled in Oportunidades.

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

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 >or=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.

Contraceptive use, birth spacing, and autonomy: an analysis of the Oportunidades program in rural Mexico.

Oportunidades, a conditional cash-transfer program instituted in Mexico in 1997, provides cash incentives to mothers to invest in the health and education of family members. Drawing from data gathered by Mexico's National Institute of Public Health, this study assesses the effect of the program on contraceptive use and birth spacing among titulares (female household heads) living in rural areas during the experimental period, 1998-2000, and during 2000-03, after incorporation of the control group. In 2000, titulares were more likely to use modern contraceptives than were women in the control group, although by 2003 all beneficiaries had the same probability of use. Change in autonomy was not a mediator, although baseline autonomy modified the program's influence on contraceptive use. Cox proportional hazard models produced estimates that birth spacing was similar between the beneficiaries and controls. Inconsistent findings may be the result of the way contraceptive use was defined in this study. Findings from this study may be useful for helping program planners better understand the role of conditional cash transfers in modifying family planning and fertility among poor rural women in Latin America.

The impact of Mexico's conditional cash transfer programme, Oportunidades, on birthweight.

OBJECTIVES: To evaluate the impact of Oportunidades, a large-scale, conditional cash transfer programme in Mexico, on birthweight. The programme provides cash transfers to low-income, rural households in Mexico, conditional on accepting nutritional supplements health education, and health care. METHODS: The primary analyses used retrospective reports from 840 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. Pregnant women in participating households received nutrition supplements and health care, and accepted cash transfers. Using multivariate and instrumental variable analyses, we estimated the impact of the programme on birthweight in grams and low birthweight (<2500 g), receipt of any pre-natal care, and number of pre-natal visits. RESULTS: Oportunidades beneficiary status was associated with 127.3 g higher birthweight among participating women and a 4.6 percentage point reduction in low birthweight. CONCLUSION: The Oportunidades conditional cash transfer programme improved birthweight outcomes. This finding is relevant to countries implementing conditional cash transfer programmes.

Structural adjustment programs and the trickle-down effect: a case study of the Fujimori period in Peru, using reproductive health as an indicator for levels of poverty.

The purpose of this analysis is to investigate whether the Organisation for Economic Co-operation and Development/United Nations/World Bank (OECD/UN/WB) poverty reduction objectives are compatible with the neo-liberal development model, using Peru as a case study. Three OECD/UN reproductive health indicators were selected to assess poverty: female literacy, infant mortality and maternal mortality. Fertility rates were also analyzed to explore the impact that neo-Malthusian policies have wielded. Shortly after his ascendance to power in 1990, President Fujimori undertook health finance reforms to promote cost-effectiveness and efficiency under political guidance from international financial institutions (IFIs). Internationally, Peru was portrayed as a neo-liberal success story. However, maternal mortality rates throw into contention claims that economic growth has a trickle-down effect. From the fertility rates, it can be deduced that the advent of structural adjustment has led to a resurgence of a neo-Malthusianism approach, putting family planning on the front burner, to the detriment of reproductive health.

Socioeconomic factors and low birth weight in Mexico.

BACKGROUND: Low birth weight (LBW) is a public health problem linked to lack of equity in populations. Despite efforts to decrease the proportion of newborns with LBW, success has been quite limited. In recent years, studies focused on explaining how social factors influence this problem have shown that populations with greater inequities have a greater proportion of newborns with LBW. METHODS: The objective was to describe socioeconomic factors related to LBW adjusted by demographic, reproductive and health services variables in Mexico City. A case-control study was carried out in three hospitals with gynaecological and obstetrics services in Mexico City during the first half of 1996. During the recruiting period all children with LBW (cases), defined as newborns weighing <2500 grams, were matched with children born on the same day to control for time of birth. Upon arrival at the hospital for delivery, women were interviewed to determine if they met our inclusion criteria. Women with a history of chronic conditions and those with twin or multiple pregnancies were excluded. Variables with clinical and statistical significance were included in a multivariate model (logistic regression). RESULTS: We found that low socioeconomic level was the most important risk factor for LBW and was independent of other factors, including those related to reproduction and nutrition, smoking, morbidity during pregnancy, accessibility to health services and prenatal care (OR 2.68; 95% CI 1.19, 6.03). CONCLUSION: We found that socioeconomic factors are relevant to LBW. However further research should be done in different population groups as well as developing precise ways of measuring socioeconomic factors and their role in reproductive health.

Desarrollo de la organización en el Hospital Materno-Infantil "Los Andes" Distrito I-El Alto, 1995 / Methodologies instruments and training for the analysis and utilization of the information on the SNIS according to decision-making and improvement of the provision of the health services district VI S. R. S. L. P. 1995

La propuesta de Intervención que presentamos está orientada a desarrollar la organización, ello está sustentado por el diagnóstico situacional realizado en octubre de 1994, en el que demostró que el área administrativa era el más afectado y dentro de él componente de organización; en junio del presente año, efectuamos un diagnóstico organizacional en el que constatamos que el ambiente, la estructura, el funcionamiento y el clima organizacional del Hospital Los Andes se encontraban afectados. por lo que es necesario desarrollar un proceso de revisión de la organización que permita mejorar la capacidad operativa del equipo de salud del Hospital. El propósito que guia a la propuesta, es el de contribuir a mejorar la callidad de la prestación de los servicios, mediante el desarrollo de la organización. El presente documento se encuentra dividido en dos partes: la primera que detalla la forma en que ha llegado a formular el problema, los objetivos que se persiguen, las estrategias plasmadas en una matriz y el detalle de las actividades que se desarrollarán para dar cumplimiento a los objetivos. La segunda parte (Anexos) cuenta con el detalle teórico sobre los temas presentado en forma de separatas para cada una de las actividades y los instrumentos que se utilizarán (encuestas, matrices de diagnóstico, formularios de recolección de actividades, instrumentos de evaluación, etc)...