Are Cash Transfer Programs Effective in Improving Maternal and Child Health in Sub-Saharan Africa? A Systematic Review of Randomized Controlled Trials

Abstract

Objective: Conduct a systematic review to assess the impact of poverty elimination on maternal and child health through cash transfer programs in sub-Saharan Africa.
Methods: We searched Medline, Embase, Cochrane library, CINAHL, PsychInfo, Pubmed, Scopus and African Journals for randomized controlled trials (RCTs) assessing cash transfer interventions for improving maternal and/or child health in Sub-Saharan Africa We also searched organizational websites, reference lists of included studies, relevant reviews and Google Scholar for grey literature using search terms such as “conditional/ unconditional cash transfer program”, “maternal health”, “child health”, “Sub-Saharan Africa” as MeSH headings or synonym search combining with AND or OR Boolean operators as appropriate. Searches were not limited to a particular language or time period. Two reviewers independently screened all potentially relevant records against inclusion criteria, extracted data and assessed methodological quality of included studies using critical appraisal skills programme scoring.
Findings: Seven studies were found to meet the inclusion criteria agreed a priori and were included in the review. Findings from one study showed increased probability of delaying pregnancy in adolescents and reduced risky sexual behaviour, with another study reporting increased utilization of antenatal care and increased skilled attendance at delivery. In terms of child health benefits, there was reduced probability of chronic illnesses in children from households who benefited from cash transfers, however, there was no  effect seen on the proportion of children vaccinated when compared to the controls. Other positive effects seen include increased acceptance of Prevention of Mother to Child Transmission (PMTCT) services, and increased birth registrations and school attendance for school age children.
Conclusion: This review suggests that cash transfers have a positive impact on maternal and child health in sub-Saharan Africa, however, the evidence is limited and this topic will benefit from more in-depth trials conducted in the region.