Improving Perinatal Outcomes Using Conditional and Targeted Transfers (IMPACTT)

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.

Study Overview

• Status: Completed
• Conditions: Birth Outcomes; Utilization, Health Care
• Intervention / Treatment: Behavioral: Risk information provision; Behavioral: Conditional cash transfer

• Study Type: Interventional
• Enrollment (Actual): 36607
• Phase: Not Applicable

Contacts and Locations

Study Locations

• Nigeria
  • Kano State
    • Kano, Kano State, Nigeria
      • Aminu Kano Teaching Hospital

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 15 years to 49 years (Child, Adult)
• Accepts Healthy Volunteers: Yes

Description

Inclusion Criteria:

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

Exclusion Criteria:

• none

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Health Services Research
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: None (Open Label)

Number of Arms

4

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
No Intervention: Control; Women in the control arm will complete the baseline and follow up surveys but will not receive any intervention.
Active Comparator: Risk information only; 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; 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.
Active Comparator: Conditional Cash Transfer only; 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; Pregnant women receive cash payments conditioned on their use of prenatal services and use of a health facility for child birth.
Active Comparator: Conditional Cash Transfer and risk information; 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: Risk information provision; 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.; Behavioral: Conditional cash transfer; Pregnant women receive cash payments conditioned on their use of prenatal services and use of a health facility for child birth.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
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 Outcome Measures

Outcome Measure	Measure Description	Time Frame
Maternal health	delivery complications	3-4 months after anticipated childbirth/delivery date
Maternal mortality	maternal death	3-4 months after anticipated childbirth/delivery date
Child weight	Child weight	3-4 months after anticipated childbirth/delivery date
Child length	Child length	3-4 months after anticipated childbirth/delivery date
Uptake of postnatal care	Probability of using postnatal care	3-4 months after anticipated childbirth/delivery date
Child vaccination	Probability of receiving recommended child immunizations	3-4 months after anticipated childbirth/delivery date
Maternal beliefs	Risk perceptions and beliefs assessed using a questionnaire	3-4 months after anticipated childbirth/delivery date
Pregnancy behavior - tetanus vaccination	Probability of receiving tetanus vaccination	3-4 months after anticipated childbirth/delivery date
Pregnancy behavior - malaria prophylaxis	Probability of receiving malaria prophylaxis	3-4 months after anticipated childbirth/delivery date
Pregnancy behavior - blood building products	Probability of receiving blood building products	3-4 months after anticipated childbirth/delivery date
Pregnancy behavior - dietary consumption	Probability of consuming nutrient-rich foods assessed using questionnaire	3-4 months after anticipated childbirth/delivery date
Quality of perinatal care	Quality score assessed using a questionnaire	3-4 months after anticipated childbirth/delivery date
Timely initiation of prenatal care	Probability of initiating prenatal care in the first trimester of pregnancy	3-4 months after anticipated childbirth/delivery date
Maternal work	Hours worked in the last seven days	3-4 months after enrollment

Other Outcome Measures

Outcome Measure	Measure Description	Time Frame
Maternal depression	Depression assessed using the Edinburgh Postnatal Depression Scale	3-4 months after anticipated childbirth/delivery date
Health facility choice	Probability of receiving care at a government or private hospital	3-4 months after anticipated childbirth/delivery date

Collaborators and Investigators

• Sponsor: RAND

Publications and helpful links

General Publications

• 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.
• 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.

Study record dates

Study Major Dates

• Study Start (Actual): July 8, 2019
• Primary Completion (Actual): June 30, 2021
• Study Completion (Actual): April 30, 2025

Study Registration Dates

• First Submitted: June 28, 2019
• First Submitted That Met QC Criteria: September 12, 2019
• First Posted (Actual): September 16, 2019

Study Record Updates

• Last Update Posted (Estimated): January 13, 2026
• Last Update Submitted That Met QC Criteria: January 12, 2026
• Last Verified: January 1, 2026

More Information

Terms related to this study

• Additional Relevant MeSH Terms: Behavior; Treatment Adherence and Compliance; Health Behavior; Patient Acceptance of Health Care
• Other Study ID Numbers: R01HD090231 (U.S. NIH Grant/Contract)

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No