Brazil’s Bolsa Família conditional cash transfer and child malnutrition: a nationwide birth cohort study

Poverty amplifies the risk of malnutrition, which is particularly harmful to children as it can perpetuate a cycle of poverty and poor health. This study aims to assess the association of a conditional cash transfer programme (Bolsa Família Program (BFP)) with child nutrition nationwide in Brazil.

Methods: We used the Centre for Data and Knowledge Integration for Health Birth Cohort (baseline data from the National Registry for Social Programmes (CadÚnico) linked with live births and nutrition registries) to conduct a longitudinal population-based study between 2008 and 2015. This cohort study followed children from birth until 5 years old between 1 January 2008 and 31 December 2015. Children exposed were those who received the BFP benefit at any time during follow-up and were compared with those who never received it. Malnutrition outcomes were assessed using height-for-age, weight-for-height and body mass index-for-age z-scores classified according to WHO cut-offs. Binary and multinomial logistic regressions and kernel-based matching were performed. Subgroup analyses considered maternal education and urban/rural areas of residence.

Results: Our cohort included 3 116 138 children born in Brazil between 2008 and 2015. BFP participation was associated with a 17% lower chance of stunting (OR 0.83; 95% CI 0.81 to 0.85). Additionally, BFP was associated with a 19% higher chance of wasting (OR 1.19; 95% CI 1.16 to 1.22). The protective association with stunting was more pronounced in children from less-educated mothers (OR 0.75; 95% CI 0.70 to 0.81) and those living in rural areas (OR 0.77; 95% CI 0.73 to 0.81). BFP participation was associated with higher overweight/obesity among children from mothers with 8 or more years of education and living in urban areas, while those with 3 or fewer years of education and living in rural areas experienced protective effects.

Conclusion: Our findings suggest a complex relationship between BFP participation and child malnutrition outcomes. The study underscores BFP participation’s benefits in child nutritional outcomes, emphasising the programme’s potential to reduce stunting in all children and to reduce overweight/obesity in the most vulnerable ones. However, BFP was also associated with an increased risk of overweight/obesity, which may be a consequence of overlapping stages of Brazil’s rapid nutrition transition, a scenario that contributes to the double burden of malnutrition. Further research is needed to understand this finding better.