According to the World Health Organization, babies born weighing less than 2,500 grams are classified as underweight and this is a risk factor for numerous complications in the future. Although child malnutrition is a worldwide problem, it most severely affects groups living in vulnerable regions, such as the Brazilian semi-arid region, where long periods of drought often occur. As part of efforts to promote neonatal health, a study recently conducted by Fundação Getulio Vargas showed how some public policies can be crucial for the health of pregnant women and newborns.

The study, titled “Climate adaptation policies and infant health: Evidence from a water policy in Brazil” and carried out at Fundação Getulio Vargas’ Sao Paulo School of Economics (FGV EESP), found that pregnant women in the semi-arid region who benefit from the federal government’s Cisterns Program have a greater chance of giving birth to healthier children. “Every week that pregnant women are involved in this program, an extra 2 grams of weight is added to babies who are about to be born,” says researcher Daniel da Mata, who coordinated the study. The authors of the study are Daniel da Mata of FGV, Lucas Emanuel of Bahia Federal University, Vitor Pereira of the National School of Public Administration and Breno Sampaio of Pernambuco Federal University.

At first glance, da Mata says that this increase in weight may not seem very significant, but taking into account the total length of a pregnancy, if a woman is involved with the Cisterns Program from the beginning of pregnancy, this means her baby will weigh an extra 80 grams.

“Through econometric analysis, comparing pregnant women who had contact with the Cisterns Program from the beginning with those who were only exposed to it for a few weeks, we identified that the greater the access to the program, the higher the weight of the newborn baby,” the researcher says.

Public policies to improve living conditions

Da Mata notes that due to its climatic vulnerability, Brazil’s semi-arid region has been the focus of various public policies seeking to generate development and improve residents’ quality of life. He says he was interested in studying the Cisterns Program, especially its “First Water” component, which involves installing cisterns in people’s homes in the semi-arid region, due to the impact that this public policy can have.

“Pregnant women who have a cistern at home no longer have to walk long distances to get water from wells and reservoirs. Several studies in the academic literature emphasize that extreme physical effort increases neonatal risks. That’s why this program, by freeing women from the need to fetch water every day from distant places and in high temperatures, ends up improving the health of newborn babies,” the researcher explains.

According to da Mata, it is interesting that pregnant women’s health benefits from this program, given that its main stated goal is to improve the lives of children and the elderly.

“Perhaps our research can serve as evidence to expand this program’s target group, as we are talking about a relatively inexpensive public policy. Producing and installing cisterns is not expensive but it significantly benefits children’s health,” he says.

The researcher also believes that research like this is useful for identifying whether a particular public policy is effective, how it works and why it works. “Given that many public policies like the Cisterns Program are targeted at vulnerable groups, it is possible to measure how effective public expenditure is at impacting the lives of these people. Therefore, the same techniques applied to one program can be applied to other existing or new public policies,” he says.

Health and social development

To arrive at their conclusions, the researchers collected 5,000 georeferenced data points on pregnant women who received cisterns between 2011 and 2017. “These administrative records about the program tell us exactly where these cisterns were built and to whom they were delivered,” says da Mata. He points out that, in total, around 400,000 cisterns were built during this period, but the researchers had to filter the data to focus on relevant information for this study.

“Cisterns are generally received by the head of the household, who in the Brazilian semi-arid region is usually a woman. Among the women who received the cisterns, we identified those who were in the first 40 weeks of pregnancy, in order to cross-check information on the receipt of these reservoirs with health data in the government’s Live Birth Information System (Sinasc),” he explains.

Da Mata points out that Sinasc contains very precise information on newborns. In addition, data on the Cisterns Program, provided by the Ministry for Social Development, makes it possible to find out if a pregnant woman received a cistern and at what stage of pregnancy she received it.

“From there we were able to analyze the impact of receiving this equipment during pregnancy and compare any differences if pregnant women received it at the beginning of their pregnancy or toward the end. When a pregnant woman receives a cistern at the beginning of her pregnancy, if the region where she lives suffers from periods of drought, she will still have guaranteed water for the coming months, and this can make a big difference to her health and that of her baby,” he adds.

Importance of schooling for maintaining water quality

According to the researcher, it is not enough to merely deliver cisterns, as the program will only be effective if it is carried out in its entirety, which involves improving broader infrastructure and maintaining the quality of the water stored in the cisterns. “As well as building the cisterns, we need to reinforce the need for continuous water treatment, constantly reminding these people of the importance of treating water properly. If a pregnant woman has a cistern but doesn’t know how to use it properly, she risks replacing contaminated water from a reservoir with contaminated water from a cistern, which would harm fetal development,” he says.

Accordingly, Da Mata points out that schooling is another fundamental factor for neonatal health. “When analyzing subgroups of pregnant women, we found that the higher the schooling level of these women, the more likely a family is to adhere to the water treatment training provided by the program. We’re talking about basic schooling, measured by around four years of formal education. However, this minimum access to education makes a big difference to the effectiveness of this public policy, according to the program’s own data,” the researcher says.

According to da Mata, these results also demonstrate the importance of the complementarity of different public policies. “The data we found also shows how water infrastructure programs can complement other public policies, such as income transfer programs or those aimed at improving access to education,” he says.

Consistency of data

Looking at the study’s results, some people may question whether the increase in newborn babies’ weight is really a consequence of the Cisterns Program. To make the results more conclusive, several econometric analyses were carried out.

“This was a concern that arose at the start of the project, so we carried out a series of analyses to check the consistency of the data. We analyzed multiple variables and simulated the possibility of pregnant woman being from another municipality or having a higher family income. Looking at numerous possibilities, all the signs indicated that the benefit came from involvement in the program,” the researcher says.

To illustrate how one of these simulated analyses worked, da Mata says that half of the pregnant women in the sample were first-time mothers, while the other half were on their second or third pregnancy.

“Taking into account the mothers who were on their second pregnancy and did not have cisterns in their home during their first pregnancy, we analyzed the birthweight of their eldest child, given that the mothers had not been exposed to the program during this pregnancy. As expected, this analysis showed no impact of cisterns on the neonatal health of the children who were not exposed to the Cisterns Program. In addition, several other econometric analyses confirmed that receiving a cistern was the only indicator correlated with improving the birthweight of children who were exposed to the program. This reaffirms the robustness of our data and reiterates the importance of this public policy in promoting neonatal health,” he concludes.

You can read the full study here.