Abstract
Despite progress over the past decades, stunting remains a major public health problem in Mexico, highly concentrated among those living in poverty. The prevalence of stunting is highest in the country among beneficiaries of Mexico’s principal social welfare program, Oportunidades. Oportunidades is a conditional cash transfer program, providing economic incentives for families to invest in themselves and provides specific benefits for education, health, and nutrition. Oportunidades has had an important impact on the growth of children in rural and urban Mexico. Beneficiary children who received the program over the course of the critical period (birth to 2 years of age) grow approximately 1 cm more than non-beneficiary children living in comparable circumstances. Over the 10 years that Oportunidades has existed in rural areas, the prevalence of stunting dropped from 44.3 to 21.8%. The impact is likely in part a direct result of consumption of the fortified food provided for children but use of the food by the population is not ideal. The impact on growth may also be related to the better economic conditions of the families and the influence that this might have on health, hygiene, and caregiving. Despite this positive impact, the challenge remaining to improve child growth in the Oportunidades beneficiary population is great. The prevalence of stunting is still high, over 35% in 2007 among some of the most vulnerable subgroups of the population. Investments to improve the quality of the nutrition and health education component of the program are urgently needed and should focus on the specific causes of growth faltering including breast and complementary feeding practices. The Oportunidades evaluation, as well as providing evidence of its accomplishments, has been extremely valuable to identify and provide evidence on how the program should be strengthened. This experience provides a valuable model of how program evaluation can be used for strengthening program design and implementation.
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Notes
- 1.
Progresa was re-named Oportunidades when the federal government under President Ernesto Zedillo finished term and President Vincente Fox came to power. For convenience, we will refer to the program throughout the document only by its current name, Oportunidades.
- 2.
For a complete listing of publically available evaluation reports, one can refer to the Oportunidades evaluation web site (http://evaluacion.oportunidades.gob.mx:8010/index2.php?a=640). The majority of the reports are available in Spanish and English.
Abbreviations
- UNICEF:
-
United Nation Children’s Fund
References
Attanasio O, Di Mario V. Efectos de mediano plazo del Programa Oportunidades sobre el consumo de los hogares en zonas rurales [Effects at midterm of the Oportunidades Program on consumption in households in rural areas]. In: Hernandez-Prado B, Hernandez-Avila M, editors. Evaluacion Externa de impacto del Programa Oportunidades 2004. Tomo IV, Aspectos económicos y sociales [External evaluation of the Oportunidades program 2004. Volume IV, Economic and social aspects]. Mexico, DF: Secretary of Social Development; 2005. http://evaluacion.oportunidades.gob.mx:8010/index2.php?a=640.
Bautista Arredondo S, Bertozzi SM, Leroy JL, Lopez Ridaura R, Sosa Rubi SG, Tellez Rojo MM, Walker D. Diez anos de Oportunidades en zonas rurales: efectos sbre la utilización de servicios y e estado de salud de sus beneficiarios [Ten years of Oportunidades in rural areas: effects in service utilization and health status of beneficiaries]. In: Hernandez-Prado B, Hernandez-Avila M, editors. Evaluación externa del Programa Oportunidades 2008: a diez anos de intervención en zonas rurales (1997–2007). Tomo II, El reto de la calidad de los servicios: resultados en salud y nutrición [External evaluation of the Oportunidades program 2008: 10 years of intervention in rural areas (1997–2007). Volume II, The challenge of service quality: results in health and nutrition]. Mexico, DF: Secretaria de Desarrollo Social; 2008. http://evaluacion.oportunidades.gob.mx:8010/index2.php?a=640.
Behrman JR, Hoddinott J. Program evaluation with unobserved heterogeneity and selective implementation: the Mexican Progresa impact on child nutrition. University of Pennsylvania, PIER Working Paper 02-006. 2001. http://ssrn.com/abstract_id=306121.
Bonvecchio A, Pelto GH, Escalante E, Monterrubio E, Habicht JP, Nava F, Villanueva MA, Safdie M, Rivera JA. Maternal knowledge and use of a Micronutrient Supplement was improved with a programmatically feasible intervention in Mexico. J Nutr. 2007;137:440–6.
Bryce J, Cotinho D, Darnton-Hill I, Pelletier D, Pinstrup-Andersen P. Maternal and child undernutrition: effective action at national level. Maternal and Child Undernutrition Study Group. Lancet. 2008;371:510–26.
Dantes Gomez BM, Morales Miranda S, Idrovo Velandia AJ, Ochoa Marin SC, Bult van de Wal S, Caballero Garcia M, Hernandez Avila M. Impacto de Oportunidades sobre los conocimientos y prácticas de madres beneficiarias y jóvenes becarios. Una evaluación de las sesiones educativas para la salud. [Impact of Oportunidades on knowledge and practices of beneficiary mothers and youth. An evaluation of the health education session]. In: Hernandez-Prado B, Hernandez-Avila M, editors. Evaluación Externa de impacto del Programa Oportunidades 2004, Tomo II, Salud [External evaluation of the Oportunidades Program, volume II, Health]. Mexico, DF: Secretary of Social Development; 2005. http://evaluacion.oportunidades.gob.mx:8010/index2.php?a=640.
Dehejia RH, Wahba S. Propensity score-matching methods for nonexperimental causal studies. Rev Econ Stat. 2002;84:151–61.
Engle PL. Maternal mental health: program and policy implementations. Am J Clin Nutr. 2009;89:963S–6S.
Escalante-Izeta E, Bonvecchio A, Theodore F, Nava F, Villanueva MA, Rivera-Dommarco JA. Facilitators and barriers for the consumption of a micronutrient supplement. Sal Publica Mex. 2008;50:316–24 (in Spanish).
Fernald LC, Gertler PJ, Neufeld LM. 10-year effect of Oportunidades, Mexico’s conditional cash transfer programme on child growth, cognition, language, and behaviour: a longitudinal follow-up study. Lancet. 2009;374:1997–2005.
Fernald LC, Gunnar MR. Poverty-alleviation program participation and salivary cortisol in very low-income children. Soc Sci Med. 2009;68:2180–9.
Flores L, Théodore F, Bonvecchio A, Blanco I, Neufeld LM. Acceptability of three supplements with identical micronutrient content in Mexican children. FASEB J. 2008;22:677.2.
Gertler PJ. Final report: the impact of Progresa on health. Report submitted to Progresa. Washington, DC: International Food Policy Research Institute; 2000.
Gutierrez JP, Leroy J, Lopez Ridaura R, DeMaria L, Walker D, Campuzano JC, Moreno K, Sevan E, Sosa Rubi SG, Bertozzi SM. Evaluación de la calidad de los servicios de atención a la salud asignados a la población beneficiaria de Oportunidades [Evaluation of the quality of health services assigned to the beneficiary population of Oportunidades]. In: Hernandez-Prado B, Hernandez-Avila M, editors. Evaluación externa del Programa Oportunidades 2008: a diez anos de intervención en zonas rurales (1997–2007). Tomo II, El reto de la calidad de los servicios: resultados en salud y nutrición [External evaluation of the Oportunidades program 2008: 10 years of intervention in rural areas (1997–2007). Volume II, The challenge of service quality: results in health and nutrition]. Mexico, DF: Secretaria de Desarrollo Social; 2008. http://evaluacion.oportunidades.gob.mx:8010/index2.php?a=640.
Habicht JP, Victora CG, Vaughan JP. Evaluation designs for adequacy, plausibility and probability of public health programme performance and impact. Int J Epidemiol. 1999;28:10–8.
Leroy JL Garcia-Guerra A, Garcia R, Dominguez C, Rivera J, Neufeld LM. The Oportunidades program improves child growth in urban Mexico. J Nutr. 2008;138:793–8.
Levy S. Progress against poverty: sustaining Mexico’s Progresa-Oportunidades program. Washington, DC: Brookings Institution Press; 2006.
Martorell R, Melgar P, Maluccio JA, Stein Ad, Rivera JA. The nutrition intervention improved adult human capital and economic productivity. J Nutr. 2010;140:411–4.
Neufeld LM, Dominguez CP, Garcia A, Habicht JP. Significant dose-response of supplementation with micronutrient syrup, a fortified food or sprinkles on child length at 24 mo of age in Mexican children. Micronutrient Forum, Beijing, China; 2009.
Neufeld LM, Domínguez CP, García Guerra A, García Feregrino R, Hernandez A. Effect of three supplements with identical micronutrient content on length and weight of Mexican children. FASEB J. 2008a;22:44.1.
Neufeld LM, García-Guerra A, Leroy J, Flores ML, Fernández AC, Rivera-Dommarco JA. Evaluación externa de impacto del Programa Oportunidades 2006. Tomo II Alimentación [External evaluation of the Oportunidades Program 2006. Volume II Nutrition]. Hernández Ávila M, Hernández Prado B, editors. Mexico, DF: Secretary of Social Development; 2006. http://evaluacion.oportunidades.gob.mx:8010/index2.php?a=640.
Neufeld LM, Mejia F, Fernandez Gaxiola AC, Garcia Guerra A, Mendez I, Dominguez CP. Diagnostico situacional del estado nutricio de ninos menores de dos anos de edad y d sus madres, beneficarios de Oportunidades en zonas rurales [Diagnosis of the nutritional status of children less than two years of age and their mothers, beneficiaries of Oportunidades en rural areas]. In: Hernandez-Prado B, Hernandez-Avila M, editors. Evaluacion externa del Programa Oportunidades 2008. A diez anos de intervencion en zonas rurales (1997–2007). Tomo II, El reto de la calidad de los servicios: resultados en salud y nutricion [External evaluation of the Oportunidades Program 2008. After ten years of intervention in rural areas (1997–2007). Volume II, The challenge of service quality: results in health and nutrition]. Mexico, DF: Secretary of Social Development; 2008b. http://evaluacion.oportunidades.gob.mx:8010/index2.php?a=640.
Neufeld LM, Sotres Alvarez D, Flores López M, Tolentino Mayo L, Jiménez Ruiz J, Rivera Dommarco J. Estudio sobre el consumo de los suplementos alimenticios Nutrisano y Nutrivida en niños y mujeres de zonas urbanas beneficiarios de Oportunidades [Study of the consumption of the food supplements Nutrisano and Nutrivida in children and women beneficiaries of Oportunidades en urban areas]. In: Hernandez-Prado B, Hernandez-Avila M, editors. Evaluación externa de impacto del Programa Oportunidades 2004. Tomo III. Alimentación [External evaluation of the Oportunidades Program 2004. Volume III. Food consumption]. Mexico, DF: Secretary of Social Development; 2005. http://evaluacion.oportunidades.gob.mx:8010/index2.php?a=640.
Peterson S. Assessing the scale-up of child survival interventions. Lancet. 2010;375:530–1.
Rivera JA, Hotz C, González-Cossío T, Neufeld LM, García A. The effect of micronutrient deficiencies on child growth: a review of results from community-based supplementation trials. J Nutr. 2003;133:4010S–20S.
Rivera JA, Irizarry LM, Gonzalez de Cossio T. Overview of the nutritional status of the Mexican population in the last two decades. Sal Pub Mex. 2009;51:S645–56.
Rivera JA, Sotres-Alvarez D, Habicht JP, Shamah T, Villalpando S. Impact of the Mexican program for education, health, and nutrition (Progresa) on rates of growth and anemia in infants and Young children: a randomized effectiveness study. JAMA. 2004;291:L2563–70.
Sepulveda J, Bustreo F, Tapia R, Rivera J, Lozano R, Olaiz G, Partida V, Garcia-Garcia L, Valdespino JL. Improvement of child survival in Mexico: the diagonal approach. Lancet. 2006;268:2017–27.
Shrimpton R, Huffman S, Zehner ER, Darnton-Hill I, Dalmiya N. Multiple micronutrient supplementation during pregnancy in developing-country settings: policy and program implications of the results of a meta-analysis. Food Nutr Bull. 2009;30:S556–73.
Stewart RC. Maternal depression and infant growth: a review of recent evidence. Maternal Child Nutr. 2007;3:94–107.
UNICEF. State of the world’s children. Oxford: Oxford University Press; 1998.
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Neufeld, L.M. (2012). The Oportunidades Program and Child Growth: Mexico Perspectives. In: Preedy, V. (eds) Handbook of Growth and Growth Monitoring in Health and Disease. Springer, New York, NY. https://doi.org/10.1007/978-1-4419-1795-9_100
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