Ensaios Sobre Programas de Visitação Domiciliar: o caso do Programa Primeira Infância Melhor

Abstract

The purpose of this thesis was to contribute to the existing literature on the effects of home visitation programs, particularly focusing on the nascent discussion about the impacts of the "Primeira Infância Melhor" Program (PIM). This thesis is structured into three essays. The first is a survey aimed at consolidating the findings from existing studies on PIM. The second and third essays investigate the program's potential effects on vaccination coverage in municipalities that adopted PIM and on the incidence of teenage pregnancy among those potentially served by the program, respectively. The first essay organizes the existing literature related to PIM's effects, highlighting its positive impacts on child malnutrition, improvements in pre- and neonatal health indicators, and school performance, especially in mathematics. It also emphasizes a 60% lower prevalence of low development scores among children whose families were registered with PIM during pregnancy, as well as the relationship between child development and cognitive improvements resulting from the program's actions. Results associated with a reduction in violent behavior related to theft, assault or threat, physical or verbal abuse, and child mortality from external causes were also observed. Regarding the latter, it's important to note that the impact is greater when evaluated under the existence of synergies between PIM and the "Bolsa Família" Program (PBF). In the second essay, the impact of PIM on vaccination coverage for the following vaccines was analyzed: BCG, DTP, Hepatitis B, Poliomyelitis, MMR, and Pentavalent. For this purpose, the Difference-in-Differences strategy proposed by Callaway and Sant’Anna (2021) was used. Statistically significant effects were identified for the vaccination coverage of four of the six vaccines analyzed. Overall, there was an approximate increase of 4 percentage points for BCG and Poliomyelitis vaccination coverage, 7 percentage points for Hepatitis B vaccination coverage, and 5 percentage points for MMR vaccination coverage. These effects are consistent with group aggregations, timing, and dynamics. The most robust results are related to the BCG and Hepatitis B vaccines, which are administered at birth, indicating that PIM's impact on vaccination might be short-term. The third essay focuses on the fertility of teenagers potentially served by PIM during early childhood. Again, the Difference-inDifferences estimator proposed by Callaway and Sant’Anna (2021) was used as the methodological strategy. The aggregated results are robust and indicate a statistically significant effect of approximately -7% on births from girls aged 10 to 14. For births from girls aged 15 to 19, no statistically significant effects were found.