Reducing malnutrition through nutrition-sensitive social protection schemes
There is growing evidence that in order to accelerate progress in reducing undernutrition, nutrition-specific approaches may be more effective in preventing undernutrition when complemented with cash transfers. In Myanmar and Nigeria, Save the Children recently implemented two First 1,000 Day Maternal and Child 'Cash Plus' pilots to improve nutrition outcomes for mothers and children by delivering nutrition-sensitive cash transfers to pregnant women during the First 1,000 Days of life.
Both programmes cover all pregnant women within implementation areas, who receive monthly unconditional cash transfers until their child is two years old. The cash transfers support women to purchase nutritious food for themselves and their children. Both projects also have complementary activities to improve knowledge and change key behaviours on nutrition and hygiene, through regular Nutrition-Sensitive Social and Behaviour Change Communication (SBCC) sessions with pregnant women, their families, and influential stakeholders.
Both pilots employed a cluster randomized controlled trial to measure the causal impact of the approaches on the health/nutrition outcomes of recipients.
WHAT HAS BEEN THE IMPACT ON CHRONIC MALNUTRITION?
- UNICEF is commissioning two forthcoming studies on this: Moving beyond cash for better nutrition: an exploratory study and Cash Transfers and Child Health: A Meta-Analysis
Evaluations of both pilots found that pairing SBCC interventions with cash transfers is an effective approach for preventing chronic malnutrition (stunting). While impacts were observed on multiple interim outcomes, we will focus on the impact on stunting.
CDGP: After two years, stunting among children who benefitted from the programme (aged 0 to 27 months) was reduced by 5.8 percentage points (an 8 percent reduction p<0.01). This preventative effect was maintained after children left the programme, with a 5.4 percentage point reduction by endline among children who were by then aged 21 to 49 months (also an 8 percent reduction p<0.05). By endline, CDGP resulted in a 4.8 percentage point (p<0.05) drop in the proportion of children who were severely stunted (aged 21 to 49 months). Endline reductions in moderate stunting were only significant among boys (p<0.05), though severe stunting only among girls (p<0.10). There was also a marginally significant reduction in the share of girls that were underweight (based on weight-for-age) by 6 percentage points (p<0.10) with no such effect for boys.
MCCT: After two years of programme delivery, there was a 4 percentage point reduction (a 13 percent reduction, p<0.10) in the proportion of stunted children (6-29 months old) covered by the Cash+SBCC intervention, compared to the control group. This result was primarily driven by a 4.4 percentage point reduction (an 18 percent reduction, p<0.05) in the proportion of moderately stunted children among the Cash+SBCC intervention group. For children in the Cash-only intervention group, no significant effects were observed in stunting compared to the control group.
The reduction in the proportion of stunted children was more pronounced for children who received maximum exposure (aged 24-29 months) in the Cash+SBCC intervention group. There was a 5.4 percentage point reduction for children in this age cohort (p<0.10).
ADOPTION AND SCALE-UP OF NUTRITION-SENSITIVE SOCIAL PROTECTION SCHEMES
Both pilots offer a promising solution for tackling stunting in the First 1,000 Days of life; a period which advances in neuroscience are showing us is critical for child development. Save the Children is using this impact evidence to support government counterparts to adopt First 1,000 Day Maternal and Child 'Cash Plus' schemes as part of comprehensive life-cycle social protection systems. In Myanmar, the government has already adopted the approach and is expanding it nationally. In Nigeria, CDGP has stimulated the emergence of new state led programmes and is leading to greater focus on the importance of social protection coverage in the First 1,000 Days.
Mathew Tasker, Social Protection Advisor, Save the Children UK
Luke Harman, Senior Social Protection Advisor, Save the Children UK