Can cash transfers solve Bangladesh’s malnutrition?

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Jawtno-photo-1 Mother-child
Silvi and her mother arrive with Silvi’s birth certificate to enroll into Jawtno. a cash transfer program that aims to help 600,000 poor families in Bangladesh access prenatal and child care. Credit: World Bank

Silvi is eight months old. She lives in a remote village in one of the poorest regions of Bangladesh.
Her mother Maya often reflects on her pregnancy and worries about her daughter’s wellbeing as she recalls her morning sickness, the uncertain and painful birth, and the long nights at Silvi’s side as the baby lay wide awake wailing, fighting one illness after the other.
She remembers, too, the thrills of hearing Silvi giggle at the sound of her rattle, and when she began to crawl.
Despite the little joys that her baby brings to Maya, Silvi’s early childhood was marked with apprehension: Shouldn’t she be a little heavier? When will she learn to walk? Will she be healthy and intelligent enough to earn a decent living when she grows up? Or would she be handed down her parents’ poverty and get married like Maya had to, at only sixteen?
But with the right kind of support, Silvi can have a chance at a better life and bring her family out of poverty.
Growing evidence has shown that adequate nutrition before birth and the two years after – or in the first 1,000-days – has lasting effects on a child’s intelligence and brain development .
When they’re properly fed and exposed to learning, children can reach their full potential and break the poverty trap .
Thus, investing in early childhood nutrition and cognitive development (CNCD) is critical to curbing poverty in a country like Bangladesh, where 36 percent of children below the age of 5 are stunted  —or too short for their age--, low birth weight is prevalent, and maternal nutrition remains poor.
Sadly, poor families like Maya’s are not utilizing services available to them.  

Truth be told, programs aimed at raising awareness oCNCD among parents have not translated into better outcomes for children unless they are complemented by incentives to improve nutrition at home. 
As such, research has found that, if implemented well, conditional cash transfers can change behaviors and lead to better human development outcomes 
In 2012-13, the World Bank supported the Government of Bangladesh in the implementation of a pilot conditional cash transfer (CCT) program. The CCT was named Shombhob ("Possible" in Bangla) and reached more than 14,000 poor households. Beneficiary mothers received cash if they attended counseling sessions to improve their children's nutrition and cognitive development and utilized children’s growth monitoring services offered by community clinics.

Silvi?s elder brother, his friends, and their mothers gather for a counselling session to make better decisions about their families? health and nutrition.
Silvi’s elder brother, his friends, and their mothers gather for a counseling session to make better decisions about their families’ health and nutrition. Credit: World Bank

This work was evaluated with support from SAFANSI. The evaluation found that Shombhob had improved mothers’ knowledge of the health benefits of exclusive breastfeeding for infants in the first six months, significantly reduced wasting—low weight for height among children 10 to 22 months old, and improved children’s intake of high-protein food.
The findings also confirmed that the first 1,000 days of a child’s life present a unique window of opportunity to make a lasting impact on their physical and cognitive development .
Building on that evidence, Jawtno (“Care” in Bangla) will provide cash transfers to 600,000 poor families provided they utilize prenatal care and children’s growth monitoring services  offered by community clinics and participate in counseling sessions that stress the importance of interactive parenting and cognitive stimulation to boost children’s development.  
A SAFANSI grant has supported Jawtno’s evaluation design. The evaluation will randomly select households, half of whom benefit from the program (treatment) and the other half from the same cohort of households but not enrolled in the program (control).
The evaluation aims to explore whether cash transfer programs contribute to increasing households’ consumption as well as their food and protein intake, and dietary diversity.
Further to that, the study will assess if children have achieved better physical, cognitive, and language development outcomes, whether early enrollment in primary school has increased, and if women make better decisions about their families’ health and nutrition.
This work will be instrumental for Bangladesh and its development partners to help children like little Silvi achieve a better future.


Laurent Bossavie

Economist in the World Bank’s Social Protection and Jobs Global Practice, Europe and Central Asia Region

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