Executive Summary
In April 2016, Save the Children International (SCI) launched a maternal and child cash transfer program (MCCT), LEGACY (Learning, Evidence Generation, and Advocacy for Catalyzing Policy). The program was implemented in three townships across Myanmar’s central dry zone and is comprised of two interventions targeting pregnant women and mothers of young children:
1. A monthly cash transfer to mothers in their last two trimesters of pregnancy until the child turns two years old (“first 1000 days”); and
2. A monthly Social and Behavioral Change Communication (SBCC) activity supplementing the cash transfers, covering a range of topics related to nutrition and child health.
Innovations for Poverty Action (IPA) worked with SCI and collaborated with researchers from the University of Michigan and Duke University to design an experimental evaluation of the LEGACY program to measure its impact on child nutrition.
Villages in the three study townships were randomly assigned into three groups. In the first set of villages, women who were at least four months pregnant received both the cash transfers along with the SBCC (Cash+SBCC). Another set of villages received only the cash transfers (Cash-Only), and a third set of villages did not receive any intervention (Control).
Through an extensive endline survey, IPA collected high-quality survey and biomarker measures, including height of children; dietary diversity; antenatal care (ANC) practices; infant and young child feeding (IYCF) practices; water, sanitation and hygiene (WASH) measures; and other health and economic indicators.
Two years after program delivery, our findings showed a 4-percentage point (13 percent) reduction from 30% to 26% (p < 0.1) in the proportion of stunted children (6 to 29 months old) among those covered by the Cash+SBCC intervention, compared to the Control group. This was driven by a 4.4 percentage point reduction (p < 0.05) from 24% to 19.6% in the proportion of moderately stunted children. Moderate wasting also improved in the Cash+SBCC, showing a 2.8 percentage point reduction (p < 0.1) from 11% to 8.2% in the proportion of moderately acutely malnourished children (MAM), compared to the Control group. Findings also show that the reduction of stunting is more pronounced for children covered by the program for longer (24 to 29 months-old children), changing from 36% to 30.6%, a 5.4 percentage point reduction (p < 0.1). Moreover, these changes are concentrated among lower socioeconomic status households as defined by average level of women’s education 5 in the village. Our analysis of the program’s impacts on child health also reveals significant impacts on several immediate and underlying determinants of nutrition, including dietary diversity, breastfeeding, health-seeking behavior, hand washing practices, and food expenditures. We finally explore potential effects on other outcomes, such as debt, savings, women’s decision making, desired fertility and family planning, usage of cash transfers, and exposure to SBCC.
Our findings underline the importance of complementing cash transfer programs with behavioral interventions such as SBCC and the value of ensuring coverage for children throughout their first 1,000 days of life.
Read also: LEGACY/Dry Zone Maternal and Child Cash Transfers RCT Evaluation: Key Findings
