Poster Topical Area: Community and Public Health Nutrition

Location: Auditorium

Poster Board Number: 34

P06-013 - Impact of a cash transfer program targeting the first 1,000 days on maternal outcomes: a cluster randomized trial in Togo

Monday, Jun 11
8:00 AM – 3:00 PM

Objectives

In two northern rural regions of Togo the Government with support from the World Bank and Unicef implemented a cash transfer (CT) program aiming at promoting maternal and child nutrition, health and rights. Approximately 8 USD/month were given to women during the first 1,000 days, combined with behavior change communication (BCC) activities. We analyze here the impact of this program on maternal outcomes.



Methods

In total, 162 villages were randomized into an intervention (CT+BCC, n=82) or a control group (BCC, n=80). Two cross-sectional surveys were conducted on random samples of mother-infant pairs before (n=2,658) and after the intervention (n=2,031). Data included information on pregnancy monitoring, place of delivery, Minimum Dietary Diversity for Women (MDD-W), knowledge in nutrition/health/hygiene and women empowerment. A difference-in-differences analysis was performed to assess the impact of the program, using logistic regressions. Intention-to-treat (ITT) analysis was preferred but per protocol (PP) analysis was also performed given that only 46% of beneficiaries had received the CT at least once at endline.



Results

Between the 2 rounds the proportion of women who had at least 1 prenatal visit increased from 88.1% to 94.1% among beneficiaries, while it decreased from 92.0% to 90.5% among non-beneficiaries (ITT: p < 0.01). The proportion of women who gave birth in health facilities increased from 39.9% to 50.2 % in the CT group and did not vary in the control group (ITT: p < 0.05). The prevalence of women reaching the MDD-W (5 food groups/10) increased equally in both groups. While the program had no impact on women’s decision-making power, it had an impact on intimate partner violence: the proportion of women who declared being humiliated by their partner decreased further in the CT group (20.9% to 12.5%) than in the control group (20.3% to 18.1%) (ITT: p < 0.05). Similar results were found with the prevalence of women experiencing physical violence (PP: p=0.04). Mother’s knowledge on nutrition/health/hygiene increased in both groups, but more strongly in the CT group.



Conclusion

Despite implementation issues, the CT program contributed to improve pregnancy monitoring, medically assisted delivery and mother’s knowledge, and to decrease intimate partner violence.




Funding Source: World Bank and UNICEF

CoAuthors: Justine Briaux - UMR 204 NUTRIPASS "Nutrition et Alimentation des Populations aux Suds", IRD/U.Montpellier/SupAgro, Institut de Recherche pour le Developpement (IRD), Montpellier, France; Sophie Carles – UMR 204 NUTRIPASS « Nutrition et Alimentation des Populations aux Suds», IRD/U. Montpellier/SupAgro, Institut de Recherche pour le Développement (IRD), Montpellier, France.; Sonia Fortin – UMR 204 NUTRIPASS « Nutrition et Alimentation des Populations aux Suds», IRD/U. Montpellier/SupAgro, Institut de Recherche pour le Développement (IRD), Montpellier, France.; Yves Kameli – UMR 204 NUTRIPASS « Nutrition et Alimentation des Populations aux Suds», IRD/U. Montpellier/SupAgro, Institut de Recherche pour le Développement (IRD), Montpellier, France.; Laura Adubra – UMR 204 NUTRIPASS « Nutrition et Alimentation des Populations aux Suds», IRD/U. Montpellier/SupAgro, Institut de Recherche pour le Développement (IRD), Montpellier, France.; Magali Romedenne – Nutrition Department, UNICEF, Lome, Togo; Felicite Mukantambara Goundjo – Social Protection Department, UNICEF, Lome, Togo; Joachim Gboko – Social Protection Department, The World Bank, Cotonou, Benin; Ayawavi Agboka – Programme de Developpement Communautaire, Ministere du developpement à la base, Lome, Togo ; Renaud Becquet – UMR 1219, Inserm, Bordeaux Population Health Research Center, University of Bordeaux, Bordeaux, France; Yves Martin-Prevel – UMR 204 NUTRIPASS « Nutrition et Alimentation des Populations aux Suds», IRD/U. Montpellier/SupAgro, Institut de Recherche pour le Développement (IRD), Montpellier, France

Mathilde Savy