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  • Publication | 2022

Social assistance programme impacts on women's and children's diets and nutritional status

Global Food and Nutrition Security

Abstract

Investments in social assistance programmes (SAPs) have accelerated alongside interest in using SAPs to improve health and nutrition outcomes. However, evidence of how design features within and across programme types influence the effectiveness of SAPs for improving diet and nutrition outcomes among women and children is limited. To address this, we reviewed evaluations of cash, in-kind and voucher programmes conducted between 2010 and 2020 among women and children, and examined associations between design features (targeting, including household and individual transfers, fortified foods and behaviour change communication) and positive impacts on diet (diet diversity, micronutrient intake) and nutrition (anthropometric indicators, haemoglobin, anaemia) outcomes. Our review has several key findings. First, SAPs improve dietary diversity and intake of micronutrient-rich foods among women and children, as well as improve several nutrition outcomes. Second, SAPs were more likely to impact diet and nutrition outcomes among women compared with children (23/45 [51%] vs. 52/144 [36%] of outcomes measured). Third, in-kind (all but one of which included fortified foods) compared with cash transfer programmes were more likely to significantly increase women's body mass index and children's weight-for-height/length Z-score, and both women's and children's haemoglobin and anaemia. However, there is limited evidence on the effectiveness of SAPs for improving micronutrient status and preventing increased prevalence of overweight and obesity for all populations and for improving diet and nutrition outcomes among men, adolescents and the elderly. Further research in these areas is urgently needed to optimize impact of SAPs on diet and nutrition outcomes as countries increase investments in SAPs.

Key Points/Highlights

  • Social assistance programmes (SAPs) can be used to improve diets of women and children.

  • Effectiveness of SAPs may differ by programme type and outcome assessed. For example, in-kind transfers (with fortified foods) compared with cash transfer programmes were more likely to significantly increase children's weight-for-length/height Z-score (WLZ/WHZ), and women's and children's haemoglobin concentration (Hb) and decrease anaemia prevalence.

  • If programmes aim to reduce stunting and anaemia or increase WLZ/WHZ, mid-upper arm circumference or Hb, they should consider targeting women and/or young children, including both household and individual transfers, fortified foods/supplement and/or behaviour change communication.

  • Evidence of the effectiveness of SAPs for improving micronutrient status and preventing an increase in overweight and obesity is scarce as is evidence for the effectiveness of SAPs for improving diet and nutrition outcomes among men, adolescents and the elderly in low- and middle-income countries.

  • To better understand which programme design features are most important for achieving impacts, randomized evaluation designs and consistency in programme and evaluation design across several programmes in different contexts are needed.