Participatory Women's Groups with Cash Transfers Can Increase Dietary Diversity and Micronutrient Adequacy during Pregnancy, whereas Women's Groups with Food Transfers Can Increase Equity in Intrahousehold Energy Allocation

Helen A Harris-Fry,Puskar Paudel,Tom Harrisson,Niva Shrestha,Sonali Jha,B James Beard,Andrew Copas,Bhim P Shrestha,Dharma S Manandhar,Anthony M De L Costello,Mario Cortina-Borja,Naomi M Saville

doi:10.1093/jn/nxy109

Abstract

BackgroundThere is scarce evidence on the impacts of food transfers, cash transfers, or women's groups on food sharing, dietary intakes, or nutrition during pregnancy, when nutritional needs are elevated. ObjectiveThis study measured the effects of 3 pregnancy-focused nutrition interventions on intrahousehold food allocation, dietary adequacy, and maternal nutritional status in Nepal. MethodsInterventions tested in a cluster-randomized controlled trial (ISRCTN 75964374) were “Participatory Learning and Action” (PLA) monthly women's groups, PLA with transfers of 10 kg fortified flour (“Super Cereal”), and PLA plus transfers of 750 Nepalese rupees (∼US$7.5) to pregnant women. Control clusters received usual government services. Primary outcomes were Relative Dietary Energy Adequacy Ratios (RDEARs) between pregnant women and male household heads and pregnant women and their mothers-in-law. Diets were measured by repeated 24-h dietary recalls. ResultsRelative to control, RDEARs between pregnant women and their mothers-in-law were 12% higher in the PLA plus food arm (log-RDEAR coefficient = 0.12; 95% CI: 0.02, 0.21; P = 0.014), but 10% lower in the PLA-only arm between pregnant women and male household heads (−0.11; 95% CI: −0.19, −0.02; P = 0.020). In all interventions, pregnant women's energy intakes did not improve, but odds of pregnant women consuming iron-folate supplements were 2.5–4.6 times higher, odds of pregnant women consuming more animal-source foods than the household head were 1.7–2.4 times higher, and midupper arm circumference was higher relative to control. Dietary diversity was 0.4 food groups higher in the PLA plus cash arm than in the control arm. ConclusionsAll interventions improved maternal diets and nutritional status in pregnancy. PLA women's groups with food transfers increased equity in energy allocation, whereas PLA with cash improved dietary diversity. PLA alone improved diets, but effects were mixed. Scale-up of these interventions in marginalized populations is a policy option, but researchers should find ways to increase adherence to interventions. This trial was registered at www.controlled-trials.com as ISRCTN 75964374.

Highlights

The nutritional status of South Asian populations is among the poorest in the world [1, 2], but there is a striking lack of evidence from this region on the effectiveness of common nutrition interventions [3]
Studies from other parts of the world have shown that food transfers can improve energy intakes [6] and birth weight when provided to pregnant women [7], whereas cash transfers tend to be more empowering for women and improve dietary diversity [3, 8,9,10]
Discrimination against women in the allocation of food is more pervasive in this region than elsewhere [11, 12], during pregnancy [13], and this may prevent women from consuming transfers delivered at the household level [14]

Summary

Introduction

The nutritional status of South Asian populations is among the poorest in the world [1, 2], but there is a striking lack of evidence from this region on the effectiveness of common nutrition interventions [3]. Interventions such as food supplements, food vouchers, and cash transfers could plausibly supplement inadequate South Asian diets [4]. PLA women’s groups with food transfers increased equity in energy allocation, whereas PLA with cash improved dietary diversity.

Objectives

Methods

Conclusion