Unintended effects of a targeted maternal and child nutrition intervention on household expenditures, labor income, and the nutritional status of non-targeted siblings in Ghana

Katherine P Adams,Travis J Lybbert,Stephen A Vosti,Emmanuel Ayifah,Mary Arimond,Seth Adu-Afarwuah,Kathryn G Dewey

doi:10.1016/j.worlddev.2018.02.025

Abstract

It is common for health and nutrition interventions to target specific household members and for evaluations of their effects to focus exclusively on those members. However, if a targeted intervention changes a household’s utility maximization problem or influences decision-making, households might respond to the intervention in unintended ways with the potential to affect the wellbeing of non-targeted members. Using panel data from a randomized controlled nutrition trial in Ghana, we evaluate household behavioral responses to the provision of small-quantity lipid-based nutrient supplements (SQ-LNS) to mothers and their infants to prevent undernutrition. We find that targeted supplementation with SQ-LNS had a positive effect on household expenditures on food, including some nutrient-rich food groups, as well as on non-food goods and services. We also find a positive impact on labor income, particularly among fathers. We then explore intrahousehold spillover effects on the nutritional status of non-targeted young children in the household. We find evidence that the targeted provision of SQ-LNS led to higher height-for-age z-scores among non-targeted children in the LNS group compared to the non-LNS group, though only among those with relatively taller mothers, which is an indicator of a child’s growth potential. These findings support existing evidence and suggest that unintended behavioral responses and spillover are a real possibility in the context of nutrition interventions targeting nutritionally-vulnerable household members. Thoughtfully considering this possibility in the design, analyses, and evaluation of targeted nutrition interventions may provide a more complete picture of overall effects.

Highlights

Nutrition in the earliest stages in the life-cycle – from conception through a child’s second birthday – shapes a child’s growth trajectory and developmental potential and, as such, has longterm consequences for human capital acquisition and economic productivity in adulthood (Black et al, 2013; GranthamMcGregor et al, 2007; Hoddinott et al, 2013; Victora, de Onis, Hallal, Blössner, & Shrimpton, 2010; World Bank, 2006)
We report the estimated effects of small-quantity lipid-based-nutrient-supplements (SQ-LNS) on the inverse hyperbolic sine (IHS) of household expenditures in Table 3.21 For reference, over the course of the intervention households in the non-LNS group were spending an average of $7.01 (2011 USD) per capita per week on food, $3.71 on nutrient-rich foods, $4.20 on frequently purchased non-food goods and services, and $4.36 on infrequently purchased non-food items
The results presented in this study show a behavioral response to a targeted maternal and infant nutrition intervention along dimensions outside the scope of the intervention

Summary

Introduction

Nutrition in the earliest stages in the life-cycle – from conception through a child’s second birthday – shapes a child’s growth trajectory and developmental potential and, as such, has longterm consequences for human capital acquisition and economic productivity in adulthood (Black et al, 2013; GranthamMcGregor et al, 2007; Hoddinott et al, 2013; Victora, de Onis, Hallal, Blössner, & Shrimpton, 2010; World Bank, 2006). Each woman received instructions on how to take her assigned supplement and was given the following nutrition message (the same message was provided to all women in the trial regardless of treatment group): ‘‘Do not forget to eat meat, fish, eggs, fruits and vegetables whenever you can. You still need these foods even if you take the supplement we have given you.”. While the individual-level randomization meant households in the group that received SQ-LNS could have been living very near households in the group that did not receive SQ-LNS, the likelihood (and self-reported frequency5) of sharing of supplements at any meaningful level between groups was low given the small daily dosage and the frequency of contact with study staff who were reiterating messages discouraging sharing

Objectives

Results

Conclusion