Willingness to pay for small-quantity lipid-based nutrient supplements for women and children: Evidence from Ghana and Malawi.

Katherine P Adams,Mary Arimond,Seth Adu‐Afarwuah,Thokozani E Phiri,Kathryn G Dewey,Stephen A Vosti,Ulla Ashorn,Emmanuel Ayifah,Kenneth Maleta

doi:10.1111/mcn.12518

Abstract

Small‐quantity lipid‐based nutrient supplements (SQ‐LNS) are designed to enrich maternal and child diets with the objective of preventing undernutrition during the first 1,000 days. Scaling up the delivery of supplements such as SQ‐LNS hinges on understanding private demand and creatively leveraging policy‐relevant factors that might influence demand. We used longitudinal stated willingness‐to‐pay (WTP) data from contingent valuation studies that were integrated into randomized controlled nutrition trials in Ghana and Malawi to estimate private valuation of SQ‐LNS during pregnancy, postpartum, and early childhood. We found that average stated WTP for a day's supply of SQ‐LNS was more than twice as high in Ghana than Malawi, indicating that demand for SQ‐LNS (and by extension, the options for effective delivery of SQ‐LNS) may be very context specific. We also examined factors associated with WTP, including intervention group, household socioeconomic status, birth outcomes, child growth, and maternal and child morbidity. In both sites, WTP was consistently negatively associated with household food insecurity, indicating that subsidization might be needed to permit food insecure households to acquire SQ‐LNS if it is made available for purchase. In Ghana, WTP was higher among heads of household than among mothers, which may be related to control over household resources. Personal experience using SQ‐LNS was not associated with WTP in either site.

Highlights

Beyond the moral imperative to provide children with adequate nutrition to thrive throughout their life‐course, economic development hinges, in many ways, on improving maternal and early childhood nutrition
Household choices, such as the choice to invest in a nutrient supplement such as Small‐quantity lipid‐based nutrient supplements (SQ‐LNS), may be shaped by household characteristics, preferences, and constraints as well as the perceived and expected costs and benefits associated with SQ‐LNS and competing investments
The empirical results presented here, based on a pair of contingent valuation studies integrated into randomized controlled nutrition trials in Ghana and Malawi, provide insight into household valuation of SQ‐ LNS, and how household characteristics, constraints, experience with SQ‐LNS, and other circumstances are associated with willingness to pay (WTP)

Summary

Introduction

Beyond the moral imperative to provide children with adequate nutrition to thrive throughout their life‐course, economic development hinges, in many ways, on improving maternal and early childhood nutrition. Small‐quantity lipid‐based nutrient supplements (SQ‐LNS) are a novel vehicle to deliver micronutrients. They provide a wide range of micronutrients along with some key macronutrients, including essential fatty acids (Arimond et al, 2015). These small‐quantity (20 g/day) home fortificants, which contain vegetable oil, dried skimmed milk, peanut paste, sugar, and a vitamin–mineral mix, are designed to enrich maternal and child diets with the objective of preventing undernutrition during the first 1,000 days, from conception to age two. Recent efficacy trials showed positive effects on birth outcomes, child growth, and development (Adu‐Afarwuah et al, 2015; Adu‐Afarwuah et al, 2016; Hess et al, 2015; Iannotti et al, 2014; Mridha et al, 2016; Prado, Abbeddou, et al, 2016), but others showed no effects (Ashorn, Alho, Ashorn, Cheung, Dewey, Gondwe, et al, 2015; Ashorn, Alho, Ashorn, Cheung, Dewey, Harjunmaa, et al, 2015; Prado, Maleta, et al, 2016; Prado, Phuka, et al, 2016)

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