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General

Study Overview

Title:

Resilience through social protection and nutrition

Study is 3ie funded:

No

Study ID:

RIDIE-STUDY-ID-631aada707a31

Initial Registration Date:

09/08/2022

Last Update Date:

08/18/2022

Study Status:

Ongoing

Location(s):

Bangladesh

Abstract:

Between 2012 and 2014, we collaborated with the UN World Food Programme on the implementation of the Transfer Modality Research Initiative (TMRI) project in Bangladesh. TMRI was a multi-arm randomized control trial with treatment arms that provided cash transfers and/or food transfers, with or without nutrition behavior change communication (BCC). Transfers and BCC were targeted to women living in poor households in two rural areas of Bangladesh: Rangpur and Kurigram Districts in the North, and Patuakhali, Pirojpur, Bhola, Khulna, and Bagerhat Districts in the South. We are, in 2022, re-surveying individuals and households that participated in TMRI, bringing evidence to bear on three knowledge gaps: (1) Do social protection interventions aimed at improving household food security and the nutrition of infants and young children have sustainable impacts on poverty, diets, child development, and household resilience capacity; (2) Are such interventions protective when shocks such as COVID-19 and climate shocks including cyclones occur? and (3) Do these interventions promote gender-sensitive resilience and sustained improvements in gender equality?

Registration Citation:

Categories:

Health, Nutrition, and Population
Social Protection

Additional Keywords:

Social protection, nutrition, shocks, resilience, Bangladesh, gender

Secondary ID Number(s):

Principal Investigator(s)

Name of First PI:

John Hoddinott

Affiliation:

Cornell University

Name of Second PI:

Shalini Roy

Affiliation:

International Food Policy Research Institute

Study Sponsor

Name:

USAID through the Feed the Future Innovation Lab for Markets, Risk and Resilience, UC Davis

Study Sponsor Location:

United States

Research Partner

Name of Partner Institution:

Bangladesh Agricultural University

Type of Organization:

Research institute/University

Location:

Bangladesh

Intervention

Intervention Overview

Intervention:

TMRI was designed to assess the impacts of different transfer modalities, with and without nutrition BCC on household food consumption, food security and the nutritional status of pre-school children. The primary beneficiaries were women with children ages 0-2 years at baseline, living in poor households in two rural areas of Bangladesh, Rangpur and Kurigram Districts in the north, and Patuakhali, Pirojpur, Bhola, Khulna, and Bagerhat Districts in the south. Both regions had the following three treatment arms: “Cash”; “Food”; and “½ cash and ½ food.” “Cash+BCC” was included as an additional treatment arm in the north, and “Food+BCC” was included as an additional treatment arm in the south. Beneficiaries in the “Cash” arms received a monthly payment of 1,500 Taka. Beneficiaries in the “Food” arms received a monthly food ration of 30 kilograms (kg) of rice, 2 kg of lentils, and 2 liters of micronutrient-fortified cooking oil. The initial value of the food rations was equal to the value of the cash transfers. Beneficiaries in the “½ cash and ½ food” treatment arms received half of each of the two types of transfers. The beneficiaries of the “Cash+BCC” arm in the North and the “Food+BCC” arm in the South received the same transfers as in the “Cash” only and “Food” only treatment groups, respectively, as well as a suite of intensive nutrition BCC interventions: (1) weekly group BCC trainings (2) twice-a-month visits to the beneficiaries’ homes, and (3) monthly group meetings between program staff and influential community leaders. In 2022 study, we are only re-surveying households in the Cash, Food, Cash+BCC, and control arms in the north and in the Cash, Food, Food+BCC, and control arms in the south.

Theory of Change:

The premise behind TMRI’s design was that improvements in household food security and child nutritional status require higher income. Improving child nutritional status may also require understanding of optimal infant and young child feeding practices. Thus, the theory of change for TMRI’s design was as follows. Food transfers and cash transfers directly increase resources available to the household for food consumption; different transfer modalities may lead to different uses of resources, including what foods are consumed. Adding nutrition BCC to transfers provides caregivers with knowledge and support on improving child diets, alongside resources to do so.

The theory of change for the 2022 study is informed by earlier findings. A 2018, post-program follow-up showed that Cash and Cash+BCC households in the North experienced sustained reductions in poverty – driven by sustained increases in savings for Cash, and sustained increases in livestock and poultry holdings for Cash+BCC. The 2018 findings also showed sustained improvements in home environment from Cash and Cash+BCC in the North, as well as sustained reductions in intimate partner violence and its drivers from Cash+BCC in the North. Thus, 2018 findings suggest potential for greater resilience to shocks (i.e., higher food security and less income loss) among Cash and Cash+BCC in the North than Food or Control arms, and potentially greater food security and diet diversity among Cash+BCC than Cash. They also suggest potential for sustained impacts on child development and gender equality. In the South, TMRI treatment arms showed fewer sustained impacts. In particular, Food+BCC showed impacts on some, but not all, poverty measures in 2018.

Multiple Treatment Arms Evaluated?

Yes

Implementing Agency

Name of Organization:

World Food Programme

Type of Organization:

Foreign or Multilateral Aid Agency

Program Funder

Name of Organization:

World Food Programme

Type of Organization:

Foreign or Multilateral Aid Agency

Intervention Timing

Intervention or Program Started at time of Registration?

Yes

Start Date:

05/01/2012

End Date:

04/30/2014

Evaluation Method

Evaluation Method Overview

Primary (or First) Evaluation Method:

Randomized control trial

Other (not Listed) Method:

Additional Evaluation Method (If Any):

Other (not Listed) Method:

Method Details

Details of Evaluation Approach:

This is a follow-up study to assess the sustainability of the original TMRI intervention and its role in promoting resilience to climatic shocks and the consequences of the COVID-19 pandemic. We are tracing and re-interviewing households that participated in four of the original treatment arms as well as households in the control group. We will first assess attrition and balance in these newly collected data using standard methods. Using baseline and the eight year post-endline data, we will estimate impact using ANCOVA (for outcomes collected in both rounds) and single-difference estimators (for outcomes not collected at baseline). Basic estimates will control for treatment status and strata; extended estimates will control for a common set of baseline characteristics. Standard errors will adjust for clustering.

Outcomes (Endpoints):

Primary outcomes are specified across five domains: poverty; food security; child development; and resilience

Poverty status: Poverty headcount (defined by whether a household has per capita consumption below the Bangladesh poverty line, updated to 2022)

Household food security: Food insecurity experience scale

Child development: cognition (Raven’s Progressive matrices and digit span), executive function (Hearts & Flowers task), behavior (Strength and Difficulties Questionnaire)

Gender: Prevalence of physical and emotional intimate partner violence

Resilience: Ability to Recover from Shocks and Stresses Index (ARSSI)

 

Secondary outcomes:

P1 and P2 poverty measures; Per capita consumption expenditure;

Income generating assets; Consumer durables; Land owned or under operation; Dwelling conditions

Agricultural production; Livestock, poultry, fish production; Non-agricultural livelihoods strategies; Labor supply; Income

Savings; Loans

Caloric availability per capita; Household dietary diversity score; Household food consumption score; Household Global Diet Quality Score

Individual Global Diet Quality Score; Individual Caloric intake; Individual anthropometry; Women’s nutrition knowledge

Individual social desirability bias

Measures of controlling behaviors; Women’s empowerment; Women’s social capital

Men’s and women’s emotional well-being (including stress and depression)

Men’s social costs of perpetrating violence; Men’s and women’s attitudes related to gender and violence

Individual perceptions of resilience

Individual aspirations

Coping strategies; Experiences with shocks; Alternative measures of resilience capacity (to be developed)

Child schooling; Home environment

Unit of Analysis:

Households; individuals

Hypotheses:

Eight years post-program:

 

• In the North, households will show significant differences in each of the following:
  • prevalence of poverty
  • household food security
  • prevalences of IPV
  • child development
  • resilience

 

across each pair of the following arms:

• Cash+BCC
• Cash
• Food
• Control

 

• In the South, households will show significant differences in each of the following:
  • prevalence of poverty
  • household food security
  • prevalences of IPV
  • child development
  • resilience

 

across each pair of the following arms:

• • Food+BCC
  • Cash
  • Food
  • Control

Unit of Intervention or Assignment:

Village

Number of Clusters in Sample:

400

Number of Individuals in Sample:

Sampling frame of 3,683 households successfully interviewed at four year post-program follow-up in 2018 (out of 4,000 households in relevant arms at baseline in 2012)

Size of Treatment, Control, or Comparison Subsamples:

There are 300 treatment clusters (cash:100; , food,: 100; cash+bcc: 50; food+bcc: 50) and 100 control clusters

Supplementary Files

Analysis Plan:

Other Documents:

Data

Outcomes Data

Description:

In-person household survey administered to the household head and spouse Community facilities survey Community price survey

Data Already Collected?

Yes

Data Previously Used?

No

Data Access:

Not restricted - access with no requirements or minimal requirements (e.g. web registration)

Data Obtained by the Study Researchers?

Yes

Data Approval Process:

Approval Status:

Treatment Assignment Data

Participation or Assignment Information:

Yes

Description:

Data Obtained by the Study Researchers?

Data Previously Used?

Data Access:

Data Obtained by the Study Researchers?

Data Approval Process:

Approval Status:

Data Analysis

Data Analysis Status:

No

Study Materials

Upload Study Materials:

Registration Category

Registration Category:

Prospective, Category 3: Data for measuring impacts have been obtained/collected by the research team but analysis for this evaluation has not started

Completion

Completion Overview

Intervention Completion Date:

Data Collection Completion Date:

Unit of Analysis:

Clusters in Final Sample:

Total Observations in Final Sample:

Size of Treatment, Control, or Comparison Subsamples:

Findings

Preliminary Report:

Preliminary Report URL:

Summary of Findings:

Paper:

Paper Summary:

Paper Citation:

Data Availability

Data Availability (Primary Data):

Date of Data Availability:

Data URL or Contact:

Access procedure:

Other Materials

Survey:

Survey Instrument Links or Contact:

Program Files:

Program Files Links or Contact:

External Link:

External Link Description:

Description of Changes:

Study Stopped

Date:

Reason: