Can Information and Cash Make a Difference in Children’s Development?

October 3, 2016

Evaluation Overview and Results

  • Problem: Children under five years old in Nepal suffer from one of the highest rates of malnutrition and stunting in the world, and women generally don’t gain enough weight during pregnancy. The Government of Nepal wants to improve young children’s development, especially cognitive and physical, by strengthening the nutritional intake of pregnant women and their youngest children. Researchers evaluated the effect of providing information about nutrition and parenting versus providing the same information with an unconditional cash transfer.
  • RESULTS: In communities where health workers spoke about nutrition and healthy child development, women’s knowledge improved. The biggest improvement was seen in communities where women also received the cash transfer. Children in these communities who were younger than two years old when the program started showed improvement in fine and gross motor skills.
  • TWO YEARS LATER: The research team went back into these communities in late 2016 to test whether improvements continued as the original group of children neared primary school age. The researchers found that in areas where women received cash and information, they were more likely to know about and be implementing appropriate health and nutrition practices. However, gains children showed previously had disappeared.
  • NEXT STEPS: Researchers are interested in looking at why improving mothers’ knowledge and behavior was not enough to lead to sustained child development gains.

Research area: Early Childhood Nutrition, Development, and Health

Country: Bangladesh

Evaluation Sample: 78 rural community clinics and 2574 households

Timeline: 2013 - 2016 (Completed)

Intervention: Nutrition, Information. Stimulation, Health

Researchers: Gayatri Acharya, World Bank; Prashant Bharadwaj, University of California, San Diego; Michael Levere, University of California, San Diego; Bishnu Bahadur Thapa, World Bank; Karishma Wasti, World Bank; Kanchan Tamang, Poverty Alleviation Fund; Frauke Jungbluth; Jasmine Rajbhandary

Partners: The Center for Economic Development and Administration at Tribhuvan UniversityPoverty Alleviation FundUniversity of California, San Diego


Policy Issue

Pregnant women and young children need nutritious food for healthy development, especially in the first 1,000 days of life (from conception through the age of two). Without the right nutrition, children can become malnourished and their growth gets stunted. This damage, which affects the body and the brain, is often irreparable and can hurt children’s development forever.


Policymakers often use conditional cash transfers to improve family’s income flow and make it easier for them to buy the food they need. But imposing conditions doesn’t always lead to behavior change, and it doesn’t ensure that families spend the money on healthy and nutritious food, or that it’s shared equally among those who need it. Imposing conditions on cash transfers also requires high administrative capacity and resources, which can be costly and difficult for some states to handle. This intervention looks at the impact of providing nutrition and parenting information to families, along with unconditional cash transfers, which are easier to implement because they don’t have conditions that need to be monitored.


Nepal has made considerable progress in reducing deaths among pregnant women and children, but chronic malnutrition among pregnant women and children is still a problem. Nepal’s economy is estimated to lose up to 3 percent annually in gross domestic product because of the economic effects of malnutrition on economic development.

Nepal’s government has run a number of campaigns to raise awareness on the importance of a balanced diet, proper sanitation and hygiene, breastfeeding, and other health matters. The results have been mixed. The Government needs to understand to what extent lack of family income perpetuates malnutrition, and whether cultural and social practices in Nepal are in part responsible. This evaluation will help the government better understand what can be done to improve nutrition and child development.

In Nepal, 46.7 percent of children under five are stunted. 
(Nepal Living Standard Survey for 2010/11)



Intervention and Evaluation Details


The intervention has two treatment arms, one receiving information only and another receiving information plus an unconditional cash transfer. A third group, which will receive nothing, will serve as the control group. The program is targeting the poorest communities in four of Nepal’s 75 districts.

Information intervention: Families will receive easy-to-understand booklets on the importance of breastfeeding, the use of vitamins, and on nutritious food. Community figures who organize and lead already existing monthly community organization meetings will be trained by nutrition and cognitive development experts. The trained volunteers, some of whom are known as Social Mobilizers and others as Female Community Health Volunteers, will present the information during monthly community organization meetings. The first information session will run for about an hour; after that the information sessions will run between 15 and 30 minutes. Every two weeks, the Social Mobilizer will call or text reminders to the families about nutritious eating. The pre-existing relationships the women in local communities have with these health workers is crucial in that it makes it more likely that women will both internalize the new knowledge and make behavioral changes as a result of learning.

Cash transfers plus information intervention: An unconditional cash transfer program will be added alongside the information campaign. Families received around US $5.00 per month for each pregnant woman and child up to the age of two. This is about 25 percent of the average household spending on food, or between 7 and 15 percent of median monthly income in each of the four districts. The money will be handed out during the monthly community meetings.


The evaluation uses a randomized control trial design. Comparison across the two treatments and the control group will allow researchers to determine the extent to which knowledge alone or knowledge and cash can bring about change in nutrition related behavior. To build the treatment and control groups, researchers randomly selected up to three community organizations in Village Development Committees in the four targeted districts, and then randomly assigned all community organizations within each Village Development Committee to one of the three groups. In total, the intervention covers 600 community organizations, each of which has approximately 30 members (each representing one household). In each community organization, researchers interviewed all households with a female community member who was either pregnant or had a child younger than 24 months old.

Primary outcomes that will be measured are weight and height for children up to the age of five, duration of breastfeeding, other maternal health indicators, food and nutritional intake, nutritional knowledge, and parental time spent with children. After the baseline survey, researchers will carry out an endline survey at the conclusion of the intervention, and continue to gather data moving forward to study the persistence of knowledge in the communities, as well as spillovers to other women within the community.

Policy Impacts

The lessons learned from this intervention are important for low-income countries that are seeking the most effective routes for improving nutritional status of pregnant women and young children. Understanding the potential of unconditional cash transfers could give governments an important policy tool, especially in countries without the administrative capacity or financing for a conditional cash transfer program. At the same time, this evaluation will help Nepal policymakers understand whether informational campaigns, such as the existing nutritional training, can result in improved nutrition and parenting that give children a development boost, or whether there’s a bigger impact when combined with unconditional cash transfers.