Effectiveness of unconditional Cash transfers and mobile behaviour change communications to reduce child under nutrition in rural Bangladesh

Intervention plan Pregnancy Surveillance: Our surveillance worker will then conduct door-to-door bi monthly visits to identify women missing two menstrual periods in a row. All such woman will undergo pregnancy test with a sensitive pregnancy urine test kit (Excel®). Women tested positive will be invited to participate in the study with appropriate informed written consent. We will conduct recruitment during the pre-monsoon season (January to June) to enrol pregnant women during the hungry season. Based on experience with our previous study with similar design and settings, we expect at least 95% of mothers will consent. Mobile platform Once registered, each woman will receive a mobile phone with standard connection and limited credit (2-3 calls/month). We will provide mobile credit till the end of the study. However the family will retain the mobile phone after the study. The efficiency of using mobile phones for cash transfers and delivering counselling provides the rationale for this additional non-cash transfer to these poor families. Each phone will be preinstalled with a cash transfer application, and we will assist participants to open a mobile bank account with bKash, the largest mobile bank in Bangladesh. We will train the women about basic phone maintenance, using the phone for cash transfers, receiving & listening to voice messages, and about collecting their cash from mobile bank agents. Mobile nutrition behaviour change communication The mobile phone nutrition BCC intervention will consist of 2 main components: voice messages about nutrition; and nutrition counselling by phone. Life cycle stage-appropriate, pre-scheduled, voice messages will be sent to the women every week. These messages were developed and tested in the pilot and cover; diet and care during pregnancy, breastfeeding, complementary feeding, care in child illness, and basic hygiene. They aim to increase both caloric intake and dietary diversity. They will be transmitted using an interactive voice response (IVR) system and a mobile application. Mobile phone, biweekly nutrition counselling will be conducted with trained nutrition counsellors from a call centre set up at icddrb. The counsellor listens to the woman’s experiences with her own diet and feeding her child, and offers suggestions and support. She will check if the woman has been listening to and understands the voice messages, and repeats them if needed. Each session will be around 5-15 minutes depending on the need of the women. We will measure and monitor the adherence to the intervention by regular analysis of built in analytics in the mobile app and call centre register. Unconditional cash transfer with mobile phones A cash transfer of US$12.5 per month will be made through the participants’ mobile phone, which is approximately 20% of average monthly income of the poorest 40% of rural households (~US$60/m). The well-developed food markets in rural Bangladesh will ensure food products are available for households to purchase. We will use a soft conditional approach with mothers being asked to listen to the messages and participate in counselling, but the cash transfers will be made irrespective of the participant’s compliance. Project staff will follow up with mothers who do not participate to explore the reasons & reinforce the importance of the messages & counselling. Cash will be transferred directly to woman’s mobile bank accounts using bKash mobile Social marketing brand & strategy A social marketing brand platform will be developed to provide an appealing overall identity for the intervention. Our understanding of the audience’s concerns, aspirations and desires from formative research will drive our social marketing approach, which will be based on an emotional connection rather than a factual communication. We will consider benefits such as convenience, social status, feel-good experience and economic gains, to position nutrition as the overall ‘smart choice’ for mothers and their families. Our communications plan will include social media, posters & leaflets, and be consistent with voice messages & counselling. We will provide the behaviour change communication intervention for 30 months starting from 1st trimester till the child is 24 months of age. The total duration of the study period is 40 months.