The impact of cash and health insurance on child nutrition during the first 1000 days: Evidence from Ghana

Child malnutrition remains a major global public health issue, with 155 million children under five stunted and 52 million children wasted. Social protection, in the form of cash transfer programmes, has been identified as a potential nutrition-sensitive intervention to address malnutrition in early childhood. This study documents the impacts on young child nutrition outcomes and underlying determinants of a Ghanaian cash transfer programme paired with health insurance fee exemptions, targeted to pregnant women and infants under one year. We use data from a 24-month quasi-experimental impact evaluation which exploits the fact that households were selected into the programme based on a continuous programme eligibility index. Using a difference-in-difference approach, our study finds no main treatment effect on nutritional outcomes. Household-level food security improved, yet child meal frequency decreased, suggesting an important role for the intra-household allocation of resources. We conclude that cash alone is unlikely to yield impacts on young child nutrition outcomes and integrated programmes that aim to address multiple underlying determinants at the same time need to be further examined, including effects on the intra-household division of resources.