CASH TRANSFERS, FOOD CONSUMPTION, AND NUTRITION 141
vention by 0.03 but rose slightly under the combined intervention by 0.02 (IFPRI 2003b, 73). This lack of impact is somewhat surprising given that the program required attendance at regular health checkups by children and pregnant women as well as participation by all children under age two in monthly growth-monitoring sessions, which included individualized counsel- ing for mothers on topics such as infant feeding and hygiene practices.4 How- ever, the monthly transfer size was small, representing only 4 percent of average monthly household expenditures (Maluccio 2004; Schady 2006). Taken together, the small transfer size, sporadic transfer distribution, and insuffi- cient supply-side services may have accounted for PRAF’s failure to produce anthropometric results (IFPRI 2003b). Although CCTs in Colombia, Mexico, and Nicaragua all resulted in a lower
prevalence of stunting and higher mean HAZ for young children, the final impact evaluation of Brazil’s Bolsa Alimentação found that the program had an adverse effect on nutritional status.5 A comparison of beneficiary and excluded children showed that even though beneficiary children began to eat a better-quality diet as a result of the program, they experienced less weight gain than their nonbeneficiary counterparts—31 grams per month less accord- ing to Morris et al. (2004) and 37 grams per month less according to IFPRI (2003a).6 Furthermore, beneficiary children began to grow less rapidly once the transfer became available to the family, even though these children had exhibited a tendency to grow faster than excluded children before they received the transfer (IFPRI 2003a, 29). In sum, as a result of Bolsa Alimen- tação beneficiary children from birth through age two had lower WAZ by 0.25 and lower HAZ by 0.11 compared to nonbeneficiaries (Morris et al. 2004, 2339).7 These results—which have subsequently been reversed—were not large, but the possible explanations are instructive with regard to under- standing the types of incentives to which one must be attentive in a condi- tioned program. A previous milk powder distribution program had removed families from the program once children gained weight, and even though this was not the case with Bolsa Alimentação, beneficiary mothers may have assumed that benefits would be discontinued for children exhibiting healthy growth and, hoping to extend the duration of their CCT benefits, may have limited the food intake of their children. Alternatively, health personnel may have manipulated the weight data, again in an effort to increase the proba-
4Growth monitoring in PRAF was based on the country’s AIN-C program. 5Estimates of the program’s impact on stunting prevalence are not noted in the literature. 6The evaluation compared beneficiaries with a control group of nonbeneficiaries who were selected to receive program benefits but subsequently excluded due to random administrative errors
(Morris et al. 2004). 7Results were adjusted for household demographic composition and Bolsa Escola beneficiary status (Morris et al. 2004).
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