Take home rations (THR) and cash transfers for maternal and child nutrition: A synthesis of evidence in India
Devoting public resources to reducing micronutrient deficiencies in children is essential for improved health, and is associated with large economic returns in the long-run through better productivity, lower health costs, and intergenerational transmission of these benefits. The Government of India has a long history of interventions focused on maternal and child health, through cash and in-kind transfers of various types. A key component of the former has been the provision of food rations under the Integrated Child Development Services (ICDS) scheme’s Supplementary Nutrition Program (SNP), established in 1975. Currently, as part of the SNP, pregnant women and mothers of children aged 6 months to 3 years receive monthly Take Home Rations (THR), and children aged 3-6 years receive a daily hot meal at the anganwadi (or crèche). Apart from this nationwide in-kind support, the central government also administers cash transfer programmes for pregnant women and lactating mothers. The Janani Suraksha Yojana (JSY) programme delivers cash conditional on an institutional birth. This study is a synthesis of existing evidence on both types of programmes, with a particular focus on ICDS/THR and JSY, along with a set of recommended policy actions. Existing data from large-scale datasets suggest that THR currently has a wider reach then cash and the prospect of transitioning to cash will likely exclude many current beneficiaries. Even as there is only limited evidence on the effectiveness of THR, there is little compelling evidence to date that warrants a shift away from THR to cash transfers. Most importantly, however, there has not been adequate attention to the possible of a combination of a cash and in-kind transfer. An approach that combines cash with in-kind (including “wet” meals) needs serious consideration.