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Ensuring nutrition and early stimulation prenatally and in the first five years maximizes a child¡¯s health and brain development. Global evidence shows that investments made at this time have the highest returns and provide benefits that last throughout the individual¡¯s life and enable them to productively contribute to society as an adult. Well-nourished children complete more years of schooling, learn better, and can earn higher wages in adulthood.

Despite the , Bangladesh still lags behind in key child nutrition indicators such as wasting and stunting, a reflection of acute and chronic malnutrition. While Bangladesh decreased stunting from 41 percent in 2011 to 28 percent in 2019, it is still among the countries with . Investing in initiatives to improve child nutrition and reduce stunting are a priority for Bangladesh and among the most cost-effective development actions to achieve its vision of becoming an upper middle-income country. 

Only about 17 percent of pregnant women visit the doctor four times as recommended . The low use of antenatal care leads to a high incidence of low birth weight and maternal malnutrition. About one-quarter of women suffer from undernutrition during pregnancy while 28 percent of children have low birth weight. For children from poor households, who are more likely to be malnourished, this undermines their human capital development potential. 

Reaping the gains 

Bangladesh¡¯s National Social Security Strategy and Five-Year Plan prioritize programs that invest in early childhood development, focusing on interventions from conception to the first 1,000 days of a child¡¯s life. Multiple pilots, such as  and the  (TMRI), demonstrated that cash transfers combined with behavior change communication led to substantial improvements in maternal knowledge and practices and a significantly lower incidence of wasting and stunting.

Scaling Up: Income Support Program for the Poorest-Jawtno

Building on the success of the Shombhob and TMRI pilots, in 2015, the government launched the (ISPP)¡ªalso known as Jawtno, meaning care in Bangla¡ªwhich is the first of its kind to incentivize mothers to utilize health and counseling services to promote better health and readiness for school for their children. The program supports 600,000 poor pregnant women and mothers with children under 5 with cash payments to incentivize their use of services focused on improving their children¡¯s nutrition and cognitive development. The program benefits the poorest households across 43 Upazilas with high child malnutrition and poverty rates in seven districts, namely, Jamalpur, Mymensingh, Sherpur, Gaibandha, Kurigram, Lalmonirhat, and Nilphamari.

Program beneficiaries withdraw quarterly payments between BDT 1200-1800 (US$14-21) using their biometrically authenticated cash cards at the Union Parishad Post Offices. To qualify for the payment, a pregnant woman needs to make at least four antenatal care visits to the community clinics; mothers of children under five need to ensure children's regular growth monitoring, and all beneficiaries need to attend monthly counseling sessions. These sessions cover topics such as pregnancy care; child feeding practices and healthy diet; immunization, health, and hygiene; social and language development, and parenting tools. 

The program is implemented by the Local Government Division through Union-level program staff, who coordinate with community clinics and health centers, and the Union Post Office.

Results 

What the participating mothers say:

• Higher uptake of antenatal care ensured the wellbeing of mothers and their children. Almost 90 percent of participating pregnant women received antenatal care, with around half completing all four visits. For the successful delivery of their healthy children, mothers gave credit to the visits. 

• Regular growth monitoring encouraged parents to provide better care. Over 90 percent of mothers brought their children for regular growth monitoring at the community clinics. Plotting children¡¯s height and weight on growth charts helped to identify any health issues and take remedial actions.

• Mothers spent more quality time with children. Mothers found the counseling sessions improved their parenting skills, encouraging them to use positive feedback and not resort to physical means of disciplining children. Program staff noted the mothers and children bonded more strongly through playing with toys and interactive games. Ninety-six percent of mothers found the information provided at the sessions useful; they also shared their knowledge with non-participating mothers, and the entire community benefitted. 

• Learning by play. Engaging in fun activities such as games, storytelling, and nursery rhymes together with other children helped build children¡¯s confidence and be better prepared for school.
  
  
• Mothers have the money to spend on their children¡¯s development:  Participating mothers had the means to act on what they learnt about child nutrition and early learning. Eighty-eight percent of mothers used the money to buy nutritious food. Forty percent of mothers bought livestock, set up small poultry farms or vegetable gardens that became a regular source of nutrition and income. The additional income made the mothers economically empowered.

Lessons Learned

The Jawtno program provides important insights for other social protection programs targeting early childhood development:

• Mentorship is critical to reinforce positive behaviors. Women benefitted from counseling andpeer learning at the sessions. During the pandemic, phone-based messaging on child health allowed uninterrupted engagement with mothers.

• Community sensitization is important to ensure buy-in and mobilize effective service delivery. Community leaders can significantly influence outcomes by supporting and encouraging household participation in services as well as monitoring quality of service delivery.
  
  
• Building an integrated package of services can lead to a more effective continuum of care.  Integrating complementary services as part of a package can mean easier access for households and streamlined processes for administrators. More than 80 percent of participating mothers processed birth certificates for their children as per the program requirement.

The government plans to scale up its investment in early childhood development programs to address challenges of child health and education and contribute to building human capital.