Exploring opportunities for linkage of Benazir Income Support Programme with food conitionalities among pregnant and lactating women and children under five in Matiari, Sindh : a cross sectional study

Under-nutrition is one of the modifiable threats to global health and child survival especially in poor and under developed settings. Pakistan bear a huge burden of malnourished children and women particularly in rural Sindh where 50 % of children under 5 are stunted, 72 % are anemic and 40 % have iron deficiency. Furthermore, 57 % of pregnant women in rural Sindh are anemic. Cash transfer programs have resulted in decreasing maternal and child undernutrition in many countries. A social cash transfer program named Benazir Income Support Programme (BISP) was initiated by Government of Pakistan in 2009. Beneficiaries of the program are females belonging to low income households. We conducted this study to find the food expenditure patterns and client related dynamics affecting the use of cash transfers for food consumption among Pregnant and Lactating women and children less than five years. Methodology: A Cross-sectional survey was carried out during July-September 2013. Households were sampled through a multistage cluster sampling technique, covering five union councils in Matiari Talukka. Local and trained data collectors interviewed study participants using structured questionnaire to BISP beneficiaries in 421 households. BISP beneficiary households, with a child less than 5 years of age and providing informed consent were included. The outcomes of the study were Household expenditure on food, Household Expenditure on food by commodity groups, Cash grant expenditure on food, and Decision making for cash grant. Data analysis was carried out on Statistical Package for Social Sciences (SPSS) version 19. Results: Household expenditure is more on energy dense foods like wheat, sugar and oil and low on micronutrient rich foods like meat, fruits and vegetables. Food is the most commonly purchased commodity from cash grant. Cashgrant expenditure remains less on vegetables and fruits and more on packed food items like cold drinks, industrialized juices etc. Client related dynamics such as purchase of meat for single meal from cash grant, consumption by all household members, preference in meals for men, low expenditure on foods for children less than five and their mothers shows that cash grant is not targeted on improving maternal and child nutrition. Women agency has increased as a result of cash grants and majority of women prefer cash grant rather than food. Conclusion: Unconditional cash transfers are mainly expended on energy dense food items with minimum spending on micronutrient rich foods for mothers and children under 5. But at the same time women agency has increased through these cash grants. Conditionalities related to behavior change communication and use of fortified foods should be introduced in the program for addressing undernutrition in pregnant and lactating women and children under 5