Rajasthan's Cash Plus Model Enhances Early Breastfeeding and Maternal Nutrition

Rajasthan Cash Plus model which is the first state-driven effort on Direct Benefit Transfers (DBT) based on Social and Behavioral Change Communication (SBCC) in India, has dramatically increased the proportion of women initiating early breastfeeding and the diet of pregnant women. The scheme started as a pilot in 2020 but was expanded in 2022 to a statewide program serving more than 3.3 million women. It combines home-based counseling, community involvement, digital media works, and cash assistance to increase maternal and child health.

Context

• In the Cash Plus model, early breastfeeding increased by 49% and dietary consumption by 49% in pregnant women. 

• More than 3.3 million women across Rajasthan have been directly benefited which is evidence to the fact that finance with behavioral change interventions.

Key Points

• The Cash Plus Way:

  • Cash Transfer (Janani Suraksha Yojana / IGMSY integration):

    • Conditional cash reward to pregnant and lactating mothers who receive antenatal visits, institutional births and immunization.

  • “Plus” Components:

    • Counseling and Behavior Change Communication (BCC): Attention is made to initiate early breastfeeding within an hour after delivery, exclusive breastfeeding in 6 months, and structured diets by mother.

    • Capacity Building: ASHAs, ANMs, and front workers training to provide systemic lactation and nutrition of the mother.

    • Community Engagement: Use of Self-Help groups (SHGs) and Panchayats as a tool of creating awareness and peer learning.

    • Strengthening of Service: to assure the availability of IFA pills, supplementary nutrition by means of Anganwadi Centres, quality care during presentation (during ante natal /post natal).

• Program Scope 

  • Cash Plus model is an amalgamation of Direct Benefit Transfers (DBT) and Social and Behavioral Change Communication (SBCC).

  • It has contributed to a 49% rise in early breastfeeding with 90% of the new babies being breastfed early.

  • A large percentage of women have become open to the idea of home counseling, being 44.

  • Diversity in food supplies of pregnant women has increased by 49%.

  • The cash support is used by 54% of additional women to target nutrition.

• Growth and scope:

  • This was piloted in 2020 in five districts and then extended to the entire state commencing in 2022, and that includes about 3.5 lakh second time pregnant women.

  • The scaled up version of the program is worth 210 crores.

• Other support services:

  • Lactating mothers and pregnant women are advised in group and at home-based nutrition advice.

  • The program is inclusive of social participation involving community activities and digital media campaigns on increasing awareness of maternal health.

• Effects and Consequences:

  • Better Indicators of Breastfeeding:

    • Increase in initiation of breastfeeding in lower end areas recorded in recent impact assessments.

  • Improved Maternal Food:

    • More intake of iron-rich foods and nutrition services consumption among pregnant women.

  • Special Assistance of High-Risk Populations:

    • Increased benefits to teenage mothers, tribes and low-income households to increase fairness.

  • The National Priorities:

    • Commends POSHAN Abhiyaan and National Nutrition Mission with the convergence of health, nutrition and sanitation.

    • Contributions to SDG-2 (Zero Hunger) and SDG-3 (Good Health and Well-being) as intergenerational malnutrition will be dealt with.

• Challenges:

  • Delivery variations of the services offered between districts.

  • Losses or slow transmission of cash.

  • Real time data monitoring needs.

• Recommendations:

  • Expanding the Cash Plus model to a national scale and with good MIS support.

  • Connection to digital sites such as RCH and Poshan Tracker.

  • Continuous capacity-building and monitoring of communities to maintain change in behaviors.

Conclusion

The innovative Cash Plus is an intervention to maternal and child health, developed by Rajasthan to integrate Cash and behavior change programs. Nevertheless it has achieved much in the area of breastfeeding, nutrition and health awareness and in general presents a good example that other states can follow.