Assessing the impact of a combined nutrition counselling and cash transfer intervention on women’s empowerment in rural Bangladesh: a randomised control trial protocol

• Published in: BMJ open 2021-06, Vol.11 (6), p.e044263-e044263
• Main Authors: Kirkwood, Elizabeth K, Dibley, Michael John, Hoddinott, John Frederick, Huda, Tanvir, Laba, Tracey Lea, Tahsina, Tazeen, Hasan, Mohammad Mehedi, Iqbal, Afrin, Khan, Jasmin, Ali, Nazia Binte, Ullah, Saad, Goodwin, Nicholas, Muthayya, Sumithra, Islam, M Munirul, Ara, Gulshan, Agho, Kingsley Emwinyore, Arifeen, Shams E, Alam, Ashraful
• Format: Article
• Language: English
• Subjects: Clinical trials; Data collection; Decision making; Economic development; Empowerment; Gender equity; Health promotion; Intervention; Malnutrition; Nutrition; protocols & guidelines; Public Health; Statistical analysis; Women
• ISSN: 2044-6055; 2044-6055
• DOI: 10.1136/bmjopen-2020-044263

IntroductionThere is growing interest in assessing the impact of health interventions, particularly when women are the focus of the intervention, on women’s empowerment. Globally, research has shown that interventions targeting nutrition, health and economic development can affect women’s empowerment. Evidence suggests that women’s empowerment is also an underlying determinant of nutrition outcomes. Depending on the focus of the intervention, different domains of women’s empowerment will be influenced, for example, an increase in nutritional knowledge, or greater control over income and access to resources.ObjectiveThis study evaluates the impact of the Shonjibon Cash and Counselling (SCC) Trial that combines nutrition counselling and an unconditional cash transfer, delivered on a mobile platform, on women’s empowerment in rural Bangladesh.Methods and analysisWe will use a mixed-methods approach, combining statistical analysis of quantitative data from 2840 women in a cluster randomised controlled trial examining the impact of nutrition behaviour change communications (BCCs) and cash transfers on child undernutrition. Pregnant participants will be given a smartphone with a customised app, delivering nutrition BCC messages, and will receive nutrition counselling via a call centre and an unconditional cash transfer. This study is a component of the SCC Trial and will measure women’s empowerment using a composite indicator based on the Project-Level Women’s Empowerment in Agriculture Index, with quantitative data collection at baseline and endline. Thematic analysis of qualitative data, collected through longitudinal interviews with women, husbands and mothers-in-law, will elicit a local understanding of women’s empowerment and the linkages between the intervention and women’s empowerment outcomes. This paper describes the study protocol to evaluate women’s empowerment in a nutrition-specific and sensitive intervention using internationally validated, innovative tools and will help fill the evidence gap on pathways of impact, highlighting areas to target for future programming.Ethics and disseminationEthical approval has been obtained from the International Centre for Diarrhoeal Disease Research (Ref. PR 17106) and The University of Sydney (Ref: 2019/840). Findings from this study will be shared in Bangladesh with dissemination sessions in-country and internationally at conferences, and will be published in peer-reviewed journals.