Babies in a rural area of India are less likely to suffer from acute malnutrition where their families are taking part in a job-guarantee programme to provide work with a guaranteed wage, an Oxford University study has found. However, the Indian government programme appears to have no effect on long-term malnutrition.
While wages earned through the scheme helped families avoid starvation when seasonal agricultural jobs were in short supply, many mothers complained wages were paid late or not in full. This means that the intended benefits of the programme were not delivered in full, the researchers say.
The Mahatma Gandhi National Rural Employment Guarantee Act (MGNREGA) is a job-guarantee scheme in rural India which provides adults willing to do unskilled manual work with at least 100 days of work in every financial year, paid at the statutory minimum wage.
MGNREGA is intended to target deprivation and food insecurity in rural households, and because of this, it has been suggested the policy may indirectly improve the health of babies and young children in these households.
Since child malnutrition is a major public health problem in India, researchers at the University of Oxford set out to investigate whether MGNREGA could improve the nutritional status of children below the age of 12 months. This is thought to be the first study to analyse the effect of the MGNREGA programme on infant nutrition.
The team measured the weight and length of infants in 528 households spread across the Dungarpur district of Rajasthan, where MGNREGA has been implemented since September 2006. Fifty-three per cent of these households had received employment through MGNREGA during the study period. The researchers also interviewed the mothers of these children and conducted 11 focus group discussions with 62 of the mothers.
Dr Manisha Nair of the Nuffield Department of Population Health at Oxford University led and carried out the study as part of her DPhil research as a Louis Dreyfus-Weidenfeld Scholar. She said: 'We found that children in households employed through the MGNREGA programme were less likely to suffer from recent malnutrition compared with children in households that did not participate in the scheme. However, we did not find any effect of the programme on long-term malnutrition.'
The researchers used statistical modelling to understand the likely cause of this beneficial effect on infant nutrition. They found that the effect was not because of improvements in household food security or infant feeding, which they would have expected. Instead, it came through improved birth weights of the infants.
'It is possible that the programme contributes to better nutrition in pregnant women which leads to improved birth weight,' suggests Dr Nair, who is originally from Assam and did her medical training at Assam Medical College in Dibrugarh. 'However, further investigation is needed to examine this.'
As well as complaints about problems with receiving wages earned through MGNREGA, the focus group discussions showed that a number of mothers didn't have a full understanding of appropriate feeding and weaning of infants. The researchers say this could act as a barrier to translating the full economic benefits of the guaranteed wage.
'It is important to identify and address these factors and target the persistent problem of child malnutrition prevalent in India through a convergence of development, health and nutrition policies and programmes,' said Dr Nair.
The positive effect of the MGNREGA programme on childhood nutrition was observed only in the poorest households, the researchers report. At present, households can participate in MGNREGA regardless of their socioeconomic status, though the programme's design tends to ensure that only those that need it apply. However, among the households included in this study, 44% of the poorer households did not receive employment through MGNREGA, while around 50% of the relatively better off households did. The team suggests that better targeting of the scheme towards the more disadvantaged households could increase the effectiveness of MGNREGA, making better use of limited resources.
'This study shows that the MGNREGA programme has the potential to reduce recent malnutrition in children. However, the economic benefits of the job guarantee scheme appear to be short term, and insufficient to have an effect on long-term malnutrition,' concludes Dr Nair. 'Ensuring timely and adequate payment could improve food security and increase the protective effect of the programme.'
She says similar studies are required to measure the effect of MGNREGA on child nutrition in different social, economic and geographical settings in India.
The researchers report their findings in the journal PLOS ONE.
The study was funded by the Weidenfeld Scholarship and Leadership Programme and the Nuffield Department of Population Health, University of Oxford.