Admissible Evidence in the Court of Development Evaluation? The Impact of CARE's SHOUHARDO Project on Child Stunting in Bangladesh

Abstract

Summary Along with the rise of the development effectiveness movement of the last few decades, experimental impact evaluation methods – randomised controlled trials and quasi‐experimental techniques – have emerged as a dominant force. While the increased use of these methods has contributed to improved understanding of what works and whether specific projects have been successful, their ‘gold standard’ status threatens to exclude a large body of evidence from the development effectiveness dialogue. In this paper we conduct an evaluation of the impact on child stunting of CARE's SHOUHARDO project in Bangladesh, the first large‐scale project to use the rights‐based, livelihoods approach to address malnutrition. In line with calls for a more balanced view of what constitutes rigor and scientific evidence, and for the use of more diversified and holistic methods in impact evaluations, we employ a mixed‐methods approach. The results from multiple data sources and methods, including both non‐experimental and quasi‐experimental, are triangulated to arrive at the conclusions. We find that the project had an extraordinarily large impact on stunting among children 6–24 months old – on the order of a 4.5 percentage point reduction per year. We demonstrate that one reason the project reduced stunting by so much was because, consistent with the rights‐based, livelihoods approach, it relied on both direct nutrition interventions and those that addressed underlying structural causes including poor sanitation, poverty, and deeply‐entrenched inequalities in power between women and men. These findings have important policy implications given the slow progress in reducing malnutrition globally and that the widely‐supported Scaling Up Nutrition initiative aimed at stepping up efforts to do so is in urgent need of guidance on how to integrate structural cause interventions with the direct nutrition interventions that are the initiative's main focus. The evaluation also adds to the evidence that targeting the poor, rather than employing universal coverage, can help to accelerate reductions in child malnutrition. The paper concludes that, given the valuable policy lessons generated, the experience of the SHOUHARDO project merits solid standing in the knowledge bank of development effectiveness. More broadly, it illustrates how rigorous and informative evaluation of complex, multi‐intervention projects can be undertaken even in the absence of the randomisation, non‐project control groups and/or panel data required by the experimental methods.

Malnutrition among children raises intimidation to their health in Bangladesh: control strategies

“…Governments must recognise the value of social protection as a ‗hand up, not a hand out' for individual beneficiaries and national prosperity. There is also a growing appetite globally to understand the long-term human and economic gains which nutrition-sensitive social protection offers (Smith et al, 2013). This review contributes to the development of this knowledge base, as a crucial step to encourage the investment of domestic resources for social protection to tackle malnutrition.…”

“…Our conclusions highlight the importance of an integrated nutrition-sensitive social protection system. This gives weight to arguments to integrate nutrition, alongside a stand-alone goal (Smith et al, 2013). Many countries have improved nutrition through social protection.…”

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“…Many projects have borne out the evidence that focusing on women's empowerment can have significant changes, not only on women's empowerment, but also on the pathways that improve nutrition. A 2011 review of CARE's SHOUHARDO programme in Bangladesh demonstrated that women's empowerment interventions were the single biggest contribution to a reduction in stunting of 6.5 percentage points a year (Smith et al 2011). The combination of maternal and child health nutrition (MCHN) and empowerment interventions together was stronger -an 8.4 percentage point reduction in stunting, while MCHN interventions alone were less than half as powerful as empowerment interventions on their own.…”

Home > All Content > Vol 49, No 1 (2018) Value Chains for Nutrition in South Asia: Who Delivers, How, and to Whom? Cover Page Edited by: Mar Maestre and Nigel Poole February 2018 Volume 49 Issue 1 There is currently much talk of the private sector role in nutrition, and whether the state can ‘shape’ the market to deliver better nutritional outcomes. This issue of the IDS Bulletin presents research findings in this area, developed by the consortium of research partners under the Leveraging Agricultur

“…While women are often charged with buying and preparing food for the household, they rarely make decisions about how much money to spend on food, and often do not set the menu. It is estimated that increasing a woman's income by US$10 will have the same health and nutritional impact in the household as increasing a man's income by US$110 (Haddad, Hoddinott and Alderman 1997 (Smith et al 2011). The combination of maternal and child health nutrition (MCHN) and empowerment interventions together was stronger -an 8.4 percentage point reduction in stunting, while MCHN interventions alone were less than half as powerful as empowerment interventions on their own.…”