Pregnant women in informal settlements face significant nutritional challenges. Conditional cash transfer (CCT) programmes are a potential policy tool to improve maternal diet, but evidence of their impact on dietary diversity in such settings is limited. This study assessed the impact of a CCT programme, conditional on prenatal care attendance, on the dietary diversity of pregnant women in Freetown's informal settlements. It aimed to quantify changes in dietary diversity scores and explore women's experiences and use of the cash. A concurrent mixed-methods design was employed. Quantitatively, a quasi-experimental study compared Minimum Dietary Diversity for Women (MDD-W) scores between CCT recipients (n=150) and a matched control group (n=150) using pre- and post-intervention surveys. Qualitatively, in-depth interviews were conducted with a purposively selected sub-sample of 25 programme recipients and 10 key informants. Thematic analysis was used for qualitative data. Quantitative analysis showed a statistically significant increase in mean MDD-W scores among the intervention group compared to controls. The proportion of women achieving minimum dietary diversity (≥5 food groups) was 68% in the intervention group versus 42% in the control group. Qualitative data revealed that cash was primarily used for purchasing diverse foods and paying for transport to clinics; however, food price volatility and household sharing of cash remained significant barriers. The CCT programme positively impacted dietary diversity among pregnant women in informal settlements. The conditional link to antenatal care reinforced health service utilisation. The mixed-methods approach provided a nuanced understanding of both the measurable benefit and the contextual constraints. Programme design should consider supplementary measures to mitigate the effects of food price inflation. Nutrition education components should be strengthened to optimise food choices. Further research should investigate long-term maternal and child health outcomes. conditional cash transfer, dietary diversity, pregnant women, informal settlements, mixed methods, Sierra Leone, maternal nutrition. This study provides evidence on the operational impact and lived experience of a CCT programme for maternal nutrition in an urban informal settlement, informing policy and programme design in similar resource-constrained contexts.
Macauley et al. (2017) studied this question.