Conditional and Unconditional Social Transfers, Early-Life Nutrition, and Child Growth: A Randomized Clinical Trial

Importance Rates of exclusive breastfeeding are declining despite the numerous benefits to mothers and their children. Objective To assess the effectiveness of conditional and unconditional social transfers on exclusive breastfeeding rates and child growth. Design, Setting, and Participants This is a prospective, parallel, 3-armed randomized clinical trial conducted between August 2022 and October 2023. The trial was conducted in 4 districts of Vientiane, Lao People's Democratic Republic. Mothers identified from a large birth cohort were randomized into 2 intervention groups (conditional social transfer or unconditional social transfer) or a control group at a ratio of 1:1:1. Data analysis was conducted from December 2023 to January 2024. Interventions Two interventions were tested: (1) conditional social transfer, in which the mother received the social transfer only if still exclusively breastfeeding at 6 months, and (2) unconditional social transfer, in which the mother received the social transfer at 6 months regardless of breastfeeding status. Mothers in the control group received educational material only. Main Outcomes and Measures The primary outcome was the proportion of women exclusively breastfeeding at 6 months post partum. Secondary outcomes included exclusive breastfeeding duration (in months) and child growth (height, weight, and head circumference). Results A total of 298 mothers (mean [SD] age, 27.2 [6.5] years) were identified from a large birth cohort and randomized into a conditional social transfer group (n = 100), an unconditional social transfer group (n = 97), or a control group (n = 101). The adjusted odds ratio of exclusive breastfeeding at 6 months post partum was 4.60 (95% CI, 2.10-10.07; P < .001) for the conditional social transfer group and 2.51 (95% CI, 1.11-5.66; P = .03) for the unconditional social transfer group compared with the control group. The risk of early exclusive breastfeeding cessation was lower for participants who received the unconditional social transfer (adjusted hazard ratio [aHR], 0.68; 95% CI, 0.49-0.92; P = .02) or conditional social transfer (aHR, 0.60; 95% CI, 0.44-0.83; P = .002) compared with participants in the control group. There were no significant differences between groups for child growth at 6 months post partum. Conclusions and Relevance The findings suggest that social transfers can substantially improve exclusive breastfeeding rates at 6 months post partum, with particularly large benefits for conditional transfers. Continued evaluation at 1, 2, and 3 years post partum will be conducted to assess the long-term outcomes of social transfers on complementary breastfeeding and child health and development over time.