The mitigating effect of social protection on undernourishment during economic downturns: A longitudinal study of 46 low- and middle-income countries over the last two decades

Abstract

Background

Low- and middle-income countries (LMICs) are particularly vulnerable to the adverse effects of economic downturns on the Prevalence of Undernourishment (PoU). Our study aimed to evaluate the impact of Social Protection and Labor Programs (SPL) on PoU in 46 LMICs from 2001 to 2019, and to estimate SPL mitigating effects during economic downturns.

Methods

This cohort study used a multi-country ecological design with two-ways fixed effects multivariable linear regression models, adjusted for relevant demographic, socioeconomic, and contextual variables. Interaction terms between economic downturns and SPL were used to evaluate SPL mitigating effects.

Findings

Our study cohort displayed an average 15.30% PoU and 34.34% SPL coverage in the initial year, contrasting with 8.58% PoU and 43.81% SPL coverage in the final year. A 10% SPL coverage was associated with a 0.51% PoU reduction (95%CI: 0.04–0.99) across all countries and 0.78% reduction within the poorest subgroup. SPL have been able to prevent an estimated 1.01 billion (95% UI: 0.16–1.86) cases of undernourishment over the study period in the 46 LMICs. Economic downturns were associated with a 4.55% PoU increase (95% CI: 1.28–7.81) in all countries, and a 6.06% PoU increase in the poorest subgroup. High SPL coverage during the downturns had significant mitigating effects, reducing an overall 1.17% PoU for every 10% SPL coverage in all countries, and 1.81% PoU in the poorest nations.

Interpretation

Amid the ongoing multiple global crises, expanding the coverage of social protection could effectively mitigate the potential increases in undernourishment during economic downturns, contributing to the achievement of nutrition-related Sustainable Development Goals in LMICs.