Rajasthan's cash-plus scheme linked to healthier birth weights, finds study published in Nature Health

Programme combining cash transfers with counselling associated with 7.4 percentage-point drop in low birthweight among 90,000+ newborns from tribal communities in southern Rajasthan

JAIPUR, India, July 22, 2026 /PRNewswire/ -- A Rajasthan state government-run maternal nutrition programme that paired conditional cash transfers with nutrition counselling and community outreach was associated with meaningfully better birth outcomes for mothers and newborns, according to a large-scale study published today in Nature Health, part of the Nature Portfolio, published by Springer Nature.

The evaluation analysed routine health records of 90,732 newborns and 60,899 mothers across four predominantly tribal districts of southern Rajasthan, where maternal undernutrition and limited access to health services remain persistent challenges. Low birthweight affects roughly one in five babies born in India, according to the National Family Health Survey (NFHS-5), and is linked to higher risks of infection, stunting and poor long-term health. Rajasthan's tribal belt has historically reported some of the state's weakest maternal nutrition indicators, making the findings especially significant for policymakers designing similar schemes elsewhere in the country.

What the study found

Rajasthan's 'Cash Plus' programme targeted women in their second pregnancy between January 2021 and August 2024, combining conditional cash transfers with individual and family counselling, community engagement, and locally designed media campaigns carrying simple health messages.

Compared with the period before the programme, it was associated with:

• A 7.4 percentage-point reduction in the prevalence of low birthweight
• An average 3.4 kg increase in mothers' pregnancy weight by the third trimester
• An increase of around 70 grams in mean birth weight

Why it matters for India

India carries one of the world's highest burdens of low birthweight and maternal undernutrition, and successive national surveys have shown only gradual improvement despite decades of nutrition programming. While cash transfer schemes and behaviour-change campaigns have each been tried separately across Indian states, robust, large-scale evidence on what happens when the two are combined and delivered through existing government systems, at scale, outside a controlled trial has been limited.

"This study adds important real-world evidence from India on how a government-led cash-plus programme may be associated with improved maternal nutrition and birth outcomes in routine settings," said Tanya Marchant, Professor of Implementation Science at the London School of Hygiene & Tropical Medicine and a co-author of the study.

"Cash assistance can help families overcome financial barriers in accessing nutritious food, but information, motivation and support are equally, and at times more, important," said Raghwesh Ranjan, Senior Director at IPE Global and a co-author of the study. "The cash-plus approach combines financial assistance with counselling and contextual behaviour nudges, giving women both the resources and the knowledge to exercise real agency over their nutrition choices. Together, cash and knowledge empower women and their family members to make informed decisions and translate resources into healthier nutrition and care practices during pregnancy."

The study was observational, using an interrupted time-series design, meaning it shows an association rather than proof of direct cause and effect. Factors including the COVID-19 pandemic and the limitations of routine administrative data may also have influenced results. Even so, the authors say the findings offer rare, large-scale evidence from a government-run nutrition intervention in India, with relevance for similar schemes being planned or scaled up in other states.

The study was conducted by researchers from the London School of Hygiene & Tropical Medicine and IPE Global and IIHMR, Jaipur in collaboration with the Government of Rajasthan.

The paper, 'Effects of a cash-plus intervention combining conditional cash transfer with social and behaviour-change communication on pregnancy weight and birth weight in India', is published in Nature Health.

Notes to editors

Article title

Effects of a cash-plus intervention combining conditional cash transfer with social and behaviour-change communication on pregnancy weight and birth weight in India

Journal

Nature Health

Article type

Original research published Open Access

DOI

10.1038/s44360-026-00143-9

Publication date

2 June 2026

Authors

Tanya Marchant, Christian Bottomley, Rupinder Sahota, Akash Porwal, Namita Wadhwa, Srei Chanda, Raghwesh Ranjan, Divya Santhanam, Mahendra Soni and Arindam Das

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