This chapter examines the longer-term development implications for food and nutrition when cash transfer interventions intersect with food system changes taking place, particularly in urban areas where food is predominantly accessed through the market. The food system in many parts of the developing world is undergoing dramatic change. South Africa offers insights into these changes and is used here as a case study due to its advanced social protection, or social grant, system. This chapter considers the possible nutritional transition-related consequences for society, while at the same time questions the livelihood-related consequences for the poor when such cash transfer systems are integrated with formal financial systems. The chapter argues that while social protection and particularly cash transfers offer real benefits to society, it questions if certain social protection initiatives, particularly those in urbanised environments experiencing rapid food system transitions, could have unintended negative consequences. Could specific social protection strategies unintentionally exclude certain actors? Ultimately, in a rapidly urbanising context, could certain approaches to social protection constrain the development ambitions embedded in these programmes?