Impact of Micronutrient

Fortification of Mid-day meals:

Evidence from a Randomized

Control Trial in Odisha

Prof Kartini Shastry| Department of Economics, Wellesley College

Prof Priya Mukherjee| Department of Economics, College of William and Mary

Prof James Berry| Department of Economics, Cornell University

New Delhi|November 10, 2016

Outline

- Background

- Research Questions

- Research Design

- Key Results

- Questions?

Background

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PROBLEM: NUTRITIONAL DEFICIENCIES among CHILDREN

- Affects child health and learning- Children likely to become low productivity adults. Have low earning potential- Lowers economic growth at macro level

POSSIBLE SOLUTION: Early Childhood Health Interventions

- The Mid-day Meals Program (MDM): A Supreme Court mandated program.- Benefits: Public school students are entitled to one hot meal every school day.- Issues: Limited resources, inadequate infrastructure, inefficiency, and poor meal quality.

Research Questions

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The study aims to answers the following questions:

-Does micronutrient fortification of mid-day meals improve meal quality, child health (hemoglobin and anthropometric measures) and educational outcomes?

-Does increased monitoring of mid-day meals improve take-up of the fortificant, meal quality and consequently, child health outcomes?

-Does micronutrient fortification and monitoring of mid-day meals have any spillover effects on the quality of mid-day meals as well as the Iron Folic Acid (IFA) program (implemented by Government of India)?

Research Sample

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Study Location: Five Blocks in Keonjhar district, Odisha

Sample: 148 Schools

Study Design: 148 schools randomly assigned to different treatment arms after stratifying by Block and School Type (whether the school has higher grades/classes)

No. of Students affected by Study: 13,692Every student in our study schools would receive the treatment their school was assigned to (on average there are 100 students in each study school)

No. of Study Subjects: 1,986Power calculations indicated that hemoglobin and anthropometric data on 15 students per school would allow us to statistically detect an effect.

Research Design

6

Treatment # of Schools

Control Continuation of un-fortified mid-day meals 73

MNM Meal provider education and micronutrient mix provision

75

High High Intensity Monitoring (5 unannounced monitoring visits during meal time in schools)

75 (37 from MNM,36 from Control)

Details of Intervention:

-Provision of Micronutrient mix comprises of Vitamins A, D, C, B1, B2, B6, B12,Niacin, Zinc, Selenium and Calcium for five months in MNM schools.

- Training Headmasters, cooks on health benefits of fortificants, how to store and use it in meals before serving.

Research Timeline

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Sept 2012-Jan 2013

Feb-Mar 2013

Apr 2013-Sept 2014

Oct 2014

Nov 2014-Mar 2015

Baseline Survey in 150 schools

Govt of India Launches IFA program

-Intervention redesigning and securing approval

Govt of Odisha approves the Intervention

-MNM Intervention

-Monitoring and data collection

Apr-July 2015Endline survey in 150 schools

Research Design

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Outcomes being measured:

-Baseline and Endline

HH SurveyCognitive testEducational testHealth measurements (height, weight, MUAC and Hemoglobin)School Survey

-Intervention Monitoring

Midday Meal Quality monitoringAttendance: Teachers & StudentsImplementation of IFA program surveyMNM Take-upNutritional Quality of Meals (Zinc and Vitamin A content in food samples)

Key Results

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Take up

-Provision of MNM to schools significantly increases Zinc and Vitamin A levels in mid-day meals served in schools.

-High intensity monitoring has no impact on MNM take-up in schools or on Zinc and Vitamin A levels of meals.

Main Effects

-Provision of MNM to schools has no significant impact on hemoglobin levels, height for age, weight for age and MUAC of children.

-High intensity monitoring has significant positive effect on hemoglobinconcentration but not on the other anthropometric measures.

Key Results

10

Interactions between programs

-High intensity monitoring improved the implementation of the IFA programme (more students reported receiving IFA tablets weekly), potentially the mechanism by which it improved haemoglobin levels.

- Provision of MNM to schools crowded out the implementation of the IFA programme and also reduced the likelihood a meal was served.

Questions?

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