NUTRITIONAL EFFECTS OF INDIA'S COOKED MID DAY MEAL PROGRAM: A DIFFERENCE-IN-DIFFERENCE ANALYSIS OF 730,110 HOUSEHOLDS

Purpose: School based food transfer programs are a common policy approach to address malnutrition among school-aged children.  Such programs function in >70 low- and middle-income countries. They have generally demonstrated effectiveness in increasing caloric intake at school, but net nutritional benefits depend critically on changes in household purchasing and consumption induced by programmatic food transfers. While accounting for changes in home-based consumption, we assess the net nutritional effects of the largest school feeding program in the world, India's Cooked Mid Day Meals (CMDM) program which serves cooked meals to 120 million primary school children.

Method(s): With a large longitudinal dataset including 730,110 households over 19 years (1994-2012), we estimate CMDM's effects on household consumption (household food purchases and corresponding caloric, macronutrient and micronutrient content). We use difference-in-difference models employing ordinary least squares regressions controlling for household characteristics, and place and time fixed-effects. We compare induced changes in home consumption to CMDM program per-meal nutrient norms, accounting for mean program exposure.

Result(s): CMDM's transfers cause CMDM-eligible households to reduce daily at-home consumption of rice and wheat (124.8 gram reduction [95% CI: 104.7 - 144.9]), legumes (5.5 gram reduction [95% CI: 3.6 - 7.5]), and vegetables (28.3 gram reduction [95% CI: 13.3 - 43.4]). At the same time oil consumption increases (4.5 gram increase [95% CI: 3.4 - 5.5]). Changes in household consumption induced by the program imply a reduction in home-based calorie, protein, iron and zinc intake, and an increase in calcium (primarily driven by households with lower levels of education). Because reductions in home-based legume and vegetable consumption do not fully offset transfers that occur via school meals delivered according to program norms, CMDM induces some dietary diversification if the program meets meal standards (Figure 1). However, overall net calorie consumption is reduced and protein intake is unchanged under the CMDM program. Effects are largest for poorer households.

Conclusion(s): The effect of school based feeding programs depends critically on how households respond to benefits transferred to school children. Our study shows that CMDM's nutritional effects are blunted by reduced household food purchases. Households reduce total caloric consumption, sometimes overcompensating for program food transfers. However, households also respond by diversifying their diets towards nutrient-rich foods. Future policy designs should carefully account for household responses to them.