CAPTURING THE DIRECT AND SPILL-OVER EFFECTS OF INDIA'S SUPPLEMENTARY NUTRITION PROGRAMS

Sunday, January 10, 2016: 09:45
Shaw Auditorium, 1/F (Jockey Club School of Public Health and Primary Care Building at Prince of Wales Hospital)

Lea Prince, MA, PhD, Centers for Health Policy and Primary Care and Outcomes Research, Department of Medicine, Stanford University, Stanford, CA, Kimberly Babiarz, PhD, Stanford University, Stanford, CA and Jeremy D. Goldhaber-Fiebert, PhD, Stanford Health Policy, Centers for Health Policy and Primary Care and Outcomes Research, Department of Medicine, Stanford University, Stanford, CA
Purpose: Nearly half of children under age 6, an estimated 230 million children, are malnourished in India. The national Integrated Child Development Services (ICDS) program aims to reduce childhood malnutrition through supplemental nutrition and food transfers.  We estimated the net impact of ICDS on nutritional intake among program-eligible households, and measured spillover or learning effects associated with ICDS among ineligible households.   

Method(s): We analyzed longitudinal data describing household expenditures on food goods and their nutrient content using the 2004-2011 Indian National Sample Surveys (n=362,701).  We used government reports to construct an annual measure of state-level program intensity (% of children below 6 years receiving food from ICDS). We performed a difference-in-difference ordinary least squares regression analysis of the impact of ICDS on food expenditures and dietary nutrients controlling for household characteristics and time/place fixed effects. Program eligibility was defined as households with children below 6 years with a comparator of otherwise similar households with no children. Spillover and learning effects were measured among households with children recently aging out of eligibility (6-10 years) also compared to households with no children. 

Result(s): At average program intensity (37%), ICDS increased eligible household daily net caloric intake (126 calories [95% CI: 39 - 212] (rural); 206 [95% CI: 123 - 288] (urban)), assuming program transfers accorded with ICDS norms. Eligible households shifted daily food purchases away from dairy (-44 grams [95% CI: -69 - -18] (rural); -21 grams [95% CI: -45 - 3] (urban)) and cereals (-36 grams [95% CI: -47 - -25] (rural); 7 grams [95% CI: -13 --0.2] (urban)) toward rice and wheat (rural households) or meat (urban households). ICDS had similar but smaller effects on nutritional consumption and food expenditure in households with children too old for program eligibility, providing evidence of spillover effects or household learning associated with ICDS.

Conclusion(s): India’s ICDS modestly increased net caloric intake especially in rural areas even as households responded to food transfers by reducing and shifting their food expenditures. As these net effects were smaller than the ICDS transfers and also occurred in households with older children, evaluations of ICDS’s benefits should account for both changes in household consumption that may offset the programs transfers and spillovers to non-eligible households.

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