- The document summarizes a study on the impact of micronutrient fortification of mid-day meals provided to school children in Odisha, India. - The study randomly assigned 148 schools to receive either regular mid-day meals (control), micronutrient-fortified meals (MNM), or MNM with high-intensity monitoring. It measured the impact on meal quality, child health outcomes, and learning. - The results found that providing MNM significantly increased zinc and vitamin A in meals but had no effect on child health measures. High-intensity monitoring improved hemoglobin levels potentially by better implementing an iron-folic acid supplementation program, while MNM crowded out the supplementation program.

1. 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

2. Outline
- Background
- Research Questions
- Research Design
- Key Results
- Questions?

3. Background
3
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.

4. Research Questions
4
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)?

5. Research Sample
5
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: 13,692
Every 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: 1,986
Power calculations indicated that hemoglobin and anthropometric data on 15 students
per school would allow us to statistically detect an effect.

6. 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.

7. Research Timeline
7
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 2015
Endline survey in 150 schools

8. Research Design
8
Outcomes being measured:
-Baseline and Endline
HH Survey
Cognitive test
Educational test
Health measurements (height, weight, MUAC and Hemoglobin)
School Survey
-Intervention Monitoring
Midday Meal Quality monitoring
Attendance: Teachers & Students
Implementation of IFA program survey
MNM Take-up
Nutritional Quality of Meals (Zinc and Vitamin A content in food samples)

9. Key Results
9
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 hemoglobin
concentration but not on the other anthropometric measures.

10. 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.

11. Questions?
11

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