21 July 2011

Some Good Nutrition News out of India?

A new paper by Eeshani Kandpal, forthcoming in the journal World Development reveals “unambiguous evidence that the ICDS (the Integrated Child Development Services programme) significantly reduces long term child malnutrition in India”.

ICDS is a child development programme with nearly a million centres throughout India. It is focused on welfare for children from birth to 6 years of age involving, feeding, health counselling, and education. Most studies have found ICDS to be ineffective in raising the levels of infant chronic undernutrition as measured by cumulative shortfalls of height for age from international standards (also known as stunting).

I feel that the paper slightly oversells its results, but maybe the temptation was strong, because the paper is very carefully done and methodologically sound and this is rare for ICDS, the largest nutrition-related programme in the world. In short, the paper is an important contribution.

The paper is noteworthy for a number of reasons:

• It uses the most recent nutrition data in India (2005-6)
• It properly uses propensity score matching to match up children in ICDS areas with those not in ICDS areas, but are identical in terms of observable factors that determine stunting rates and observable factors that determine participation in ICDS. The matching is vital, because ICDS is supposed to be targeted to areas in which stunting rates are highest. Without matching it is very possible that ICDS children would show higher stunting rates because of this targeting (and this is what the author actually finds)
• It compares matched and unmatched estimates of the effects of ICDS
• It breaks the results down by severely and moderately stunted children and by children under the age of 2 and under the age of 3, and by gender.


• For all children, the matched estimates show that ICDS has a positive and significant impact of 6% on child stunting. The unmatched estimates show a negative and significant impact of ICDS of about 7%. Matching matters, big time.
• The positive impacts seem stronger for the moderately stunted than for the severely stunted
• The results are stronger (magnitude and significance) for boys
• These analyses are run for the 1992-93 data and for the 1998-99 data and the results are generally zero. So ICDS is now having an overall positive impact on stunting, whereas before it did not.
• The 2005-06 results show stronger effects for those less than 3 years of age compared to those only less that 2 years of age
• A separate analysis of where and how ICDS centres are placed finds that placement is likely to be pro-poor, although areas with more educated mothers are favoured and areas with gender population imbalances are not favoured
• Another analysis of ICDS expenditures at the 29 state level indicates that stunting levels do not drive allocations, but votes for the political alliance that won the 2004 national election have a positive impact on the ICDS funds received

The paper shows that ICDS has an overall positive impact on stunting rates using the 2005-06 data (unlike with previous rounds of data), but that this impact is not particularly well focused on the most stunted or on under 2s.

The author suggests that the ICDS investment yields a 3.75 fold net return. The questions that remain: (a) did anything happen in ICDS design to result in this recent impact? (b) is a certain level of wealth needed before national integrated programmes such as ICDS can have an effect (as opposed to more focused cash transfers?), and (c) how much can the net benefit/cost ratio of 3.75 be improved (community based nutrition promotion reach ratios of 12:1--see Horton, Alderman and Rivera 2008, Copenhagen Consensus) through a more nutrition focused allocation of ICDS funds to states, through better placement of ICDS centres and through a better focus on under 2s, on those with severe stunting and on girls?

At last, we have a good nutrition story out of India (although not quite as good as the author would have us believe).


  1. It's an important study on how the program is able to reduce malnutrition in the country.

  2. Just like other countries in Asia, malnutrition is one main of the problems resulting to their people being so sick.

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  3. It is understand that Malnutrition is most found in Asia and Africa because they have lacking of basic needs, they even do not have a pure water to drink and we are talking about expensive and fresh food . . .
    nutrition articles

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  5. Breaking bad news to someone is difficult. Having to tell him bad news that is totally unexpected makes the situation even more difficult. Regardless of the circumstances surrounding the situation, you should try to make the person you are breaking the bad news to as comfortable as possible. Thanks.

  6. Good news then. It's good that there's a particular program that can help alleviate the nutrition problem in India.