India has the world’s highest number of undernourished children and the largest school-feeding programme – the Mid-Day Meal (MDM) scheme – but limited evidence is available on the intergenerational impact of the programme. Based on data from the National Family Health Survey and National Sample Survey, this article shows if a mother was a beneficiary of MDM during schooling, there is a 20-30% reduction in height deficits of her children.
By April 2020, schools in 170 countries were closed to curtail the transmission of Covid-19. In India, 247 million children have been out of the classroom for over a year. Beyond the devastating consequences school closures are having on learning, health experts are particularly concerned about vulnerable Indian children missing out on the free lunch they receive at school.
School feeding programmes
Today, India has the world’s highest number of undernourished children and the largest school feeding programme – the Mid-Day Meal (MDM) scheme1.
Undernourishment, and particularly stunting (that is, being short for one’s age), is a marker of suboptimal conditions early in life and is associated with poor life outcomes such as lower productivity and earnings, and higher incidence of chronic diseases (Leroy and Frongillo 2019). Numerous studies have shown that programmes providing free meals to children at school can combat hunger, and support their education and long-term wellbeing (Chakraborty and Jayaraman 2016, Singh et al. 2014). School meals are especially beneficial for girls, incentivising their staying in school longer, postponing marriage, and lowering the chances of teen pregnancies, all of which are, unfortunately, still common in South Asia and have negative consequences on the nutrition of girls and their children (Afridi 2011, Scott et al. 2020, Nguyen et al. 2019).
But what is still unknown is whether the nutrition benefits of school feeding programmes carry over to the next generation.
Intergenerational impact of India’s midday meal scheme
India’s MDM scheme was launched in 1995, and thus its early beneficiaries are now of childbearing age. We hypothesise that women who received free meals when they were children in primary school would be better nourished and more educated as adults, and consequently would have children with improved height. To explore this hypothesis, we use MDM coverage data from the National Sample Survey – Consumer Expenditure Surveys (NSS-CES 1993, 1999, 2005), and child growth data from the National Family Health Survey (NFHS-4, 2016) (Chakrabarti et al. 2021). We examine associations between historic MDM coverage and current child stunting, and explore potential pathways through which receiving a free meal in school may benefit future child growth.
A first look supports our initial hypothesis: prevalence of stunting in 2016 is lower in states where more girls received free meals in school in 2005 (Figure 1).
Figure 1. Stunting prevalence and state-level coverage of Mid-Day Meal scheme
Source: National Family Health Survey (NFHS)-4 (2016) for stunting data, and 61st National Sample Survey (NSS) Consumer Expenditure Survey (2005) for state-level MDM coverage data.
Notes: (i) Figure shows association between stunting prevalence among children under five years of age in 2016, and MDM coverage among girls in the 6-10 years age group in 2005. (ii) Each circle represents an individual state in India, with circle size representing the state population size. (iii) Fit line and shaded 95% confidence interval are also weighted by state population size. (A confidence interval is a way of expressing uncertainty about estimated effects. A 95% confidence interval means that if you were to repeat the experiment over and over with new samples, 95% of the time the calculated confidence interval would contain the true effect.)
Our empirical analysis shows that this observed association between MDM in school and stunting prevalence among the next generation, holds when tested with rigorous statistical models. Our three key findings are: First, our statistical models that account for biasing factors2, show that if a mother was a beneficiary of MDM during schooling, there is a 20-30% reduction in height deficits of her children. This effect is greater among poor households. Second, to put these effects into perspective, our models estimate that 29% of the improvement in HAZ (height-for-age z score3) from 2006 to 2016, is explained by the MDM. Third, these findings are supported by programme pathway analysis4 showing that MDM beneficiaries have more years of education, are taller, give birth later and have fewer children, and are more likely to use health services compared to non-beneficiaries.
These findings provide evidence that, when intergenerational effects are considered, the complete benefit of school feeding programmes for nutrition is much larger than previously understood. School feeding programmes can address many fundamental drivers of undernutrition in a large segment of the population during pre-adolescence and adolescence, which are periods of high nutritional needs5.
Extending such programmes into and beyond middle school, and improving the quantity or quality of meals provided may further enhance their benefits. Programme expansion has substantial financial implications, but the multigenerational benefits likely outweigh the costs, as both education and nutrition improvements are societal needs. Many exciting initiatives to improve school meals are currently underway in India including – school gardens, breakfast meals, provision of eggs, micronutrient fortification of food staples, and integration of nutrition and hygiene education. Evidence of the impact and relative benefit of these initiatives are limited, demanding further evaluation, but such efforts to deepen and expand the impact of school meals should generally be welcomed, given their broad positive effects. A learning agenda that explores the multiple contributions of expanding programme coverage and improving meal quality can help ensure impact and cost effectiveness. Bringing stakeholders together to co-create this learning agenda is critical as schools re-open and as India seeks to ensure that the millions of school-aged children continue to get the nutrition they need to lead healthy and productive lives.
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- Launched in 1995 as a centrally sponsored scheme, the Mid-Day Meal (MDM) scheme provides children in government and government-aided schools (later extended to cover more groups of schools) with a nutritious, prepared midday meal. The scheme aims to improve the nutritional status of children studying in class one to eight, and to encourage children from disadvantaged sections to attend school more regularly and concentrate on school activities.
- The statistical models we use control for child age, sex, birth order, area of residence, religion, caste, access to services from the Integrated Child Development Services and Public Distribution System. Models include ‘fixed effects’ for mother’s birth year, state, household wealth, and the interaction of state and mother’s birth year. Fixed effects control for time-invariant unobserved individual characteristics.
- The z score expresses the anthropometric values such as height or weight as a number of standard deviations below or above median value of the reference population. (Standard deviation is a measure that is used to quantify the amount of variation or dispersion of a set of values from the average of that set.)
- Full MDM coverage predicts 3.9 years of attained maternal education, a delay in age at first birth by 1.6 years, having a fewer (−0.8) children, a higher probability (22%) of having at least four antenatal care visits, and a higher probability (28%) of giving birth in a medical facility.
- This would be particularly true for girls at the onset of menstruation.
- Afridi, Farzana, “The impact of school meals on school participation: evidence from rural India”, The Journal of Development Studies, 47(11): 1636-1656.
- Chakrabarti, Suman, Samuel P Scott, Harold Alderman, Purnima Menon and Daniel O Gilligan (2021), “Intergenerational nutrition benefits of India’s national school feeding program”, Nature Communications, 12: 4248.
- Chakraborty, Tanika and Rajshri Jayaraman (2019), “School feeding and learning achievement: Evidence from India's midday meal program”, Journal of Development Economics, 139: 249-265.
- Leroy, Jef L and Edward A Frongillo (2019), “Perspective: What Does Stunting Really Mean? A Critical Review of the Evidence”, Advances in Nutrition, 10(2): 196–204. Available here.
- Nguyen, Phuong Hong, Samuel Scott, Sumanta Neupane, Lan Mai Tran and Purnima Menon (2019), “Social, biological, and programmatic factors linking adolescent pregnancy and early childhood undernutrition: a path analysis of India's 2016 National Family and Health Survey”, The Lancet: Child & Adolescent Health, 3(7): 463-473.
- Scott, Samuel, Phuong Hong Nguyen, Sumanta Neupane, Priyanjana Pramanik, Priya Nanda, Zulfiqar A Bhutta, Kaosar Afsana and Purnima Menon (2021), “Early marriage and early childbearing in South Asia: trends, inequalities, and drivers from 2005 to 2018”, Annals of the New York Academy of Sciences, 1491: 60-73. Available here.
- Singh, Abhijeet, Albert Park and Stefan Dercon (2014), “School Meals as a Safety Net: An Evaluation of the Midday Meal Scheme in India”, Economic Development and Cultural Change, 62(2).