The Journal of Development Studies

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Does the ICDS Improve Children’s Diets? Some

Evidence from Rural Bihar

Nitya Mittal & J. V. Meenakshi

To cite this article: Nitya Mittal & J. V. Meenakshi (2018): Does the ICDS Improve Children’s
Diets? Some Evidence from Rural Bihar, The Journal of Development Studies, DOI:
10.1080/00220388.2018.1487054

To link to this article: https://doi.org/10.1080/00220388.2018.1487054

Published online: 10 Jul 2018.

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The Journal of Development Studies, 2018
https://doi.org/10.1080/00220388.2018.1487054

Does the ICDS Improve Children’s Diets? Some

Evidence from Rural Bihar
NITYA MITTAL* & J. V. MEENAKSHI**
*Centre for Modern Indian Studies, University of Goettingen, Goettingen, Germany, **Department of Economics, Delhi School
of Economics, University of Delhi, Delhi, India

(Original version submitted February 2017; final version accepted May 2018)

ABSTRACT Although there are several studies documenting the impact of the Integrated Child Development
Scheme (ICDS) – the largest preschool intervention – in India, few have documented to what extent it improves
the quantity and quality of food consumed by young children. This paper attempts to provide causal estimates of
the impact of the ICDS on calories, protein, iron, and Vitamin A intakes of children. Using matching techniques to
define an appropriate counterfactual, and a primary survey in four villages in rural Bihar, our results suggest that:
(a) for older children three to six years who benefit from cooked meals, the ICDS did result in higher intakes of
calories, protein, and iron, and no substantive evidence that as a consequence there was substitution away from
food at home. However, there was no impact on vitamin A intake; (b) for younger children whose mothers are
given take-home rations, there is no evidence the ICDS improved intakes of calories or any other nutrients. Thus,
even though the monetary value of the transfer was the same across both age groups, there is evidence to suggest
the mode of transfer does seem to matter to ICDS effectiveness, consistent with other literature.

1. Introduction
A prolonged period of sustained economic growth notwithstanding, India continues to be home to the
largest population of undernourished people in the world (FAO, 2015). Young children are particularly
vulnerable to food insecurity, and India’s rates of child malnutrition remain high. In rural India, nearly
61 per cent of one to three year olds and 40 per cent of four to six year olds consume less than 70 per
cent of the recommended dietary allowances for energy. The corresponding figures for iron are 65 and
61 per cent, and for vitamin A, 88 and 86 per cent, respectively (National Nutrition Monitoring
Bureau, 2012). These low intakes also manifest in biochemical indicators: the prevalence of sub-
clinical vitamin A deficiency among rural pre-school children has been estimated at 62 per cent, while
that of moderate and severe anaemia is 43 per cent (National Nutrition Monitoring Bureau, 2006).
These magnitudes are of concern, as anaemia may lead to impaired physical and cognitive develop-
ment (WHO, 2001) while Vitamin A deficiency is implicated in preventable blindness and morbidity
(related to measles for example) as well as higher mortality among children.1
The Integrated Child Development Scheme (ICDS) is a nation-wide early childhood care and develop-
ment intervention to improve nutritional outcomes for children under six years of age. The major
component of the ICDS2 is supplementary nutrition (SN) which has the explicit objective to ‘. . .bridge
the gap between the Recommended Dietary Allowance (RDA) and the Average Daily Intake (ADI) of
children. . .’ (http://icds-wcd.nic.in/icds/icds.aspx), by providing 500 calories and 12–15 grams of protein
per day to each child (with higher amounts for children who are severely malnourished).

Correspondence Address: J. V. Meenakshi, Department of Economics, Delhi School of Economics, University of Delhi, Delhi
110007, India. Email: meena@econdse.org

© 2018 Informa UK Limited, trading as Taylor & Francis Group

2 N. Mittal & J. V. Meenakshi

The mechanism by which the ICDS delivers the supplementary nutrition varies by age group.
Children aged between three and six years are provided a cooked meal at the ICDS centre, known as
the anganwadi, six days a week. Mothers of children aged young than three years are provided an
equivalent amount of take-home rations at regular intervals.
Irrespective of the mode of transfer, the intervention may not automatically translate into an increase
in food intakes of beneficiary children by the programme-mandated 500 calories and 12–15 grams of
protein. For instance, the ICDS centres may not be functional, or serve less than the mandated amount
of food. However, even if there were no supply constraints, or leakages in implementation, these
magnitudes could well be lower depending on the extent to which parents substitute away from food
provided to the child at home.
The intervention amounts to an exogenous implicit income transfer, since the ICDS is universal in
coverage. To this extent, food intakes should increase. Several outcomes are possible: (i) if the ICDS
transfer is treated as other income, the child’s food intake should increase by the marginal propensity
to consume; (ii) however, since the programme counsels mothers, who may have different preferences
(as compared to fathers) over spending on child-specific goods, and may view food transfers
differently from income transfers (see Lundberg & Pollak, 1996), intakes may increase by more
than what would be indicated by an untargeted income transfer and could even equal the programme-
mandated amounts, with low or limited substitution of food provided to the child at home. But (iii), it
is also possible that mothers perceive that their children are well-nourished (implying near-zero
income elasticities), and therefore completely substitute for the ICDS intervention by correspondingly
allocating less food to the child at home, translating into no increase in the child’s net food intake; (iv)
finally, even if overall intakes of calories remain unchanged, it is possible that the quality of the diet
changes as a consequence of the ICDS, and is reflected in higher intakes of micronutrients.
This provides the context for this paper, which attempts to provide causal estimates of impact of the
ICDS on (a) the quantity (calories) and (b) the quality (protein, iron, and Vitamin A) of food consumed
by young children. In particular, it examines if impact varies across children one to three years old
who receive take home rations, and children three to six years old who are served a meal on-site. For
the older children, the paper quantifies impact on the quantity and quality of (i) overall intakes and (ii)
food consumed at home, to examine whether parents compensate for the ICDS meal either in whole or
in part. The paper is based on a primary survey conducted in rural Bihar.
Although there are several papers evaluating the causal impact of the ICDS on child anthropometric
outcomes (see for example Lokshin, Gupta, Gragnolati, & Ivaschenko, 2005; Kandpal, 2011; Jain, 2015;
Mittal & Meenakshi, 2015), there is limited literature on its impact on food intakes of young children, and
the degree of substitution for food at home. Beaton and Ghassemi (1982) review the impact of participation
in eight pre-school food supplementation programmes, including two Indian programmes implemented in
the 1970s. They report that these interventions resulted in an increase in food intakes of between 66 and
110 calories per child. Vaid and Vaid (2005) find that ICDS participants have higher intakes of calories,
proteins, fats, and iron than non-participants, but their study is based on a relatively small sample and on a
simple comparison of averages. Afridi (2010) finds that the mid-day meal programme, which provides
cooked-meals to older (school-going) children, reduced the prevalence of calorie and protein deficiencies,
and that increased intakes of calories and proteins constituted at least 50 and 60 per cent of the intended
transfer, respectively.3
This paper thus attempts to contribute to the literature by providing more recent, and causal
evidence of impact of the ICDS programme on food intakes. A second contribution of this paper is
its focus on calories and the quality of food. A third distinguishing feature is that it is based on the
utilisation of (in contrast to access to) ICDS services, and thus is conditional on supply. Our results
suggest that the ICDS significantly increased calorie intakes of three to six year old children who were
fed a cooked meal on-site, but had no impact on younger children whose mothers were given take-
home dry rations. The impact on diet quality was modest, and again restricted to the older children.
The paper is organised as follows. The sampling strategy, method of estimation of food intakes,
and summary statistics are set out in Section 2, while Section 3 sets out the matching methods
 ICDS and food intakes in rural Bihar 3

used to estimate impact, disaggregated by mode of transfer. Section 4 discusses results and Section
5 concludes.

2. Sampling design, estimation of food intakes, and summary statistics

2.1. Sampling design
The analysis is based on a primary survey conducted from February to April 2013 in two villages,
each in the Patna and Darbhanga districts in Bihar. These four villages are part of the Village
Dynamics of South Asia sample of the International Crops Research Institute for the Semi-Arid
Tropics. In each village, the sampling frame comprised of households with children in the target
age-group of one to six years. These households were then stratified into four classes based on size of
holding (including the landless), and sampled with probability proportional to size in each stratum.
Thus, 30, 25, 12, and 13 households were randomly selected from the landless, small, medium, and
large land owning categories, respectively, adding up to 320 households, 80 in each village. A
reference child was then randomly selected from eligible children within each household. Among
them, there were 215 children aged above 33 months who received cooked meals,4 and 105 younger
children whose mothers received take-home rations.5

2.2. The ICDS in the sample villages

Fourteen ICDS centres served the four sample villages. Apart from one village, this conformed to the
norm of one ICDS centre per 800 population, with each centre expected to serve 80 children.
For the most part, the 14 centres were functional, and were housed in solid structures that had roofs,
flooring, and exterior walls, and had adjoining open areas for physical activities. Our sample house-
holds reported that food was prepared and served all six days of the week.
Take-home rations, consisting of 2.5 kilograms of rice and 1.25 kilograms of pulses are supposed to
be provided to mothers of younger children once a month.6 We asked households whether the
reference child had received take-home rations in the last three months. For nearly half the households
whose response was yes, we further probed about how often they were received. In our sample, 73 per
cent reported receiving take-home rations once a month, while 6 per cent received them once in two
months and 21 per cent once in three months.
During the field work (which lasted nearly three months), we visited each centre at least four
times, each on different days of the week. These visits were not pre-announced, and were timed to
coincide with lunch time, to preclude the possibility that a morning visit would influence how
much was cooked. In each instance, the centre was functional and served meals to between 30 and
35 children. We found that the menus specified for the day were indeed being cooked. By design,
the various menus are equivalent in calorie and protein content7 and therefore do not vary greatly
from day to day.
Also, nearly all centres had teaching aids. However, most centres had dysfunctional weighing
machines (necessary for growth monitoring) and did not store a basic medicine kit.
Thus as far as supplementary nutrition is concerned, the ICDS seems to be functioning reasonably
well.8 Of the entire sample of 314 children,9 145 (46%) had received SN from the ICDS. Similar
participation rates were also obtained among the two sub-samples: 48 out of 102 children aged under
three years received take-home rations at least once during the previous three months, and over the
same period, 97 of the 212 children three to six years got cooked meals at the anganwadi. The value of
the take-home rations, evaluated at prevailing market prices in the sample villages, amounted to Rs.
104 per beneficiary household per month; a magnitude that was the same as that of the cooked meal
provided to older children.
4 N. Mittal & J. V. Meenakshi

2.3. Estimating energy and nutrient intakes for young children

The survey questionnaire consisted of several modules, including one on household-specific socio-
economic characteristics, and another on care-giver (mother)-specific information. The unique
aspect of the data collection, however, was the estimation of food intakes of each reference
child, using a multiple-pass, 24-hour recall methodology outlined in Gibson and Ferguson
(2008). The respondent (for each of these modules) was the mother of the young child (or a
grandmother, if she was the primary care giver). A team of two female enumerators, who belonged
to the same area, first visited the household to introduce the study, take consent, and elicit
demographic and anthropometric information. Mothers were provided colourful plates and asked
that the reference child be fed separately from this plate (in this region it is common for adults to
feed children from their plates) and to observe how much the child was consuming. On the third
day, mothers were asked to detail how much was cooked and consumed by the household, child,
and its parents. These quantities were then converted into nutrient intakes using food composition
tables and recipes specific to the region. We also checked if snacks had been consumed by children
outside the home, and made adjustments accordingly.10 Though there is only one observation per
child, the survey was carried out on all days of the week (including Sundays and holidays) to
average out with-in week variation in intakes.
For children one to three years old, this provides an estimate of their total food intakes. For older
children three to six years, however, it is necessary to include the nutrient content of the ICDS meal.
In the sample villages, the ICDS menu consisted of khichdi (a dish made of rice, pulses, and
vegetables), pulao (made with rice, vegetables, and groundnuts), halwa (made using wheat flour,
gram flour, and jaggery) and kheer (made of rice, jiggery, and groundnuts). Khichdi was served
thrice a week, while all other dishes were served once a week. Unlike some other states, none of
these foods were fortified with micronutrients. These recipes were designed specifically for
children.
Since it was not possible for us to measure the quantity of food consumed by each child at the
centre, we account for the nutrient content of the ICDS meal using estimates provided by Fraker, Shah,
and Abraham (2013) who conducted laboratory tests of the energy and protein content of ICDS meals
collected from 200 centres in Bihar. They find that on average, the ICDS meal provided 386 calories
and 11.7 grams of protein per day per child, which is 78 per cent of the mandated amount.11 It was not
possible to get a more granular estimate of the content of the ICDS meal. And though our visits to
anganwadi centres suggested they all provided supplementary nutrition regularly, the possibility that
there was centre-level variation in the nutrient content of meals that contributes to the measurement
error in computing total food intakes cannot be ruled out.
The use of Fraker’s estimates to determine the average nutrient content, introduces measurement
error for other reasons as well. First, there are no fixed portion sizes: once all children were given a
single helping, they could ask for as many helpings as they wanted; these were not refused; so some
children may have eaten more than others (we did not observe any child leaving uneaten food on the
plate). Second, it is quite likely that older children consumed higher amounts than younger children;
once again this could not be verified. Finally, it is also possible that, since some recipes (for instance
those involving jaggery) are more liked than others, children may have had more servings on days that
such foods were given. Although our expectation is that this would average out over the week, our
results need to be interpreted in light of these sources of measurement error.
Since there are no mandated norms for the micronutrients, the iron and vitamin A contents of the ICDS
meal were computed from the recipes as detailed above.12 Fraker’s estimate of 78 per cent was then taken
as the actual content: this is equivalent to 250 mcg of vitamin A and 2.9 mg of iron.
Another issue in estimating nutrient intakes has to do with breast feeding. Nearly 80 per cent of the
one-year olds and half of the two-year olds were breastfed; these proportions were the same across
ICDS participants and non-participants. It was not possible to assign a nutrient value to breast milk,13
and nor do we have information on the frequency of breast-milk. As a proxy, albeit imperfect, we
include a dummy variable on breast-feeding status in the estimation.
 ICDS and food intakes in rural Bihar 5

2.4. Summary statistics

Estimates of total intakes, and of food consumed at home for the full sample and each of the two sub-
samples of children are presented in Table 1. For children three to six years, the total and at-home
intakes differ by the amount of the ICDS meal. A nutrient value for the ICDS meals is imputed only
for those children who consumed it on the day of the survey; further, all such children are assumed to
have received the same quantity of calories and nutrients from the meal. Note that this is not the same
as adjusting the caloric intake of all participating children by this amount, as on the day of the survey a
participating child may not have eaten at the centre (because the survey day may have coincided with
the centre’s weekly off-day or for other reasons); thus the estimated distribution of total calorie
(nutrient) intakes is not merely a mean-shift of the distribution of calorie (nutrient) intakes from
food eaten at home. Among all SN participants, 60 per cent consumed an ICDS meal on the day of the
survey.14 Since the younger children get take-home rations and do not eat any meals at the ICDS
centre, no adjustments are necessary; the total and at-home intakes coincide.
Calorie and protein intakes from food at home for ICDS participants was significantly lower for the
full sample, as well as the two sub-samples. Total energy and protein intakes were, however, no
different across participants and non-participants for the full sample. This is suggestive of substitution
for the ICDS meal. Children three to six years old who received cooked meals had higher intakes of
energy (by 99 calories), and of protein (by 4.2 grams).
To put these numbers in perspective, among the three to six year olds who received SN, 37 per cent
had intakes of calories below the age-specific requirements (Indian Council of Medical Research
(ICMR), 2010); the corresponding figure for non-participants was 48 per cent. For children one to
three years, 56 per cent of participants and 39 per cent of non-participants had energy intakes that were
lower than the requirements. For protein, 9 per cent of three to six year olds and 44 per cent of the one
to three year old ICDS participants had inadequate intakes; the percentages in both cases being higher
for non-participants.
Intakes of micronutrients are also low: more than four-fifths of the sampled children had inadequate
intakes of iron and vitamin A, and there were no differences in intakes across participants and non-
participants for both age groups.
Participants and non-participants differ in other ways as well. Participants in both the sub-samples
are more likely to belong to poorer households.15 They are also less likely to belong to ‘other’ caste
category households and more likely to belong to the same caste as the ICDS worker, suggesting that
social access costs (or caste-based social networks) matter. Also, they were more likely to have used
ICDS services previously. SN participants among the older cohort lived closer to the ICDS centre (but
by a difference that is not economically meaningful) and also differed in the degree to which mothers
had bargaining power16 within the household, and had nutritional knowledge.17 No other character-
istics were significantly different across the two groups.18
These systematic differences in average characteristics between participants and non-participants
suggests that it is necessary to account for them in constructing a counter-factual that is comparable to
participants to estimate impact of the ICDS. Matching methods discussed below help achieve this.

3. Empirical strategy
Given that participation in the ICDS is voluntary, it is necessary to account for selection into the
programme. The summary statistics above suggest that the two groups cannot be treated as if they
were randomly allocated to participation status, so that it is necessary to create a valid comparison
group to obtain unbiased estimates of impact.
Under the maintained assumption that the factors that determine participation are observed, match-
ing techniques can be used to create the appropriate counterfactual. This is the approach used by most
studies examining the impact of the ICDS on anthropometric outcomes, including Jain (2015),
Kandpal (2011), and Mittal and Meenakshi (2015). Matching methods match participants with non-
participants who are similar on these observed characteristics.
 Table 1. Summary statistics, disaggregated by age group

Full sample Children 3–6 years Children 1–3 years

6 N. Mittal & J. V. Meenakshi

Variables SN participants Non participants Difference SN participants Non participants Difference SN participants Non participants Difference

A. Energy and nutrient intakes of reference child

Energy intakes at 1,085 1,223 −138*** 1,141 1,273 −132** 972 1,116 −144**
home (kcal/day) (32.86) (30.62) (44.91) (39.54) (39.01) (55.54) (55.96) (44.87) (71.73)
Total energy intakes, 1239 1,223 16 1,372 1,273 99*
(kcal/day) (36.35) (30.62) (47.53) (40.64) (39.01) (56.33)
Protein intakes at 24.2 27.6 −3.4*** 26.9 29.6 −2.7* 18.6 23.2 −4.6**
home (grams/day) (0.92) (0.90) (1.29) (1.05) (1.09) (1.51) (1.55) (1.42) (2.10)
Total protein intakes, 28.9 27.6 1.3 33.9 29.7 4.2***
(grams/day) (1.11) (0.90) (1.42) (1.16) (1.09) (1.60)
Iron intakes at 6.7 7.4 −0.7 7.7 8.0 −0.3 4.6 6.2 −1.6*
home (mcg/day) (0.37) (0.38) (0.53) (0.43) (0.46) (0.63) (0.61) (0.65) (0.89)
Total iron intakes, 7.8 7.4 0.4 9.4 8.0 1.4**
(mcg/day) (0.41) (0.38) (0.56) (0.45) (0.46) (0.64)
Vitamin A intakes at 517 614 −97 546 685 −139 458 463 −5
home (mcg/day) (116.22) (142.38) (183.79) (155.65) (200.92) (254.16) (157.79) (124.64) (201.08)
Total vitamin A intakes, 617 614 3 696 685 11
(mcg/day) (116.01) (142.38) (183.66) (154.76) (200.92) (253.62)
(continued )
 Table 1. (Continued)

Full sample (n = 314) Children 3–6 years (n = 212) Children 1–3 years (n = 102)

Variables SN participants Non participants Difference SN participants Non participants Difference SN participants Non participants Difference

B. Household Characteristics
Assets owneda 0.59 0.86 −0.27*** 0.54 0.78 −0.24*** 0.69 1.03 −0.34*
(0.05) (0.06) (0.08) (0.05) (0.08) (0.09) (0.10) (0.12) (0.16)
Scheduled caste (%) 32 19 13*** 29 23 6 40 13 27***
(3.90) (3.06) (4.96) (4.62) (3.92) (6.06) (7.13) (4.61) (8.50)
Backward class (%) 59 59 0 60 55 5 56 67 −11
(4.10) (3.80) (5.59) (5.00) (4.66) (6.84) (7.24) (6.48) (9.71)
Other caste (%) 9 22 −13*** 11 22 −11** 4 20 −16**
(2.38) (3.19) (3.98) (3.24) (3.92) (5.08) (2.91) (5.53) (6.25)
Belong to the same caste as 71 55 16*** 73 57 16*** 67 50 17*
ICDS worker (dummy) (3.78) (3.84) (5.39) (4.52) (4.63) (6.47) (6.88) (6.87) (9.72)
Used ICDS prior to 85 59 26*** 87 56 31*** 81 65 16*
the survey (dummy) (2.99) (3.80) (4.84) (3.48) (4.65) (5.81) (5.69) (6.56) (8.69)
Time taken to reach ICDS 13 16 −3*** 13 17 −4** 13 15 −2
centre (minutes) (0.77) (0.86) (1.15) (0.95) (1.00) (1.38) (1.32) (1.66) (2.12)
C. Child and Parental Characteristics
Age of the child 42 45 −3 50 54 −4** 24 23 1
(months) (1.28) (1.41) (1.91) (1.05) (1.24) (1.63) (0.93) (0.88) (1.28)
Mother’s nutritional 1.15 1.43 −0.28*** 1.10 1.42 −0.32*** 1.26 1.47 −0.21
knowledge indexb (0.05) (0.05) (0.07) (0.06) (0.06) (0.09) (0.09) (0.10) (0.13)
Mother’s bargaining −4.61 −4.02 −0.59* −4.36 −3.90 −0.46* −5.11 −4.28 −0.83
power indexc (0.25) (0.16) (0.30) (0.21) (0.16) (0.26) (0.63) (0.36) (0.73)
Number of Observations 145 169 97 115 48 54

Notes: aAn index for number of assets owned constructed using PCA. bAn index for knowledge constructed using PCA. cAn index for mother’s bargaining power
constructed using PCA. Standard error in parentheses; ***, ** and * indicate significance at 1, 5, and 10 per cent respectively.
Source: Based on primary survey data collected by authors in Bihar in February–April, 2013.
ICDS and food intakes in rural Bihar 7
8 N. Mittal & J. V. Meenakshi

Let D be an indicator variable, where a value of 1 represents participation and 0 represents non-
participation, and F1 and F0 be the corresponding outcomes (in this case, intake of calories, protein, vitamin
A, and iron). Let Z denote the vector of observed variables which determine participation. The average
treatment effects on the treated (ATT) can be computed as (Rosenbaum & Rubin, 1983; Rubin, 1977):

ATT ¼ EðF 1 jZ; D ¼ 1Þ  EðF 0 jZ; D ¼ 0Þ

The main assumption that underlies the identification of impact estimated this way is that after controlling ‘
for observable characteristics Z, treatment assignment may be treated as random, that is, F 1 ; F 0 DjZ:
This also implies that treatment assignment is random conditional on some specific function of Z (such as
‘
propensity score): that is, F 1 ; F 0 DjPðZÞ, following Rosenbaum and Rubin (1983). In other words, there
are no unobservable characteristics that influence both outcomes (calories and other nutrients) and SN
programme participation.
For the entire sample, as well as each of the subsamples based on two age groups (modes of
transfer), two methods are used: propensity score matching (Rosenbaum & Rubin, 1983) and covariate
matching (Abadie & Imbens, 2002). Both produce unbiased estimates of impact provided the
orthogonality condition above is met, but differ in the way the metric that is used to match the
participants with non-participants (achieve balancing) is generated. While propensity score matching
uses the probability of participating in the SN programme, covariate matching uses the Euclidean
distance between the observable characteristics.
Within propensity score matching, there are several methods that are used to create counterfactuals which
differ in the way weights are assigned to matched non-participants. This paper uses two of the methods as a
check on robustness of the results: first, nearest neighbour matching, which matches a treatment observation
to the n closest neighbours (in terms of propensity score) and gives equal weight to all n neighbours (five
neighbours in this estimation). The analytical standard errors proposed by Abadie and Imbens (2006) are used
for this method. The second is kernel matching, which unlike nearest neighbour matching, uses a weighted
average of all observations in the control group to construct the counterfactual. The weights assigned to each
control observation depend on the distance to treatment observations for which the counterfactual is being
created; a closer observation is assigned higher weights. The asymptotic distribution for the kernel matching
was provided by Heckman, Ichimura, and Todd (1998).
Following related literature (Lokshin et al., 2005; Kandpal, 2011; Jain, 2015; Mittal & Meenakshi, 2015)
the potential covariates Z that enter the matching equation include (a) the economic costs of accessing the
ICDS centre, as determined by the time taken to visit the ICDS centre, the mother’s participation in the labour
force, (b) social access costs, (c) child’s characteristics such as age, gender, birth order, size at birth, whether
the child is currently breastfed (for younger sub-sample), whether the child fell ill in past one month, number
of siblings, and dummy for using ICDS before, (d) mother’s characteristics (age, literacy status, nutritional
knowledge, bargaining power, child care practices followed), (e) father’s characteristics (age, literacy status,
dummy for non-migrant fathers), (f) household-specific characteristics (number of alternative caregivers,
household size, access to hygienic sanitation facility, and economic status), and (g) village fixed effects. The
final set of covariates varies somewhat by subsample (depending on the age group) and was determined
based on which yielded the best balance (in terms of insignificant differences in averages of various
covariates across participant and matched non-participants).

4. Impact of the ICDS on energy and nutrient intakes

The outcome variables are intakes of energy, protein, iron, and vitamin A; estimates are presented
separately for total intake and intake from food consumed at home. As mentioned earlier, at-home and
total intakes differ only for children three to six years old; the younger children get take-home dry
rations and do not consume meals at the anganwadi centre.
 ICDS and food intakes in rural Bihar 9

In all cases, those estimates that are significant across at least two of the three matching methods are
interpreted. In other words, if for a given outcome only one of the matching estimates of impact is
significant, this is not deemed as evidence of impact.

4.1. Estimated impact, full sample

For the full sample (Table 2), there is no evidence of impact on total energy intakes, as all the matched
differences between participants and non-participants are insignificant. This does not imply that the ICDS
has had no impact, since beneficiaries consumed between 105 and 122 calories less than non-beneficiaries
from food consumed at home, indicating that there was some substitution between food received at the
anganwadi, and food provided at home. However, this is not seen in any of the age-specific sub-samples.
In the case of protein, ICDS does not seem to have had much effect on the intakes at home, while
the total protein intake of participants is higher by 2.1–2.8 grams per day than non-beneficiaries; this
translates into between 13 and 17 per cent of the average requirements for pre-school children. For
iron and Vitamin A none of the differences in intakes – whether total or at-home – are significant.

4.2. Estimated impact, children three to six years

A shaper picture emerges when impact estimates are disaggregated by age-group or mode of transfer
(Table 3). Children aged three years or older, who obtain one meal a day at the ICDS centre, have
energy intakes that are 130–170 calories higher than those who don’t. There is no statistically
significant evidence of substitution of food at home.
Similarly, total protein intakes for ICDS beneficiaries in this age group are higher by between 5.9
and 6.8 grams. These figures represent 35–40 per cent of average requirements of children in this age
group. There is no difference in protein intake from food consumed at home between the two groups
of children. Similarly, total iron intakes increased by between 2.0 and 2.5 mg per day, providing 16–21

Table 2. Impact of ICDS on energy and nutrient intakes, full sample

Outcomes Unmatched differences Nearest Neighbour Matching Covariate Matching Kernel Matching

Calories (kcal per day per child)

Total intake 167 49 32 49
(home + transfer) (47.18) (45.40) (50.42) (65.02)
At home −138*** −105** −122** −105*
Consumption (44.91) (43.33) (47.52) (63.09)
Proteins (grams per day per child)
Total intake 1.3 2.1* 2.8* 2.4
(home + transfer) (1.41) (1.20) (1.48) (1.92)
At home −3.4*** −2.6** −1.9 −2.3
Consumption (1.29) (1.10) (1.38) (1.82)
Iron (mg per day per child)
Total intake 0.4 0.8 0.9* 0.9
(home + transfer) (0.56) (0.52) (0.52) (0.78)
At home −0.8 −0.4 −0.3 −0.2
Consumption (0.53) (0.50) (0.50) (0.76)
Vitamin A (mcg per day per child)
Total intake 3 151 320 193
(home + transfer) (187.56) (149.98) (210.98) (275.63)
At home −97 51 220 93
Consumption (187.67) (149.81) (211.44) (275.72)

Notes: Actual intake is a sum of intake at home and that provided through ICDS meal. Sample size is 314.
Standard error in parentheses; ***, ** and * indicate significance at 1, 5, and 10 per cent respectively.
Source: Based on primary survey data collected by authors in Bihar in February–April, 2013.
10 N. Mittal & J. V. Meenakshi

Table 3. Impact of ICDS on energy and nutrient intakes, children three to six years receiving cooked meals at the
anganwadi centre

Outcomes Unmatched differences Nearest Neighbour Matching Covariate Matching Kernel Matching

Calories (kcal per day per child)

Total intake 99* 141** 130** 169**
(home + transfer) (56.54) (60.92) (64.53) (85.11)
At home −132** −90 −101 −61
Consumption (55.88) (59.47) (62.93) (84.59)
Proteins (grams per day per child)
Total intake 4.3*** 5.9*** 5.9*** 6.8***
(home + transfer) (1.59) (1.35) (1.73) (2.39)
At home −2.7* −1.1 −1.0 −0.2
Consumption (1.53) (1.30) (1.66) (2.33)
Iron (mg per day per child)
Total intake 1.4** 2.1*** 2.0*** 2.5**
(home + transfer) (0.65) (0.53) (0.65) (0.99)
At home −0.3 0.4 0.3 0.7
Consumption (0.63) (0.51) (0.64) (1.0)
Vitamin A (mcg per day per child)
Total intake 11 338** 286 332
(home + transfer) (260.93) (156.07) (240.59) (415.10)
At home −139 188 136 182
Consumption (261.37) (157.34) (241.76) (415.43)

Notes: Actual intake is a sum of intake at home and that provided through ICDS meal. Sample size is 212.
Standard error in parentheses; ***, ** and * indicate significance at 1, 5, and 10 per cent respectively.
Source: Based on primary survey data collected by authors in Bihar in February–April, 2013.

per cent of average requirements, with no substitution in iron intakes from food consumed at home.
For vitamin A, however, there is no evidence of impact.

4.3. Estimated impact, children one to three years old

For younger children aged one to three years, the treatment group is defined as the group of children
whose parents reported getting the ICDS take-home rations at least once in the previous three months.
For this age group, the ICDS has clearly not had a positive impact on energy and protein intakes
(Table 4), with only one of three methods yielding a significant but perverse estimate. All matching
methods yield insignificant estimates of impact for iron and vitamin A.

4.4. Robustness checks

The validity of the impact estimates presented above rests on the assumption that selection into the
ICDS is based on observables. While this assumption cannot be tested directly, a number of robustness
checks can be performed, by assessing the quality of matching and varying some of the assumptions
used to generate the impact estimates.

4.4.1. Quality of matching. One way to assess whether the matching exercises succeeded in creating
an appropriate counterfactual group is to compare the balancing of each covariate independently after
matching. Whatever statistically-significant differences there may have been between participants and
non-participants before matching, these should vanish after matching, and this is indeed the case.19
Another involves measuring joint significance of all covariates, by comparing the Pseudo-R2 before and
after matching (Caliendo & Kopeinig, 2008). As indicated in Table 5, the Pseudo-R2s before matching are
significant while those after matching are not, suggesting that the quality of matching was good.
 ICDS and food intakes in rural Bihar 11

Table 4. Impact of ICDS on energy and nutrient intakes, children one to three years receiving take-home rations

Unmatched Nearest Neighbour Covariate Kernel

Outcomes differences Matching Matching Matching

Calories (kcal per day −182** −180*** −125 −161

per child) (77.47) (64.37) (82.84) (129.22)
Proteins (grams per day −4.6** −3.4** −3.5 −3.3
per child) (2.10) (1.80) (2.14) (3.45)
Iron (mg per day −1.6* −1. 6 −0.8 −1.2
per child) (0.90) (1.96) (0.77) (1.46)
Vitamin A (mcg per day −5 115 248 −80
per child) (199.00) (177.92) (167.35) (267.80)

Notes: Sample size is 102. Standard error in parentheses; ***, ** and * indicate significance at 1, 5, and 10 per
cent respectively.
Source: Based on primary survey data collected by authors in Bihar in February–April, 2013.

Table 5. Results for Pseudo-R2 test conducted to evaluate matching quality

After matching

Outcomes Before matching Nearest Neighbour Matching Kernel Matching

Full sample 0.19*** 0.05 0.03

Children aged 3–6 years 0.22*** 0.07 0.05
Children aged 1–3 years 0.28* 0.19 0.17

Notes: ***, ** and * indicate significance at 1, 5, and 10 per cent respectively.

Source: Based on primary survey data collected by authors in Bihar in February–April, 2013.

4.4.2. Redefining treatment and control groups. The treatment group for the older children three to
six years old has thus far been defined as any child who participated in the ICDS in the last three months.
As an alternative, the treatment group may also be defined more narrowly as the subset of children who
consumed a cooked meal on the day of the survey, and their outcomes compared to those who did not
participate in the SN programme. These alternative impact estimates are presented in Table 6. Even
though there is a reduction in overall sample size from 212 to 175, the impact estimates are considerably
stronger, and suggest that the calorie intakes of children receiving cooked meals from the ICDS centre on
the day of the survey is higher. This is despite the evidence of some substitution away from calories
allocated at home. Similarly their protein intakes were higher by roughly 10 grams, vitamin A intakes
341–381 mcg higher, and iron intakes 3.5–3.8 mg higher. These magnitudes are, not unexpectedly, all
higher than those reported in Table 3; unlike in Table 3, this restricted sample shows a positive impact on
vitamin A intakes as well (which were earlier insignificant). And, there is no evidence of any substitution
of proteins or the two micronutrients in the food consumed at home.20
Similarly, for children one to three years old, an alternative is to define the treatment as those who
reported receiving take-home rations every month in the previous three months. Restricting the focus
to this smaller sample does not alter the conclusion of insignificant impact of the ICDS on this age
group (results are not presented for reasons of space but are available on request).

5. Summary and conclusions

This paper has tried to contribute to the evidence on the impact of the ICDS on intakes of calories, protein,
vitamin A, and iron by children in the age group one to six years, and the degree to which impact is
vitiated by households substituting at home, in entirety or in part, for the food provided at/by the centre. A
12 N. Mittal & J. V. Meenakshi

Table 6. Impact of consuming cooked meal at anganwadi centre on energy and nutrient intakes, children three to
six years

Outcomes Unmatched differences Nearest Neighbour Matching Covariate Matching Kernel Matching

Calories (kcal per day per child)

Total intake 184*** 310*** 221*** 282***
(home + transfer) (64.04) (35.84) (73.49) (96.23)
At home −202*** −76** −165** −104
Consumption (64.04) (35.84) (73.49) (96.24)
Proteins (grams per day per child)
Total intake 8.1*** 9.5*** 9.5*** 10.1***
(home + transfer) (1.81) (1.73) (2.05) (2.74)
At home −3.6** −2.2 −2.2 −1.6
Consumption (1.81) (1.73) (2.05) (2.74)
Iron (mg per day per child)
Total intake 2.6*** 3.5*** 3.5*** 3.8***
(home + transfer) (0.75) (0.28) (0.92) (1.12)
At home −0.4 0.6** 0.6 0.9
Consumption (0.75) (0.28) (0.92) (1.12)
Vitamin A (mcg per day per child)
Total intake −20 341** 381** 342
(home + transfer) (293.56) (134.37) (176.66) (416.63)
At home −271 90 130 92
Consumption (293.56) (134.37) (176.66) (416.63)

Notes: Actual intake is a sum of intake at home and that provided through ICDS meal. Sample size is 175.
Standard error in parentheses; ***, ** and * indicate significance at 1, 5, and 10 per cent respectively.
Source: Based on primary survey data collected by authors in Bihar in February–April, 2013.

distinguishing feature of the analysis is that the impact estimates are conditional on supply, as they rely on
child-specific measures of participation/treatment, and account for the fact that in the sample villages, the
ICDS meal contained approximately four-fifths of the mandated calories and protein.
Our results suggest that for the entire sample there was no overall change in intakes of energy and other
nutrients; instead the ICDS transfer seems to have led to a substitution, only in part, from the food provided
at home. A different picture emerges, however, when impact estimates are disaggregated by age group.
Children three to six years of age, who benefitted from cooked food provided at the anganwadi, had
higher net intakes energy – of 130 to 170 calories – enough to meet 10–14 per cent of the daily (age-
specific) requirements. While significant, these amounts are much lower than the amount of the ICDS
transfer. This is also true of protein and iron intakes, with increased intakes meeting 35–40 per cent,
and 16–21 per cent of the age-specific daily requirements, respectively (food consumed at home is not
rich in iron). However, there is no evidence of impact on Vitamin A intakes. For this sub-sample of
children, all the impact estimates for food consumed at home are insignificant, indicating that there
was no re-allocation of food at home for any nutrient.
For children aged one to three years, whose mothers are given take-home rations, there is no
evidence of improved intakes of calories or any of the other nutrients as a consequence of participating
in the SN programme.21
Before interpreting these results, it is worth reiterating the caveats regarding various sources of
measurement error – for example, in computing nutrient values for the ICDS meal (among three to
six year olds), and in accounting for breast milk (for younger children).
At first glance, these differences across age groups are puzzling, since as noted in the introduction, the
magnitude of the implied income transfer is the same irrespective of whether cooked meals are provided or
take-home rations are given. Since the ICDS transfers are infra-marginal, only an income effect should be
relevant. There is evidence that income elasticities for calories/nutrients are either zero or small in
magnitude, not only for households but also for young children (see for example, Behrman &
Deolalikar, 1990; Roy, 2001; Jha, Gaiha, & Sharma, 2009).22 However, any income-elasticity based
 ICDS and food intakes in rural Bihar 13

explanation should hold equally for both groups of children, which is not the case. Similarly, a gender-
based explanation (with fathers less likely to invest in their children than mothers) is not applicable here.
Why was there no impact on nutrient intakes for the younger children, given that mothers were counselled
about the fact that the rations were meant for them? Several factors may have been responsible: for instance,
mothers may have perceived that their children were adequately nourished and therefore did not need
additional food. This is possible, since 86 per cent of mothers in the sample reported that their children were
‘above average’ in terms of health (in their subjective perception), and an additional 6 per cent reported that
their child was ‘average’. However, this cannot explain the lack of impact entirely, since similar percentages
of older children (for whom the ICDS resulted in higher food intakes) were reported to be above average.
Another explanation may have to do with cultural practices: as is common in eastern India and Bangladesh,
children in this age group are commonly fed from the household pot, as soon as they are able (Rasheed et al.,
2011). Nearly all these children consumed rice and 74 per cent consumed pulses for at least three days in the
previous week (rice is the common staple in this region). Infant-specific foods other than gruel are generally
not given: five households in the entire sample reported feeding infants formula or other infant-specific
foods. Only half of our sample report consuming milk everyday (excluding breast milk), and 40 per cent
consumed any other animal sourced food at least once in the week before the survey.
It is also possible that the mode of transfer matters. Although not directly comparable (given the
confound in the present study between age of children and mode of transfer), evidence of differences
in impact across on-site meals and take home rations have been reported elsewhere in the literature. A
study of five countries with supplementary food programmes found that while 78–86 per cent of
children consumed food from on-site feeding, only 50 per cent of children who received take-home
rations did so (cited in Kennedy & Alderman, 1987). Similarly evaluating the school meal programme
in India, Afridi (2010) finds that children receiving cooked meals in the school had higher nutrient
intakes as compared to those getting take home rations of similar magnitude. This suggests that one
explanation for the results in these papers and the findings of this study is that mothers have a different
behavioural response (as manifest in the food provided at home) to transfers such as cooked meals,
that are targeted to children.
The only impact on calories, protein and iron is seen in children three to six years; younger children
did not benefit. There was no impact whatsoever on Vitamin A. One implication is that it may be
useful to account for micronutrient content in the menus of cooked meals for older children, so that
diet quality (which is low to begin with) can also improve.
The lack of impact on the younger children points to the need to strengthen the services
provided to this age group: undernutrition at this age has long-term consequences. Despite the
suggestive evidence in the paper that cooked meals may be more effective, given that toddlers are
usually at home, it may difficult to offer them ICDS-based meals. Therefore, take-home rations
may continue to be a more practical solution. One possibility is to modify the rations to include
foods of higher diet quality, or fortified foods that are not easily merged with the family pot. Some
states (such as Andhra Pradesh) provide eggs as part of take-home rations; it is worth assessing if
this has helped improve diet quality.
In addition, there is a substantial literature that indicates that it is necessary to provide supervised
and intensive nutrition education in a form that conforms to community knowledge systems and
practices (see Kristjansson et al., 2016 for a review).
This has implications for the design and implementation of the ICDS, which has tended to pay
greater attention to the three to six year old age group. A focus on younger infants and on diet quality
is warranted to ensure that the supplementary nutrition achieves greater impact.

Acknowledgements
Funding for the fieldwork was provided by ICRISAT. We are grateful to ICRISAT, NCAP, and ICAR-
RCER, Patna and in particular to R.K.P. Singh, R. Padmaja, and Anjani Kumar for their support.
Thanks are due to Deepti Goel, Anirban Kar, Uday Bhanu Sinha, and the referees of this journal
14 N. Mittal & J. V. Meenakshi

whose comments greatly improved this paper. Last but not least, we are indebted to all the enumerators
for painstaking data collection.

Funding
This work was supported by an ICRISAT VDSA grant.

Disclosure statement
No potential conflict of interest was reported by the authors.

Notes
1. World Health Organization. Nutrition: Micronutrient deficiencies. http://www.who.int/nutrition/topics/vad/en/, accessed on
14th June, 2016.
2. There are six components of the ICDS in all: supplementary nutrition, immunisation, health check-ups, growth monitoring,
preschool education, and nutrition education to their mothers. This paper, however, focuses only on supplementary nutrition.
3. Other than anthropometric outcomes, studies involving the ICDS have also focused on education outcomes (Nandi &
Laxminarayan, 2016) and on the role of anganwadi worker training in improving outcomes (Singh & Masters, 2016). Dreze
and Khera (2017) have a review of the broader literature around the ICDS. For countries other than India, the literature on
food intakes largely pertains to school-going children, and examines whether interventions succeed in transferring the entire
amount of the intended transfer to the target population. This literature also makes a distinction between whether the
transfers from targeted programmes are higher than what would be expected from an equivalent income transfer alone. For
instance, while Jacoby, Cueto, and Pollitt (1996) find that the energy intake of children participating in a school breakfast
programme in Peru increased by 50 per cent of the intended transfer, other studies find a higher impact. Studies by Ahmed
(2004) for the United States, Murphy et al. (2003) for Kenya, and Jacoby (2002) for Philippines find that 50–100 per cent of
the intended transfer sticks with the beneficiary child. However, results of Bhattacharya, Currie, and Haider (2006) are
contrary to all other studies. Evaluating the school breakfast programme in the United States, they do not find any impact of
participation on calorie intake of school going children. Adelman, Gilligan, and Lehrer (2007) conclude that the differences
in the magnitude of impact across countries could be due to differences in the level of calorie intake before the programme
was implemented. Food supplementation programmes have a higher potential of increasing the total calorie intake in
countries which have a low level of food consumption.
4. The sampling strategy was to select from each sampled household one pre-school child; the further disaggregation into
children above three years and those younger was done subsequently. Note, however, that (as expected) the distribution of
households with children above three years of age, across size of land holding, is similar in both the census and sample. This
is also true of households with children below three years of age.
5. A sample size of 100 children (spread over two groups) would have been powered to detect a difference of 250 calories,
6.8 grams of protein, and 1.9 mg of iron, but perhaps not of vitamin A, based on a first difference in means and assuming a 5
per cent probability of type I error and 20 per cent probability of type II error. These magnitudes represent half of the
nutrient content of the ICDS meals, and was chosen to allow for the possibility of substitution from food provided at home.
6. Guidelines for Bihar are at: (http://www.icdsbih.gov.in/SupplementaryNutrition.aspx?GL=9&PL=8&SL=1).
7. The nutrient content of the ICDS meal can be calculated from the schedule of meals and weekly menu, which also specifies
the quantity of each ingredient (per child) to be used in cooking. An average (per day per child) was then calculated over the
week, weighted by the number of days each dish is served, results in the approximately 500 calories and 12–15 grams of
protein that are supposed to be the norm.
8. At one of the centres, despite there being no appointed ICDS worker, SN services were provided with the help of other
centres in the village.
9. We had to drop three observations for each of the sub-sample because we use characteristics of both parents to match SN
participants with non-participants in our estimation and these children only had one parent alive.
10. Please refer to Mittal and Meenakshi (2016) for details of the dietary recall survey instrument.
11. We also carried out the analysis using the magnitude of intended transfer for adjusting the intake from ICDS meal for
children aged three to six years. These results are not very different from the ones presented in the paper and will be made
available on request.
12. Two of the dishes on the menu, khichdi and pulao, are supposed to include seasonal vegetables, the choice of which is at the
discretion of the ICDS worker. We use an average of vitamin A and iron content of vegetables that were available during the
time of survey.
13. As far as we are aware, the only way to accurately assess the energy/nutrient content of breast milk is to weigh the child
before and after each feed; this was not feasible given our resources and field context.
 ICDS and food intakes in rural Bihar 15

14. Out of these 39 children, for 11 children, the day of the survey was Sunday and therefore ICDS meal was not available. We
do not know the reason why other children did not consume the ICDS meal on the day of the survey.
15. The index for assets owned was constructed using information on ownership of assets such as farm implements, livestock,
and consumer durables through Principal Component analysis (PCA).
16. The difference in the age of parents and mother’s rank (in terms of her status) in the household, both of which are
exogenous, were used to create an index of mother’s bargaining power using PCA.
17. Several questions were asked to elicit mother’s nutritional knowledge. These included questions about awareness of vitamin
A, iodine, and treatment of diarrhoea. All these variables were combined using PCA to create an index of nutritional
knowledge.
18. Several other variables were examined, including: differences in the proportion of male children among surveyed children,
birth order of the child, health endowment of the child, number of siblings, parents’ age, their literacy status, child care
practices adopted, time spent in child care, presence of alternative caregiver, proportion of households with non-migrant
father, household size, and land ownership. None of these variables was significantly different across participation status.
19. A comparison of the distribution of propensity scores also shows considerable overlap. All these results are available with
the authors on request.
20. To assess if results are sensitive to the assumption regarding the energy content of a meal taken outside the home, all impact
estimates were recomputed, assuming that the energy content of the meal was the lower bound of the 95 per cent confidence
interval estimated by Tandon and Landes (2011). These results are largely unaffected (tables available with the authors on
request).
21. The potential benefits that accrue to these children from other components of the ICDS, including vaccinations, health
checks, and nutrition education (of their mothers) are not considered here.
22. A related literature has also examined whether the marginal propensity to consume from cash differs from in–kind transfers.
For example Del Ninno and Dorosh (2003) find that for poor households, the marginal propensity to consume wheat from
in-kind transfers was about 0.25, while that from cash income was near zero. Hidrobo, Hoddinott, Peterman, Margolies, and
Moreira (2014) is another example that suggests that food transfers have a greater impact on calories, while cash vouchers
impact diet quality.

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