Implementation and effects of India's national school-based iron supplementation program

Reducing the rate of anemia is a primary public health concern in many developing countries. This paper studies the Indian government's school-based Iron and Folic Acid (IFA) supplementation program. We provide a descriptive analysis of program implementation patterns across 377 schools in the state of Odisha. We document that the more advantaged blocks had more consistent tablet distribution, and that distribution within the less advantaged blocks was less predictable, and plausibly random. We use this quasi-random variation to estimate the causal effect of the policy using a difference-in-differences strategy. The IFA program had no effect on hemoglobin levels at the mean, but there is a significantly larger effect for moderately anemic students in schools that were more recently distributing tablets, relative to schools that had run out of tablets. These results suggest that school-based supplementation has the potential to improve hemoglobin levels, but that breaks in supplementation - either due to inconsistent tablet distribution or the constraints of a school calendar - limit the long-term efficacy of school-based supplementation programs.