Department or Program
Primary Wellesley Thesis Advisor
Gauri Kartini Shastry
Reducing the rate of anemia is a primary public health concern in many developing countries, where more than half of school-aged children suffer from the many serious consequences of childhood anemia. India has some of the highest rates of iron-deficiency anemia in the world and in 2013 implemented the national school-based Iron and Folic Acid Supplementation Program (IFASP) with the goal of reducing the prevalence and severity of anemia among school children. Although many highly controlled efficacy trials document the ability of iron supplementation to improve iron levels, there is little evidence about the best methods for providing supplements to large populations. This paper examines the tablet distribution patterns of the IFASP and its effects on children’s iron levels. I use implementation data for 378 schools in five administrative blocks of Keonjhar District, Odisha to provide descriptive analysis of program implementation patterns and find that although the more advantaged blocks had the most universal tablet distribution, tablets were quasi-randomly distributed to schools within the less advantaged blocks. This variation in tablet receipt provides the framework to estimate the causal effect of the policy using a difference-in-differences strategy. My primary empirical finding is that the IFASP raised hemoglobin levels by 0.3 g/dL overall and had the largest effect on mildly anemic students and students who had received tablets most recently. This suggests that, though effective, school-based supplementation may not be sufficient to address high rates of more severe anemia and may be limited by non-optimal distribution and the constraints of a school calendar.