Impact of India's nationwide supplementary nutrition programme for pregnant women on birth weight of their newborns: a quasi-experimental evaluation

Abstract

Background: This study assessed whether supplementary nutrition provided to pregnant women under the Integrated Child Development Service (ICDS) programme in India has reduced the burden of low birth weight or LBW (weight at birth: <2500 g), very low birth weight (VLBW: <1500 g) and extremely low birth weight (ELBW: <1000 g), among their newborns. Methods: We analysed data of 148 265 index children from the nationally representative 2019-2021 National Family Health Survey. A quasi-experimental method, Coarsened Exact Matching (CEM), was employed to estimate the causal effects of mother's receipt of supplementary nutrition during pregnancy on the prevalence of LBW, VLBW and ELBW. CEM outperforms conventional matching methods by reducing imbalance between treatment and control groups, model dependence, estimation error, bias, variance, mean square error and related criteria that can challenge study findings. Results: Mothers of only 62.6% children always benefited from supplementary nutrition programme. The survey-weighted prevalence of LBW, VLBW and ELBW was 17.8% (95% CI: 17.5% to 18%), 1.14% (95% CI: 1.06% to 1.22%) and 0.13% (95% CI: 0.11% to 0.15%), respectively. The CEM analysis revealed that supplementary nutrition reduced the prevalence of LBW in pregnant women by an estimated 1.35 percentage points (β: -0.0135; 95% CI: -0.0211 to -0.0060, p: 0.001) or 7.5%, and VLBW by 0.26 percentage points (β: -0.0026; 95% CI: -0.0046 to -0.0005; p: 0.018) or 20.2%. No effect of supplementary nutrition on ELBW was identified (p: 0.114). Conclusions: Supplementary nutrition provided to pregnant women under the ICDS programme could be helpful in mitigating the burden of LBW and VLBW in India. Intensified efforts to increase uptake of the programme are warranted.