Can Iron-Fortified Salt Control Anemia? Evidence from Two Experiments in Rural Bihar

Iron deficiency anemia is frequent among the poor worldwide. While it can be prevented with the appropriate supplement or food fortification, these programs often do not consistently reach the poorest. This paper reports on the impact of a potential strategy to address iron deficiency anemia in rural areas: double fortified salt (DFS) - salt fortified with iron and iodine. We conducted a large-scale experiment in rural Bihar. In 200 villages, randomly selected out of 400, DFS was introduced at a price that was half the regular retail price for DFS. After two years, we find no evidence that either selling DFS in villages or providing it for free directly to households has an economically meaningful or statistically significant impact on hemoglobin, anemia, physical health, cognition or mental health. For the sales experiment, we can reject at the 95% level a reduction of 2.5 percentage points in the fraction anemic in the entire sample, and 3.7 percentage points among those who were previously anemic. Using an IV strategy, we find a statistically significant, though relatively small, increase in hemoglobin and reduction in the fraction anemic for adolescents, a subgroup that has responded well to supplements and fortification in earlier studies. These disappointing results are explained both by relatively low take up and by low impact of DFS even when consumed more regularly for the majority of the population.