EXPLORING THE USE OF BEHAVIORAL ECONOMICS TO IMPROVE MEAL DIVERSITY IN BANGLADESH

Kelly A. Davidson and Jaclyn D. Kropp

This presentation contains preliminary results. Please do not cite without the permission of the authors.

Thank you

• Special thank you to USAID INGENAES for funding this research!

Motivation

• Low dietary diversity contributes to undernutrition – 70% of daily energy intake from rice in Bangladesh– 35.3% of households in rural areas are food-energy

deficient (IFPRI, 2013)• Can we use behavioral economics tools to

encourage the consumption of nutrient-rich foods?

Behavioral Economics: Nudging

• “Nudge”: a subtle cue that influences an individual’s behavior without removing that individual’s freedom of choice– Richard Thaler and Cass Sunstein (2009)

• Research in the US shows UDSA MyPlate is an effective nudge toward healthier foods• Miller, Gupta, Kropp, Grogan, Matthews (2016) • Brown et al. (2014)• Harman (2013)

Food Plate

• SHIKA project: collaborative effort to improve diet and nutrition in rural Bangladesh – Focus on pregnant women and

children 0 to 2 years of age• SHIKHA food plate is a tool for

nutrition and health workers– Originally targeted to pregnant

and lactating women• FHI360, FAO, BRAC, and USAID

Research Objective

• To evaluate the use of the “SHIKHA food plate” as a “behavioral nudge” to encourage dietary diversity– Improve nutrition through healthy food choices– Men and women– Short-term (immediate) impacts

• To measure the effects of the food plate when combined with nutrition education and gender-aware nutrition education – Participatory training

Experimental Design

• Exposure to SHIKHA food plate– Treatment: participants use the nutrition plate during

one of the two lunch buffet meals– Control: participants use a regular plate

Participants assigned toplate treatment also take home one nutritionplate per family member

Experimental Design

• Education treatment: participatory workshop designed by INGENAES

• Nutrition education– “What goes on the plate?”

• Gender education – “Who gets what to eat?”

Experimental Design

Plate Intervention Nutrition Education Intervention

Meal 1 Meal 2 No Education Nutrition Nutrition and Gender

Regular plate Regular plate Group 1 Group 2 Group 3

Regular plate Food plate Group 4 Group 5 Group 6

Food plate Regular plate Group 7 Group 8 Group 9

Randomized controlled trial with two treatments, target N = 1,200– Exposure to SHIKHA food plate, cluster-randomized at village level– Nutrition education, randomized at individual-level

• Three levels: nutrition only, nutrition and gender, no nutrition education

Experimental Design

Participants recruited through BAU Extension Center (BAUEC) and Sushilan• Mymensingh and Amtoli• Target = 600 participants per district

Survey respondents are invited to two lunch buffet meals, one month apart• Two meal observations capture individual

preferences or behavior

• Guests first participate in nutrition workshop (depending on treatment)

Meal Observation Data Collection• Measure food selected and quantity

consumed– Self-serve lunch buffet of local cuisine (10

food items)

• Hidden food scale for rice– Visual inspection for other items

• Standardized weights for spoonfuls • ¼ spoonful increments

• Plate waste data - visual inspection• Post-meal survey data

– How hungry were you?– Was there any food item you did not like?

Methodology

• Do participants consume more diverse / healthier food items when exposed to the nutrition plate and/or participatory training?

• OLS regression to measure treatment effects on meal diversity– Control for individual and household characteristics– N = 2,156 meal observations

38%

8%8%5%

6%

7%

5%

9%

7%

8%

Mean Consumption of Food Items (per 100 kg)

RiceChickenFishSaladEggMixed vegetables Leafy green vegetablesLentilsFruitYogurt

23%

22%

11%

13%

12%

19%

Participants by Treatment

Nutrition education only

Nutrition and gender education

Plate intervention

Plate + nutrition education

Plate + nutrition with gender education

Control

Variable Mean

Mymensingh district 0.53

Household monthly income (USD 1 = 79 BDT) 10917.03

Poverty score 47.00

Farm diversity (count of crops and livestock) 15.35

Household food insecurity access score 1.93

Buy food at the market 0.39

Muslim 0.95

Female 0.70

Age 38.09

No education 0.36

Junior secondary school 0.11

Secondary school 0.06

SSC pass 0.06

Postsecondary school 0.07

Spouse of household head 0.51

Other relationship to the household head 0.13

Hunger at time of the event 3.71

Key Findings

• No statistically significant impact of the plate alone

• Participatory training encourages meal diversity in all cases! – Largest impacts for plate + nutrition education and plate +

nutrition and gender education

• No statistically significant change in rice consumption (kg) in any case

Summary of results

• Participatory training significantly impacts meal diversity– Food plate diagram alone will not nudge

participants to consume a variety of food items, particularly in a population with low literacy

• Strong preference for rice consumption is difficult to overcome

Future analysis

• Consumption of food items using plate portions (percentage) – Test the specific recommendation “half plate of

rice and at least four other food items”

• Long-term effects of the plate intervention at home using baseline and endline survey data

This presentation was produced as part of the United States Agency for International Development (USAID) and US Government Feed the Future project “Integrating Gender and Nutrition within Extension and Advisory Services”

(INGENAES) under the Leader with Associates Cooperative Agreement No. AID-OAA-LA-14-00008. The University of Illinois at Urbana-Champaign is the prime awardee, and partners with the University of California-Davis, the

University of Florida, and Cultural Practice, LLC. www.ingenaes.illinois.edu

The research and this report were made possible by the generous support of the American people through USAID. The contents are the responsibility of the authors and do not necessarily reflect the views of USAID or the United

States government.

Covariates (Xi)

• Household-level– District– Household income– Poverty score– Farm diversity– Market access– Household food security

access score (HFIAS)

• Individual-level– Religion– Sex– Age– Education– Relationship to head of

household– Hunger level– Food preferences

Covariate EstimateNutrition education 0.016***Nutrition and gender education 0.019***Plate intervention -0.000Plate + nutrition education 0.019**Plate + nutrition and gender education 0.012**Mymensingh district 0.049***Household monthly income (BDT) -0.000Poverty score 0.001Farm diversity (count) -0.000Household food insecurity access scale 0.000Buy food at the market 0.006*Muslim 0.069***Female 0.001Age -0.000No education -0.005Junior secondary school -0.001Secondary school 0.007SSC pass 0.012*Postsecondary education 0.013Spouse of household head -0.003Other relationship to household head 0.002Hunger at time of event 0.003Constant 0.660***

Meal diversity score

(Preliminary Results)

Covariate EstimateNutrition education -0.010Nutrition and gender education -0.020Plate intervention -0.002Plate + nutrition education -0.026Plate + nutrition and gender education -0.023Mymensingh district -0.065***Household monthly income (BDT) 0.000Poverty score -0.001*Farm diversity (count) -0.001Household food insecurity access scale 0.002Buy food at the market -0.003Muslim 0.112***Female -0.064***Age -0.000No education 0.004Junior secondary school -0.015Secondary school -0.003SSC pass -0.008Postsecondary education -0.060**Spouse of household head 0.033**Other relationship to household head 0.006Hunger at time of event -0.000Constant 0.398***

Rice consumption