Freeman Spogli Institute for International Studies Program on Energy and Sustainable Development Stanford University

Research at PESD

Healthy Head Start: Targeting Pregnant Women to Improve Child Health

REAP Project


Up to 50% of school-aged children and even higher rates of preschool children suffer from micronutrient deficiencies, including iron deficiency (ID) and associated anemia. Our previous work has targeted school-aged and preschool-aged children and shown that interventions of vitamin supplements and school lunch programs reduce anemia rates and raise test scores.

However, we may have missed working with one of the most vulnerable and important population groups. Nearly 30% of pregnant and lactating women in China have iron deficiency (ID) anemia. During pregnancy when high iron demand for the fetus and post-birth infant is needed, iron stores are often unfulfilled, leading to higher rates of infant ID anemia, mortality, preterm delivery, low birth weight, and fetal stunting.

Anemia can thus affect babies born to women who were anemic even before conception, as well as those born to women who only became anemic during pregnancy. The low iron levels at infancy due to maternal ID anemia often leave infants with insufficient iron for appropriate cognitive and physical development, the adverse effects of which may be irreversible. 

Nutritional improvements for women during pregnancy have had mixed results. While some researchers have found that supplementation during pregnancy has significant effects on the health and development of infants, other researchers have found no effect at all. Some evidence suggests that this might be because it is difficult for women to build up their iron stores once they are already pregnant. Perhaps by intervening before pregnancy, women will be able to build up the iron stores needed to nourish both themselves and the growing fetus.

Our proposed project aims to test this theory by administering oral multiple micronutrient tablets to women before as well as during pregnancy to determine the most effective intervention period to improve maternal and infant health in rural China.


The overall goal of our proposed work is to identify simple and sustainable ways of improving infant nutrition and child health in rural China. As far as we know, it will be the first such project to use rigorous econometric methods to evaluate the effectiveness of maternal nutrient supplementation on infant health outcomes in China, and one of the largest such projects in the world. The proposed project will study the impact of multiple micronutrient supplementation (including iron) on maternal and infant health. The project will aim to build capacity at the community level by providing new mothers, their families and local health providers with the knowledge and nutritional supplements they need to alleviate maternal and infant anemia.


Both mothers and their newborns will be measured in terms of a number of relevant health indicators including weight, height, and hemoglobin measurements for mothers, and length, weight, hemoglobin measurements and the Bayley Scales of Infant Development (BSID) for infants. These indicators will assist in quantitative assessments of the effects of nutritional supplements pre- and post-intervention. The project is designed to answer the following research questions:

  • What effect does multiple micronutrient supplementation have on the health of the mother? On the health of the infant?
  • When is the best time to intervene with oral vitamin and mineral supplements to improve maternal and infant health?


This project is classified as on-going.