School Feeding Programs in Middle Childhood and Adolescence

Almost every country in the world has a national school feeding program to provide daily snacks or meals to school-attending children and adolescents. The interventions reach an estimated 368 million children and adolescents globally. The total investment in the intervention is projected to be as much as US$75 billion annually (WFP 2013), largely from government budgets. School feeding may contribute to multiple objectives, including social safety nets, education, nutrition, health, and local agriculture. Its contribution to education objectives is well recognized and documented, while its role as a social safety net was underscored following the food and fuel crises of 2007 and 2008 (Bundy and others 2009). In terms of health and nutrition, school feeding contributes to the continuum of development by building on investments made earlier in the life course, including maternal and infant health interventions and early child development interventions (see chapter 7 in this volume, Alderman and others 2017). School feeding may also help leverage global efforts to enhance the inclusiveness of education for out-of-school children, adolescent girls, and disabled persons, as called for in the Sustainable Development Goals (see chapter 17 in this volume, Graham and others 2017). Although the series focuses on low- and middle-income countries (LMICs), evidence from high-income countries (HICs) is included because of the near universality of school feeding and the insights that inclusion can provide as economies develop. For example, the design of school feeding in countries undergoing the nutrition transition may provide some lessons on how to shift from providing access to sufficient calories to promoting healthful diets and dietary behaviors for children and adolescents (WFP 2013). Agricultural development has increasingly gained attention. It is clear that to enable the transition to sustainable, scalable government-run programs, the inclusion of the agricultural sector is essential (Bundy and others 2009; Drake and others 2016). Accounting for the full benefits of school feeding through cost-effectiveness and benefit-cost analysis is challenging, similar to other complex interventions, but undertaking this accounting is critical for assessing the tradeoffs with competing investments. This chapter reviews the evidence about how school feeding meets these objectives and provides some indication of costs in relation to benefits. The costs of the intervention are well established; estimates that encompass all the benefits of school feeding are more challenging. The benefits must be quantified and translated to the same unit to allow for aggregation. Moreover, how school feeding interventions are designed and implemented varies significantly across countries. Given that delivery of school feeding often involves multiple sectors, common policy frameworks and cross-sectoral coordination are required to achieve maximum benefit (Bundy and others 2009). Several other chapters in the volume highlight school feeding. These include chapter 11 (Lassi, Moin, and Bhutta 2017), chapter 20 (Bundy and others 2017), chapter 22 (Plaut and others 2017), and chapter 25 (Fernandes and Aurino 2017).