Improving diet quality for female workers through market innovations: evidence from Assam's tea estates.

Introduction: Despite the economic significance of the tea industry in India, its female workers suffer from high rates of malnutrition, particularly anemia. A three-year intervention aimed to improve diets among tea workers through behavior change and supply-side strategies across tea estates in Assam, India. Key activities included community-based edutainment, cooking demonstrations, and a market-based approach to increase access to nutritious foods via door-to-door entrepreneurs or local shops. Methods: The study used a mixed method, repeated cross-sectional design. Baseline (Feb-Mar 2021) and endline (Mar-Apr 2023) data were collected via household surveys (989 tea workers, 66 clusters), 20 key informant interviews, and 10 focus group discussions. A multi-stage sampling design selected 30 estates, 66 divisions, and 15 households per division. Women aged 15-49 were the primary respondents. Monitoring data tracked coverage and outputs. Propensity score matching controlled for differences in selected households. Results: The estimated intervention effect was a 38.3 percent increase in the consumption of vitamin A-rich fruits and vegetables and a 13.2 percentage point increase in the consumption of fortified cooking oil. Overall, this resulted in a 28.2 percentage point increase in the proportion of women meeting a minimally diverse diet. Some differences were seen across the market-based models. Conclusion: The intervention's combination of supply-side innovations and behavior change efforts was effective and highlighted the potential for market-based approach to positively transform food environments in low-income settings. Future research should explore the long-term sustainability of such market-based interventions in improving nutritious foods consumption.