ABSTRACT
Objectives: Adequately iodized salt needs to be made accessible to the most marginalized. Madhya Pradesh, a state in central India, is home to a substantial proportion of India's poor. In 2009, the coverage of adequately iodized salt in the state was nearly 90% among the richest households, but only about 50% among the poorest. Methods: In an effort to provide adequately iodized salt to the most vulnerable, in 2009 Madhya Pradesh launched a state-wide initiative to ensure the use of iodized salt in two national flagship nutrition programmes: the Supplementary Nutrition Programme of the Integrated Child Development Services and the Midday Meal Scheme. Programme staff members were taught how to correctly store salt and monitor its iodine content. Field monitors assessed the iodine content of the salt in the common kitchens of participating schools and anganwadi centers monthly. Results: Two hot meals prepared with adequately iodized salt were served daily for more than 21 days per month to approximately 89% of the 12,113,584 children aged 3-6 years enrolled in anganwadi centers (June 2011-March 2012). One meal on school days was served to 78% of 5,751,979 primary-school children and to 79% of 2,704,692 secondary school children (April 2011- March 2012). Most of the kitchens visited in 2010 (79%) and 2011 (83%) were consistently using adequately iodized salt to prepare hot meals. Conclusions: India has successful large-scale social safety net programmes targeting the most deprived population. Both national and state-level policies should mainstream the use of adequately iodized salt in these programmes.