Nutrition‐Sensitive Agriculture: What Works and Why Katherine Dennison RD MPH, USAID‐Bureau for Food Security

     

Iron & folic acid

2

Toolbox of Proven Solutions

Improved BF

Vitamin A

Behavior change Food supplementation

WASH

Agriculture

Women’s EmpowermentDisease prevention & control

Multi-Sectoral Nutrition Strategy Global Learning and Evidence ExchangeEast and Southern Africa Regional Meeting

   The ‘F’ Diagram

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   WASH‐Nutrition Conceptual Framework

Water source far from home Inadequate storage Water pricing High amount spent on water

Low water quantity

Unimproved sanitation Poor hand-washingLess money

for food Less time for

food preparation Faecal contamination of home

DiarrheaEnvironmental EnteropathyNematode infection Poor water quality

Poor nutritional status Unprotected water source

Source: O. Cumming, London School of Tropical Medicine and Hygiene, 2013

Multi-Sectoral Nutrition Strategy Global Learning and Evidence ExchangeEast and Southern Africa Regional Meeting

      

5

How Does Agriculture Affect Nutrition?

Food  Consumed • Calories • Protein

• Micronutrients

Income  Invested  in… • Diverse  diet, 

nutrient‐rich  foods

• Health  care

• Sustainable  livelihood  for  year‐round  food  and  health  care  access

Gender  in Agriculture• Maximizing 

women’s  control  of  income

• Managing  time  and  energy  demands

Multi-Sectoral Nutrition Strategy Global Learning and Evidence ExchangeEast and Southern Africa Regional Meeting

Main  Agriculture  &  Nutrition  Pathways

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Agriculture as a source of food

• Production  decisions  are  influenced  by  market  prices,  relative  costs  and  risks,  productive  assets,  preferences  and  cultural  norms

• Processing  and  storage  impact  food  access  and  nutrient  content

Multi-Sectoral Nutrition Strategy Global Learning and Evidence ExchangeEast and Southern Africa Regional Meeting

Evidence  on  Food  Production  Pathway

Multi-Sectoral Nutrition Strategy Global Learning and Evidence ExchangeEast and Southern Africa Regional Meeting

• Household  food  production,  esp.  nutritious  foods Ghanaian  children  in  HH  keeping  poultry  twice  as  likely  to  have  minimum  dietary  diversity In  Burkina  Faso,  HHs  collecting  wild  foods  and  those  producing  food  rather  than  cash  crops  had  better  dietary  diversity;  also  in  Burkina,  women’s  BMI  improved  in  a  project  promoting  micronutrient‐rich  food  consumption. 

 • I Rn w anda,  hemoglobin  and  serum  ferritin  both  improved  among  those  consuming  high‐iron  beans.  OFSP,  vitamin  A  cassava,  and  iron  pearl  millet  also  have  some  positive  results.

    

                            

 

     

         

         

       Evidence on Food Production Pathway

Processing & Storage

• Micronutrient Fortification

• Good management, processing and storage can increase food access and reduce stunting (perhaps by 1 SD!)

• Occupational risks:

– E.coli and Salmonella in agricultural wastewater

– Increased malaria where water is stored

– Risks in value chains (e.g., zoonosis)

Multi-Sectoral Nutrition Strategy Global Learning and Evidence ExchangeEast and Southern Africa Regional Meeting

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      • Improve  d year‐round  income  and  cash  flows  to  meet  household  needs,  including  diverse,  nutritious  foods,  and  health  care

• Assumes  nutritious  foods  and  health  services  are  accessible  – reflect  s the  importance  of  generating  demand  and  need  for  nutrition  behavior  change

Agriculture source  of  income

as a

Multi-Sectoral Nutrition Strategy Global Learning and Evidence ExchangeEast and Southern Africa Regional Meeting

                           

       

            

     

          

                           

     

     Evidence on Income Pathway

Multi-Sectoral Nutrition Strategy Global Learning and Evidence ExchangeEast and Southern Africa Regional Meeting

Patrick Webb, and Steven Block PNAS 2012;109:12309-12314

• Income correlated with stunting reduction at macro level, but evidence at micro level is sparse.

• Increased obesity in rural areas.

• Household income correlated with household dietary diversity, especially for female‐headed households

• Role of non‐agricultural income during lean season

• Correlation between income and diet diversity, but not evidence of effects on nutrition at household and individual level

                     

       

                 

   

12

          

Multi-Sectoral Nutrition Strategy Global Learning and Evidence ExchangeEast and Southern Africa Regional Meeting

Agriculture as a means to women’s empowerment

• Women are more likely to spend added income on the health and nutritional needs of the household

• Women’s access to income is more often considered than time and energy use

          

                

              

     

             

     Evidence: Women’s Empowerment Pathway

Control over assets and use of income

• Women’s control lead to better diets for women and children

Time Use & Child Care

• Tension between earning income and caring for child

Female Energy Expenditure

• Physical work compromises pregnancy and lactation nutrition

Multi-Sectoral Nutrition Strategy Global Learning and Evidence ExchangeEast and Southern Africa Regional Meeting

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Enabling Environment: Food Market

• Int ‐ra household  decisions  on  food  production,  expenditure  and  savings,  and  power  dynamics  are  influenced  greatly  by  the  enabling  environment

• Availability  and  affordability  of  diverse,  nutritious  foods  in  local  markets  drive  choice,  preferences

• Ti  me and   energy  availability  are  influenced  by  ease  of  food  preparation 

• Disea  se bur den  influenced  greatly  by  food  safety  environment,  and  environmental  sanitation

Multi-Sectoral Nutrition Strategy Global Learning and Evidence ExchangeEast and Southern Africa Regional Meeting

     

15

Achieving Better Nutrition Outcomes

Design nutrition-sensitive agriculture activities, outcomes, and indicators that link with nutrition-specific activities in co-located areas.

Reference the frameworks, principles, and pathways.

Multi-Sectoral Nutrition Strategy Global Learning and Evidence ExchangeEast and Southern Africa Regional Meeting

 

16

Works Cited

Multi-Sectoral Nutrition Strategy Global Learning and Evidence ExchangeEast and Southern Africa Regional Meeting

Balagamwala,  Mysbah,  Haris  Gazdar,  and  Hussain  Bux  Mallah.  2015.  “Women’s  Agricultural  Work  and  Nutrition  in  Pakistan:  Findings  from  Qualitative  Research.”  LANSA  Working  Paper  Series. De  Moura,  Fabiana  F.,  Amanda  C.  Palmer,  Jere  D.  Haas  Julia  L.  Finkelstein,  Michael  J.  Wenger  Laura  E.  Murray‐Kolb,  Erick  Boy  Ekin  Birol,  and  Juan  Pablo  Peña‐Rosas.  2014.  “Are  Biofortified  Staple  Food  Crops  Improving  Vitamin  A  and  Iron  Status  in  Women  and  Children?  New  Evidence  from  Efficacy  Trials1– 4.” Advances  in  Nutrition,  568–70.  doi:10.3945/an.114.006627. Du,  Lidan,  2014.  Leveraging  Agriculture  for  Nutritional  Impact  through  the  Feed  the  Future  Initiative:  A  Landscape  Analysis  of  Activities  Across  19  Focus  Countries.  Arlington,  VA:  USAID/Strengthening  Partnerships,  Results,  and  Innovations  in  Nutrition  Globally  (SPRING)  Project. Eichler,  K.,  Wieser,  S.,  and  Brügger  Rüthemann,  I.  U.  2012.  “Effects  of  Micronutrient  Fortified  Milk  and  Cereal  Food  for  Infants  and  Children:  A  Systematic  Review.” BMC  Public  Health 12  (506). Grace,  Delia,  Kristina  Roesel,  Bassirou  Bonfoh  Erastus  Kang’ethe,  and  Sophie  Theis.  2015.  “Gender  Roles  and  Food  Safety  in  20  Informal  Livestock  and  Fish  Valu  Chains.”  International  Food  Policy  Research  Institute  (IFPRI). Griffiths,  Jeffrey  K.  2013.  “The  Role  of  Water  in  Linking  Agriculture,  Nutrition,  and  Health.”  presented  at  the  Agriculture  and  Nutrition  Global  Learning  and  Evidence  Exchange  (AgN‐GLEE),  Guatemala  City,  Guatemala,  March  5. Herforth,  Anna,  Andrew  Jones,  and  Per  Pinstrup‐Andersen.  2012.  “Prioritizing  Nutrition  in  Agriculture  and  Rural  Development:  Guiding  Principles  for  Operational  Investments.”  Health,  Nutrition,  and  Population  Family  (HNP)  of  World  Bank  Human  Development  Network. Kadiyala,  Suneetha,  Jody  Harris,  Sivan  Yosef  Derek  Headey,  and  Stuart  Gillespie.  2014.  “Agriculture  and  Nutrition  in  India:  Mapping  Evidence  to  Pathways.” Annals  of  the  New  York  Academy  of  Sciences 1331  (Paths  of  Convergence  for  Agriculture,  Health,  and  Wealth):  43–56.

Leverhulme  Centre  for  Integrative  Research  on  Agriculture  and  Health  (LCIRAH).  2015.  “Agri‐Health  Research:  What  Have  We  Learned  and  Where  to  next?  Presentation  and  Poster  Abstract  Booklet.”

Martorell,  R.,  et.  al.  2015.  “Effectiveness  Evaluation  of  the  Food  Fortification  Program  of  Costa  Rica:  Impact  on  Anemia  Prevalence  and  Hemoglobin  Concentrations  in  Women  and  Children.” The  American  Journal  of  Clinical  Nutrition 101:  210–17.

SPRING.  “Multi‐Sectoral  Nutrition  Strategy  Technical  Guidance  Brief:  Interventions  for  Addressing  Vitamin  and  Mineral  Inadequacies.”

Turner,  Paul  C.,  Andrew  C.  Collinson,  YunYun  Gong  Yin  Bun  Cheung,  Andrew  M  Prentice  Andrew  J  Hall,  and  Christopher  P  Wild.  2007.  “Aflatoxin  Exposure  in  Utero  Causes  Growth  Faltering  in  Gambian  Infants.” International  Journal  of  Epidemiology,  no.  36  (June  2007):  1119–25.  doi:10.1093/ije/dym122.

Turner,  Paul  C..  n.d.  “The  Molecular  Epidemiology  of  Chronic  Aflatoxin  Driven  Impaired  Child  Growth.” Scientifica 2013:  1– 21.http://dx.doi.org/10.1155/2013/152879.

Webb,  Patrick.  2013.  “Impact  Pathways  from  Agricultural  Research  to  Improved  Nutrition  and  Health:  Literature  Analysis  and  Research  Priorities.”

Webb,  Patrick,  Eileen  Kennedy.  2014.  “Impacts  of  Agriculture  on  Nutrition:  Nature  of  the  Evidence  and  Research  Gaps.” Food  and  Nutrition  Bulletin 35  (1):  126–32.

Webb,  Patrick,  Steven  Block.  2012.  “Support  for  Agriculture  during  Economic  Transformation:  Impacts  on  Poverty  and  Undernutrition.” Proceedings  of  the  National  Academy  of  Sciences  of  the  United  States  of  America 109  (31):  12309– 14.  doi:10.1073/pnas.0913334108.

The  World  Bank.  2013.  “Improving  Nutrition  Through  Multisectoral  Approaches.”

Multi-Sectoral Nutrition Strategy Global Learning and Evidence ExchangeEast and Southern Africa Regional Meeting

https://www.usaid.gov/what-we-do/global-health/nutrition/technical-areas

Multi-Sectoral Nutrition Strategy Global Learning and Evidence ExchangeEast and Southern Africa Regional Meeting

https://www.usaid.gov/what-we-do/global-health/nutrition/technical-areas