Pathways to household nutrition

in Asia-Pacific Region

GCARD 2012

Punte del Este, Uruguay

Context: Renewed investments in agriculture, nutrition, gender equality

“

“Achieving gender equality… is also crucial for agricultural development and food security.” (FAO SOFA, 2011)

“Fighting malnutrition should be the top priority for policy makers and philanthropists.”

(Copenhagen Consensus 2012) “There is no greater engine for

driving growth…than investments in agriculture.” (GCARD Roadmap, 2010)

HKI’s nutrition priorities in Asia

Agriculture-based nutrition

Infant Young Child

Feeding

Vitamin A

Women’s nutrition and gender

Build the evidence base for agriculture-based nutrition approaches

Ensure lasting capacity to deliver effective nutrition services

Create a supportive environment to prevent and treat malnutrition

Develop replicable, scalable evidence-based models

HKI’s agriculture for nutrition model Goal: Increase production and consumption of micronutrient-rich foods.

Evolving toward child growth focus, but limited data on impact. Core components:

Institutional linkages (health, agriculture, livestock, markets) Community-based extension targeting poor smallholder women

(demo farms) Horticultural training (micronutrient-dense varieties) Poultry and livestock support (animal source foods and income) Nutrition BCC (IYCF, micronutrients, cooking, gender)

Consistent evidence: Improved dietary diversity Greater food security Increased income (in women’s control) Greater participation in decision-making (small decisions)

Ensuring lasting capacity to deliver nutrition services: Governance model, Nepal

Partners: Government Ministries of Health, Agriculture and Local Development, the Nepali Technical Assistance Group (NTAG) and NGOs.

National and district planning workshops to define objectives, areas for integration

Food Security and Nutrition Committees formed at District and VDC level

Health workers trained as demonstration farmers

Outcomes: Nutrition commitments

Demonstration farms integrated into government extension system at VDC level

District and VDC-level food security & nutrition working groups linked in Multi-sectoral Nutrition Plan (MNSP)

Recognition of synergies and potential between Agriculture, Health, Local Government

AAMA initiatives sustained beyond HKI withdrawal

Village Development Committee Funds Contributed to nutrition initiatives:

Kailali – VDC $9800 ENA training, seed distribution,

poultry distribution, vaccination, IYCF food demonstration

Batadi - VDC $2500 ENA / HFP training, seed

distribution, coop improvement, poultry vaccination, pol house construction

Bajura - VDC $36000

More than messages: Importance of integrated nutrition BCC strategies

• Grounded in formative research

• Has specific behavior objectives

• Uses multiple channels and methods

• Addresses gender + intra-household issues

• Uses adult learning principles (learning-by-doing, cooking demonstrations, games)

• Invests in facilitation and counseling skills

Grandmothers laugh at “ludo,” learn about breastfeeding-support

Child Growth in ENA Pilot Area

A M J J A S O N D J F M A M J J A S*Pre-intervention Period Training Period Post-Intervention

-1.30

-1.25

-1.20

-1.15

-1.10

-1.05

-1.00

-0.95

-0.90

-0.85

Average weight-for-age z-scores in pilot and non-pilot areas

Selected nearby areas Selected ENA pilot project area

All children in ENA unions

Investment in nutrition BCC skills accelerates child growth •Supplemental training and facilitation skills to existing MCHN program area•Trained TBAs, health volunteers, midwives•Used adult-learning, participatory tools•Improved counseling skills•Growth rates improved within six months of implementation

Source: Training Communities on Essential Nutrition Actions. HKI Bangladesh April 2010.

Developing an ag-nutrition-gender strategy

Strategy: “Let’s all care for each other.”

Problems Strong family support at birthBreastfeeding drops at three months, women return to fields; harvest-time workloads Grandmothers enforce food taboos, poor IYCF

Reposition breastfeeding as valuable labor and family investment

Build on fathers’ caring practices around childbirth

Seasonal calendars for family workload support sharing

Work with church, agriculture, health groups (whole family)

Use neighborhood committees to allocate harvest-season work, including breastfeeding support

Train iodized salt sellers on marketing, nutrition

Organize local, district, regional agriculture-nutrition fairs and competitions

Community strategy

Creating a supportive environment: Gender- transformative pathways

•

•Addressing intra-household power relations• Treating child feeding as valuable work and time investment•Engaging men, mothers-in-law in workload-sharing strategies

Holding integrated nutrition-agriculture community events

Treating women as farmers; men as carers; establishing role models

Building women’s market skills and providing supplemental support

Measuring gender-based violence and social norms

Challenge: Building the evidence baseA Systematic Review of Agricultural Interventions that Aim to

Improve Nutritional Status of Children found: “The studies reviewed report little or no impact on the impact of

agricultural interventions on the nutritional status of children. However, we attribute this to the lack of statistical power of the studies… rather than to the efficacy.” (Masset et al, 2011)

Methodological gaps in agriculture-for-nutrition studies: Absence of control groups Poor attention to determinants of participation, little

socioeconomic data Inconsistent metrics of income, consumption, nutritional

outcomes

Fish on Farms RCT, Cambodia

Partners: HKI, University British Columbia, WorldFish, Cambodian Ministry of Agriculture and Fisheries, IDRC

22-month, 3-arm RCT: Horticulture Horticulture + aquaculture Control group

Target population: 600 food insecure women with <2

children Indicators:

Anemia Vitamin A Anthropometry , BMI Dietary diversity Economic data and marketing practices Gender and decision-making Household livelihood strategies

Partnerships to build the evidence base and scalable models: What can agriculture research bring? Rigorous evaluation designs Food-systems thinking: integrated analysis of

care, production, income, markets Better understanding of consumption-income-

generation choices Building evidence of behavior-change

communication channels in agriculture; what are the appropriate channels and messages for the extension sector? How can we use market actors and create demand for nutritious crops and diets?

Technologies: For drudgery, efficient use of small plots, for processing and packaging foods

Using common nutrition indicators and outcomes

Establishing common, long-term gender-transformative goals for changes in agriculture sector (attitudes, norms, representation)