Rethinking Stunting – Placing importance on nutrition-sensitive agricultural programmes
The ‘Voice for Change Partnership’ (V4CP) programme, is a program funded by the Dutch Ministry of Foreign Affairs and implemented in six countries (Kenya, Rwanda, Burkina Faso, Ghana, Honduras and Indonesia) under the leadership of SNV in conjunction with the International Food Policy Research Institute (IFPRI). The goal of the 5-year project is to improve the food security and nutrition of poor by supporting CSOs to foster collaboration among relevant stakeholders, influence agenda-setting and hold the government and private sector accountable for their promises and actions. Working closely with CSO’s IFPRI provides research-based policy solutions and evidence to sustainably reduce poverty and end hunger and malnutrition in target countries
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Written by: Marie Ruel , Director, Poverty, Health and Nutrition Division, International Food Policy Research Institute, IFPRI.
Rethinking Stunting – Placing importance on nutrition-sensitive agricultural programmes
For the greatest impact on nutrition, agricultural programs should aim to improve the diet quality of all household members, rather than focus on reducing child stunting!
Linking research to guide future practices
For more than three decades, researchers have been exploring the links between agriculture, human health, and nutrition. Key areas of enquiry included understanding how a farmer’s agricultural production affects their family’s nutrition; whether or not diversifying farm production ensures greater dietary diversity among poor households, women and young children in particular; and how empowering women may help unleash the benefits of agriculture for nutrition.
Reviews of the nutritional impacts of agricultural development programmes, published between 2000 and 2013, confirms that:
Programmes provide nutritional benefits to households, such as improvements in food security and dietary diversity, and increased intake of nutrient-rich foods targeted by the programmes.
Programmes have impacts on women’s empowerment (for example in decision making and access to financial resources).
There is little evidence that that these programmes help reduce childhood stunting.
Since then, a new wave of agricultural programmes were designed and implemented with nutrition in mind. These nutrition-sensitive programmes included enhanced homestead food production systems with or without small animal rearing, livestock projects, value chains, irrigation projects; and the nutrition specific interventions usually focused on improving maternal and child health and nutrition knowledge and practices and the distribution of micronutrient powders - to improve children’s intake of essential micronutrients.
Many of these new programmes targeted nutritionally vulnerable women and young children and included interventions to empower women and to raise community awareness on gender equity issues.
These improved programmes were often paired with rigorous evaluations, generating reliable and credible evidence on the potential of agricultural programmes to improve nutrition. An additional improvement is the inclusion of an analysis on how impacts are achieved in programmes - allowing for evidence and learning to not only focus on whether, but also how, agricultural programmes improved nutrition outcomes.
What have we learned and where do we go from here?
In a recent review published in Global Food Security, and as a discussion paper from the International Food Policy Research Institute (IFPRI), my co-authors, Agnes Quisumbing and Mysbah Balamgawala, and I summarise results from recent evaluations of these newer nutrition-sensitive agricultural programs published between 2013 and 2017.
In general, the results of these studies confirm that newer programmes met their main goal of increasing household, maternal, and child dietary diversity and the consumption of targeted animal-sourced foods, fruits and vegetables. As a result, the programmes increased the intake of key essential micronutrients, such as vitamin A and iron, and reduced (where measured) the prevalence of child and maternal anaemia (globally, about half of the anaemia is due to iron deficiency).
While several studies found small reductions in child wasting (thinness) and diarrhoea prevalence, only one found a positive impact on stunting. This study, which tested the effects of different packages of nutrition interventions in Burkina Faso, found that improvements in nutrition require multi-sectoral approaches which address the multiple determinates of undernutrition. This package included the promotion of diversity in agricultural production, including small animal rearing, behaviour change communication, and women’s empowerment activities, combined with enhanced water, sanitation, and hygiene education and the distribution of micronutrient supplements.
Overall, compared with earlier agricultural programmes, more recent programmes are generally better designed, targeted, evaluated; and have clearer project objectives regarding nutrition and women’s empowerment. Many of the recent evaluations also reflect a changing culture—one in which programme implementers and evaluators: (1) work together to carefully think through programme design and hypothesized impact pathways; (2) use evidence to strengthen and adapt programme design and service delivery; and (3) integrate participants’ feedback into program design and implementation. An excellent example of this approach is the Helen Keller International (HKI) and IFPRI’s decade-long partnership in testing and rigorously evaluating different nutrition-sensitive agricultural programmes. HKI is using the findings and learnings to adjust, adapt, and strengthen its programmes in Burkina Faso and elsewhere.
Main takeaways from the review:
The main takeaway from our review is that agricultural programmes may be better suited to improving household and individual access to nutrient-rich foods and diverse diets than to reducing stunting. So far, positive impacts on diets have been measured only for mothers and young children who are considered most at risk of undernutrition. It is likely, however, that many agricultural interventions are benefiting all household members, including other nutritionally vulnerable groups such as adolescents and the elderly.
Lowering stunting rates through agricultural programmes is possible, as was demonstrated in Burkina Faso, but doing so requires multiple inputs and interventions from various sectors. In practice, this could prove to be too complex to be implemented and scaled up successfully. Improving the diets of all household members through nutrition-sensitive agricultural programmes is a more reasonable and achievable goal for agriculture, and is just as critical for achieving the Sustainable Development Goals. Regardless, nutrition-sensitive agricultural programmes should continue to be designed carefully, taking into account local contexts, and by using state-of-the-art research methods to identify and address the main constraints limiting women’s empowerment, the household’s, and the individuals’ access to healthy diets and good nutrition.
For more information please visit: http://www.snv.org/project/voice-change-partnership-v4cp
References:
1. Ruel MT, Quisumbing AR, Balagamwala M. Nutrition-sensitive agriculture: What have we learned so far? Glob Food Sec 2018; published online Feb. DOI:10.1016/j.gfs.2018.01.002.
2. Ruel MT, Quisumbing AR, Balagamwala M. Nutrition-Sensitive Agriculture What Have We Learned and Where Do We Go from Here? IFPRI Discussion Paper #01861. Washington, D.C.: International Food Policy Research Institute (IFPRI), 2017 file:///D:/Users/MRUEL/Downloads/131673.pdf.