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

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

2 Toolbox of Proven Solutions WASH Improved BF Iron & folic acid Agriculture Vitamin A Behavior change Food supplementation Disease prevention & control Women s Empowerment 2

3 The F Diagram

4 WASH Nutrition Conceptual Framework Water source far from home Inadequate storage Water pricing High amount spent on water Low water quantity Less time for food preparation Unimproved sanitation Faecal contamination of home Poor hand-washing Less money for food Nematode infection Environmental Enteropathy Diarrhea Poor water quality Poor nutritional status Unprotected water source Source: O. Cumming, London School of Tropical Medicine and Hygiene, 2013

5 Food Consumed Calories Protein Micronutrients How Does Agriculture Affect Nutrition? 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 5 Nutrition Strategy Global Learning and Evidence Exchange

6 Main Agriculture & Nutrition Pathways

7 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 7 Nutrition Strategy Global Learning and Evidence Exchange

8 Evidence on Food Production Pathway 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 R n wanda, hemoglobin and serum ferritin both improved among those consuming highiron beans. OFSP, vitamin A cassava, and iron pearl millet also have some positive results.

9 Processing & Storage Micronutrient Fortification Good management, processing and storage can increase food access and reduce stunting (perhaps by 1 SD!) Occupational risks: Evidence on Food Production Pathway E.coli and Salmonella in agricultural wastewater Increased malaria where water is stored Risks in value chains (e.g., zoonosis)

10 Agriculture as a source of income 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 Multi-Sectoral 10 Nutrition Strategy Global Learning and Evidence Exchange

11 Evidence on Income Pathway Patrick Webb, and Steven Block PNAS 2012;109: 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 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 12

13 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 Evidence: Women s Empowerment Pathway

14 Enabling Environment: Food Market 14 Intra 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 meand energy availability are influenced by ease of food preparation Disea seburden influenced greatly by food safety environment, and environmental sanitation

15 Achieving Better Nutrition Outcomes Design nutrition-sensitive agriculture activities, outcomes, and indicators that link with nutritionspecific activities in colocated areas. Reference the frameworks, principles, and pathways. Multi-Sectoral 15 Nutrition Strategy Global Learning and Evidence Exchange

16 Works Cited Balagamwala, Mysbah, Haris Gazdar, and Hussain Bux Mallah 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 Are Biofortified Staple Food Crops Improving Vitamin A and Iron Status in Women and Children? New Evidence from Efficacy Trials1 4. Advances in Nutrition, doi: /an Du, Lidan, 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 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 Gender Roles and Food Safety in 20 Informal Livestock and Fish Valu Chains. International Food Policy Research Institute (IFPRI). Griffiths, Jeffrey K 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 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 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): Leverhulme Centre for Integrative Research on Agriculture and Health (LCIRAH) Agri Health Research: What Have We Learned and Where to next? Presentation and Poster Abstract Booklet. Martorell, R., et. al 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: 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 Aflatoxin Exposure in Utero Causes Growth Faltering in Gambian Infants. International Journal of Epidemiology, no. 36 (June 2007): doi: /ije/dym122. Turner, Paul C.. n.d. The Molecular Epidemiology of Chronic Aflatoxin Driven Impaired Child Growth. Scientifica 2013: Webb, Patrick Impact Pathways from Agricultural Research to Improved Nutrition and Health: Literature Analysis and Research Priorities. Webb, Patrick, Eileen Kennedy Impacts of Agriculture on Nutrition: Nature of the Evidence and Research Gaps. Food and Nutrition Bulletin 35 (1): Webb, Patrick, Steven Block 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): doi: /pnas The World Bank Improving Nutrition Through Multisectoral Approaches. Multi-Sectoral 16 Nutrition Strategy Global Learning and Evidence Exchange

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