Development and Nutrition Eliana La Ferrara Invernizzi Chair in Development Economics Università Bocconi ABF Workshop, 24/10/2015
The nutrition poverty trap Poor nutrition Low income Low productivity 2
What do we know About the current state of nutrition The causes of undernutrition Potential policy responses Some disturbing facts 12.5% of the world s population undernourished 26% of children are stunted (40% in Sub- Saharan Africa) 45% of child deaths <3 yrs due to poor nutrition 3
% of children under 5 who are stunted Most stunting is in Sub-Saharan Africa and South Asia 4 Source: UNICEF, 2013
Decreasing trends in under-5 stunting, but not everywhere 5 Source: Black et al. (Lancet 2013)
Increasing trends in under-5 overweight 6 Source: Black et al. (Lancet 2013)
7 Source: WHO, 2010 Double burden : underweight & overweight
Why are so many people undernourished? 1. Food production 2. Food consumption & caloric intake 3. Distribution of resources within the household 8
1. Do we produce as much food as we can? 9
Agricultural yield gap 10 Source: Deininger and Byerlee (2011)
Reasons for low yields: (1) Technology More (adequate) technology needed? Technology exists but farmers do not adopt: 20-30% of farmers report using fertilizers in past year in Kenya, Ethiopia, Mali Low adoption of relatively simple and inexpensive agricultural innovations. Is this the rational response to low returns on inputs? No: use of fertilizers is low despite returns of 69% per year (Duflo, Kremer, Robinson, 2008) 11
Factors affecting technology adoption Why are farmers not using enough of these technologies despite high returns? Lack of information Credit constraints Take-up is 50% higher if fertilizer offered with 50% discount (Duflo, Kremer, Robinson, 2011) Time-inconsistent preferences Take-up is 50-70% higher if fertilizer offered right after harvest (Duflo, Kremer, Robinson, 2011) 12
Social learning Factors affecting technology adoption (cont d) Pinapple cultivation in Ghana: adoption higher if members of social network have adopted (Conley and Udry 2010) Risk aversion Buying fertilizer too risky for Ethiopian farmers (Dercon and Christiaensen 2011) Yet rainfall insurance take-up low (Cole et al, 2013; Giné et al., 2009) Gender differences in preferences within hh Women choose healthier stoves more often than men in Bangladesh, only when they are for free (Miller and Mobarak 2013) 13
Reasons for low yields: (2) Land rights Security of tenure and economic outcomes Higher tenure security lower risk of expropriation higher investments (Besley 1995) Historical institutions regarding property rights matter for today s economic outcomes (Banerjee and Iyer 2005, Hornbeck 2010) Investments and output are higher in plots controlled by individuals holding powerful positions in local government (Goldstein and Udry 2008) Yields on plots cultivated by women are lower Resources are inefficiently allocated across plots (Udry 1996) Differences in inputs access or usage (Horrell and Krishnan 2007) Women have weaker rights to own and inherit land (Agarwal 1994, Cooper 2012,...) 14
2. Do we get the max caloric intake we can? 15
Poor people spend a low fraction of their income on food 39%-79% among extremely poor in rural areas (Banerjee and Duflo 2011) Food subsidies do not generate higher caloric intake Poor people use them to buy more expensive and better tasting food The expenditure choices of the poor do not always translate into max caloric intake 16
Deeply rooted cultural norms can affect nutritional outcomes Do food cultures alter people s caloric intake? People make nutritionally suboptimal choices due to preference for traditional food: they pay a caloric tax (Atkin 2013) Evidence on migrants in the United States (McDonald and Kennedy 2005, Giuntella 2014) At time of migration, they have better health than natives They cannot afford to maintain their food habits in the host country They opt for fast food, with negative effects on their health 17
3. How is food distributed within the household? 18
3. Distribution within the household Social norms affect distribution of resources Decisions on how food is distributed within the family respond to customary practices Son preference generates differences in nutritional outcomes within a household Social norms affect intra-household distribution 19
Son preference Some differences in nutritional status within a household due to son preference Unequal breastfeeding practices (Jayachandran and Kuziemko 2011) Women with a first-born daughter tend to have more children, are less likely to use contraceptives and have shorter birth intervals (Milazzo 2014) Sibling rivalry: more resources are allocated to male children (Garg and Morduch 1998) 20
Importance of pregnant women s nutrition Nutrition received in utero has long-lasting effects on children s health Children in utero during flu pandemics in US had worse health and higher death rates (Almond) Children in utero during Ramadan earn less (Almond) Iodine supplementation to pregnant women in Tanzania improved children s educational outcomes (Field and Torero) Yet, 40% of pregnant women in the world are anemic (WHO) Need to ensure that pregnant women get right nutrients 21
22 Policy responses
1. Food production Interventions to facilitate technology adoption National policies to improve security of land rights (e.g., titling) National policies to improve gender equality in land rights (e.g., inheritance reforms such as the Hindu Succession Act) 23
2. Consumption of nutrients Not only programs that emphasize the quantity of food (e.g., subsidized rice distribution) Nutrition programs that enrich basic food with iron, vitamins, etc. 24
Nutrition programs scaled up at national level Nicaragua Malawi Rwanda Honduras Honduras Pakistan Georgia Iron Folate supplementation in pregnancy for 90+ days 25 Early initiation of breastfeeding within 1 hour of birth Exclusive breastfeeding, <6 months Source: www.globalnutritionreport.org Minimum acceptable diet, 6-23 months Minimum dietary diversity, 6-23 months Coverage % Vitamin A supplementation, <60 months Zinc supplementation with Diarrhea, <60 months Salt consumption is Iodized
2. Consumption of nutrients Nutrition programs that enrich basic food with iron, vitamins, etc. Information campaigns and media-based interventions to change people s preferences towards certain foods (e.g., educational entertainment) 26
3. Food distribution within the hh Economic empowerment of vulnerable hh members (e.g., women & microfinance) Interventions to change cultural norms (e.g., media-based) Direct targeting by government or NGOs Conditional Cash Transfers targeted to women School meals programs 27
Conclusions Overall clear need for interventions in this area Importance of targeting resources to most effective programs Need for a careful evaluation of program impact 28