AReviewofFoodSecurityandHumanNutritionIssuesinNepal

GeraldShively,JaredGarsandCelesteSununtnasukDepartmentofAgriculturalEconomics

PurdueUniversityWestLafayette,IN47907

September28,2011

ABSTRACT.Nepalfacesmultipledevelopmentchallenges,includingchronicandwidespreadfood insecurityandadultandchildmalnutrition.Duetopopulationgrowth,agriculturalstagnationandarangeofinstitutionalfailures,thethreatofa serious food crisis in Nepal is substantial. The recent scaling back of WFPassistance means that food security conditions in some parts of Nepal willundoubtedlyworsen in thenear future. This paperpresents abrief reviewoftopicsandavailableevidence regarding foodsecurity,malnutritionand relatedsubjects in Nepal. It is intended to document important sourcematerial andprovideanoverviewoftopicsfornonspecialistsorthosemovingintonewareasofconcern.

Thisworkwasmadepossible through supportprovidedby theBureauofEconomicGrowth,AgricultureandTrade,U.S.AgencyforInternationalDevelopmentthroughtheGlobalNutritionCollaborative Research Support Program. The opinions expressed herein are those of theauthorsanddonotnecessarilyreflecttheviewsofthesponsoringagency. PatrickWebbandShibani Ghosh provided helpful suggestions and input on an earlier draft. Please directcorrespondencetoshivelyg@purdue.edu.ThisisPurdueUniversityDepartmentofAgriculturalEconomicsStaffPaper1105.

1.Introduction

Nepalfacesmultipledevelopmentchallenges,includingchronicandwidespreadfoodinsecurity

andadultandchildmalnutrition.Asaresultofrapidpopulationgrowth,agriculturalstagnation

andarangeofinstitutionalfailures,thethreatofaseriousfoodcrisisinNepalissubstantial.1

Nepalsmostrecent(2010)GlobalHungerIndex(GHI)scoreis20,whichplacesit27thoutof84

rankedcountries;westernregionsofthecountryscorefarlower(HollemaandBishokarma,

2009).Governmentexpenditureonagricultureiscurrentlythelowestithasbeenindecades,

andthecountryhasrecentlyexperiencedsubstantialfoodgraindeficitsof225,000mtin2007

and133,00mtin2009(Hobbs,2009).TheWorldHealthOrganization(WHO)placesthecurrent

malnutritionrateatcrisislevel,andarecentWorldFoodProgram(WFP)reportnotesthat

thecountrysuffersfromtheworstmalnutritioninAsia,onparwiththeDemocraticRepublicof

theCongo,Sudan,Uganda,andSomalia(Hobbs,2009).Withmorethan3.5millionpeople

moderatelytoseverelyfoodinsecure,manyoftheminregionsgeographicallyremoteand

difficulttoreach,foodaidhasplayedaprominentandgrowingroleinmeetingfoodneedsin

recentdecades(Frankenbergeretal.,2010).However,accordingtorecentmediareports,

reducedfundingresultingfromtheglobalfinancialcrisishasforcedcutsinmanyfood

assistanceprojects.ThescalingbackofWFPassistance,includingthehaltofhelicopterandair

operationsusedtoflyaidintoremoteregions,isprojectedtodecreasethenumberofthose

1ThemajorityofdistrictsinNepalwereestimatedtobefoodinsecurein2007,andthirteendistrictsreportedannualpercapitacerealproductionbelow150kg/person.IndecreasingorderofdeficitthesedistrictsareKathmandu,Humla,Lalitpur,Bajura,Achham,Dolakha,Bhaktapur,Mahottari,Kalikot,Baitadi,Bajhang,DolpaandRautahat.Inaddition,fourteenotherdistrictshadpercapitacerealproductionbetween150kg/personand180kg/person,significantlybelowthenationalaverageandbelowthelevelconsideredtheminimumrequirementforsufficiency(FAO/WFP,2007).

receivingfoodaidfromonemilliontoapproximately100,000,2suggestingthatfoodsecurity

conditionsinsomepartsofNepalwillundoubtedlyworseninthenearfuture.

Thispaperpresentsabriefreviewoftopicsandavailableevidenceregardingfood

security,malnutritionandrelatedsubjectsinNepal.Itisbynomeanscomprehensiveinits

scopeorcoverage,butisintendedtodocumentimportantsourcematerialandprovidean

overviewoftopicsfornonspecialistsorthosemovingintonewareasofconcern.Thematerial

isorganizedunderaseriesofbroadthematicheadings,althoughitisimportanttorecognize

thatmostofissuescoveredinthepaperareinterconnectedbothintheircausesandtheir

impacts.Throughoutthepaper,referenceismadetodataderivedfromtheNepal

DemographicandHealthSurvey(NDHS).DHSsurveydataforNepalareavailablefor2001and

2006.Bothsurveysarenationallyrepresentative,georeferencedandpubliclyavailable(see

theAppendixfordetails).Acurrentroundofthesurveyisbeingcollectedatthetimeof

writing,andwilllikelybemadepublicinthenext1218months(byearly2013).TheDHSdata

providethemostcomprehensiveassessmentofnutritionoutcomesavailableforNepal.

2.Malnutrition,FoodInsecurityandHealth

Nepalisoneoftheleastwellnourishedcountriesintheworld.Accordingtodatafromthemost

recentNepalDemographicandHealthSurvey(NDHS,2006),halfofallNepalesechildrenunder

theageoffivehavealowheightforageorsufferfromstuntingasaconsequenceofchronic

2SeereportsbyABCandBBCathttp://www.abc.net.au/pm/content/2011/s3220545.htmandhttp://www.bbc.co.uk/news/worldsouthasia13422384.TheWFPprograminNepalisdescribedathttp://www.wfp.org/countries/Nepal/Operations.

malnourishment.Approximately40percentareunderweight.Thehighestratesofhungerare

foundintheFarandMidWesternHillandMountainregions.AccordingtoHollemaand

Bishokarma(2009)HungerIndexscoresintheseareasofNepalareclosetoorabove30,andno

subregionfallsintoeitherthemoderatehungerorlowhungercategories.Evenso,anddespite

ahighlyunstablepoliticalenvironment,Nepalhasmadestepstowardsachievingimproved

healthindicatortargetsasidentifiedinthecountrys10thfiveyearplanningperiod.These

includereducingchildandmaternalmortalities(WorldBank,2010).AsFAOdatapresentedin

Figure1indicate,boththenumberandtheproportionofundernourishedpeopleinNepal

peakedin1998.Nevertheless,about15%ofthepopulationremainedundernourishedasof

2005.RecentdataprovidedbytheNDHS(seeFigure2)showasignificantdeclineinthe

percentofchildrenwithstuntedgrowthandamodestdeclineinthepercentofchildrenthat

areunderweight.Despitethesegains,theMillenniumDevelopmentGoaltoreducethe

proportionofunderweightchildrenby50percentbefore2015remainselusive.ArecentUnited

NationsChildrensFund(UNICEF)reportshowsthat69percentofNepalesechildrenare

severelydeprivedofoneormoreofthesevenbasicnecessitiesincludedintheBristolindex

(sanitation,information,water,shelter,food,education,health)and38percentareseverely

deprivedoftwoormoreoftheseindicators,whichisconsideredamarkerofabsolutepoverty

(UNICEF,2010).Ofparticularconcernaretheindicatorsofmalnutritionandsanitation.More

thanhalfofallchildrenbetween0and17monthsofagelackaccesstoanykindoftoiletand

sufferfromthecombinedeffectsofinsufficientnutritionandpoorhygiene(UNICEF,2010;

Kohleretal.,2009).

UndernutritionisanationwideprobleminNepal,butdisparitiesacrosssocioeconomic

groupsandecologicalregionsaremaskedwhenlookingatnationalaggregates.Asanexample,

54percentofchildrenunderagefivewerefoundtobeunderweightinthelowestincome

quintile,comparedwith24percentinthehighestquintile(MOHP,2007).Intermsofregions,

53percentofchildrenfromtheMidWesternregionwerefoundtobeunderweight,in

comparisonto37percentofchildrenfromtheEasternregion.Lookingatthesubregional

level,childmortalityrangesfromalowof4percentintheCentralHillsubregionto18percent

intheWestern,MidWesternandFarWesternMountainsubregions(Hollemaand

Bishokarma,2009).From1996to2004,poverty(asmeasuredbyaconsumptionindex)declined

from42percentto31percentinNepal,largelyduetoariseinremittanceflows,highernon

agriculturalincomes,increasedurbanization,andfertilitydeclines.However,largeincome

disparitiespersistacrossecologicalzones,urbanandrurallocations,andalonggender,

ethnicityandcastelines.Althoughthedeclineinconsumptionpovertyhasbeenaccompanied

bysubstantialreductionsinchildpovertyoverthesameperiod(from44percentto36

percent),11percentofchildrenfallmorethanthreestandarddeviationsbelowthe

internationalreferencepopulationforweightforage,whichisanindicatorofsevere

malnutrition.Childreninruralareasaredisproportionatelyaffectedbymalnutritionrelativeto

theirurbancohorts,with51percentvs.36percentstunted,and41percentvs.23percent

underweight(Hobbs,2009).

Figure1:TrendsinundernutritioninNepal(Source:FAO,2007)

Usinglivelihoodasamarker,Romer(2004)identifiesover9millionNepaleseas

vulnerabletofoodinsecurity.Ofthese,themajorityaremarginalfarmhouseholdslocatedin

theHillsandTerai,followedbyruralcastes,agriculturallaborersintheTerai,marginalfarmers

intheMountains,porters,andpoorurbanhouseholds.However,thosemostvulnerabletofood

insecurityaresubpopulationswithinthosegroups,namelywomen,children,indigenous

people,andthoseinthelowestcastes.Lowdietarydiversityalsoisaconcern.Accordingto

NDHSdata,accesstofoodsrichinvitaminAisseverelylimited.NDHSdatafrom2001and2006

showthat,intheweekleadinguptothesurvey,fewerthanonethirdofchildrenbelowage

threehadconsumedvegetablesandfruitsrichinvitaminA.Urbanruraldisparitiesarealso

evidentintheavailabilityoffruitsandvegetablesrichinvitaminA.Forexample,37percentof

urbanchildrenconsumethesefoodscomparedtojust28percentofruralchildren.VitaminA

supplementationiswidespreadinruralandurbanareasofNepal,althoughasomewhatlarger

proportionofchildreninruralareasreceivedirectvitaminAsupplementationthaninurban

areas(80percentvs.75percent)(Pradhan,2005).

Figure2:Childnutritionalstatus(Source:NDHSdata;figurefromWorldBank)

Inanenvironmentwhereoneofeverytwochildrenisalreadymalnourished,the

incidenceandeffectsofdiseasescanbelifethreatening.Withserioushealthimplications,the

mostwidespreadseveredeprivationfacedbychildreninNepalislackofsanitation,whichisa

directcontributortothediseaseburden.Nearly6.4millionofNepalschildren(morethanhalf)

defecateintheopen.Thislackofsanitationhasimportantramificationsforthespreadof

disease.Ruralchildrenarethreetimesworseoffthantheirurbancounterparts(UNICEF,2010).

ThoselivingintheWesternMountains,theMidwesternHills,andtheCentralTeraisuffer

disproportionately.Over70percentofchildrenintheseareasdefecateinopenspaces.In

additiontopoorsanitation,11.4percentor1.3millionchildreninNepallackaccesstoasafe

andadequatesupplyofwater.Theresultsofpoorsanitationanduncleanwaterincludeworm

infestations(affectingnearlyallchildren),typhoid(affecting200,000childrenin2004),anda

rangeofvectorborneillnessesincludingJapaneseencephalitisandMalaria(UNICEF,2010).

Rai,etal.(2002)provideacomprehensiveoverviewofinfectiousdiseasesinNepaland

theirlinkstomalnutrition.NumerousinfectiousdiseasesarewidespreadinNepaland

accordingtotheNationalPlanningCommission(NPC)infectiousdiseaseisimplicatedinnearly

threequartersofallillnessesanddeaths(NPC,1998).IntestinalparasitosisisoneofNepals

mostimportantpublichealthproblems.Itisestimatedthat60percentofthepopulationis

infectedwithoneormorespeciesofparasite(Ishiyama,OnoandRai,2001),withinfection

ratesashighas90percentinsomeruralareas(Estevez,LevineandWarren,1983;Raiand

Gurung,1986;Raietal.,2000a).Choleraoutbreaksandinfectionsofthesmallintestinespeak

duringtherainyseason(Iseetal.,1996).

Soiltransmittedhelminthes,alsoknownasintestinalworms,arethemostcommon

intestinalinfectioninNepal(Adhikarietal.,1986;Raietal.,1994;2000a).Thewormsareso

widespreadthatRaietal.(2000b)reportthateventhesoilinKathmanduiscontaminatedwith

eggs.Additionally,ithasbeenestimatedthatnearly50percentofotherwisehealthyNepalese

(Rai,1999)andmostlivestock(Raietal.,1996)areinfectedwithToxoplasmagondii,anormally

minorinfectionthatcanbefatalforfetusesandnewborns.ThroughouttheTeraiandinvillages

alongrivers,vectorbornediseasesincludingmalaria,leishmaniasisandJapaneseencephalitis

areendemic(Raietal.,2001).

FewstudiesreportcomprehensivedataregardingmicronutrientnutritioninNepal.The

mostrecentnationalmicronutrientstatussurveydatesto1998(WorldBank,2010).That

surveyfoundlowprevalenceofnightblindness(0.24percent)andBitotsspots(0.33percent),

andlowserumretinollevelsamongpreschoolchildren(32.3percent).3Thesemeasurements

indicatechroniclackofvitaminAconsumption.Additionally,Iodinedeficiencydisorderssuchas

goiterwerepresentamong40percentofthetotalpopulation,andamong32percentoftested

preschoolers.TheNDHS2006surveyrevealedhighprevalenceofanemiaamongwomenand

children:48percentofchildrenages659monthswerereportedasanemic(WorldBank,2010).

AkeycontributortochronicundernutritioninNepalislowweightatthetimeofbirth.

MorethanathirdofNepalesechildrensufferfromlowbirthweight(LBW),whichoriginates

withpoormaternalnutrition.AroundaquarterofNepalesewomenhaveabodymassindex

(BMI)belownormalandabout36percentofpregnantwomenareanemic.Anotherbarrierto

reducingtheprevalenceofunderweightchildrenissuboptimalinfantandyoungchildfeeding

(IYCF)practices.ContrarytoWHOsbreastfeedingrecommendations,whichcallforexclusive

breastfeedingupto6months,only53percentofNepalesechildrenunder6monthsare

exclusivelybreastfed.RecommendedIYCFpracticescallformilkormilkproductsandfoods

fromspecificallyrecommendedfoodgroupsandaskthatinfantsarefedatleastthe

recommendedminimumnumberoftimes(WorldBank,2010).AlmostallNepalesechildren

aged623monthsarebreastfedorgivenmilkproducts,butonly57percentofchildrenare

providedwiththerecommendednumberoffoodsitems(foodfromthreeormoregroupsfor

breastfedchildren),and18percentarefedlessoftenthanisrecommended.Anotherfactor

3WHOusesa0.5%prevalencerateforBitotsspotsanda1.0%prevalenceratefornightblindnessasthelowerthresholdsfordeterminingapublichealthconcern.

thatgreatlycontributestochildhoodundernutritioninNepalispooraccesstosafedrinking

waterandadequatesanitation(WorldBank,2010).

In2007,theGovernmentofNepalundertookstepsthroughtheDepartmentofChild

HealthDevelopment(CHD)toendproblemsofchildmalnutritionthroughthedraftingofthe

NationalNutritionActionPlan(NNAP),whichadvocatesforacomprehensive,integratedand

intersectoralstrategyforaddressingtheproblemofmalnutritioninNepal.However,whileit

wasanimportanteffortfromthegovernment,thedocumenthasnotbeenfinalized.The

GovernmentofNepal(GON)hasmadeseveraleffortsandinterventionswithdifferentdegrees

ofsuccesstoaddresstheproblemofundernutrition,includingtheestablishmentofa

nationwideprogramformiddaymeals.Althoughthemiddaymealprogramhasbeenjudged

asquitevaluableforpromotingeducationandschoolattendance,itsrecordasanutrition

interventionprogramislesswellestablished(WorldBank,2010).Nepalhasimplementeda

NationalVitaminAProgramme(NVAP),aNationalIodineDeficiencyDisordersControl

Programme(NIDDCP),andanumberofprogramsaimedatsupplementingironandfolatefor

pregnantandlactatingwomen.TheNationalNutritionPolicyandStrategy,whichis

administeredbytheChildHealthDivisionoftheDepartmentofHealthServices,strivesto

improvehealthandimplementbasicnutritionalaidssuchasvitaminAsupplementation.The

distributionofvitaminAandothernutritionalsupplementsismainlydoneviaFemale

CommunityHealthVolunteers(FCHV)andVillageHealthWorkers(VHW).Amongother

responsibilities,thesegroupsalsomobilizecommunitiestohelpwithfamilyplanning,maternal

careandchildhealth.OtherministriesinNepalhavebeeninvolvedinnutritionrelatedplans

withinspecificsectors.TheseincludetheMinistryofAgriculture,theMinistryofEducation,and

theMinistryofWomen,Children&SocialWelfare(WorldBank,2010).

DetailedmalnutritionmapsweredevelopedandpublishedjointlybytheNepalCentral

BureauofStatistics,theWorldFoodProgramandtheWorldBankinSeptember2006.4These

mapsillustrateahighdegreeofoverlapamongwastingandunderweightindicators;in

contrast,stuntingisfarmoreprevalentinMountainsubregions.Themapsunderscorethe

considerablegeographicdiversityamongnutritionindicatorsinNepal.Thehighestincidences

ofstuntingandunderweightoccurintheMountainandHillareasoftheFarandMidWestern

developmentregions.Intheseareas,60percentofchildrenshowsignsofstuntingand50

percentregisterasunderweight.Theseoutcomescanbeattributedlargelytothelimited

availabilityoffoodandhighunderlyingratesofpovertyintheseareas.

IntheTerai,onaverage,17percentofchildrensufferfromwasting,althoughratesas

highas21percentarereportedintheCentralTerai.BothUNICEFandActionContreLaFaim

(ACF)haveconductednutritionsurveysindroughtaffectedNepalesedistricts.TheUNICEF

reportshowsthat72percentofchildrenarestuntedinBajuradistrictand70percentare

underweight.InJumla,ratesofmalnutritionareevenmorestriking,withindicationsthat82

percentofchildrenarestuntedand77percentareunderweight(FAO/WFP,2007).Wasting

levelsrecordedinthesedistrictsarealsoextremelyhigh.Aseparatesurveyconductedin

January2007byACFinthedistrictofBajhangplacedthechronicmalnutritionrateat59

percent(FAO/WFP,2007).

AseparateWFPsurvey,alsoconductedin2007indroughtaffectedareas,used

4Threemaps(oneeachforprevalenceofstunting,wastingandunderweight)areavailableat:http://www.un.org.np/sites/default/files/maps/tid_113/MalnutritionMap.pdf

measurementsofmidupperarmcircumference(MUAC)togaugemalnutritionlevels.Results

showmalnutritionratesinexcessof50percentintheseareas,withanadditional24percentof

childrenatrisk(FAO/WFP,2007).Thesamestudyinvestigatedfoodconsumptionpatternsand

concludedthatpeopleindroughtproneareasdonotgenerallyconsumedietsrichinproteins,

vitaminsandminerals.Accordingtothesurvey,householdsconsumedfish,meat,eggsand

freshfruitveryrarely.Furthermore,consumptionpatternsinareasaffectedbydrought

deterioratesharplysurroundingsevereweatherevents.Asanexample,despitetheirroleas

basicingredientsintheNepalidiet,lentilsandpulseswerenotconsumedbymorethanhalfof

householdsindroughtaffectedareas.Ontheotherhand,onlyabout12percentofhouseholds

fromnondroughtareashadnotconsumedlentilsandpulses.Similarly,thesurveyshoweda

reductionintheintakeofgreenvegetablesamonghouseholdsindroughtaffectedareas

(FAO/WFP,2007).Overall,householdsinthesemostvulnerableareashavefewviablecoping

strategies;marketstendtofunctionpoorly,alternativesourcesofincomeandlivelihoodare

rareandtemporaryorpermanentmigrationisdifficult.Themessage,therefore,isthat

householdsinareaspronetodroughtandotherexogenousshocksmustconsequently

internalizeasignificantproportionoftheseshocksthroughreducedconsumptionand

subsequentdegradationofnutritionandhealth.

3.AgriculturalProduction,LivelihoodsandFoodSecurity

Incomefromfarmingremainsadominantsourceofincomeforalargemajorityoftherural

populationinNepal,especiallythoselocatedintheMountainregionsandmanyareasofthe

HillsandTerai.Datafromthe2004NepalLivingStandardsSurveyshowthatnearlyhalfof

householdincomecomesfromagriculturalproduction.Thesecondlargestincomesourceis

nonfarmwages(28percent),followedbyremittances(11percent).Thecontributionof

agriculturetooverallincomeisloweratthenationallevelthanfortheMountainregions,

where60percentofhouseholdincomeisderivedfromfarmingactivities,withnonfarm

incomejust19percentandremittanceincome9percent.Thepooresthouseholdsrely

disproportionatelyonfarmincome.Thepoorestandsecondpoorestquintiles(basedon

consumption)derive62percentand58percentoftheirincome,onaverage,fromfarming

activities,andreceivelowerthanaverageremittances(8and9percent,respectively)(Floydet

al.,2003).

ThemostrelevantongoingproblemintheHillsandMountainsoftheFarandMid

Westernregionsissimplelackoffood.Thisproblemisexacerbatedbyverylowpurchasing

powerandextremelyhighmarketpricesintheseremotelocations.Whentheseareasfacefood

deficitstheyrarelyseeaninfluxofprivatesupplies(FAO/WFP,2007).Moreover,deficitstend

nottobefilledbynationalorinternationalagenciesbecauseofextremelyhightransportation

costs.Thesehighcostsprohibitthenecessaryquantitiesoffoodfrombeingtransportedto

thesedeficitareas.Ontheotherhand,problemswithfoodinsecurityintheTeraiandLower

Hills,whichtendtobefoodsurplusareas,arerelatedtodistribution,accessandpurchasing

power.TheselatterareasarecharacterizedbylowerratesofpovertythanarefoundintheHills

andMountainsoftheFarandMidWest;however,theconcentrationofpoverty(asmeasured

bythenumberofpoorpeoplepersquarekilometer)isquitehigh(FAO/WFP,2007).

MostNepalesehaveextremelylimitedpurchasingpower.AccordingtotheWorldFood

Programsmissionobservations,incomeinequalitytendstobehigherintheTeraithaninthe

HillsandMountains,andgroupsthattendtobeespeciallyvulnerable(suchasDalits,Adivasi

JanajatisandKamayas)oftenstruggletoaccessfoodinsufficientquantities.Asaresult,the

Terairegionischaracterizedbyveryhighwastinglevels,oftenaboveemergencylevels.Dueto

theheterogeneityofNepalslandscape,analysisofaggregateddataismisleading.

Unfortunately,disaggregateddataarerarelyavailabletoprovidebetterinsightonfoodsecurity

withinmarginalizedgroups(especiallywithintheTerai).Thesegroupsoftensuffernotjust

economically,butsocially.Theyhavelimitedknowledgeregardingnutritionandappropriate

hygieneandcaringpractices,andtheirviewsregardinggenderdivisionswithinthehousehold

tendtoplacewomenindisadvantagedpositionsvisvismen(FAO/WFP,2007).

Fromtheperspectiveoffoodproduction,overallperformanceinNepalisdisappointing

andagriculturalproductivityremainslowbySouthAsianstandards.A2004reportbythe

MinistryofAgriculture(MOA)indicatedthatthemainstaplefoodcropsinNepal(wheat,maize,

rice,andpotato)wereproducedatonly50percentofthemaximumattainableyield;cereal

yieldsareestimatedtoberoughly2tonsperhectare.Theprimaryreasonsputforwardforlow

productivityareaheavilyrelianceonrainfedproduction(roughlytwothirdsofagricultural

productionisrainfed)andsubsistenceorientation.Populationgrowthcompoundsthese

problemsbyreducingfarmsizesovertime.5TheMOAreportedthatthesourcesoflowyields

werelowinvestmentinirrigation,infrastructure,fertilizers,ruralcreditandruralpower,aswell

asalackofresearchintoimprovingagricultureandverylittlecoordinationamonggovernment

departments(Shresthaetal.,2008).Asaresultofthesefailures,theannualgrowthrateof

5Nepalspopulationgrowthratepeakedat2.5%in1996.Asof2009,thepopulationgrowthratewas1.8%andtotalpopulationstoodat29.3million.

agricultureremainsquitelow(below3%).Notsurprisingly,observershavepointedto

increasingagriculturalproduction,marketingandtradeaspathwaystoreducemalnutritionin

Nepal,withaspecificfocusonboostingagriculturalactivityintheremoteareasoftheHilland

Mountainregions.Althoughtheeconomyincludesservices,smallscalemanufacturingand

tourisminadditiontoagriculture,thelargestshareofnationalincomebyfarisderivedfrom

agriculture,whichprovideslivelihoodformorethan80percentofthepopulationandaccounts

forapproximately40percentofGrossDomesticProduct(FAO/WFP,2007).Furthermore,much

ofthecountrysindustrialactivityisdirectlyorindirectlyrelatedtoagricultureandthe

processingofagroindustrialproducts.Theseproductsincludejute,sugarcane,tobaccoand

grains.GiventhecurrentstructureofNepalseconomy,economicdevelopmenteffortsmust

emphasizetheagriculturalsector.

SeasonalfoodshortagesarequitecommoninmanypartsofNepal,apatternthatis

drivenbysharpmonsoonalinfluencesinproduction,poorpostharveststorageandhandling,

andweaktransportinfrastructureandmarketintegration(Sonogo,2008).Acropcalendarfor

NepalsmaincerealcropsispresentedinTable1.Thisindicatesstrongtemporalcorrelationsof

harvestswithinagroecologicalzones,butsubstantialnegativecovarianceofproductionacross

agroecologicalzones.Thislatterfeatureprovidessomeunderlyingopportunitiesforspatialand

temporalgapfillingthroughinternaltrade,apotentialthathasnotyetbeenrealized.Panter

Brick(1993)demonstratesthatthestrongseasonalpatternofsubsistenceagricultural

productioninNepalhasimportantramificationsforwomensactivityandenergydemands,

especiallyduringpregnancyandlactation.Levine(1988)reviewsaseriesofcasestudiesthat

provideinsightsintotherelativeworkburdensandtimeallocationofwomeninmountainous

areasofNepal,concludingthat,atalllevelsofincome,womentendtoplacegreateremphasis

onproductiveactivitiesthanchildcare,andtendtoorganizethelatteraroundtheformer.Asa

result,seasonalpeaksinagriculturallabordemandtranslatedirectlyintotimeconstraintsfor

womenandincreasedvulnerabilityforchildren.

InmuchofNepal,pricesforstaplefoodsarestronglylinkedtocorrespondingpricesin

Indianmarkets,asthecerealmarketsinmuchoftheHillandTeraiareasareintegratedinto

thoseofNepalssouthernneighbor.ThemarketsoftheMountainregionaremuchmore

isolated,however,whichleadstorelativelyhigherricepricesthere.From2004to2007,prices

forriceintheMountainregionwereonaverage177percenthigherthanforthemarketsinthe

Terairegionandwere123percenthigherthanintheEasternregion(FAO/WFP,2007).

Additionally,householdslocatedintheMountainregionsspentasmuchas65percentoftheir

incomeonfood,comparedwithanationalaverageof37percent(FAO/WFP,2007).When

undernourishmentismeasuredintermsofinsufficientcaloricintake(usingtheCBSminimum

of2,124kcalsperday)thepercentageofpeoplethatareundernourishedatthenationallevelis

approximately41percent.Asonemightexpect,theWesternregionshaveamuchlower

averagecaloricintakethantherestofthecountry(2,310and2,250kcal/dayvs.2,405kcal/day

forthecountryasawhole).Thesamebasicgeographicpatternholdsforthoseconsideredtobe

severelyundernourished(FAO/WFP,2007).

SuchregionalpatternsleadShresthaetal.(2008)todescribepovertyinNepalasa

predominantlyruralphenomenonrelatedtoalackofdecentralizationofprogramplanningand

misallocationofresourcesinruralareas.Asinmanypoorruralareas,individualsinruralNepal

sufferfrominadequatecalorieintake,widespreadnutritionaldeficiencies,lowratesofliteracy

(especiallyamongwomen),pooremploymentopportunities,lowprovisionofhealthservices

(includinglowlevelsofprenatalcare),andlimitedaccesstosafedrinkingwater.Asaresult,

manyyoungpeopleattempttomigrateoutofruralareasinsearchofemploymentinthetowns

andcitiesofNepal,inIndia,oroverseas.Aspartofthistransitioninvolvinghumancapital

movingoutofruralareas,thenatureofagriculturalproductionhasbeenchangingandpresents

opportunitiesandchallengesforagriculturaldevelopment.

Table1:CropCalendarforMainCerealCropsCultivatedinNepal(Source:FAO,2007)

Isaresponsetoongoingagriculturalchallenges,avarietyofprogramshavebeen

implementedacrossNepalinrecentdecadesaimedatincreasingagriculturalproduction,

especiallyforsmallholders.TheNepalAgriculturalResearchCouncil(NARC)wascreatedin1991

asanautonomousresearchbodymeanttoinformpolicymaking,andtocoordinateand

implementresearchonagricultureinNepal.TheNARCcurrentlyimplementsmorethan400

projectsannually.Italsopartnerswithregionalandinternationalorganizationstodevelop

technologiesandsystemsaimedatincreasingfoodsecurityandreducingpoverty.Many

projectsfocusoninformationdiffusion,infrastructuredevelopment,anddispersionof

technology,irrigation,andvillagesavingsfunds.However,progresshasbeenimpededby

institutionaldeficienciesinoversightandinnovation(Shresthaetal.,2008).

In2007,theFAOandWorldFoodProgramengagedinanationwideassessmentto

betterunderstandthecausesofchronicandtransitoryfoodinsecurityinNepal.Themetrics

usedinthatassessmentincludedharvestindicatorsforyear2007wintercerealcrops,a

measureoffoodavailability,marketaccessassessments,andnational,subnationaland

householdlevelindicatorsoffoodutilization.6Thereporthighlightstheimportanceof

agriculturalmodernizationinreducingfoodinsecurity.Asdiscussedabove,irrigationavailability

isoftenaprimarydeterminantofcropchoice,thetimingofcropplantingandultimatefarming

success.IntheTerai,wherereliableirrigationexists,threeannualricecropscanbegrownand

harvested.IrrigationintheHillsallowsfortwocropsofrice(summerandspring).IntheTerai,

maizecanbeharvesteduptothreetimesperyear;intheHills,twomaizecropscanbeplanted.

6TheremainderofthissectiondrawsfromthatFAOreportandothersources.Thefullreportisavailableathttp://documents.wfp.org/stellent/groups/public/documents/ena/wfp135449.pdf.

SomeearlymaturingmaizevarietiescanbeusedintheHills.Theseallowformoreflexibilityin

croprotationandgreatercroppingintensity.Inadditiontomaize,wheatandbarleycanbe

plantedbetweenthemonthsofOctoberandDecember.Milletisplantedprimarilyasasummer

cropintheMountainsandasarelaycropintheHills,mostoftenfollowingamaizeharvest.In

theHills,areasthatarelocatedclosetoriversandonlowerslopesbenefitfromirrigationdue

totheirproximitytorivers.Thisallowsfarmerstogrowriceastheirmajorcropinthesummer

andwheatastheirwintercrop.WhereirrigationisavailableintheHills,plantingpatternsare

similartothosefoundintheTerai.However,areasintheHillsthatmustrelyonrainwaterasa

sourceofirrigationlargelythoseathigherelevationsgrowprimarilymaize.Inshort,

croppingpatternsandagriculturalsuccessintheHillslargelyreflecttheavailabilityofwaterand

irrigationresources.

LowproductivityandlackofagriculturalcompetitivenessservetomagnifyNepals

povertyandfoodinsecurity.RiceyieldsinNepalhavegraduallyincreasedsincetheearly1990s,

althoughtherealizedgrowthratehasbeenmuchlowerthanthoseofneighboringcountries.

Between1990and2005,Nepalsriceyieldincreasedby13percent.Thiscompareswithgrowth

overthesameperiodof20percentinIndia,37percentinPakistanand47percentin

Bangladesh.Basedonaverageyieldsovertheperiod2001to2005,Nepalsriceyieldswere7

percentbelowPakistans,8percentbelowIndias,and22percentbelowBangladeshs.Yields

arehighestintheTerai,makingthisthedominantriceproducingregionofNepal.Nevertheless,

averagericeyieldintheTeraisubstantiallylagsthoseofNepalsneighbors.Inthecaseofmaize,

acomprehensivestudyconductedbyCIMMYTconcludedthat,asof2001,therehadbeenvery

fewimprovementsinyieldsovertheprevious30years.Theauthorsattributethistothe

expansionofmaizeintolesssuitableagroecologicalzones,decliningsoilfertilityandslow

adoptionofimprovedmanagementpractices(Paudyaletal.,2001).Thesameauthorsalso

underscoretheproblemsofseasonalandinterannualvariabilityinyields.

ManyfactorscontributetoNepalslowagriculturalproductivity,includingtheuseof

cropsandlivestockwithinherentlypoorgeneticcharacteristics,inadequateandoften

inappropriateallocationofinputsinproduction,aheavyrelianceonlabor,traditionbound

socialandeconomicconditions,andpoormarketsandmarketingsystems.Inanattemptto

addressNepalsproblemoflowagriculturalproductivity,anumberofimprovedcerealcrop

varietieshavebeenreleasedinrecentyears.Theseofferhigheryieldpotential,arebetter

suitedtolocalgrowingconditions,andareinsomecasesmorehighlyresistanttoeconomically

importantdiseasesandpests.Improvingriceyieldshasbeenaparticularlyimportantobjective,

sincericeistheprimarystapleinNepal,andmorethan15millionhectaresareallocatedtorice.

TheNARCreportsthat38ricevarietiesformainseasoncultivationand11varietiesforearly

seasonplantinghadbeenreleasedasof2007.Secondtoriceasastaplefoodismaize,ofwhich

therewere19differentvarietiesbeinggrownatthetimeofwriting(NARC2007).Amongthese

varieties,onemaizehybridhadbeenreleasedforcultivationinseveralagroecologicalzones.

ThethirdmostimportantstaplecropinNepaliswheat,ofwhich28varietieshadbeenreleased

by2007(mostlymatchedtodifferentagroecologicalregions).Maizehasbeengainingin

popularityasamajorcrop,asevidencedbyannualincreasesinplantedarea,productionand

productivity.Nevertheless,maizeyieldsremainlowbymoststandards,withanationwide

averageyieldofjustover2mt/ha.

Anotherdragonproductionistherelativescarcityofarableland.The1992National

SampleCensusofAgriculture(NSCA)reportedanationalaveragefarmsizeof0.9hectares.

Furthermore,landownershipisextremelyskewedinNepal.Forexamplemarginalfarmers

constitute43percentoffarmhouseholdsbutcultivatejust11percentoftotalagriculturalland.

Pyakuryaletal.(2005)arguethatwithsuchsmallandskewedlandholdings,prospectsfor

productivitygrowthinagriculturearebleak.Investmentsinagricultureandlandimprovements

areestimatedatjust3percentofhouseholdincomeandcurrentoverallproductivitygrowthin

agricultureisjust0.4percentperyear.

Nepalreportslowratesofuseofmoderninputs,inparticularfertilizer.Measuredin

termsofavailablenutrient,ratesoffertilizeruseinNepalareapproximately60kg/ha

comparedwithapproximately90kg/hainIndia.Thegovernmentsubsidizedfertilizerpurchases

formanyyears,butsubsidieswereeliminatedin1999.Anumberofobservershaveargued,

however,thattheprimaryconstrainttogreateruseoffertilizerinNepalhasnotbeenlackof

affordability,butlimitedsupplies.Becausethecountrydoesnotproducefertilizers,all

commercialfertilizerusedinagriculturemustbeimported.Theremovaloffertilizersubsidies

hadtwopronouncedeffects.First,andnotsurprisingly,fertilizerpricesincreased.Thisincrease

wasseenasinevitablefollowingtheremovalofsubsidies.However,asecondandlesseasily

predictedoutcomewasthattheoverallsupplyoffertilizerincreased.Althoughformalimports

offertilizerhavefallen,informalimportsfromIndiahaveincreasedbymorethanenoughto

offsetthedecline(UN,2010).

Despitetheuptickinfertilizeruseinrecentyears,anumberofissueshavearisenin

responsetothesubsidyremoval.Perhapsthemostimportantistheunreliabilityoftheinformal

sectorasafertilizersource.Thisperceivedunreliabilityarisesduetoexportrestrictions

imposedbyIndia,whichpartlyhavetheirrootsinNepalssubsidyprogram.Additionally,many

blameinformalimportsfordrivingdownprices,therebyunderminingtheviabilityand

developmentofNepalsprivatesector.Anotherargumentregardsthefertilizerprovidedbythe

informalsectortobeoflowerordubiousqualitycomparedwithformalchannelimports.

Adulterationisthetypicalargument.Nevertheless,evenwithrelativelyabundantsuppliesof

fertilizerviainformalchannels,aroutinecomplaintisthattherisingcostoffertilizerreduces

Nepalsagriculturalcompetitiveness,especiallyvisvisIndia(Karkee,2008).Basedonthe

GlobalCompetitivenessReportof20062007,Nepalranks110outof125countriesin

competitiveness,afactthatunderscorestherangeofdifficultiesfacingallsectorsofthe

Nepaleseeconomy,notjustagriculture(Pyakuryal,2008).

Ashighlightedearlier,irrigationisakeyagriculturalinputthatremainsunderutilizedin

Nepal.Irrigationisespeciallyimportantfordroughtmanagement,andtheuseofshallowtube

wellirrigationcaninmanycasesallowfarmerstobeginplantinghighervaluecropssuchas

vegetables.ManyexpertswithinNepalarguethatshallowtubewellswillbeessentialfor

increasingproductionandenhancingfoodsecurity.Onebenefitofshallowtubewellsisthat

theyarerelativelyinexpensiveandthereforewithinthereachofpoorfarmers.Formerly,tube

wellsweresubsidizedbytheGovernmentofNepal.In2000,however,irrigationsubsidieswere

eliminatedaspartofNepalsStructuralAdjustmentProgram(aroundthesametimeasthe

fertilizersubsidieswerephasedout).IntheTerai,shallowtubewellsholdmuchpromise

becausetheareaisdrybutcontainssubstantialgroundwaterthatcanbeaccessedbythe

shallowtubewells.Onerecommendationhasbeentoconnectgroupsoftubewellstorural

electricitygridstoimproveuptakeandreduceenergycosts.

WhilefertilizersupplyandavailabilityhaveimprovedinrecentyearsinNepal,theseed

sectorremainspoorlydeveloped.Themainissueappearstobetheactualqualityofseeds,

ratherthanavailability.Governmentsourcesandvariousstudiessuggestthatasizeable

proportionofcultivatedareainNepaliscoveredbyimprovedseeds(estimatesrangebetween

80and90percentforcerealsandvegetables)(GON,2006).However,becauseofpoorseed

quality,performanceremainsdisappointing.Mostfarmersuseseedsfromtheirownprevious

harvest,orthatofaneighbor.Eveniftheseseedscomefromimprovedstrains,theyrarely

performwellafterafewgenerations.Themainconcernistoswitchtheoldimprovedseeds

thatfarmerscurrentlyhavewithnewimprovedseeds.Itwouldbedesirabletoreplace

improvedseedsatarateof25percent,oreveryfouryears.Doingsowouldremoveseedsfrom

usebeforetheydegeneratebeyondtheirvalue.Theactualreplacementrateisnotknown

becauseoflackofstatisticsinseedreplacement,butisthoughttobeabout5percentforwheat

andevenlowerforriceandmaize.Someobserversareoptimisticaboutchangesthatcanbe

broughtaboutbysimplyupgradingthequalityofseedsusedbyfarmers,claimingthatcereal

productioncouldberaisedby20percentthroughsuchmethodsalone(GON,2006).Atwoyear

projectundertheEUFoodFacilityoftheEuropeanCommissionsoughttoprovidevulnerable

farmerswithhighqualityseedsandotherqualityinputssuchasfertilizertoincreasefood

productioninJuneof2009.Ofthe92,000targetedhouseholds,themajoritywereinthemid

hillsandTerairegion.Inassessingsuccessesandimpactsofvariousprogramsrelatedto

nutritioninNepal,Adhikari(2011)recognizedtheprospectofscalinguptheprograminfood

deficitareas,incollaborationwithactivitiescurrentlyundertakenbytheWFP,FAO,andMoAC.

Unfortunately,theinstitutionalinfrastructureneededtosupportagricultureinNepalis

weak.WhiletherearemanyruralfinancialinstitutionsinNepal,andthebasicinstitutional

structurenecessarytosupporttheexpansionofagriculturalcredit,formalsectorruralcreditis

severelyconstrained.Theformalsector(thoseentitiesregisteredwiththeCentralBankof

Nepal)consistsofanetworkofcommercialbanks(withmorethan300ruralbranches),the

AgriculturalDevelopmentBank(with450branches),andarangeofvariousdevelopmentbanks,

savingsandcreditcooperatives,andmicrofinanceNGOs.Inadditiontoformallending,alarge

numberofruralcreditprograms,savingsandcreditcooperatives,andNGOshaverurallending

asoneaspectoftheiroperation.SomeNGOsremainoutsideofthesupervisionoftheCentral

Bank;otherinformallendersincludecommunityorganizations,tradersandmoneylenders.

Theforgoingdiscussionsuggestsseveralpointsofentryforpublicpolicytopromote

agriculturalproductionandfoodsecurityinNepal.Howpotentiallyvaluablemightbepublic

expendituresinagricultureorinagriculturalareas?Therehavebeenmodestattemptsto

quantifythehouseholdwelfareimpactsofpublicexpendituresonagricultureinNepal.For

example,Dillonetal.(2011)usehedonicestimatesofplotvaluetomeasurethebenefitsof

ruralinfrastructureinvestments.Theirmetricsofinvestmentincludetraveltimetotheclosest

market,accesstoirrigation,andvisitsfromextensionservices.TheyemployNepalLiving

StandardsSurvey(NLSS)datafrom1996and2004andcontrolforarangeoffixedeffects,

includingdistrictlevelinitialpublicinvestmentandagroecologicalzones.Asanalternative

methodology,theyalsousepaneldatamethodsappliedtothesamedatasettomeasurethe

impactofpublicinvestmentonconsumptiongrowth,agriculturalincomes,andpovertystatus.

Resultsshowthatimprovingaccesstoroadsiswelfareimproving,leadingtoimprovementsin

landvalues,incomegrowth,consumptiongrowthandpovertyreduction.Theyreportmixed,

butgenerallypositiveeffectsofirrigationonlandvalues,butfindnomeasurablehousehold

welfareeffectfromextensionservices,regardlessofthemethodtheyemploy.Thislatterpoint

emphasizescurrentweaknessesinNepalsagriculturalextensionservice,aswellasthe

challengingenvironmentinwhichitmustoperate.

AnadditionalagriculturalchallengeofemergingimportanceinNepalisthe

contaminationoffoodandfeedwithmycotoxins.Mycotoxinsaretoxicsecondaryfungal

metabolitesthathavesignificantbiologicaleffectsonhumansandanimalswhencontaminated

cropsareconsumed.Ofthemainclassesofmycotoxins,AspergillusflavusandAspergillus

paraciticusaretheprominentproducersofaflatoxins(Farombi,2006).AflatoxinB1isanatural

carcinogenandthemosttoxicandabundantofaflatoxins(Koiralaetal.2005).Theoccurrence

ofthechemicalisheavilyinfluencedbyconditionsfavorabletomoldgrowthduringpreand

postharvestingprocessesandstorage.Theseconditionsincludehightemperature(36to38C)

andhumidity(above85%)levels(Hell&Mutegi,2011).Dietarystaplessuchascorn,peanuts,

cassava,andricearesomeofthemorecommonagriculturalcommoditiescontaminatedwith

thetoxins,andpoorprocessingandstorageleavedevelopingcountriesmorevulnerableto

contamination(Farombi,2006).

ThefirstexaminationofmycotoxinlevelsinNepalbeganin1978aspartoftheRegional

MonitoringofFoodContaminantsProjectunderneaththeFAOandUnitedNations

EnvironmentalProgramme(UNEP).Foodsamplesweretakenfromfourcountries(Nepal,India,

Pakistan,andSriLanka)andtestedforaflatoxinbetween1980and1987(Karki&Sinha,1989).

Resultsshowedthatcornandpeanutswerethetwocommoditiesmostpronetoaflatoxin

contamination,andtheplainsoftheTeraiprovidedthemostfavorableenvironmentforthe

growthofA.flavusgiventheregionshightemperaturesandhumidity.KarkiandSinha(1989)

notedthattheprocessbywhichcornwasharvested(athighmoisturecontent[1821%]and

thendriedandstoredwithoutbeingshelledforsixmonths)providedampleopportunityforthe

growthofmolds.ThetransportofgrainsfromtheTerairegiontofooddeficitareasintheHills

andMountainsfurtherprovidedanopportunityforaflatoxincontamination.Another832

sampleswererandomlycollectedbetween1995and2003from16districtsineasternNepalto

testforaflatoxinbyKoiralaetal.(2005).Highlevels(greaterthan30ppb)weredetectedin

peanuts,cornflakes,peanutbutter,andvegetableoil.Onethirdofallsamples(32.8%)were

contaminatedwithaflatoxinB1orB2.

Whilecornandpeanutsaretwoofthemostcommonlyreportedfoodcommoditiesfor

contaminationofaflatoxin,ricerepresentsanequallyimportantNepalesestaplefoodatriskfor

growingaflatoxinproducingfungi.Lackofproperstoragefacilities,particularlyinthestorageof

ricegrainsthatmustbedriedinthesunduringthewetseason,mayresultinhighermoisture

contentmakingthegrainsmorepronetofungiandbacteria.AstudyconductedbyReddy,

Reddy,andMuralidharan(2008)detectedlevelsofAspergillusspeciesinnearlyall1,200rice

samplescollectedacrosstwentystatesinIndia.ThemostfrequenttoxindetectedwasA.flavus,

theproducerofaflatoxin.Degreesofcontaminationwereheavilyinfluencedbystorage

conditionsandenvironmentalfactorsineachstate,withlevelsofaflatoxinB1mostprominent

wherestorageconditionsofricewereopenandexposedtorain.ThisfindingfromIndia

suggestsaflotoxinproblemsinricelikelyextendtoNepal,althoughspecificevidenceislacking.

Economicconsequencesofcontaminationincludecroplosses,reducedfertilityandfeed

efficiencyandutilizationinanimals,andthecostsofmonitoring,testing,anddecontamination

ofthetoxin(Bryden,2007).Thehealthandnutritionalconsequences,particularlyindeveloping

countries,areofevengreatersignificance.InadditiontostrongevidencethataflatoxinB1

contributestohighincidencesoflivercancer(particularlyinindividualswithHepatitisBorC),

exposuretoaflatoxininchildrenagesninemonthstofiveyearshasbeenassociatedwith

stuntingandbeingunderweight(Bryden,2007;Gongetal.,2002).

Preharveststrategiestoreducemycotoxinlevelsincludetheuseoffungicidesand

insecticides,irrigationtopreventmoisturestresswhenwaterislimited,andpropertimingof

harvesting.Toprotectcommoditiesfromthegrowthoffungusorproductionoftoxinsbefore

orduringstorage,grainsmustbedriedquicklyafterharvestandaeratedproperly,damage

causedbyinsectsmustbeminimized,andmoisturecontentandtemperatureduringstorage

shouldberegularlymeasured.Sodiumbisulfite,ozone,andammoniaarechemicaltreatments

thatmaybeusedtodetoxifycontaminatedgrain,andhydratedsodiumcalciumaluminosilicate

(HSCAS)hasbeenidentifiedasadietaryadditivethatcanpreventthetoxinsabsorptionwhen

ingested(Bryden,2007).

AfinalfeatureoftheagriculturallandscapeinNepalthatdirectlybearsonfoodsecurity

isanongoingproblemoflanddegradation,which,inthefaceofstagnantproductivitygrowth,

hasbecomeincreasinglyworrisomeasaresultofhighpopulationdensityrelativetolandmass

(Hobbs,2009).Onefindslargedifferencesacrossregionsduetodifferencesintopology,

population,geology,andexistingandhistoricallandusepatterns.Desertificationand

deforestationhavebeenidentifiedasthetwomostpressingconcerns.IntheMountainsub

regions,landslidesanddeforestationhavebeenmajorsourcesofcroploss,whileonethirdof

thetotalareahasnovegetationgrowthandisthereforecharacterizedasacolddesert.Over

twothirdsofthelandareainNepalisconsideredgeologicallyfragile,andwithhighratesofsoil

erosiontheman/landratiocontinuestorise.Officialreportsindicatethatinordertomaintaina

subsistenceliving,afamilyrequiressomewhatmorethanonehectareoflandintheMountain

districtsandhalfofahectareintheHillsandTerai;currently,overhalfthepopulationoccupies

lessthanhalfahectare(Paudeletal.,2009).Beyondgeologicalconsiderations,athirdofthe

districtsinNepalhavepoortoverypoorwatershedconditions.Sedimentationiscontributingto

ariseinriverbedswhichresultsinincreasedflooding(Paudeletal.,2009).Deforestationalso

increasestimerequiredforcollectionoffuelwood,whichcompeteswithotheractivities,

especiallyamongwomenandchildrenforwhomfuelwoodcollectionisatraditionalchore.

4.Vulnerability,WeatherShocksandCopingStrategies

WardandShively(2011)useEMDATcountryleveldataovertheperiod19802007to

investigatetheextenttowhicheconomicdevelopmentreducesbothacountry'sdisasterrisk

anditssocialvulnerabilitytoclimaterelateddisasters.TheiranalysisindicatesthatNepalranks

amongthetop10countriesfordisasterrisk,andthatNepalspredicteddisasterimpact(in

termsofdeathsper1,000people)ismuchhigherthanaverageforthecountrysunderlying

levelofdisasterrisk.IndividualslivingindroughtproneareasofNepalareespeciallyvulnerable

tonutritionaldeficiencies.Duetoisolation,thishasbeenalongstandingprobleminsome

locations,althoughPyakuryaletal.(2005)arguesthattheproblemhasintensifiedinrecent

decades.Beginninginthe1990s,shockstofoodproduction(includingflooding,drought,and

varioussevereweatherconditions)ledtoannualfooddeficitsatthenationallevel.A2006

winterdroughtresultedinnearly900,000householdsexperiencingacutefoodandlivelihood

crises.Asimilarwinterdroughtin2009ledtoacuteandseverefoodinsecurityamong700,000

people(aboveandbeyondthe2.7millionNepalesethatwerealreadychronicallyfood

insecure).Historically,floodsandlandslidesarethemostcommonnaturaldisastersinNepal,

althoughtheincidenceoffiresanddroughtshasincreased.Between2006and2009,extreme

weatherdetrimentallyaffectedfoodproductioninNepal.Theeventsin2009reducedwinter

cropharvestsintheMountain,Hill,andTerairegionsby40percent,25percent,and10

percent,respectively.Despiteoneofthelargestsummercropsonrecord,aggregateproduction

ofwheatandbarleydecreasedby15and17percent,respectively,in2008/09,resultingina

cerealdeficitof133,000mt.Giventhatstocklevelswerealreadylowfrompreviousseasons,

theisolatedsubregionsintheWesternHillsandMountainswereseverelyaffected.

WhileisolatedareasinNepalhavealwaysbeensubjecttoseverehunger,theproblem

seemstohavebecomemorewidespreadinrecentyears.Todealwiththeadverseweather

disasterslistedabove,andperiodicallyhighfoodprices,manyNepalesemustresorttoarange

ofcopingmechanismstosurvive.Forexample,inthe42districtssurveyedbytheWFP,one

thirdofhouseholdssoldagriculturalassetsin2008,incontrasttoonlyonetenthin2006;the

proportionthatconsumedseedstockdoubledfrom19to38percent.Oneinthreerural

familiesreportedremovingachildfromschoolwhilealmost80percentofhouseholdsreported

borrowingmoneyorbuyingfoodoncredit.Halfofthehouseholdssurveyedreportedeating

less(Hobbs,2009).

Tobetterunderstandtheimpactofextremeweatherandotherexogenousshockson

localfoodsecurityinruralNepal,theWFPundertookasurveyfocusedonthisissuein2007.

ThesurveyresultspointoutthefragilityofthefoodsecuritysituationinmuchofruralNepal;

94percentofthehouseholdssurveyedreportedthatadverseshocks(drought,lackof

employment,illness,death,etc.)resultedinsomedegreeofimmediatefoodshortage.Inthe

areasthatweredirectlyaffectedbydroughtin20062007,morethan85percentofhouseholds

reportedthatfoodshortagesweremoreseverethaninthepreviousyear;themajorityhad

depletedtheirstocksoffoodasaresponsetothedrought.TheWFPfoundthathouseholdfood

grainstockswouldbedepletedin90daysinareasthatwerenotaffectedbythedrought,while

thecorrespondingfigurewas15daysindroughtaffectedareas(FAO/WFP,2007).Overall,a

householdsabilitytoprotectitselffromadverseshocksappearstobelargelydependentonits

socioeconomicstatus.Poorandexcludedgroupsfounditdifficulttomaintainconsumption

relativetobetterpositionedandwealthierhouseholds.Regionaldifferencesincopingalso

werereported.HouseholdsintheFarandMidWestregionsweremorelikelytoresortto

irreversibleandharmfulcopingstrategies,suchassellingproductiveassets(FAO/WFP,2007).

Thefindingssuggestthatpracticallyallhouseholdsaffectedbydroughtshiftedtheir

consumptiontowardslessexpensiveandlesspreferredfoods.Inaddition,morethan75

percentofhouseholdswereforcedtoborrowmoneytosupplementconsumptionandjust

underthisproportionreducedoverallfoodconsumption(FAO/WFP,2007).Amoredramatic

impactofthedroughtwasthatnearly37percentofhouseholdsresortedtowildfoodsources

andalmost50percentdidnoteatforatleastoneday.Nearlyhalfofallhouseholdssenta

familymemberinsearchofwork,and20percentsoldland(FAO/WFP,2007).

Followingthe20062007drought,thelargestfooddeficitswerereportedintheCentral

regions(281,000tonsintheCentralHillsand113,000tonsintheCentralTerai).Inpartthis

reflectshighratesofurbanizationinthesepartsofthecountry(whichincludestheKathmandu

Valley).However,whenexaminedinpercapitaterms,thefoodgraindeficitsweremostsevere

intheFarWesternHills(142kg/person),theFarWestMountains(143kg/person),theMid

WesternMountains(158kg/person),andtheWesternMountains(165kg/person)(FAO/WFP,

2007).Theonlyfoodstuffsimportedintotheseregionsweresubsidizedriceprovidedthrough

theNepalFoodCorporation(NFC),smallamountsofinternationalfoodaid,andgrainbrought

inbymigrantworkersreturninghome.Duetothelimitedcapacitytobringinfood,localfood

productionisconsideredakeyfactorinprovidingfoodsecurityintheseregions.Localizedcrop

failureshavethecapacitytodramaticallyimpactfoodavailability,whichcouldleadtoacute

foodcrisesinthefuture(FAO/WFP,2007).

5.CivilUnrestandPriceVolatility

Pricevolatilityisknowntohavenegativeconsequencesforgrainproductionandthecaloric

intakeofruralhouseholds.Whileweatherdisastersrepresentthelargeststochasticthreatto

foodsecurityinNepal,civilunrestthatismanifestedinblockadesandgeneralstrikes(locally

knownasbandhs)disruptfoodsuppliesandmarketoperation,therebyresultinginfood

shortagesandgenerallyhigherfoodprices.AnApril2009strikethatoccurredintheTeraileft

almost40percentofthemarketsintheMountainsandHillswithinsufficientsuppliesofmajor

commodities.Thefirstsixmonthsof2009sawjust12dayswithoutlargescalebandhs(Hobbs,

2009).SosevereandubiquitousarestrikesinNepalthattheUnitedNationsmaintainsa

workingmonthlyupdateofthedistributionofbandhsacrossthecountry.7

Bandhshavebeencitedby20percentoftradersasthemostimportantfactor

7ThelistcanbefoundontheUNwebsiteforNepal,www.un.org.np.

influencingrisingpricesforimportedcommodities.Thegoodsthatareaffectedbybandhsare

notlimitedtofoodandincludehumanitarianaidonaweeklyordailybasis.Hobbs(2009)

reportsthat,foraperiodoftendaysinApril2009,theWFPcouldnotdistribute3,000mtof

foodintheTerai;thisaffected325,000highlyfoodinsecurehouseholds.Whilebandhstypically

beginintheTerai,theycanquicklyproducefarreachingeffectsonpricesandquantities

throughoutthecountry.

WorkingundertheassumptionthatruralhouseholdsinNepalmakeproductionand

consumptiondecisionsrecursively,Panetal.(2009)findthatthepresenceofpriceuncertainty

inproductionreducesthecropincomeofruralhouseholdsatharvesttimeandthatthislower

incomeleadstoareductioninthecaloricintakeofruralhouseholds(duetothepositive

incomeelasticityofdemandforcalories).Whendemandforcaloriesishighlypriceinelastic,

caloricintakedecisionsarenotstronglyaffectedbychangesinthepricesofstaplefoods.From

thisitcanbearguedthatthecaloricintakeofruralhouseholdsinNepalisdeterminedlargely

byincomenotprices.Inpartthisreflectsthesubsistenceorientationofmanyruralfarm

households.Ifmuchofstaplecropconsumptioncomesfromownproduction,responsetoprice

signalswillbeweak.Inaddition,thosefarmersthatparticipateinthemarkettendtoselltheir

outputatharvest,ratherthanstorethecropforlatersale(atpresumablyhigherprices).This

patternreflectshighonfarmstoragelosses,indebtedness,andcashneedstomeetfamilyand

socialobligations.Thesefactorsallcontributetoexplainingthestylizedempiricalfactthatrural

farmhouseholdsinNepalarenotveryresponsivetopricechanges(Panetal.,2009).

Withthisinmind,Pyakuryaletal.(2005)arguethatmediumrundevelopmentpolicyin

Nepalshouldfocusonthestorageandmarketingofcropsbyprivateenterprises.Plausible

incentivestofacilitatethisincludedevelopmentoftransportationandstoragefacilities.Alarge

proportionofgovernmentsubsidieshasbeendirectedtowardsplantinggrainsduetothe

adversegeographyofthecountry.Thisincludesairtransportforshippinggrains.Pyakuryalet

al.(2005)arguethatatransitiontogroundtransportationwillimprovefoodsecurity.Longrun

goalsmightthereforeincludeintegratingmarketsthroughroadnetworks,infrastructureand

marketing.

6.Society,GenderandNutrition

InoneofmultiplestudiesoffactorscorrelatedwithmalnutritioninNepal,Pant(2008)argues

thatmalnutritiondoesnotnecessarilyresultfromalackoffoodproduction,butratheris

causedbyarangeofsocialproblemsandtheinherentlylowstatusofwomeninNepalese

society.Inmanyinstances,theeffectsofsocialindicatorscanactuallybeattributedtogroup

normsbecauseethnicgroupsinNepalhavestronginfluenceonlaborsupply,familyplanning

decisionsandthetimingofbirths(Thapa,1989).Usingdatafromthe1996NepalLiving

StandardsSurvey,Nyyssla(2007)findsarelationshipbetweenmothersstatusandher

childrensfoodsecurity,showingthatanincreaseinchildbearingageandmotherseducation

leadtohigherzscoresamongchildren.

Motherseducationisakeydeterminantofnutritionaloutcomesatthehouseholdlevel,

sinceaprimarycauseofmalnutritionissimplyalackofknowledgeregardingthefactorsthat

contributetoimprovedhealthandnutrition(Marmot,2007).NDHSdatafrom2006showthat

childrenofuneducatedmothersaremorelikelytobeunderweightthantheircohorts,andthat

thispatternholdsacrosswealthquintiles(UNICEF,2010).Thissuggestsnutritioneducation

interventionsmaybenecessaryatalllevelsofwealth,notjustforthepoorestfamilies.

Moreover,acorrelationbetweenmotherseducationandnutritionalstatusexistsformultiple

deprivationoutcomes.Thelargestmarginalimpactsofimprovementsineducationarelikelyto

befoundintheMountainregions,wheremalnutritionratesareonethirdlowerforwomen

withprimaryeducationthanforthosewithnoeducation.TheNDHSdataindicatethatfewer

thanhalfofallNepalesewomenareliterate,whichcreatesalargeimpedimenttoimproving

childhealthandnutritionoutcomes(UNICEF,2010).InNepal,manyparentsarereluctantto

investineducationfortheirdaughtersbeyondfifthgrade,sincethisrequiresafamilytooffera

largerdowrytoattractahusbandofsimilarorhighereducationalstature(Sah,2005).

AgricultureinNepalisincreasinglyanactivityoffemalemembersofthehouseholdas

moremenmigrateandenterthenonfarmsector.Thischangehasbeenaccompaniedbya

changeinthestructureofincomesforruralfamilies,inwhichfarmincomehasdeclinedasa

resultoflowerproductivityandnonfarmsourceshaveincreasedinimportance.Theseforces

haveledtoarelativedeclineinwomensincomescomparedtomens.Becausefemaleliteracy

islessthan35percentandgirlstendtodropoutofschoolbeforeboys,theyhavelower

productivityandhaveheavierworkloads,highriskofpregnancy,poornutrition,andworse

health.Mengenerallyhaveauthorityoverfamilyplanningandfinancialissues,andeveninthe

casewherewomenhaveautonomyinthehousehold,theyareconstrainedinmanycasesby

communityconsiderations(Sah,2005).

InastudyofthedeterminantsofchildnutritionintheTerai,Sah(2005)foundthatsocial

factorsweresignificantinexplainingobservedlevelsofunderweightandstuntinginchildren.

DataweredrawnfromapostinterventionevaluationofachildnutritionprograminDhanusha

in2003.Theoutcomesofinterestwerestunting,measuredasheightforage,andunderweight,

measuredasweightforheight.Bivariatecorrelationsrevealedastrongrelationshipbetween

thenutritionalstatusofchildrenunder36monthsofageandthreefactors:mothers

education,theuseofricescum,andage.Theuseofcolostromwasastrongpredictorof

underweightbutwasnotcorrelatedwithheightforageatstatisticallysignificantlevels.

However,indicatorsofhouseholdssanitarybehaviorswerepositivelycorrelatedwith

nutritionalindicators.

Sahusedregressionanalysistodemonstratedifferencesinnutritionalstatusacrossage

groups,whereolderchildrenweremorelikelytobeunderweightthanchildrenunder6months

ofage.Amongchildrensixmonthsofageoryounger,onlyasmallproportionwerefoundtobe

underweight,buttheproportionincreasedmarkedlyatagegroupsof712monthsandbeyond.

Amonghouseholdsocioeconomicindicators,beingamemberofaminoritygroupincreasedthe

probabilityofachildbeingbothstuntedandunderweight.Themostpronounceddifferences

wererelatedtotheliteracyofthemother,ratherthaneconomicwellbeing.Sahdidnotfind

genderdifferencesinchildoutcomes.

Amongtheattributesassociatedwithfeedingpracticesandhealth,theintakeof

colostrumhasbeenfoundtohaveameasuredeffectonunderweight.Also,householdsthat

reportedutilizingricescumhadareducedpropensityofbothunderweightandstunting.Finally,

washinghandspriortofeedingreducedstunting.Inlinewithotherstudies,Sahsresearch

suggeststhatbeginningsupplementaryfeedingsixmonthsafterbirthisbeneficialtoachilds

nutritionalstatus,becausemothersmilkprovidesinsufficientnutritionbeyondthisage.For

SahssampleofchildrenintheTerai,lateinitiationofsupplementaryfeedingwascorrelated

withincreasedprobabilityofachildbeingunderweight.Saharguesthattheresultsreflect

socialtaboosoftwoformsthosethatprohibitwomenfromconsumingnutritiousfoods

duringpregnancyandchildbirth,andthosethatpreventthemfromreceivingpropermedical

attentionduringpregnancyandchildbirth.Hismainconclusionisthatsupplementaryfeeding

atappropriateagescombinedwithattentiontomaternalcarearethepathwayswithgreatest

potentialtoreducechildmalnutrition.

Gittelsohnetal.(1997)useddietaryjournals,comprisedofbothfoodintakerecalland

directobservationofmeals,toshowthatdespitevariationintheapplicationofculturalnorms

relatedtofoodconsumption,dietaryprescriptionsdohaveadirectimpactonfood

consumptionbehavior.Theyfoundapositiverelationshipbetweentheamountofcalories

consumedandtheintakeofvariousmicronutrientsforthewholepopulation,butnorobust

patternacrossparticularsubpopulations,includingadultwomenandadolescentgirls.These

groupsareatriskfordietdeficienciesinvitaminsAandC,especiallyinruralareasinNepal.The

authorsfoundthatfoodbeliefsandpracticesresultedinsubgroupsbeingatriskfornutritional

deficiencies,whichmayexplainthelowcorrelationbetweenmicronutrientintakeandenergy

intake.Genderdifferencesinaccesstoparticularfoodswerefoundtobeassociatedwith

specificfoodbeliefsandpractices,resultinginthereductionofwomensconsumptionoffoods

richwithmicronutrients.Practicesincludedietaryrestrictionsduringmenstruation,pregnancy,

andlactation.Compoundingtheseparticularpracticesisageneraldiscriminationinfavorof

menforintrahouseholdallocationoffood.Theauthorsarguethatstaplefoods,suchasrice,

lentils,bread,andsoup,arefairlyevenlydistributedacrossgenderlines,butthatsidedishes

richinmicronutrients,suchasvegetables,yogurt,ghee,andmeat,areallocatedpreferentially

tosmallchildrenandadultmales.

UsingdatafromtheNepalDemographicandHealthSurvey(2006),Dancerand

Rammohan(2009)showthatmotherseducationhasalargepositiveinfluenceonthenutrition

ofallchildren,particularlygirls.Theyfindthatprimaryeducationhasverylittleimpactonthe

heightforagemeasureofmalechildren;however,therearesubstantialimprovementsonthe

heightforagezscoresacrossthewholesamplewhenthemotherreceivesasecondary

education(comparedtonoschooling).Childrenwithmotherswhohadreceivededucation

throughprimaryschoolwerefoundtobelessstunted.Theeffectsofsecondaryschoolingon

stuntingweredramaticforbothsexes,buttheeffectwaslargestforfemalechildren:those

withamotherwhohadasecondaryeducationwerehalfaslikelytobestuntedasthosewith

uneducatedmothers.Formales,thecorrespondingoddsofnotbeingstuntedwere1.45times

greater.Whilethemotherseducationhadanimpactonchilddevelopment,afathers

educationdidnotcorrelatewithstunting.Whenawomanhadmoreautonomyindecision

making,thereweremuchhigheroddsofherchildnotbeingstunted.

Pokhreletal.(2005),using1999NLSSdata,reportsevidenceofgenderbiasinthe

reportingofillness,andthatthebiasgrowsfollowingtheinitialdecisiontoseekmedicalcare.A

culturalexplanationisputforth,basedontheobservationthatmanypeopleinNepalhavea

strongsonpreference.Consideringhealthcareasaninvestment,somefamiliesmaynot

capturetherewardsofaninvestmentinagirlifshesubsequentlymarriesandleavesthefamily.

However,themagnitudeofthisgapinthepredictedprobabilityofreportinganillnessis

relativelyconstantacrossincome,suggestingthatgenderdiscriminationdoesnotresultwholly

fromeconomichardship.

Anadditionalfindingisthatchildgendernotonlyinfluenceswhetherafamilyutilizes

healthcare,butalsoimpactsmultipledecisionsregardinghealthactions.Inadditionto

influencingthedecisiontoreportanillnessandthentosubsequentlyseekcare,childgender

hasalsobeenfoundtoinfluencewhetheronechoosesapublichealthcareprovider,compared

withseekingnocareorusinginformalsources.Asmightbeexpectedgiventheprevious

finding,expendituresonprivatecarefavormalechildren,afindingthathasalsobeenobserved

inKeralastateinIndia,wheregenderwasnotassociatedwithwhetherthechildwastreated

butdidplayaroleintheselectionintoallopathictreatmentversusalternativetreatments.

Inanefforttodeterminewhethersmallincreasesinfemaleincomehaveasignificant

effectonfamilywelfare,health,andnutrition,Katzetal.(2001)conductedanonrandomized

controlledexperimenttomeasuretheimpactofsmallamountsofincome(deliveredtofemale

membersofahousehold)onfoodexpendituresandthenutritionalstatusofwomen.Women

inthestudywereparttimeworkersinahealthproject.Becausetheywerescreenedfor

employment,thosethatwerehiredtendedtobeyoungerandbettereducatedthanwomen

notemployed,butsimilarinotherrespects.Baselinecomparisonsbetweenthegroupsshowed

thatthewomenweresimilarincaste,householdsize,ownershipofanimalsandhousehold

durables.Additionally,themidupperarmcircumference(MUAC)acrossthegroupshada

differenceofjust.2cm,andfoodconsumptionexpendituresaftercontrollingforbaseline

characteristicswerealsocomparable.Followupsurveystakenaftertwoyearsshowedno

differencesinMUACbetweenthetwogroups.However,womenintheemployedcategory

consumedghee,meat,eggs,fish,andvegetablesathigherrates.Overthesurveyperiod,

consumptionofhighervaluedproductsdecreasedacrossbothgroups,buthouseholdswith

employedwomenmaintainedrelativelyhigherlevelsofconsumptionoftheseproducts.

Finally,inanotheranalysisofhouseholdfoodsecurityinruralNepal,Gittelsohnetal.

(1998)usedaprincipalfactormethodtooperationalizetheconstructionofhouseholdfood

security.Householdfoodsecuritywasconceivedofasbeingmadeupofthreecomponents:

pastfoodstability,currentfoodsupply,andfutureproductivity.Theresultsoftheanalysis

indicatedthathighcasteandsocioeconomicstatushadpositivecorrelationswiththe

consumptionofgreenvegetables,tubers,anddairyproducts.Currentfoodstocks,aswellasa

measureoffutureagriculturalproductivity,werefoundtobeusefulpredictorsofdietary

varietyandconsumptionofdairyandmeats.Theresultssuggestthathouseholdfoodsecurity

inthesamplehadnosignificantrelationshipwithconsumptionofgrainandbeans,astheyare

consideredstaplefoods.However,themeasuresdidseemtoimpactdietarydiversity,inthe

formofleafyvegetables,dairy,andmeats.Householdcasteandsocioeconomicstatushad

similarimpacts.Generally,thestudyrepresentsanattempttocreateaformalframeworkfor

analyzingfoodsecurityatthehouseholdlevelbytakingintoaccountmultipledimensionsof

foodsecurityacrosstime.

7.ImpactAssessmentofNutritionInterventions

AgrowingbodyofresearchseekstoreportontheefficacyofnutritioninterventionsinNepal.

Pantetal.(1996)reportresultsfromarandomizedcontrolledexperimentthatwasundertaken

insevendistrictsoftheTeraiandMidHillareasofNepal.Theyevaluatedtheperformanceof

twoprogramsdesignedtoimprovevitaminAstatus.Thetwoprogramsfocusedon

supplementationandeducation.Theeducationcomponentincludedhorticulturalandpublic

healthactivities.Theauthorsarguethatalthoughnutritioneducationhasbeenpromotedas

oneofthebestwaystoimprovethenutritionalstatusofatriskindividualsandpopulations,

educationprogramscanbedifficulttoimplement.Theirargumentisthatnutritioneducation

programstoaddressvitaminAdeficiencywillhaveverysmallimpactsunlesseducationis

combinedwithpersonnel,finances,andequipment.

TheprogramimplementedbyPantetal.(1996)usedtwocriteriatocompareoutomes:

(1)thecostfortheoverallproject(whichwasextrapolatedtoassessdifferentlevelsofprogram

intensity),and(2)theprojectsimpactonindividualhealthstatus(primarilyxerophthalmiaand

wasting).Tomeasureoutcomesoftheinterventions,theyalsoincludedasametricof

performancetotalcoverage,asawaytojudgeanypotentialspillovereffectthatmayariseina

traditionalsupplementationprogram.Twosamplepopulationswerestudiedtomeasurethe

impactofthetwoprograms.Cohortswerefollowedfor24monthsafterprogram

implementationinordertocaptureshortrun,mediumterm,andlongerruneffectsonvitamin

Adeficiencystatus.Resultsrevealedaconsistentpatterninwhichsocioeconomicand

ecologicalproblemsexplainedalargeamountofthevariationinvitaminAlevels,vitaminA

deficiencyrisk,wasting,andexcessivemortality.Bothnutritioneducationandsupplementation

werefoundtobeeffectiveinreducingrisksamongchildren;however,neitherprogramhada

significantinfluenceoverwhetherthecommunitycouldbeconsideredahighriskclustersite.

Theyconcludethatimprovingeconomicopportunities,sanitaryconditions,andagricultural

productivityareessentialtominimizingtheimpactsofvitaminAdeficiency.However,the

authorsalsoconcludethatdistributingmegadosecapsulesonasemiannualbasis,boosting

vegetableconsumption,andimprovingaccesstoprimaryhealthcareservicesshouldbepolicy

initiativesintheshortterm.Whenconsideringtheimplementationofasupplementation

programinNepal,theiranalysispointsoutthatdecisionsregardingprogramchoicemaybe

influencedmorebytherelativecostsoftheprogramthanbydifferencesinprogramoutcomes.

Theirresultsshowthateducationandsupplementationhadcomparableeffects,althoughthe

overallcoveragerateofthesupplementationprogramexceededthatoftheeducation

program.TheprimarybenefittheyobserveincontrollingvitaminAdeficiencyisareductionin

mortality.Mortalityriskwasreducedbyasomewhatgreateramountamongthe

supplementationcohorts,althoughspecificaspectsoftheirnutritioneducationandmaternal

literacyprogramsweremoreeffectiveinreducingmortalitythansupplementationalone.

Overall,resultsofPantetal.sstudysuggestthatnutritioneducationinNepalcanbe

justaseffectiveasdirectsupplementation.However,wherematernalliteracyratesarelowand

pathwaysforcommunicatingpublichealthandnutritionmessagesareweakornonexistent,

achievingthesamelevelofeffectmaybemorecostlyforeducationthanforcapsulebased

supplementation.TheyobservethatpolicymakersinNepalhavebeenreluctanttouse

nutritioneducationprogramstoaddressvitaminAdeficiencybecauseeducationhasbeen

viewedaslesseffectivethansupplementation.Theirfindingsshowthatnutritioneducation

maybelesscosteffectivethansupplementationnotbecauseitislesseffective,butbecauseit

tendstobemorecostly.

AdifferentrandomizedcontroltrialwasundertakenbyChristianetal.(2003)tostudy

theeffectsofdifferentcombinationsofmicronutrientsonbirthsizeandriskoflowbirth

weight.Theyfoundthatprovidingmotherswithsupplementalfolicacid(alone)didnot

influencechildsizeatbirth.However,combiningthefolicacidsupplementwithironincreased

meanbirthweightby37g(the95%confidenceintervalwas16gto90g).Thiscombination

alsoreducedthepercentageoflowbirthweightbabies(thosebelow

disabilityadjustedlifeyearsavedshouldbeconsidered.Thisprogramsatisfiesthis

requirement.Furthermore,beyondtheprogrambenefitsquantifiedinthestudy,theauthors

suggesttheprogramalsoprovidedlongtermbenefitsforsubsequentpregnancies,reductions

inmorbidity,andpotentialcostsavingsinsettingupandsupervisingfutureprojects.

8.ProjectsUnderway

DuetothenumerousfoodsecuritychallengesNepalfaces,ithasbeenselectedasoneof

twentycountriestobenefitfromtheU.S.FeedtheFuture(FtF)PresidentialInitiative.Aspart

oftheprogram,16districtsoftheWesternTeraiandHillregionsofNepalhavebeenchosenas

programbeneficiaries.8TheUS$68millionprogramforNepal,whichisplannedtorunfrom

20112015,callsforamultisectorapproachtoincreaseagriculturalproductivity,raiseincome,

increasenutrition,andstemchronicfoodinsecurityinthetargetedregions.Thethreefociiof

theprogramare(1)nutritionandhygiene,(2)highvalueagriculturalproduction,and(3)

integrationofvulnerablegroups.

Withrespecttoagriculturalproductivity,theUnitedStatesAgencyforInternational

Development(USAID)planstointroduceyieldenhancinghighvaluecropsandtechnologies,

improvetechnicalsupportforfarmers,expandaccesstoirrigation,andimprovesmallscale

marketinfrastructure.Fornutritionaloutcomes,theplanfocusesonincreasingproductionof

highnutritionfoods,trainingandemployingthousandsofcommunityfacilitatorsandnutrition

hygienevolunteers,andincreasingaccesstosafedrinkingwater.Finally,toaddressinequalities

8ThesedistrictsareBaitadi,Dadeldhura,Kanchanpur,Doti,Kailali,Achham,Dailekh,Jajarkot,Rukum,Surkhet,Salyan,Rolpa,Phuthan,Banke,BardiyaandDang.

inaccessandeducationforparticulargroups(women,children,minorities),theplanseeksto

provideliteracy,nutritionandentrepreneurialskillstraining,toencouragefemalefriendly

farmingpractices,andtotargetallfamilymemberswitheducationintendedtoshapeand

changebehaviors.

InadditiontothemassiveFtFprogram,USAIDhasoveradozenprogramsrunning

throughoutthecountrywithafocusonhealth,nutrition,growth,education,orfoodsecurity.

USAIDisoneofthelargesthealthdonorsinNepal,withannualinvestmentsin2010ofover

US$26milliontowardsthedevelopmentofequitableandwellgovernedhealthsystemswith

thegoalofreducingmortalityamongwomenandchildrenandimprovingaccesstohealth

services.

Since1963,theWorldFoodProgramhascarriedout51projectsandprogramsforan

increasingnumberoffoodinsecurepopulationsinNepal(Frankenbergeretal.,2010).Many

foodaidoperationsaregeographicallyconcentratedinfooddeficitareasintheHillsand

MountainsoftheFarandMidWesternNepal,wherepoorinfrastructureisamajorobstruction

tothedistributionoffoodfromsurplusareastomarkets.AsnotedbyCodling(2011),many

aspectsoffoodinsecurityrelatetoaccessissuesandpoverty.Povertyisconcentratedinthe

agriculturalsectorwhichmakesup70%ofNepalsworkforce(Codling,2011).Inadequateroads

andmarketscoupledwithlowagriculturalproductivitymakeitdifficulttoproducesufficient

income.Asaresult,householdsmustdependdirectlyonproductionfortheirfood.

CurrentWFPoperationsincludeFoodandCashforAssets(F/CFA),micronutrient

supplementationinterventionsforchildren,schoolfeedingprograms,girlsincentiveprogram

(GIP),MotherandChildHealthCare(MCHC),andfoodassistanceforBhutaneserefugees.Food

andCashforAssetsprogramsareamongthemostwidelyimplemented,comprising38%of

totaloperationsbetween2002and2009,and1.6millionweretargetedfortheprogramin

2010(Frankenbergeretal.,2010).Throughtheseprograms,participantsworkoncommunity

infrastructureprojectssuchasbuildingandrepairingroadsandbuildingirrigationsystems.

WhileWFPassessmentsfoundthattheseprogramswereabletopositivelyimpactimmediate

incomeandfoodneeds,theprogramswerelessaffectiveatimprovinglivelihoodsinthelong

runthroughtherestorationofkeyassets(Frankenbergeretal.,2010).

DecreasesinfundingrelatedtotheglobalfinancialcrisishaveforcedtheWFPto

dramaticallyscalebackoperationsinsomeofthemostfoodinsecureareasinwesternNepal.

TheWFPhasrecognizeditslimitsinaddressinglongtermfoodsecurityincomparisonwith

shorttermneeds,andacknowledgedthatthegovernmentmuststepintoleaddevelopment

projectstoaddresschronicfoodinsecurityintheregion.Ina2009nutritionassessmentand

gapanalysisreport,Pokhareletal.(2009)suggestthattheGoNintegratepoliciesrelatedto

povertywithnutritioninterventionprogramstopreventfutureemergencycrises.Establishinga

formalandinstitutionalizedapproach,ornutritionarchitecture,toguidecoordinationacross

sectorsmayhelptoensurethatpreviousprogramfailuresarenotrepeated.

Appendix:DataAvailability

TwolargecountrywidedatasetsavailableforNepalaretheDemographicandHealthSurveys

(DHS)andtheNepalLivingStandardsSurveys(NLSS).DHSsurveydataareavailablefor2001

andforthemostrecentround,conductedin2006.Botharegeoreferencedandarepublicly

available.Acurrentroundofthesurveyisbeingcollectedatthetimeofwriting,andwilllikely

bemadepublicinthenext1218months(byearly2013).The2006sampleincludes10,793

womenand4,397menbetweentheagesof15and59.Characteristicsofthesampleinclude

datacoveringabortionhistory,anemiaandanemiatesting,anthropometry,birthregistration,

causeofdeath,earlychildhoodeducation,HIVknowledgeandtesting,malaria,micronutrient

intakes,reproductivecalendar,TB,tobaccouse,vitaminA,andmaternalmortality.

TheNLSSdatasetswerecollectedin1996and2003/2004andincludeapartialpanel

datacomponent.AthirdNLSSdatasetwascollectedin2010/2011andpreliminaryfindings

wereprovidedbytheCentralBureauofStatisticsofNepalinAugustofthisyear;however,afull

statisticalreporthasyettobereleased.TheNLSSincludesinformationonarangeofhousehold

welfareindicators,includingincome,consumption,housing,labormarketparticipation,

educationandhealth).Secondrounddataaresimilarincontentandcoveragetofirstround

data.TheNLSSsurveyfollowstheapproachoftheWorldBanksLivingStandards

MeasurementStudy(LSMS).Thesurveyconsistsofanintegratedhouseholdquestionnaire

supportedbyacommunityquestionnairetocollectinformationonavailablefacilities,service

delivery,pricesandgeneralconditionsfacinghouseholds.Thesurveyincludesamodule

focusedspecificallyonhealth,andincludesanumberofancillaryquestions.Thesequestions

includedistancetohealthfacilities(modeoftransportandtime)andexpendituresonhealth

services(duringthepastmonthandyear).Thehealthmodulecontainsinformationonchronic

illnessesandrecentillnesses,includinglengthofaffliction,amountoftreatmenttime

incapacitated,andcurrentselfreportedhealthstatus.Immunizationinformationiscollected

forchildrenunder5,alongwithmaternityinformationandfamilyplanninginformation.

Subjectivequestionsincludehowthefamilyratesthequalityoftheirhealthservices.Food

consumptiondataarebasedonvariableperiodrecall.Questionscoverwhetheraparticular

foodwasconsumedoverthepastyear,howmuchwasgrownandconsumed,howmuchwas

typicallyconsumedpermonth(byweight),foodexpendituresfortypicalmonth,andthe

amountoffoodreceivedinkind.ThelistoffoodsistypicalofanLSMSsurveyanddoesnot

varybyquality.Additionalinformationincludeshouseholdproduction,wageemployment,

education,creditandsavings,householdbusinessactivity,remittances,andothersourcesof

income.

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