Linking Agriculture and Nutrition:
What are the Opportunities?
Marie Ruel, IFPRI
CHANGE INCEPTION WORKSHOP
NAIROBI, 27-29 MAY 2013
NAIROBI, KENYA
Agriculture and Nutrition Working Together to Improve
Nutritional Outcomes: The Global Landscape
Photo: HKI
Marie Ruel, IFPRI
AGRICULTURE-NUTRITION-GLEE
Washington, DC, June 18th, 2013
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THE CHALLENGE
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Challenges in Global Environment
• Persistent hunger: ~ 870 million people
chronically undernourished (FAO 2012)
• Growing, urbanizing population
• Changes in food consumption patterns
• Food price volatility
• Climate change – increased occurrence of
shocks
Focus on Feeding 9 Billion People (yields,
productivity)
Need to focus also on access to high quality
diets Page 3
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Lancet 2013 - Nutrition:
A Massive Unfinished Agenda
165M children stunted
(1 in 5 children)
Malnutrition is
responsible for 45% of
< 5 deaths (3.1M)
32.4M babies born SGA
(27% births in LMICs);
responsible for 20% of
stunting
Childhood obesity is on
the rise
Marie Ruel, IFPRI
MN deficiencies persist
(zinc, VA, iodine, iron) affect
growth, survival, health,
cognitive development,
productivity
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Stunting Rates Slowly Decreasing, but
Numbers Increasing in Africa
• Figure 4
5
2.1% annual rate
of reduction is not
fast enough to
reach WHA target
Source: Lancet Nutrition Series 2013
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Wasting in Children <5 Years is Still
Unacceptably High
0
2
4
6
8
10
12
Pro
port
ion (
%)
Wasting
52 million children under 5 are wasted,
19 million severely wasted
6 Source: Lancet Nutrition Series 2013
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Lancet Paper 2:
Interventions Across the Lifecycle
7 Source: Lancet Nutrition Series 2013
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34 Countries Account for 90% of Global
Burden of Malnutrition
8
Scaling up 10
nutrition-specific
interventions to
90% coverage in
34 high-burden
countries would
reduce stunting
by 20%
8
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We need to find solutions beyond
targeted nutrition-specific interventions
and beyond the health sector
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10
Agriculture &
Food Security
Social
Protection
Poverty
Reduction
Health
Water &
Sanitation
Private
Sector
Trade/Fiscal
Policies
Environment &
Climate Change
GOVERNANCE GENDER
Work
Multi-
Sectorally
We Need to Leverage Relevant Sectors
Source: World Bank 2011
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DFID Department
for International
Development
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WHAT CAN AGRICULTURE DO TO
IMPROVE NUTRITION?
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Agriculture can affect nutrition through
multiple pathways
• Provides food: increases food availability and
access (own production)
• Provides income: from agriculture wages and/or
marketing of commodities produced
• Affects food prices: which affect income of net
sellers and purchasing power of net buyers .
• Can affect women’s social status and
empowerment
• Can affect women’s time
• Can affect (and be affected by) women’s health
and nutritional status
Page 13 Source: Lancet Series 2013; adapted from Gillespie, Harris and Kadiyala 2012
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Agriculture Can Improve Nutrition:
Through Increases in Income
17
A 10%
increase in
GDP/PC
leads to a 6%
reduction in
stunting
Source: Lancet Nutrition Series 2013
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Income Growth Can Have Unintended
Consequences on Risks of Overweight & Obesity
18
A 10%
increase in
GDP/PC
leads to a 7%
increase in
overweight
and obesity in
women
Source: Lancet Nutrition Series 2013
INTERNATIONAL FOOD POLICY RESEARCH INSTITUTE Source: Webb and Block, 2011
Countries with Policy Support for
Agriculture Have Greater in Stunting
Analysis of 29 developing countries, 1980-2007
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At Global Level
Economic growth – and investments in
promoting agriculture growth – are necessary to
improve nutrition, but they are not sufficient
We need to do a lot more to ensure that
agriculture growth and investments in agriculture
and food systems are nutrition-sensitive
We also need to complement these efforts with
nutrition-sensitive targeted agricultural
programs that reach the poorest of the poor
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EXAMPLES OF INITIATIVES, GUIDANCE
AND REVIEWS ON HOW TO IMPROVE
NUTRITION THROUGH FOOD SYSTEMS
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World Bank
Source: Yurie Tanimichi Hoberg, World Bank, Meeting of the Minds on Improving Nutrition through Food Systems,
Geneva, March 2013
INTERNATIONAL FOOD POLICY RESEARCH INSTITUTE Page 23 Source: Noreen Mucha, Defining nutrition-sensitive development, Meeting of the Minds on Improving
Nutrition through Food Systems, Geneva, March 2013
INTERNATIONAL FOOD POLICY RESEARCH INSTITUTE Page 24 Source: Noreen Mucha, Defining nutrition-sensitive development, Meeting of the Minds on Improving
Nutrition through Food Systems, Geneva, March 2013
INTERNATIONAL FOOD POLICY RESEARCH INSTITUTE Page 25 Source: Dangour et al. 2012; Hawkes and Ruel, 2011
Value Chain Approach to Improve Nutrition
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Concepts and Guidance
Agriculture and Food Policy
Support to Nutrition (Herforth et al)
1. Increase incentives for sustainable
production, distribution, and
consumption of diverse, nutritious and
safe foods
2. Monitor dietary consumption and
access to diverse, nutritious, safe
foods
3. Build capacity to improve nutrition
through food and agriculture sector
with adequate financing
4. Support multi-sectoral strategies to
improve nutrition within national,
regional, local government structures
5. Include measures that
protect and empower the
poor, and women
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IMPROVING NUTRITION THROUGH
NUTRITION-SPECIFIC AGRICULTURAL
PROGRAMS AT COMMUNITY LEVEL
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Targeted Agricultural Programs:
Integrating agriculture and Nutrition at
Household and Community level
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Improving Nutrition
Through Empowerment of Women
Evidence shows: Positive associations between women’s empowerment and maternal and child nutrition
Positive impacts of cash transfers and agricultural programs on measures of women’s empowerment
There is evidence that men and women allocate food
and other resources differently
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Negative associations between women’s disempowerment (e.g. domestic violence) and child nutrition
Source: Lancet Nutrition Series 2013
Photo credit: A. Quisumbing
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Example from HKI’s Homestead Food Production
Program in Bangladesh
Program:
• :
• Impact:
Source: Millions Fed, IFPRI 2009; www.ifpri.org/millionsfed
Production-focused: micronutrient-rich vegetables,
small livestock production
Nutrition education to promote consumption
Focus on women: income generation,
empowerment
Nutrition objective: Improve diet diversity,
micronutrient intake
Tripled vegetable production; increased income
73% of gardens managed by women
Improved food security for 5 million people
No evidence of impact on child nutritional status
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Lancet Nutrition Series 2013: Results of Review of
Nutritional Impacts of Targeted Agriculture Programs
Evidence of
impacts on
nutrition is
inconclusive
Livelihoods, income, food security
Diet quality, women’s empowerment
…and complement essential global efforts to enhance
agricultural productivity − increasing producer incomes
while protecting consumers from high food prices
31
Have impacts on
several underlying
determinants of
nutrition:
Likely due to weaknesses in design, targeting, implementation, evaluation
Except for vitamin A
Source: Lancet Nutrition Series 2013
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Meta-Analysis of Impacts of Agricultural
Programs on Child Anthropometry
Stunting
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Wasting
Source: Girard et al, 2012
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Meta-Analysis of Impacts of Agricultural
Programs on children’s vitamin A status
Page 33 Source: Masset et al. 2012
Photo: Julie Ruel-Bergeron
Biofortification for Improved Nutrition
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0 20 40 60 80 100
Control
Model 2
Model 1
%
High adoption rates
(Mozambique, 2009)
Source: Gilligan et al. forthcoming
68% retained
vines in next season
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20%
52%***
60%***
21%
5%
7%
59%
43%
33%
Control
Model 2
Model 1
Orange Yellow White
91 g/d
94 g/d
57 g/d
Large impact on intake of OFSP in
children 6-35 months, Mozambique
Source: Hotz et al. 2012
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Vitamin A intake doubled
0 100 200 300 400 500
Control
Model 2
Model 1
Vitamin A μg RAE per day
ProjectEnd
Children 6-35 months in Mozambique
Source: Hotz et al. 2012
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Reduced Prevalence of children 3-5 y with
Low Serum Retinol in Uganda by 9 PP
Source: Hotz et al. 2012
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Burkina Faso HKI Enhanced
HFP program
AIM:
• :
Increase year-round availability of: MN-rich
vegetables (OFSP, green leafy), small livestock
eggs; dairy
Income generation: sale of surplus production
Increase knowledge & promote optimal nutrition practices
(incl. intake of MN-rich foods)
Target, engage and empower women
Use different social network channels for diffusion of
information within villages
Impact evaluation: Cluster randomized trial
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What Have we Learned?
Agriculture does not automatically improve nutrition;
we need to make agriculture nutrition-sensitive – Recommendations from Lancet 2013:
• Include specific, clear nutrition goals and nutrition
interventions (e.g. BCC; distribution of MN-fortified products)
• Target right age group, for as long as possible within
the first 1000 days
• Target, engage, empower women (include men as
well); focus on social and gender equity
• Use agriculture programs as delivery platforms for
other inputs and services (e.g. distribute fortified
products; link to health services; integrate WASH,
etc.) (integrate or co-locate?) Page 40
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Guidance on Improving Nutrition through
Agriculture (Anna Herforth et al.)
1. Include nutrition goals
and indicators & prevent
harm
2. Assess local context
to identify needs
3. Target vulnerable,
focus on equity
4. Foster inter-sectoral
collaboration
5. Maintain and improve
resource base
6. Empower women
7. Promote production
diversification
8. Enhance nutrient
content & prevent loss
along the value chain
9. Expand market
access for vulnerable
groups
10. Incorporate nutrition
promotion and education
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Where Do we Go from Here?
We have a momentum: global consensus, new
initiatives, committed donors, experienced NGOs
and other implementers, and skilled researchers
We have opportunities and examples of success on how
to bridge the agriculture-nutrition divide; need to innovate
in program design, implementation and evaluation
We have challenges; our biggest challenge AND
opportunity is to work together - cross-sectorally (how?)
We need to do much better at documenting successes –
and failures through rigorous, credible evaluations; we
need the evidence for advocacy and to stimulate
investments
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Photo: One Acre Fund
Now is the time to unleash the real potential of
agriculture to improve nutrition!