Agricultural Interventions and Nutritional Status

Cross-posted from the FSP India website written by Bas Paris

Photo credit:Flickr, Sowmya's Photography
Photo credit:Flickr, Sowmya's Photography

A paper in Food Policy provides a review of various studies on the impacts of agricultural interventions on the nutritional status in South Asia. Past review exercises and studies have analysed the available evidences to understand the ways in which agriculture can be leveraged to enhance nutritional status, however, very few of them have employed a systematic approach encompassing a significant number of studies. This paper aims to fill this gap through conducting a systematic review assessing the existing evidence in 25 studies for combating food insecurity and malnutrition through agricultural interventions.

The paper analysed studies on the impact of interventions in agriculture and allied sectors (horticulture, livestock, fisheries and forestry) in South Asia (and India) on the nutritional outcomes for adults and children, published since the year 2000. The nutritional outcomes were captured through intermediate outcome indicators such as dietary diversity, calorie intake and nutrient intake, and outcome indicators such as anthropometric factors and DALYs (Disability Adjusted Life Years). The studies selected were not homogenous in terms of a common outcome indicator and the studies used different metrics for examining the linkage. Some studies analysed nutritional outcomes by examining the stunting and wasting of children and adolescents, whereas others analysed the Body Mass Index for determining adult malnutrition or levels of micronutrients such as vitamin A and haemoglobin. Some studies used intermediate outcome indicators, such as changes in consumption patterns, dietary diversity, and intakes of certain foods. Most of the included empirical studies analysed data from secondary datasets and had large sample sizes. Others were primary baseline surveys, with smaller sample sizes.

The paper categorizes the findings of the studies according to six pathways developed by UNICEF, and slightly modified by the paper, through which agriculture can influence nutritional outcomes. These six pathways are: sources of food, source of income of households involved in agriculture, agricultural policy and prices, women in agriculture and their socio-economic status, maternal employment in agriculture, and maternal nutrition and health status.

Regarding the sources of food the study highlights that 22 of the 25 reviewed studies examined the contribution of agriculture as a source of food for nutrition. The studies indicate strong evidence that the dietary intake of agricultural households largely depends on food supplies from their own farm, this is because subsistence farming is common across South Asia. The evidence, however, is not conclusive for the impact of supply of livestock on food consumption. A negative and significant association was also reported in three studies between improvements in agricultural productivity and under-nutrition. Particularly, the interventions for increasing the productivity and production of specific nutritious food crops such as vegetables and pulses, widely grown and consumed in India, showed positive implications for increased intake and child nutrition. However, a number of studies, two of which focused on India, estimated a weak relationship between calorie consumption and nutritional outcomes.

8 out of 25 studies investigated the impact of agricultural incomes on nutrition. In this regard the paper highlights that it is unclear whether agricultural growth leads to improvements in nutrition. Specifically, Heady illustrates that high agricultural growth rates in some states of India, such as Gujarat, Rajasthan and Bihar, were not accompanied by a decrease in under-nutrition. However, a number of studies find that nutritional security was reported to be significantly influenced by per capita agricultural income, one study also reported that increased household wealth also significantly positively affected the diet diversity of children in India.

Only 5 studies analysed the role of agricultural policies aimed at reducing relative prices or increasing the affordability of food on nutritional status. Based on the representative sample for India, it was demonstrated that policy interventions for affecting food prices played an important role in diet diversification and nutritional outcomes. The policy of improving the affordability of staples by the public distribution system provided food and nutritional security. However, the relative price of staples has a strong and significant association with diet diversity, but not with calorie availability.

8 studies covered the importance of women empowerment in agriculture and its contribution to household food and nutritional security. The nutritional status of the mothers, measured using the BMI, had statistically significant positive effects on height and weight for age scores of their children aged less than three years. Women empowerment influenced the quality of feeding practices for infants and young children, but was weakly associated with child nutrition status.

In conclusion the paper highlights that agricultural interventions (pathways 1-3) have the potential to influence nutritional outcomes in India and South Asia. However, the available evidence linking the agricultural interventions and their impact on the nutritional status of women and children is small (pathways 4-6). Overall, the paper stresses that these findings show that linkages between agriculture and nutrition are complex and require multi-sectoral and multi-dimensional approaches to tackle malnutrition problems. The findings clearly indicate the importance of the home production of nutrient-rich food crops for improving the nutritional outcomes. This suggests that bio-fortification of staples and homestead gardens can influence the intake of a micronutrient-rich diet and consequently nutritional outcomes. This also suggests that the diversification of agriculture towards fruits and vegetables can potentially promote dietary diversity and improve nutritional outcomes.

The full paper can be accessed here

Undernutrition Garners Little Attention in Indian Media

Undernutrition is an emergency in India, where almost half of all children under the age of three are underweight. However, even in the face of such a crisis, this issue garners little attention in Indian media.

POSHAN Media Fellows
POSHAN Media Fellows

To address the lack of nutrition reporting in India, POSHAN and OneWorld Foundation implemented the six-month OneWorld-POSHAN Fellowship on Maternal and Child Undernutrition from May–December 2013. Six journalists from various media outlets such as The New York Times, Dainik Jagran, The Hindu, Chapte Chapte, The Hindustan Times, and www.newsclick.in participated in the program.

On March 19th, POSHAN and OneWorld organized a workshop with the six media fellows to share their learnings from their reporting from the field. The workshop focused on their experiences and observations during the course of their travels to various parts of the country collectively preparing over 30 pieces on mother and child undernutrition.

Many fellows spoke about the huge problems they saw in the field with nutrition services for the poor. For example, Mukesh Kejriwal of Dainik Jagran presented photos exposing flaws with the Integrated Child Development Services (ICDS) scheme. One photo showed a broken-down Anganwadi centre without a roof. He spoke about the lack of commitment of officials at the centres that he visited, and how in one centre, the officials had locked up the materials that were meant to be used for the welfare of children.

Malavika Vyawahare from The New York Times spoke about how there is no proper compilation of nutrition data on which the government can actually base its work. She also spoke of an instance in which she saw a modern, electric weighing machine in an Anganwadi centre in a tribal district in Maharashtra, which was useless because that part of the country is not connected to the electricity grid.

Neha Dikshit, who wrote her articles for www.newsclick.in, focused on the fact that some of the government schemes meant to improve the plight of rural women and children have in fact been detrimental for them. She mentioned how a Haryana government scheme providing cash assistance to marriageable women led to teen marriages, deaths of pregnant girls, and parents started forced schools to give under-age certificates.

Pankaj Jaiswal, from The Hindustan Times, spoke about the existence of undernutrition in the so-called 'well fed' urban population. Thanking the fellowship program for raising his awareness on the issues, he said that he is likely to keep writing on the issue.

Freelance journalist Saadia Azim spoke about how migrants are facing the brunt of nutrition problems. During her travels to villages in Bengal, she found that poor diet haunted all migrants, regardless of caste, religion, or even region. For her, a huge issue was that nobody was even talking about malnutrition as an election issue.

The fellows concluded the meeting with a consensus on how much more the media needs to do in terms of reporting on nutrition. They stressed that the issue of undernutrition has an impact on national security and wellbeing of the country and thus needs to be taken up much more in the media and addressed by the government.

Learn more by visiting the OneWorld-POSHAN Fellowship on Maternal and Child Undernutrition site to read all the news articles.

New Abstract Digest on Maternal and Child Nutrition Research – Issue 7

We are pleased to release Issue 7 of our bi-monthly Abstract Digest on maternal and child nutrition. This issue features interesting publications examining nutrition from both a biological and political lens, in India and beyond. Highlights include:

Abstract Digest-Issue 07
Abstract Digest-Issue 07
Click to download PDF (708 Kb)

Abstract Digest-Issue 07

  • A special open-access issue of Annals of the New York Academy of Sciences on integrating nutrition and early childhood development interventions
  • Two articles from Advances in Nutrition discussing 1) how nutrition research can become more useful in informing global nutrition guidelines (Stoltzfus 2014), and 2) arguing for the need to develop implementation science to enable stronger delivery of adequate nutrition to those in need (Habicht and Pelto 2014).
  • One study in Bio Medical Education identifying gaps in South Asian postgraduate nutrition programs to build capacity to address the current public health nutrition challenges (Khandelwal et al. 2014).
  • Two reviews, one providing an overview of the evidence-base for nutritional deficits in early life and greater risk for non-communicable diseases in later life (Langley-Evans 2014) and the other recommending investments in improving maternal autonomy to improve child nutritional status (Carlson et al. 2014).
  • Several articles focusing specifically on malnutrition in India, including on determinants of anemia (Anand 2013), vitamin A programming in India and its reach (Aguayo 2014), and management of severe acute malnutrition (Singh et al. 2014; Kumar et al. 2013).

 

POSHAN New Policy Note Explores Lessons Learned in Working Multisectorally to Improve Nutrition Globally and India

Photo Credit Aishwarya Pillai
Photo Credit Aishwarya Pillai

It is recognized that eliminating undernutrition requires actions across multiple sectors.  A child must receive food with adequate energy, protein, and micronutrients while at the same time having access to safe water, good sanitation, and quality health care.  However, services that need to be delivered are typically not led by the same sector, agency, or actor.  The agricultural sector, for example, focuses mostly on food production. The health sector usually focuses on clinical care, rather than on care and feeding in the home.

Though it is recognized that working multisectorally is critical to ensuring that adequate food, health, and care reach children, it isn’t always clear how to do so and it is rarely easy. With an aim of garnering lessons learned that could inform India’s policymakers and program implementers, POSHAN commissioned a review of global and Indian experience in improving nutrition through multiple sectors. The new Policy Note Working Multisectorally to Improve Nutrition: Global Lessons and Current Status (Please see below the paper)  in India examines best practices from other countries, including Bolivia, Colombia, Peru, Senegal, and Thailand, as well as the status of current multisectoral initiatives in India in nutrition, which include the Multisectoral Nutrition Programme to Address Maternal and Child Undernutrition, which was conceived in 2008 by the Prime Minister’s National Council on India’s Nutrition Challenges and launched in 2014. The paper features recommendations to ensure better implementation and sustainability of multisectoral approaches in India.

Last year in May 2013, POSHAN had organized a consultation on multisectoral approaches to improve maternal and child nutrition in India and had brought together key policymakers and policy advisers from a variety of ministries at the national level and from the Indian states of Odisha, Andhra Pradesh, Karnataka and Madhya Pradesh. This event highlighted lessons and experiences from other countries and from India.

Download the POSHAN Policy Note Working Multisectorally to Improve Nutrition Globally and India.pdf (661 Kb)

Updating India’s Plan for Achieving Sustainable Nutrition Security

File photo (a newborn being weighed): Photographer-Aishwarya Pillai
File photo (a newborn being weighed): Photographer-Aishwarya Pillai

In light of new evidence, the 2010 Leadership Agenda for Action (LAA), a documented plan for achieving sustainable nutrition security in India, is being updated to reflect recent scientific findings and to include strategies for scaling up successful programs.

The Coalition for Sustainable Nutrition Security in India, a group of nutritionists, policy and program leaders, and other experts, met on November 15, 2013 in New Delhi for the First Task Force Meeting.  The meeting had two objectives:

  1. Review and seek consensus on a) the list of the Leadership Agenda for Action(LAA) Essential Interventions (the “what”) based on the  online discussion recommendations, available new evidence, and additional suggestions made by task force members and b) the list of the suggested actions for each intervention (the “how’).
  2. Discuss and decide on other issues:

a)   How to organize the paper and LAA revision process and timeline
b)   How to address the conflict of interest (COI)

Highlights of the discussion:
Key recommendations of the online discussion (organized from Oct 16-18, 2013) were shared between the task force members. The online discussion covered wide range of topics in the areas of environmental health, maternal mental health, nutrition in emergencies, urban nutrition strategy, nutrition education, complementary feeding among others. For details please see attached online discussion summary for more details on these topics.

  • The task force discussed the “conflict of interest” issue which was highlighted during the online discussion of LAA.  It was suggested to refer the WHO COI guidelines and adapt the same for LAA Task Force. The Nutrition Coalition Secretariat will share the WHO COI with all task force members for review.
  • The task force members decided to review the essential interventions using a matrix that was agreed upon by all the members. The group could not complete reviewing all essential interventions and decided to complete through an online discussion before the next task force meeting.
  • The India Health Report prepared by Public Health Foundation of India need to be referred by the task force to keep a synergy between the Leadership Agenda for Action and India Health Report.
  • The second task force meeting will review all essential interventions and will focus on suggested actions for each intervention (the “how’). The second meeting will be held on December 17, 2013.

For further information, please contact the Nutrition Coalition Secretariat in the following email id: l.palo@savethechildren.in

Leadership Agenda for Action Summary of online discussion below:

LAA 2013 online discussion summary

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