Special focus on nutrition-sensitive programming

Editorial
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
do not have strong in-house research capacity,
because that is not their core business.
In summary, several factors – a deep understanding
of context, an explicit theory of change
and a credible research design – would go a
long way to improving the evidence base for
nutrition-sensitive programming; these observations
concur with the research priorities identified
in the Lancet series (Ruel et al, 2013). But
this is no small task, and one that implementing
agencies and government institutions are oen
not equipped to undertake alone. e sections
below provide a brief summary of some of the
key evidence on nutrition-sensitive actions in
certain crucial sectors, from the literature and
from articles submitted for this special edition.
Agriculture
Investment in agriculture and nutrition has
been happening for decades (Siling et al, 2015)
with renewed global vigour in scrutinising this
area (Dufour, 2015).
In this edition, a range of articles feature
agriculture and nutrition linkages, from nutrition-sensitive
agriculture in Zambia (Mayer et
al, 2015) to nutrition-sensitive potential of agriculture
in the context of school feeding in Haiti
(Mallonee et al, 2015), nutrition incentives in
dairy contract farming involving the private
sector in Senegal (Bernard et al, 2015), among
others (Mayer et al, 2015; Klein, 2015; Moyo et
al; 2015, Mallonee et al, 2015, Ouedraogo et al,
2015; Bernard et al, 2015; Titus, 2015; Danton,
2015; Dufour, 2015). Agricultural and pastoral
communities form a large proportion of the
beneficiaries of development aid programmes,
and small-scale agriculture is a major provider
of both food and income for these families; on
a macro scale, agriculture also determines food
prices and is the driver of many economies. As
such, it might be assumed that raising productivity
and incomes should be the major preoccupation
of the agriculture sector, and these are certainly
important factors in reducing hunger and poverty
but, with a nutrition-sensitive lens, this is not
all the agriculture sector can do.
Purely increasing income does not reduce
undernutrition rates fast: a 10% rise in gross
domestic product (GDP) is associated with a
6% decline in stunting and a 7% decline in underweight,
so it would take decades to eliminate
undernutrition in a typical agricultural economy
through this route. Rising income also leads to
a commensurate rise in overweight or obesity:
a 10% rise in GDP is associated with a 7% rise
in obesity in women (Ruel et al, 2013). us, in
order to be nutrition-sensitive, agriculture programmes
need to go beyond income and address
the determinants of all forms of malnutrition.
A key nutrition outcome is the quality of
diets, and agriculture is the sector with the most
influence on what is available, affordable and
accessible to be eaten, beyond starchy staple
foods. So diets are a product of all of the key
pathways from agriculture to nutrition (through
changes in production, income and women’s
empowerment), and should be a key outcome
indicator of agricultural programmes. A review
of agency guidelines has formed quite a consensus
on Key Recommendations for Improving Nutrition
through Agriculture (Herforth et al,
2014) at both policy and programmatic levels.
One of the most common nutrition-sensitive
agriculture-sector programmes is homestead
food production. In 2011, a systematic review
of published research (Massett et al, 2012)
assessed whether this broad category of programmes
was effective in impacting nutrition
outcomes. It found that anthropometric and
biomarker nutrition indicators were rarely
affected through these programmes, but that
there were oen positive impacts on diets (increased
consumption of foods produced).While
there were limitations to the studies and metaanalysis,
it did appear that programmes were
more likely to be effective if they included attention
to empowering women in agriculture.
A more recent set of studies looking at farmlevel
pathways to nutrition (Winters et al, 2015)
backed up the key finding: in general, farming
households producing a greater diversity of
crops had greater access to a diverse range of
foods and children in those households had
more diverse diets.
In agriculture projects, one potential negative
impact that has been studied is on women’s
time use, as time spent on agriculture competes
with time used for other nutrition-relevant activities
such as childcare and feeding, as well as
resting and socialising. A recent review (Johnston
et al, 2015) confirmed that agriculture in general,
and interventions in particular, do disproportionately
take up women’s time. e impacts on
nutrition depended on how this additional time
burden was managed, whether by reducing rest
time, switching to more convenient foods, reducing
time for feeding and cooking, or sharing
domestic duties within the household. is context
of trade-offs and potential responses should
therefore be considered as part of programme
planning, in agricultural and other time-intensive
interventions.
e Food and Agricultural Organization
(FAO) guidance on nutrition-sensitive agriculture
and food systems highlights that in agriculture,
a consumer-centred approach may be at odds
with a food-supply driven approach (Dufour,
2015). In other words, nutrition objectives may
compete with economic objectives, and policy
change at each stage of the food system is
needed. Going beyond sensitisation takes time,
perseverance, multi-stakeholder dialogue, trial
and error and improved learning that involves
experience-based evidence, as well as research.
An FAO-led regional workshop featured in this
issue looked to capitalise on existing experiences
and knowledge on linkages between livestock
and human nutrition in the Sahel (Dominguez-
Sala et al, 2015). Participants explored impact
pathways and how to optimise the nutrition
impact of interventions; country case studies
(two of which we feature) heavily informed discussions
(Bonde, 2015 and Bernard et al, 2015).
Social protection/cash transfer
programming
Social safety net programmes, which include
conditional and unconditional cash transfer
(CT) programmes, are increasingly being implemented
in development and humanitarian
contexts. ese programmes currently provide
cash, voucher, or food transfers to an estimated
one billion poor people and those affected by
shocks (e.g. natural disasters). Cash programming
and research feature in a number of articles in
this edition (Shwirtz et al, 2015; Oxford Policy
Management, 2015 and Adamu et al, 2015), in
the form of both conditional (Oxford Policy
Management, 2015) and unconditional transfers
(Shwirtz et al, 2015 and Adamu et al, 2015).
ere is strong evidence that CTs increase household
income and protect household assets from
being sold, and it is widely thought that these
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
4
©IFPRI/Gert-Jan Stads