6 indirect approaches to improving nutrition – part two

Malnutrition is pervasive, far-reaching and complex. Because of this both the immediate impacts as well as the underlying causes must be addressed simultaneously if malnutrition rates are to be reduced, warranting the need for both nutrition-specific and nutrition-sensitive approaches. In part one of this article we discussed the roles agriculture, livestock production and resilience building can have in improving people’s nutrition. More productive and diverse farming and reduced vulnerability to environmental and other risks can boost household nutrition. In part two we look at how gender inequality, marginalisation from society, poverty and climate change pose both threats to nutrition and how, as a result, we can fight malnutrition through building gender equality, providing social protection and mitigating climate change.

4. Gender

The theme for this year’s Africa Day for Food and Nutrition Security was “Empowering Our Women, Securing Our Food, Improving Our Nutrition,” and without question, women are central to producing food in the fields and putting food on the table for their families. In some African countries, 90% of women are engaged in agricultural and related activities. Yet these women often lack secure land rights and access to machinery, markets, inputs and technologies that could increase their harvest and their and their family’s nutrition. Additionally, proper nourishment “empowers people to live and take on new opportunities”, giving people the energy and vitality to innovate and be even more productive.

An article in the Guardian further explains why gender is critical for nutrition. Women play important roles within a family, in agriculture and in their community. Their links between work, home and society mean investing in women has knock-on effects, in particular for nutrition, given that they are often the providers of food. Gender inequality reduces a woman’s power in making decisions and in bringing about change, and should be tackled in society and governance. And there is evidence that investing in women can bring about advances in development. A study by the International Food Policy Research Institute (IFPRI) found that half of the reduction in hunger between 1970 and 1995 could be attributed to improvements in women’s societal status. Additionally improvements in women’s access to education (which accounted for 45% of gains in food security) was nearly as significant as increased food availability (26%) and health advances (19%) put together.

But gender is not just about women. It is also important to educate men on, for example, “the right kind of food, doing home gardening, rearing cows, poultry farming, using safe water, building sanitary latrines and hygiene”. Men and boys have a central role in improving nutrition and in bringing about gender equality. The Food and Natural Resources Policy Analysis Network (FANRPAN) have developed a way of creating dialogue about the importance of valuing women and girls in agriculture and communities through theatre, and through a travelling company are engaging with elders and men.

5. Social protection

Social protection aims to reduce people’s vulnerability and is delivered through a variety of mechanisms: weather-indexed insurance, public works programmes, emergency food aid, buffer stock management, agricultural input subsidies, conditional cash transfers and employment guarantee schemes. Devereux (2015), in a study of the links between social protection programmes and enhanced entitlements to food, comes to the conclusions that principles of social justice need to be introduced to the design and delivery of social protection programmes and that a comprehensive approach is needed that combines interventions around stabilising as well as increasing income and/or food production.

Recently, conditional cash transfer programmes, have become an increasingly popular social protection strategy, particularly in Latin America. In Brazil the Bolsa Familia programme (BFP), the largest conditional cash transfer programme in the world reaching some 25% of the population, has several objectives around poverty, health, education and food and nutrition security. The programme grants households cash directly, most often to the female head of the household, based on a cut-off income level or whether a family includes children aged up to 17 years old. A household enrolled in the programme must meet certain health and education conditions such as minimum school attendance.

An investigation into the relationship between the BFP and health and nutrition surveys finds empirical evidence that the cash transferred by the BFP results greater income that is then spent on purchasing better food. A separate study indicated that households, part of the BFP, had aspirations around consuming healthier and more diverse foods such as vegetables and fruits. These foods are not always easily accessible, however, as greater household spending power has motivated “manufacturers of foods with low nutritional value” to enter the market. Thus while the transfer of money can bring immediate improvements in access to resources, the government must do more to ensure nutritious food resources are available.

A UNICEF study looking at the impact of conditional cash transfers and child nutrition in sub-Saharan Africa found while many studies find the results and role of cash transfers to be positive, allowing households greater access to food, health, education, clothes, transportation etc., there is little evidence of impact on anthropomorphic determinants of child nutrition such as growth, height and weight. Greater investigation is needed into whether such programmes along with other social protection strategies increase household dietary diversity, food purchasing behaviour and household dynamics.

6. Climate change

Climate change is likely to alter what food we can produce, how much and where. Field trials of wheat, rice, maize and soybeans also indicate that higher atmospheric CO2 levels will make these crops less nutritious, reducing levels of iron, zinc and protein content. Although the biological mechanism is not fully known, such an effect is widespread it will increase levels of malnutrition. Although these staple crops are relatively low in iron and zinc, many people in developing countries rely on them as major sources due to low levels of meat in diets. For example, in Bangladesh, Iraq and Algeria the majority of people get over 75% of their zinc and iron from these crops. We already need food production to double by 2050 to meet population demands, it will be even more difficult to have to increase productivity due to needing to eat more to make up for the drop in crop nutrition.

It is estimated that some 25 million additional children under the age of five will be at risk of malnutrition by 2050 due to climate change. Clearly we need to mitigate climate change if we are to address malnutrition. We also need climate change adaptation and climate-smart farming is believed by some to be part of the solution. The Rome Declaration on Nutrition and Framework of Action adopted by the 2nd International Conference on Nutrition in November 2014 recognized “the need to address the impacts of climate change and other environmental factors on food security and nutrition, in particular on the quantity, quality and diversity of food produced, taking appropriate action to tackle negative effects”, but so far little attention has been given to the relationship between climate change and nutrition.

The opportunities for both improving people’s nutrition as well as their welfare are vast. Greater social equality, improved individual and community resilience, reducing poverty and increased food production are beneficial for people, for society and for the economy, and the good news is they can also help tackle malnutrition. But there are significant factors that prevent us from eradicating malnutrition and threaten to reverse any progress made, such as climate change, failing to value the role women play in families and farming, or struggling to prepare and recover from environmental crisis, war or other shocks. When talking about nutrition it inevitably becomes a twin-track discussion: nutrition-specific and nutrition-sensitive, direct and indirect, nutrition and food, nutrition and gender, immediate and long-term. And it seems clear that is you can’t have one without the other and expect to reduce malnutrition. If we are to truly fight malnutrition in all its forms we need to do so from all directions.