6 indirect approaches to improving nutrition – part one

Malnutrition, in its various forms, is thought to affect over 2 billion people in the world and, as such, has far reaching consequences for societies, economies and livelihoods. Tackling poor nutrition is both complex and opportunistic in that there are links between nutrition and a whole other range of factors. In other words by tackling nutrition directly we may positively contribute to other developmental problems but there are also multiple ways to address undernutrition indirectly. While there is broad consensus on the need to take direct nutrition interventions such as promoting exclusive breastfeeding or biofortification of crops with micronutrients such as vitamin A or zinc, there is also an urgent need to tackle the underlying and inter-related determinants of malnutrition. The Lancet, for example, suggests that direct nutrition interventions, even if implemented at 90% coverage in high-burden countries would only reduce global stunting by 20%.

So-called nutrition-sensitive approaches are gaining popularity and the importance of including nutrition in a wide variety of sectors and policies is becoming better understood. Here we discuss some of the alternative routes through which malnutrition is impacted and thus could be reduced.

1. Agriculture

The contribution of agriculture to meeting the nutritional needs of the population cannot be overstated, and the nutrition component of agricultural policies and investment plans needs to be strengthened. In Africa, agricultural development has been primarily focused on boosting production and developing markets with little attention given to nutrition. But agriculture is at the heart of addressing malnutrition. Its products provide us with the energy, protein, vitamins and minerals our bodies need. And in many developing countries the majority of people who are malnourished live in rural areas and depend on smallholder farming for their livelihoods. In fact, demographic and health survey (DHS) data shows that individuals living in rural areas are between 1.3 and 3.3 times more likely to be stunted than people in urban areas, which indicates that agriculture still has a long way to go in providing the global population with the right nutrition and adequate calories. It also indicates that by improving agricultural diversity and productivity in rural farming areas, malnutrition could be significantly reduced, although evidence on the impact agriculture can have on nutrition is currently limited in formal literature.

So how does agriculture need to change in order to better serve the world’s nutritional needs? The food system needs to provide access to enough nutritious foods, promote social norms that foster good nutrition practices and provide adequate income to purchase nutritious foods. Ensuring nutritious foods are affordable, accessible and available is essential and has typically been overlooked in the agricultural sector, rather being the domain of development and health. Home and school gardens, small livestock production, aquaculture and marketing policies which keep the prices of such foods at affordable levels are examples of food-based nutrition improvement initiatives. Some argue that the entire food chain needs to be put under a “nutrition lens” in order to identify areas for intervention such as “expanding and diversifying food production, improving food processing, preservation and preparation of foods, reducing losses and waste and assessing intervention impact on dietary consumption”.

The Soils, Food and Health and Communities (SFHC) project, used participatory research methods and awareness raising activities in Ekwendeni village in Northern Malawi to help smallholder famers select and test mixtures of diverse legume species for growing in combination with maize. Project results show that the intercropping of maize with legume mixes has led to improved nutrition for children in communities where the project is being implemented (over 9000 farmers have adopted this technology so far).

Nutrition-sensitive agriculture: a collection of case studies

A new report recently released by the United Nations Standing Committee on Nutrition, entitled, The Nutrition Sensitivity of Agriculture and Food Policies, investigates, through eight country case studies, current understanding of effective nutrition-sensitive agriculture and food policies, and the development of food-based solutions that help countries to scale up nutrition.

Recognition of the links between agriculture and nutrition is growing, and both countries and institutions are working towards making agricultural policies more nutrition sensitive. The report discusses the work of Brazil, Malawi, Mozambique, Nepal, Senegal, Sierra Leone, South Africa, and Thailand to make agriculture, a sector important for both economic development and livelihoods in many developing countries, more able to address issues of nutrition insecurity, gender inequality and resilience.

The links between agriculture and nutrition are complex, and not well understood. In particular our knowledge of how agricultural programmes or policies can impact nutritional outcomes and consumption patterns have only recently begun to be investigated. As agricultural systems become more complex and global in nature, the links to nutrition, experienced at an individual or household level, become harder to understand and manage. What is understood is that the current food systems are not well designed to provide nutrition security and, for those countries suffering a high burden of malnutrition, guidance and practical advice in making nutrition-sensitive policy decisions and measuring their impact is needed.

Addressing nutrition requires a multi-sectoral, multi-stakeholder and multi-disciplinary approach, which, through agriculture, attempts to reduce unintended consequences of agricultural policies on consumer welfare while maximising positive nutrition outcomes. The report states that food and nutrition security are a product of both dietary diversity and quality, as well as being able to access sufficient calories. As the country case studies show many countries are now thinking about the links between agriculture and food and nutrition security and are committing to achieving positive nutrition outcomes, although rarely across the whole sector or with any formal measurement of impact. Nutrition outcomes can also be seen as secondary to sector-specific objectives, particularly worrisome if this leads to negative consequences for nutrition.