Mara van den Bold

Women's Empowerment and Nutrition: An Evidence Review

This paper starts by reflecting on the concept and measurement of women’s empowerment and then reviews some of the structural interventions that aim to influence underlying gender norms in society and eradicate gender discrimination. It then proceeds to review the evidence of the impact of three types of interventions—cash transfer programs, agricultural interventions, and microfinance programs—on women’s empowerment, nutrition, or both.

Closing the gender asset gap: Learning from value chain development in Africa and Asia

This paper explores initial findings from four case studies in the Gender, Agriculture, and Assets Project on changes in gender relations in different agricultural interventions. It documents the adaptive measures projects are taking to encourage gender-equitable value chain projects. Findings suggest that the dairy and horticulture value chain cases have successfully increased the stock of both men’s and women’s tangible assets and those assets they own jointly.

Can Integrated Agriculture-Nutrition Programmes Change Gender Norms on Land and Asset Ownership? Evidence from Burkina Faso

Abstract This article uses a mixed-methods approach to analyse the impact of an integrated agriculture and nutrition programme in Burkina Faso on women’s and men’s assets, and norms regarding ownership, use and control of assets. We use a cluster-randomised controlled trial to determine whether productive asset transfers and increased income-generating opportunities for women increase women’s assets over time. Qualitative work on gender norms finds that although men still own and control most assets, women have greater decision-making power and control over home gardens and their produce, and attitudes towards women owning property have become more favourable in treatment areas.

Agriculture, Food Systems, and Nutrition: Meeting the Challenge

Malnutrition is a global challenge with huge social and economic costs; nearly every country faces a public health challenge, whether from undernutrition, overweight/obesity, and/or micronutrient deficiencies. Malnutrition is a multisectoral, multi‐level problem that results from the complex interplay between household and individual decision‐making, agri‐food, health, and environmental systems that determine access to services and resources, and related policy processes. This paper reviews the theory and recent qualitative evidence (particularly from 2010 to 2016) in the public health and nutrition literature, on the role that agriculture plays in improving nutrition, how food systems are changing rapidly due to globalization, trade liberalization, and urbanization, and the implications this has for nutrition globally. The paper ends by summarizing recommendations that emerge from this research related to (i) knowledge, evidence, and communications, (ii) politics, governance, and policy, and (iii) capacity, leadership, and financing.

Leveraging agriculture for nutrition in South Asia and East Africa: examining the enabling environment through stakeholder perceptions

South Asia and sub-Saharan Africa are the two regions of the world with the highest concentration of undernutrition. The majority of the nutritionally vulnerable populations in both regions is dependent in some way upon agriculture as a primary source of livelihood. The agriculture sector and wider agri-food system is considered to be central to sustained progress in reducing undernutrition – and yet not enough is known about how to unleash this potential. Recent scoping assessments have also revealed a paucity of information on wider political, institutional and policy-related challenges relating to the agriculture-nutrition nexus globally. Contextualized research into policy processes and the political economy of agriculture and nutrition is needed to better characterize “enabling environments” for agriculture to benefit nutrition, and how these environments can be shaped and sustained. This study aims to contribute to filling this gap, by drawing upon evidence from a set of case studies in South Asia (India, Bangladesh and Pakistan) and eastern Africa (Ethiopia, Uganda and Kenya). In synthesizing results across countries, while recognizing important nuance and detail, we conclude by highlighting four key issues to be addressed. First, improving knowledge and perception of undernutrition and its links to agriculture, on the part of agricultural policymakers and programme managers. Second, generating system-wide incentives for decisions and actions to become more pro-nutrition. Third, developing transparent systems of accountability for nutrition-relevant action throughout the agriculture sector, through linking timely and actionable data and evidence with incentives. And fourth, cultivating and strengthening leadership and capacities at different levels, underpinned by adequate financing.

Is There an Enabling Environment for Nutrition-Sensitive Agriculture in South Asia? Stakeholder Perspectives from India, Bangladesh, and Pakistan

Background: Almost half of all children in South Asia are stunted. Although agriculture has the potential to be a strong driver of undernutrition reduction and serves as the main source of livelihood for over half of South Asia’s population, its potential to reduce undernutrition is currently not being realized. Objective: The Leveraging Agriculture for Nutrition in South Asia (LANSA) research consortium seeks to understand how agriculture and agrifood systems can be better designed to improve nutrition in South Asia. In 2013 and 2014, LANSA carried out interviews with stakeholders influential in, and/or knowledgeable of, agriculture–nutrition policy in India, Pakistan, and Bangladesh, to gain a better understanding of the institutional and political factors surrounding the nutrition sensitivity of agriculture in the region. Methods: Semistructured interviews were carried out in India, Bangladesh, and Pakistan with a total of 56 stakeholders representing international organizations, research, government, civil society, donors, and the private sector. Results: The findings point to mixed perspectives on countries’ policy sensitivity toward nutrition. There was consensus among stakeholders on the importance of political commitment to nutrition, improving nutrition literacy, strengthening capacities, and improving the use of financial resources. Conclusions: Although there are different ways in which South Asian agriculture can improve its impact on nutrition, sensitizing key influencers to the importance of nutrition for the health of a country’s population appears as a critical issue. This should in turn serve as the premise for political commitment, intersectoral coordination to implement nutrition-relevant policies, adequately resourced nutrition-specific and nutrition-sensitive programs, and sufficient capacities at all levels.

Evidence to Action: Highlights From Transform Nutrition Research (2012-2017):

Background: The Transform Nutrition (Transform) research consortium (2012-2017), led by the International Food Policy Research Institute, sought to generate evidence to inform and inspire action to address undernutrition in 4 high-burden countries (India, Bangladesh, Kenya, and Ethiopia) and globally. Objective: Within the context of the literature, this synthesis article brings together core findings of Transform, highlighting priorities for future research. Methods: This article uses a narrative approach to synthesize diverse study findings that collectively address Transform’s three primary research questions: (1) How can nutrition-specific interventions be appropriately designed, implemented, scaled, and sustained in different settings?; (2) How can the nutritional impact of social protection and agriculture be improved?; and (3) How can enabling environments be promoted so as to use existing political and economic resources more effectively? Results: Highlights of Transform include (1) improved understanding of the relative effectiveness of different combinations of nutrition-specific interventions and the ways in which they can be scaled for maximal impact; (2) evidence that shows that social protection and agriculture need to be explicitly linked to nutrition in order to contribute to stunting reduction; (3) identification of key components of “enabling environments” for nutrition and how they can be cultivated/sustained; (4) research that examines ways in which leaders emerge and operate to change the political and policy landscape in different settings; and (5) “stories of change” that provide in-depth contextual knowledge of how transformative change has been driven in countries that have made inroads in reducing malnutrition. The conclusion highlights the contributions of the consortium and provides recommendations for future research.

Understanding the role of intersectoral convergence in the delivery of essential maternal and child nutrition interventions in Odisha, India: a qualitative study

BackgroundConvergence of sectoral programs is important for scaling up essential maternal and child health and nutrition interventions. In India, these interventions are implemented by two government programs – Integrated Child Development Services (ICDS) and National Rural Health Mission (NRHM). These programs are designed to work together, but there is limited understanding of the nature and extent of coordination in place and needed at the various administrative levels. Our study examined how intersectoral convergence in nutrition programming is operationalized between ICDS and NRHM from the state to village levels in Odisha, and the factors influencing convergence in policy implementation and service delivery.MethodsSemi-structured interviews were conducted with state-level stakeholders (n = 12), district (n = 19) and block officials (n = 66), and frontline workers (FLWs, n = 48). Systematic coding and content analysis of transcripts were undertaken to elucidate themes and patterns related to the degree and mechanisms of convergence, types of actions/services, and facilitators and barriers.ResultsClose collaboration at state level was observed in developing guidelines, planning, and reviewing programs, facilitated by a shared motivation and recognized leadership for coordination. However, the health department was perceived to drive the agenda, and different priorities and little data sharing presented challenges. At the district level, there were joint planning and review meetings, trainings, and data sharing, but poor participation in the intersectoral meetings and limited supervision. While the block level is the hub for planning and supervision, cooperation is limited by the lack of guidelines for coordination, heavy workload, inadequate resources, and poor communication. Strong collaboration among FLWs was facilitated by close interpersonal communication and mutual understanding of roles and responsibilities.ConclusionsCongruent or shared priorities and regularity of actions between sectors across all levels will likely improve the quality of coordination, and clear roles and leadership and accountability are imperative. As convergence is a means to achieving effective coverage and delivery of services for improved maternal and child health and nutrition, focus should be on delivering all the essential services to the mother-child dyads through mechanisms that facilitate a continuum of care approach, rather than sectorally-driven, service-specific delivery processes.