Improving nutrition through agriculture: priorities and approaches
Kimberly Keeton and John McDermott, CGIAR Research Program on Agriculture for Nutrition and Health (A4NH), led by the International Food Policy Research Institute (IFPRI), Washington, USA.
Commissioned by Technical Centre for Agricultural and Rural Cooperation ACP-EU (CTA).
Undernutrition (including chronic malnutrition and micronutrient deficiency) is a global health issue that, if addressed, can increase economic productivity and growth and improve human welfare. Stunting affects 165 million children, 80% living in just 14 countries (UNICEF, 2013). India has the highest number of stunted children, while the prevalence is highest in Africa, at 38% for children under five (http://www.childinfo.org/malnutrition_status.html). Several recent initiatives focus on the global priority of decreasing child malnutrition. The Scaling Up Nutrition Initiative (http://scalingupnutrition.org ), with 46 committed countries (31 in Africa), works through a country-level multi-stakeholder platform to ensure that programmes in all sectors of government are sensitive to nutrition, and increase coverage of proven interventions that improve nutrition during the critical first 1,000 days period.
Given the complex interplay of malnutrition determinants, the policy and programme responses need to be multi-sectoral (Garret and Natalicchio, 2011). One example is the critical but changing role of agriculture in healthy diets. Increases in agriculture production alone do not necessarily lead to improved nutrition outcomes, such as reduction in child stunting rates, despite having “positive” effects on diet (Masset et al., 2011). A commitment is required to nutrition-sensitive interventions where nutrition targets and goals (with an explicit focus on women’s empowerment) are integrated into agriculture, social safety nets, child development and education (Ruel and Alderman, 2013). This enabling environment requires government and policy to embrace nutrition through three areas: knowledge and evidence, politics and governance, and capacity and resources (Gillespie et al., 2013).
Agriculture and food interventions to improve nutrition
Healthy diets are necessary but not sufficient, and agriculture contributes through food production, in terms of availability, accessibility, utilisation and sustainability. The role of agriculture and food is changing. Agriculture is both market-oriented and focused on household subsistence. How can nutritional quality, food safety and price be factored in? Over recent decades, higher prices and supply have constrained access, and less diversity in the diet means that staple foods are more important in meeting nutrient needs; especially micro-nutrients.
There are several known agricultural strategies to boost more nutritious food systems. The first approach is to improve household productivity of nutritious foods to boost food and nutritional security (see Box 1), by targeting households engaged in small farm production, utilising seasonal crop production of traditional and local foods.
[Box 1] Smallholder food production
Homestead Food Production (HFP) describes a comprehensive intervention promoting home gardening, small livestock production and nutrition education. Popularised by Helen Keller International (HKI) in the early 1990s in Asia, it has since expanded to several sites in Africa (UNICEF, 2013). HFP increases household availability and access to micronutrient-rich foods and generates sales income for families. HKI has demonstrated significant impacts on infant and young child feeding practices, anaemia, and women’s anthropometry.
The HKI and A4NH have collaborated on evaluating agriculture and nutrition programmes, like HFP. HKI has developed and institutionalised its own programme impact pathway, which has been essential in programme design, monitoring, and evaluating impacts (UNICEF, 2013). The pathway allowed better understanding of what HFP programme adjustments in Cambodia would help household-level benefits translate into significant maternal and child health and nutrition improvements.
One targeted and cost-effective strategy for reducing micronutrient deficiency in populations through commonly-consumed, staple foods is biofortification, i.e. the breeding of staple crops with enhanced levels of bioavailable nutrients (See Box 2).
[Box 2] Biofortification – recent progress
Micronutrient malnutrition is often referred to as hidden hunger. Globally, 2 billion people have insufficient vitamins and minerals (micronutrients), compromising their health and human potential. Last year, Sight and Life, using prevalence data on childhood stunting, developed indices and maps of the global burden of hidden hunger (UNICEF, 2013).
HarvestPlus, a part of A4NH, demonstrated that breeding can increase key micronutrients to levels that improve nutrition, while maintaining or even improving yields. Biofortified crops contain key micronutrients – such as Vitamin A, iron, and zinc – and improve the micronutrient status in target populations of children and women. A bioavailability study among women in Benin aged 18-45 found that the daily consumption of 160 grams of biofortified pearl millet flour prepared in a typical way provided more than 70% of their daily iron needs (UNICEF, 2013). HarvestPlus developed a Biofortification Prioritization Index to identify the “highest opportunity” countries for scaling biofortification.
This year, Harvest Plus is scaling out delivery of biofortified crops in 10 target countries. A4NH will evaluate nutritional efficacy, particularly for women and children in the 1000 days window of opportunity, while mainstreaming biofortified seeds and food products. World Vision and HarvestPlus have agreed to focus on improving access to biofortified staple crops for home consumption and sale in local markets starting first in Burundi, Tanzania, Malawi, Ghana, and Sierra Leone.
Another approach is to enhance market-oriented food production systems, e.g., by offering target areas opportunities to invest in improved productivity, such as irrigation systems. Also, more efficient food systems that consider nutritional quality, food safety, and lower prices can help (see Box 3). Food systems can be improved post-harvest by focusing on food quality and safety, such as through the fortification process.
[Box 3] Food safety
Improving access to nutritious foods is unhelpful if poor food safety at points along the value chain increase episodes of illness. Some nutritious fruits, vegetables and animal-source foods, are particularly vulnerable to microbial and chemical contamination. Food-borne disease is critical in developing countries, with 2 billion annual illness episodes by biological contamination and 70% of diarrhoea episodes among children under 5 years old linked to biologically contaminated food. Annually, 1.9 million people die from food- and water-borne diarrhoeal diseases, mostly children (UNICEF, 2013).
Government responses lean towards regulation and control, frequently harming informal markets, which in many developing countries is where smallholder farmers and the poor participate. International Livestock Research Institute (ILRI) research through the Safe Food, Fair Food Project and others, emphasises risks in informal markets, and that increased legislation may not significantly reduce risks. Studies on the dairy value chains in Kenya and India, and beef value chains in Nigeria, have shown that simple interventions – such as using wide-necked vessels for milk which are easier to clean; training traders to use simple tests, including lactometers to check for added water to milk; and certification systems to denote trained vendors — can lead to substantial improvements in food safety. An economic assessment of the Smallholder Dairy Project in Kenya, which recognised the informal sector through food safety training and certification, resulted in benefits worth US$ 28 million per annum (UNICEF, 2013).
Lastly, policy and strategic investments can lead to improved food systems through the adoption of sustainable agricultural growth for vulnerable populations that also offer adequate social protection that meets productive safety needs.
Agriculture must keep up with a growing global population and increasingly consider how it can address nutritional challenges such as reducing childhood stunting and micronutrient malnutrition (McDermott et al., 2013). The CGIAR Research Program on Agriculture for Nutrition and Health (A4NH) (www.a4nh.cgiar.org) is examining how a number of food-based strategies, typically targeting smallholder farmers, can be positioned to maximise household nutrition and health benefits.
Prioritising and planning actions
The growing evidence base on the potential impact of nutrition-sensitive interventions is driving future research and implementation. This helps guide agricultural and nutrition stakeholders in setting priorities for nutrition-sensitive approaches in various country contexts. Viergever et al. (2010) emphasise preparatory steps (including identifying contextual factors, deciding on a comprehensive approach, and embarking on inclusive information-gathering), followed by priority-setting steps (pinpointing criteria and methodology), and final steps (plan evaluation and transparent information-sharing). Others identify knowledge gaps and producer stakeholder maps to evaluate demand for research solutions and examine the probability of success. Another approach offers a four-step priority-setting process that looks at an intervention’s location, sector, choice of impact pathways, and effectiveness of actual interventions. These guides are intended to filter research topics and approaches to maximise the likelihood of improving nutrition and health. Key questions are: Is this research best carried out by the agriculture or health sectors acting alone – or by agriculture and health researchers working collaboratively, or, Is there likely to be demand for such research from both agriculture and health sectors?
Researchers can combine existing evidence for improving nutrition through agriculture, including: the production of diverse, biofortified foods, improving food safety in value chains, and better food policies. To scale up nutrition-sensitive agriculture though proven approaches, capacity development, extension support and cross-sectoral partnerships are critical. So too are gender and local empowerment (McDermott et al., 2013), given the role of women in household decision-making and the relative roles of men and women. Furthermore, strengthening household capacity to address nutritional needs is central to offsetting the immense demands on poor households, to relieving the high cost of malnutrition and accelerating positive nutrition outcomes through agriculture.
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The State of Food and Agriculture (SOFA), Food and Agriculture Organization of the United Nations (FAO), 2013: http://www.fao.org/publications/sofa/en/
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More information on 1,000 Days: http://www.thousanddays.org/about/
More information on SUN: http://scalingupnutrition.org/about
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