The critical “1,000 days” window for child development, spanning gestation to the second birthday, is a key period for building nutritional resilience. Investments in establishing child health and good nutrition in this period pay lifelong dividends. In this period, children’s still-developing immune systems make them highly vulnerable to disease. Their high and very specific nutrient needs and the limited quantity they can eat at any single meal place them at risk of poor growth outcomes. Research shows that nutrition deficits suffered during this period lead to lifetime lags in growth and development, even if health and food intake subsequently improve.
Nutrition resilience is built by promoting healthy nutritional status (reflected in child growth) or restoring it rapidly after a hunger shock, then actively maintaining optimal levels. The time of year when this is most possible occurs after the harvest, when food is plentiful and families either eat from their own production or can buy food relatively inexpensively in the market.
It is important to promote vigorous child growth and development during the critical first 1,000 days of life: strong child growth in the early years enhances health in the early years, school achievement in the later childhood years, and productivity and income in the adult years1. After these early years, the growth trajectory is set and largely irreversible. But investments in the health of young children pay lifelong resilience dividends.
The approach to programming that builds healthy nutritional status and resilience among children in the first 1,000 days is fairly well established. A multipronged, largely preventative approach, it involves elements such as medical treatment to cure diseases quickly, thereby preventing their worst consequences; promotion of breastfeeding and complementary feeding; promulgation of good hygiene practices, and provision of safe water and sanitation to prevent illness; expansion of accessible health care to address diarrhea, pneumonia, malaria, and other diseases; antenatal care to ensure iron supplementation in pregnancy; and family planning to encourage child spacing.
Nutrition In The Health And Agriculture Sectors
But any discussion of nutrition and health inevitably involves the availability of good food, and that in turn involves the agriculture system. And this intersection of nutrition and agriculture programming is one that clearly warrants closer analysis. As perhaps the world’s largest integrated food security program, one focused on increasing the resilience of program beneficiaries, the U.S. Agency for International Development (USAID)-led Feed the Future (FTF) initiative provides an unprecedented opportunity to explore how to enhance nutrition outcomes in agriculture programs.
We have drawn preliminary lessons from multisectoral agriculture value chain projects being implemented by DAI among smallholder farmers in the Democratic Republic of the Congo (DRC), Liberia, Malawi, and Tajikistan. Each of these FTF programs is expected to improve productivity and incomes for between 250,000 and 400,000 households. In these programs, DAI is applying new principles of nutrition sensitivity to link previously stove-piped agriculture and health-nutrition programs and beneficiary groups2. The lessons learned in designing and implementing these FTF programs prompt 10 initial recommendations for better nutrition-sensitive agricultural programming within the FTF initiative; these recommendations are discussed in more detail in a paper prepared for the Food and Agriculture Organization-World Health Organization Second International Nutrition Conference3.
Build A Common Understanding Of Nutrition And Agriculture Terms
Nutrition terms have various meanings and nutritionists and agriculturists may use them differently. To achieve clarity on the aspects of nutrition that can be improved in a given program, FTF program managers should first articulate a consistent lexicon of terms, and then use that lexicon to specify project objectives. It is useful to understand the larger picture, and then segment it into discrete parts at the nexus of nutrition and agriculture. For example, the nutrition topic can be segmented into dietary diversity, anemia, vitamin A deficiency, child stunting, adolescent nutrition, nutrition during pregnancy, and other factors; agriculture can be segmented into productivity, storage, processing, marketing, food access, and so on; and, at the nexus, FTF programming can be segmented into food consumption, dietary quality, hunger, and so forth. The potential objectives and outcomes become clearer and more feasible as the parts are divided into segments that can be understood, planned, and implemented.
Raise Awareness About Nutrition Among Stakeholders
Global awareness of nutrition among policy makers and other influential figures is on the rise, due in part to advocacy by the Scaling Up Nutrition movement, the 1,000 Days initiative, and others. Within FTF itself, several years were spent designing how to include nutrition in the new global FTF agenda. Now this process is extending to agency offices and ministries in the FTF countries, where the potential for agriculture to improve diet and nutritional status must be compellingly argued anew. The best arguments to make this case depend on the country and program context. To some stakeholders, projected school performance and adult productivity and wages make the case; to others, addressing undernutrition in young children is simply the right thing to do. Once nutrition is established on the policy agenda, its advocates must find a balancing point where any new nutrition objectives seem achievable (specific and feasible) yet not overly simplified (for example, not a single intervention).
Understand The Multifactoral Nature Of Child Stunting
Child growth and development, as summarized in the child stunting indicator, depend on multiple factors in the realms of food, care behavior, and health. Young children might be fed well, but might still experience diarrhea, pneumonia, or malaria that stunts their growth. Even if protein and calorie intake is sufficient, stunting can still result if key micronutrients are lacking in the diet. Any of multiple factors could be the limiting one. The implication is that no one set of interventions can ensure good child growth and development. Thus, agriculture programs on their own cannot be expected to reduce child stunting, but can contribute to more and better food and diets4. Understanding the multifactoral nature of child stunting is critical to setting realistic objectives and assessing success by aligning the right indicators to them.
Leverage The Position Of Women At The Nexus Of Nutrition And Agriculture
Women are the primary caretakers of their children. For the youngest, most dependent children, this responsibility involves breastfeeding, preparing and feeding complementary (weaning) foods, seeking preventive health care and dietary supplements, and treating sick children. Women also do a lot of agricultural work, and while they may not have significant influence on agriculture resource decisions, they tend to work in the fields extensively. Thus, they are the linchpin between their households’ nutrition and its agricultural practices. In DAI’s Malawi program, women who lead community health care groups (which complement the efforts of community health workers) are often the same women who serve on district committees of the national farmers’ association, providing a bridge for cross-fertilization and innovation that spans agriculture and nutrition. This simple alignment helps to make nutrition-sensitive agriculture a reality. It should be noted that leveraging means being strategic about women’s time and roles, not overburdening women with more and more work, since these women already have a difficult balancing act to budget their time and energy across their nutrition, agriculture, and other responsibilities.
Capitalize On Agriculture’s Economic Focus
Agricultural sector managers often view their efforts largely from an economic perspective. How can crop and livestock productivity be enhanced? How can income be maximized and losses minimized? Where are the markets and how can they be reached more easily? To capitalize on this economic perspective, nutrition-sensitive agricultural efforts should consider when and where to promote business options. An example is to provide technical support for the development, testing, and sale of food storage and food processing supplies and techniques. In the DRC, DAI’s FTF project is working with local food companies to enhance food processing as well as incorporate vitamin and mineral fortification. Economic benefits accrue through reduced post-harvest crop loss and more jobs and income for food processors. Public health benefits accrue through access to safer and more nutritious food. Also, the business incentive in agriculture may contribute to public health benefits in nutrition. An example is the Tajikistan project’s approach to homestead demonstration gardens. Project nutritionists worked with families to choose nutritious crops and to demonstrate cultivating and canning, while project agriculturists advised on enhancing productivity. In short, emphasizing agriculture’s economic perspective does not preclude nutrition-sensitive activities; it simply highlights the activities on which an economic-facing value chain project could most profitably focus.
Understand The Different Approaches To Targeting
Agricultural value chain projects often have various target beneficiaries. People with the spirit and circumstances allowing for risk-taking business behavior are often targeted as early adopters and first beneficiaries, such as model farmers and small business entrepreneurs who can demonstrate the economic potential and feasibility of project interventions like new seeds and new food processing techniques. Middle and late adopters will benefit as they decide to adopt new products or behaviors, often after observing results among the early adopters. The early adopters may be better off economically and less vulnerable than the later ones, although benefits will ultimately accrue across the spectrum. In public health nutrition settings, project beneficiaries are usually drawn from the most vulnerable populations, such as mothers with undernourished children, and the beneficiaries are not always viewed as the actors determining how the new products or behaviors are being adopted. Both the agricultural and nutrition approaches to targeting are useful to their objectives, but can cause confusion when trying to design nutrition-sensitive agricultural programming. Clarity about beneficiary targeting at the design phase is recommended, so the points for complementarity can be identified. One example of achieving complementarity is realizing that women hold key roles in both realms — establishing the household’s diet and producing its agricultural harvest.
Promote Consumption Of Animal-Source Foods
Animal-source foods — such as milk, meat, eggs, insects, and fish—are an important ingredient of a diverse, high-quality diet, especially for young children. The main constraint to their consumption is usually their high price relative to other foods. Animal-based value chains have been chosen in some FTF countries with the aim of addressing both nutrition and income, yet consumption by targeted beneficiaries has remained limited. In Liberia, goats are one of the target value chains but tend to be kept by the beneficiary households as an asset to be sold when needed for cash, and only eaten occasionally. In Malawi, dairy is one of the selected value chains, but most milk is sold into the urban market. To allow more consumption of animal-source foods among the nutritionally vulnerable, other animal-based value chains should be considered.
Test Ways To Build Nutrition-Sensitive Agriculture
Most practitioners in either agriculture or nutrition have limited experience promoting a nutritionally diverse, tasty, safe, and affordable diet along the so-called farm-to-fork continuum. Various aspects of this crop-to-food-to-diet continuum require further exploration. How, for example, does producing and marketing crops in particular ways influence the food consumption and the diets of rural and urban people vulnerable to undernutrition? One way to deepen our understanding is to experiment under more controlled circumstances before scaling up. Both the experimentation and the scale-up could occur within the framework of the larger project. For example, if we are focusing on the productivity, processing, and marketing of the crops chosen as target value chains, but it is not clear if these efforts are reducing hunger or leading to greater year-round access to food, we could study the incidence and prevalence of hunger in select sites over several lean seasons to see if it is reduced.
Capture Consumption And Diet Benefits Among Urban Consumers
In DAI’s FTF projects, technical support for increasing agricultural productivity is directed primarily to farmers in rural areas, and their households are the only populations monitored. Meanwhile, an implicit goal of each project is to increase the food being sold into the markets of one or more major urban areas, but nutrition outcomes are not monitored there. While the intention is to benefit rural farmers by enabling them to sell a greater amount of produce, urban consumers may also benefit from greater food supply at lower prices. As part of its learning agenda, the FTF initiative should also assess consumption and dietary diversity benefits to urban consumers.
Manage The Nutrition-Sensitive Agriculture Mandate
Each country’s FTF program decides the number of projects it will support to achieve its local contribution to USAID’s global agriculture and nutrition impact objectives. A USAID mission might decide to divide the agriculture and nutrition components into separate projects or combine them into one. Depending on the design, nutrition-sensitive agriculture needs to be managed accordingly. If the agriculture and nutrition objectives are contained in one project, implementing partners will be the parties managing the nutrition-sensitive agriculture mandate and nurturing the cross-sectoral relationships (as in Malawi FTF). If the nutrition and agriculture mandates are in separate projects, the FTF program will be the party managing the alignments between the agriculture and the health-nutrition projects and the related funding streams (as in the DRC, Liberia, and Tajikistan). The lessons from each approach should be analyzed, documented, and applied to future projects.
- Preventing child malnutrition is an important way to build resilience and buffer children from the worst effects of acute malnutrition that can occur during the food shocks of the lean season.
- Paying particular attention to nutrition in a child’s first 1,000 days—to their mothers during pregnancy and the children in their first two years—builds individual resilience and provides a foundation for life-long physical and intellectual development.
- Agricultural programs can play an important role in enhancing nutrition for vulnerable populations. USAID’s Feed the Future initiative is yielding valuable lessons on how agricultural programs can contribute directly to enhancing nutrition for vulnerable populations and how nutrition-sensitive design and implementation of agriculture programs can best be implemented to achieve nutrition outcomes and build resilience.
Victora, Cesar, Linda Adair, Caroline Fall, Pedro Hallal, Reynaldo Martorell, Linda Richter, and Harshpal Singh Sachdev. 2008. “Maternal and Child Undernutrition: Consequences for Adult Health and Human Capital.” The Lancet Maternal and Child Undernutrition Series, January: 23–40. ↩
Herforth, Anna. 2012. Synthesis of Guiding Principles on Agriculture Programming for Nutrition (FAO). Rome: Food and Agriculture Organisation (FAO). ↩
Kurz, Kathleen. 2013. “Nutrition-Sensitive Interventions and Agriculture Value Chains: Preliminary Lessons from Feed the Future Implementation in Four Countries.” Background Paper on Nutrition-Enhancing Food and Agriculture Systems for the FAO-WHO Second International Nutrition Conference (ICN-2). ↩
Masset, E., L. Haddad, A. Cornelius, and J. Isaza-Castro. 2012. “Effectiveness of Agricultural interventions That Aim to Improve Nutritional Status of Children: Systematic Review.” British Medical Journal 344,. ↩