Global Workshop on Nutrition-sensitive Fish Agri-food Systems 5-8 December 2017, Siem Reap, Cambodia

1. Nutrition-Sensitive Agriculture
in Achieving the End of
Hunger and Malnutrition
Rob Bertram
U.S. Agency for International Development

2. • Rates of hunger and
poverty declining
• Agriculture-Nutrition
linkages
• Stunting rates coming
down, but still high
• Global Commitment in
SDG 2
• Global Food Security
Act signals US support
Progress and
Commitment

3. Hidden Hunger Index (micronutrient deficiencies)
Poverty and hunger
declining
0
10
20
30
40
World Africa Asia Pacific LAC
1990-92
2012-14
Prevalence of undernourishment (%)
Source: FAO 2015
Prevalence of poverty (US $1.25/day, 2005 PPP), (%)
Source: PovCalNet 2015
Source: Muthayya et al. 2015
0
20
40
60
80
100
1981 1984 1987 1990 1993 1996 1999 2002 2005 2008 2011
East Asia South Asia
SSA World

4. Diverse nutritional status
demands diverse solutions
0
5
10
15
20
25
30
35
40
Hungry Stunted children Obese
0
5
10
15
20
25
30
35
40
Hungry Stunted children Obese
0
5
10
15
20
25
30
35
40
Hungry Stunted children Obese
Low income countries Middle income countries
High income countries
% population
Reduce energy
deficiency
Reduce
micro-nutrient
deficiency
Reduce excessive
net energy and
unhealthy diets

5. Poor Most Undernourished
IN MOST COUNTRIES, THE POOR ARE MOST
LIKELY TO BE UNDERNOURISHED0
10
20
30
40
50
60
Prevalence,%
Cambodia
0
10
20
30
40
50
60
Prevalence,%
Bangladesh
0
10
20
30
40
50
60
Prevalence,%
Ethiopia
0
10
20
30
40
50
60
Prevalence,%
Nigeria
Stunting prevalence by wealth quintile, select countries

7. What Works to Reduce
Undernutrition?
• Nutrition-specific interventions are those that
address the immediate causes of undernutrition
– Health Status
– Nutrient Intake
• Examples
– Infant andYoung Child Feeding Practices/ENA
– Micronutrient fortification/supplementation: Iron, Zinc,Vit.A
– Integrated Management of Child Illness
– Community Management of Acute Malnutrition
7

8. Why Isn’tThis Enough?
Findings from Lancet series 2013
– If 90% of the population is reached with 10 key
nutrition-specific interventions
• an estimated 900,000 lives could be saved in 34
high nutrition-burden countries;
• prevalence of stunting could be reduced by
20%;
• number of children with stunted growth and
development would be reduced by 33 million;
• estimated cost of $9.6 billion.
8

9. Source: Smith and Haddad, 2013
Food: 32% Water &
Sanitation: 35%
Women’s Education
+ status: 33% 116 developing countries
(1970-2010)
Marie Ruel, IFPRI
Contribution of Sectors to
Improving Nutrition Globally

10. Rice Expenditure and
Underweight 1992-2000
From Martin Bloem, UNICEF
Staples matter!

11. Non-Staple food expenditure
and Undernutrition 1992-2000
From Martin Bloem, UNICEF
Staples matter (cont’d)

12. Nutrition-sensitive
Pathways
• Food access from own production
• Income from own production
• Food prices linked to supply and demand
• Women’s status and control over
resources
• Women’s time through participation in
agriculture
• Women’s health and nutrition from
participation in agriculture Ruel and Alderman, 201312

13. Nutrition-Sensitive
Agriculture approaches
13
Target production of nutrient-rich foods, ideally those
that include nutrients lacking in diet
Include behavior change communication component
specifically aimed at consumption of target crops
Ensure target food availability and affordability in
local markets and support consumption education
Measure outcomes, including intermediate targets
such as consumption and market availability
Opportunities for improved hygiene/food safety

14. Beyond food prices relative to incomes, other data reveals
systemic impacts on nutrition:
• Barnwell et al. 2017 find that modern variety (MV) introduction
led to a large declines in infant mortality, using DHS data on
600,000 births in 37 developing countries
• Masters et al. 2014 find that agricultural productivity drives
establishment of towns and cities, which in turn improves
nutrition of children who remain in rural areas (Darrouzet-
Nardi and Masters 2015)
Pathways by which agricultural research have increased resilience
of farm households include:
• Development of food markets and other services that allow
“nutrition smoothing” against seasonal and annual shocks
(Darrouzet-Nardi and Masters 2017, Mulmi et al. 2016).
14
Evidence for impacts on
nutrition Masters , Pray, Ayoub 2017

15. Ruel et al. NSA Review
45 PAPERS (2014-2017)
• 17 from impact evaluations biofortification (3);
homestead food production/home gardens (9); livestock (3);
value chains (1); irrigation (1)
• 28 from association studies production/consumption
diversity (11); livestock (health and nutrition) (10); agriculture
- women’s empowerment-nutrition (4); climate change &
environment (2)
• NSA programs all aimed at increasing HH and individual
access to nutrient rich foods
• All had impacts on HH and child DD (mothers’ DD), MN
intake (1 study measured it), consumption of ASF, fruit or
vegetables (as targeted), and maternal knowledge and
practices
Marie T. Ruel, IFPRI 15

16. SUMMARY OF IMPACTS
Bioforti-
fication
(3)
EHFP
(9)
Livestock
(3)
Value
Chain (1)
Irriga-
tion (1)
CHILD
DD/intake of nutritious foods X X X N/A X
Intake of fortified product (2) X X
Anemia/Hb (4) X X
Diarrhea/days sick (4) X X X
Stunting/HAZ (1 of 6 studies) X
Wasting/WHZ (3 of 6 studies) X X
MOTHER
Underweight/Hb (2) X
Empowerment domains (2) X
Marie T. Ruel, IFPRI 16

17. NSA Conclusions –2017
from Ruel et al.
.
NSA PROGRAMS WORK! Lots of learning - ongoing
• Improve a variety of diet and nutrition outcomes (HH, mother,
child), esp. when combined with BCC,WE actions, WASH &
MN-fortified products
• Impacts on stunting: hard to achieve - even with well-
designed, targeted, implemented programs and evaluations
• Are programs getting too complex and challenging to
implement? (co-location vs. integration)?
• They recommend that NSA programs:
– Focus on improving access to/intake of high-quality diets for
all household members (incl. adolescents, elderly) rather than on
reducing childhood stunting
– Be carefully tailored to specific context, culture, economic &
food environment factors (esp. markets, nutrient gaps, gender roles)
17

18. Impacts of adding WASH and LNS to
the EHFP program in Burkina Faso
• Benefit of addingWASH
– Reduced anemia by
additional 11 pp
• Benefit of adding LNS
– Reduced anemia by
additional 12 pp
– Reduced iron deficiency
by 10 pp
– Reduced vitamin A
deficiency by 9 pp
– Reduced stunting by 7 pp
55
60
65
70
75
80
85
90
0 2
Survey, y
EHFP
EHFP+WASH
EHFP+WASH+LNS
**
**
Impacts on Anemia
Source: Olney et al. forthcoming
18

19. ASF supplementation effects on
children’s test scores
Adapted from Demment, 2013; Weldon
2016

20. Next 3,000 days: ASF for
healthy brains

21. Foods in “Top 10” for
vitamins
Nutrient Food
Thiamin Fish, pork
Riboflavin Cheese/milk, beef, lamb,
eggs, pork, seafood
Niacin Fish, poultry, pork, liver, beef
B6 Fish, poultry, pork, beef
B12 Shellfish, liver, fish, crab, beef,
milk, cheese, eggs
A Liver, butter, eggs

22. % energy in food supply
from ASF
< 5 %
5-10 %
10-15%
15-20%
> 20 %
B12 deficiency prevalence high if % ASF kcal =10-15%

23. Since “Feed the Future activities
primarily occur in “zones of
influence”… attribution will always be
difficult.”
Source: Elliott and Dunning (2016) Assessing the US Feed the Future
Initiative. Center for Global Development Paper 75, March 2016
Question: What impact has USAID’s support for
aquaculture and horticulture had on production
of nutrient-dense foods, and their marketing,
diets and nutrition?

24. 24
2010
Bangladesh Aquaculture-Hort
Production-Consumption Link
Preliminary Findings
• Increased diversity of production  increased DD
• Co-production of aquaculture + hort = more output
and sales of both
• More output of aqua+hort = more diversity of
species/products
• More production diversity associated with consuming
nutrient-dense foods, and with more diet diversity
(mother and child).
• Value chain promoting key; selling in urban markets
rising rapidly.
• Better educated, wealthier hh do better in aquaculture
from: P. Webb et al.

25. 1. Extremely rapid growth of aquaculture
2. Rapid commercialization
… 10% of farmed fish are home-consumed, 90%
sold
3. Urbanization key
… 42% of farmed fish sold to Bangladesh cities
4. A domestic value chain…
… 94% of sales to domestic market; 6% exported
5.A Quiet Revolution in the off-farm
components of the value chain
… 300% growth in volumes and actors in 1 decade
in feed mills, feed traders, hatcheries, traders… and
all SMEs not multinationals from: Hernandez et al 2017
“Quiet Revolution”:
Bangladesh aquaculture

26. And in Myanmar….
1. Again, mainly (80%) domestic market, 20%
of aquaculture output exported
2. Large fish farms dominate in volume, but
small fish farms proliferating fast
3. A portion of farms (small and large) are
intensifying (feed, non-traditional spp. , seed)
4. As in Bangladesh, a “Quiet Revolution” in
the off-farm components: feed, hatchery,
wholesale, SMEs, not multinationals or
government
5. Massive growth of domestic value chain to
Yangon and from Delta in South to Mandalay in
North
From: Belton et al, 2017

27. NSA: Progress but still
refining/learning
• Staples and non-staples important, esp for poor
• Productivity matters—income and affordability
• Importance of gender confirmed
• Urbanization is opportunity for poor producers
• Importance of diverse production inverse to
market access
• May need dual dynamic vs. hinterland strategies
• Animal source foods:“triple win”…income,
nutrition, resilience?
• Knowledge-intensive (production, utilization,
value preservation, hygiene, food safety, markets)27

28. My wish list…?
Knowledge/techs./capitalization
of smallholder systems
Small scale irrigation
Mechanization (less drudgery)
Major productivity/affordability
gains especially for quality
foods—all low income benefit!
Do not forget the poor! ASF/
Fish is for all, reducing poverty
and improving food security!
Photo and last point from: Rohana P. Subasinghe

29. Please See our Feed the Future Website
Thank You!
www.feedthefuture.gov