This section presents actionable insights for practitioners from our collaboration of experts.
Today, 28th May, is World Hunger Day and also the International Day for Action for Women’s Health. World Hunger Day calls for a holistic development approach — one that includes peace-building, social harmony, human rights, and good governance — to ensure the empowerment of people living in hunger and poverty. The International Day for Action for Women’s Health focuses on sexual and reproductive rights for what they are: An indivisible and inalienable part of human rights.
While the agenda for both days and associated discourses in both sectors are diverse, there is a common knot that ties the two: Women’s reproductive health and nutrition.
This isn’t a new theme! Gender rights advocates and development practitioners, especially those in the health sector, have long been highlighting the issues related to gender inequalities of intra-household food consumption patterns, gender division of labor in the household, women’s work in agriculture, and all the associated problems of women’s reproductive health: Anemia, miscarriages, maternal mortality and morbidity, feeding practices, etc.
What is new is the consideration of these issues through different, cross-sectoral lenses — agricultural livelihoods, market mechanisms, savings and credit, behavioral economics — to further the understanding of the health and nutritional narrative and develop impact models.
A formative study in 2016 on ‘Agricultural Incomes and Nutrition: The Effect of Seasonality and Household Coping Mechanisms’ by Vrutti Livelihoods Resource Center, supported by the Bill and Melinda Gates Foundation, provided some important insights on nutrition in general and the nutrition of women and children in particular. The study was conducted in Madhya Pradesh, which has very poor nutrition indicators for women and children, significantly below the national average: For instance, in Madhya Pradesh 69% of children were anemic and 28% of women had a BMI below normal, as compared to the national averages of 58% and 23% respectively (NFHS-4). The primary, mixed-method survey by Vrutti covered around 2,800 sample households spread over 115 habitations across the four districts of MP, namely Hoshangabad, Sehore, Vidisha, and Panna. The initial hypothesis purported that seasonality of agricultural income led to seasonal variation in consumption of pregnant women and infant children, and savings could be an important channel to smoothen consumption over the year. However, as data was collected and analyzed, the findings painted a completely different picture of the consumption patterns in MP.
Some key insights from the study:
What does this study imply for our engagements with the health sector?
Cross-sectoral explorations and engagements, as complex as they may seem, provide the holistic picture that drives behavior which often a focused consideration through health lenses may miss out. Placing the consumption patterns in the center of the agri-economy and market explains the need for households to stock wheat as a precautionary response to prices of wheat and tur.
Households are able to protect total food intake in the face of poor rainfall and other income shocks, but this is achieved by increasing the share of stored grains of lower nutritional value. Thus, while they are able to maintain consumption levels and stave off hunger when incomes are low, nutrition suffers.
Despite decades of interventions in gender equality, food and nutrition security, social norms continue to rule the roost and are a barrier to behavior change when it comes to the intra-household distribution of food consumption. ASHA and anganwadi workers, who are the carrier of messages for change, are themselves of the social fabric and not convinced about the need for these changes, and therefore may not promote them. Interventions need to revisit the messages and their delivery to make an impact.
To conclude, nutrition of women and children and the positive RMNCH+A outcomes that are associated with nutrition may improve with economic policies that reduce price volatility of food (making diverse food accessible), and increase return on financial savings (promoting a monetary savings culture — as against savings in the form of low-nutrition grain — that could be channeled into food when required). Models and interventions targeting RMNCH+A outcomes need cross-sectoral engagements with agriculture and food distribution sectors. In socio-cultural contexts like those in MP, creative communication that influences thought processes rather than simply carrying messages would go beyond increasing awareness to changing practices related to savings and caring for pregnant and lactating women.
To read a post by the research team: Dr. Anjini Kochar, Stanford University, C. Nagabhushana and N. Raghunathan, CMS, “Aggregate Risk, Saving and Malnutrition in Agriculture Households” click here.
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