AgriculTurAl & rurAl DEvElOpmENT NOTES 53340 From Agriculture to Nutrition: pathways, Synergies and Outcomes iSSuE 40 July By cOriNNA hAwkES AND mAriE T. ruEl 2008 The relationship between food production and food This note discusses the direct pathways through which consumption is intuitively direct. Increases in food agricultural production can contribute to improved production should lead to increased food availability, nutrition. It then reviews recent changes in the global access, and ultimately, food intake. In reality, how- environment which affect the ways in which agriculture ever, the relationship between agriculture and human and nutrition are linked. It concludes with a discussion nutrition is far more complex. The persistence of mal- of how nutrition-related objectives can be effectively nutrition globally despite the success of agricultural incorporated into the design of agriculture programs production belies any notion that under-nutrition can for maximum impact on the poor. be solved entirely by simply increasing food produc- tion. An individual's nutritional status is the result of a pAThwAyS liNkiNg FOOD complex set of inter-related factors that act synergisti- prODucTiON TO NuTriTiON cally and are dependent on the environment in which OuTcOmES people live and the intra-household processes they are exposed to. A widely used conceptual framework devel- Production for the household's own consump- oped by UNICEF in 1990 identifies three main underly- tion. This is the most fundamental and direct pathway ing determinants of nutritional status: availability and by which increased production translates into greater access to the right amount and combination of foods food availability and food security at the household of adequate nutritional quality, feeding and care-giving level. Production of fruit, vegetables, dairy foods, practices, and access to health care services. eggs, fish, and meat are more likely to increase the quality of diets and intakes of essential micronutients, such as iron, zinc, vitamin A, and calcium. Animal source foods, in particular, are not only energy- and protein-dense, they also contain significant amounts of essential micronutrients in their most bioavailable form. Given favorable intra-household food distribu- tion, these developments can greatly improve the food intake and nutrition of the more vulnerable members of the household. Some proportion of the food pro- duced may be sold at local markets. Some households may, for instance, meet their staples requirements through their own production, while depending on markets for other products, such as fruits, vegetables, or meat. Others may rely mainly on home gardens for fruits and vegetables. Under this scenario, the role of production-for-income is secondary to the principal purpose of producing food to meet the household's own food requirements. Income-oriented production for sale in markets. Market orientation brings a second pathway into play, one in which income-related production becomes more ThE wOrlD BANk important than subsistence-related production Income requirement that must be met. Income is therefore very now becomes a principal determinant of food availability important, even among households that produce princi- and access, while the household's production for its own pally for their own consumption. The income and price consumption assumes a supplementary role. Production pathways are, likewise, overlapping in that the price decisions are based on tradability, the ability to sell what is reductions resulting from increased food supply contrib- produced at market, and the price it is expected to com- ute to raising real income. mand as a commodity, more than on its desirability for the household's own use. The translation of increased pro- duction into better child nutrition depends on a series of DrivErS OF A chANgiNg intra-household factors and processes, including women's AgriculTurE-NuTriTiON status, education, knowledge, health-related practices, cONTExT decision-making power, control over income, and access Over time, changing developments are driving behavior to and use of health and sanitation services. changes among food producers and consumers, and are bearing heavily on the pathways The empowerment of women. linking production and consump- The resources and income that tion. These changes or "drivers" women command by engaging in are also very significant for the agriculture is a pathway that car- dietary quality of consumption, ries special significance for nutri- and present producers with some- tion, especially among children. thing of a moving target in terms Women have consistently been of opportunities and risks as they found to be more likely than men endeavor to orient production to to invest in their children's health consumer demand. The drivers and well-being, and the income are agricultural technology, agri- and resources that women control cultural policy, women's empow- wield disproportionately strong erment, and retail food prices. effects on health and nutrition outcomes generally. Agricultural technology. Technology carries significance Lowering food retail prices. for every niche of the food sup- The effects of increased food pro- ply chain. The public agricultural duction on food prices is anoth- research and plant breeding char- er pathway linking agriculture acteristic of the Green Revolution to nutrition. Raising production has maintained its importance. exerts downward pressure on Today, however, public research food prices, especially in areas where markets are less takes place alongside the mounting presence of private integrated and where poor people tend to be concen- sector, profit-oriented research. The development has trated. For net food consumers, reduced prices facilitate opened entire new legal realities around intellectual prop- greater access to food and essential nutrients. This, in erty rights. Agricultural technology is extremely important turn, results in better health and productivity of the gen- for the relative prices of different food baskets and for eral workforce, while also freeing additional household labor demand among different agricultural production resources from food to other expenditures, including systems. Its direct applications to nutrition outcomes productive investments. relate to both plant breeding for nutrient content and to fortification during food processing. Technology has had These pathways are not mutually exclusive. Subsistence important implications for food safety as well, equipping production, for instance, generally takes place alongside regulatory agencies with new means of detecting food production for sale since few households are self-suf- contaminants and improving the shelf life of processed ficient in food, and since food is not the only household food products. 2 Agricultural policy. International trade, in particular, house. These food marketing systems are also influenc- brings agricultural policy firmly into this treatment. Trade ing what is being produced by farmers around the world has tremendous importance for food producers and through their extensive networks of suppliers. food consumers. The macroeconomic impacts of trade liberalization on food prices are contingent on whether a country is a net food producer-exporter, or a net food con- AgriculTurAl prOgrAmS sumer-importer, but more meaningful indicators are usu- AND NuTriTiON OuTcOmES ally commodity-specific. Liberalization's impact on food Agricultural programs that have nutrition-oriented objec- producers tends to rely on whether a country's agriculture tives are generally classified by the commodity they sup- sector was protected or taxed prior to liberalization. Its port. Programs supporting staple crops like maize and impacts on nutrition outcomes rely broadly on a country's rice tend to focus principally on aggregate production level of economic development. Least developed countries and food availability, while those covering fruits, veg- with protected agriculture sectors appear to have the etables, and animal-source products carry more potential least ability to capitalize on oppor- for addressing micronutrient defi- tunities in international markets, ciencies. Their ultimate effects on and as a result nutrition outcomes consumption are often assumed often see negative impacts from to follow naturally as a result trade reform. of increased income. Income effects are, of course, commonly Changing consumption pat- monitored and evaluated, and terns. The demand for higher at times evidence does emerge value, micronutrient rich foods to suggest a positive relationship increases as incomes rise and live- between increased income and lihoods diversify around expand- increased food expenditure and ing markets, many of them urban. more diversified diets. The nutri- Increasing incomes and urban- tion outcomes achieved by these ization drive changes in demand programs have been surprisingly that provide food suppliers with mixed. However, evidence from market signals that tend to reori- recent programs suggests that ent agricultural production away nutritional outcomes improved from the cultivation of staples significantly when the following and toward higher value products. elements are incorporated into For smallholders in particular this program design. reorientation is often in effect compulsory, since the viability of Incorporate nutrition out- farming lower value staple crops relies on much larger reach and behavior change. Programs with compo- scales of production than are possible on small farms. nents devoted to educating beneficiaries and informing The ability of poor producers to respond may depend on them about the nutritional qualities of the foods they the success of arrangements like contract farming, which produce and consume have better nutritional outcomes enable poor farmers to link their production with large, than those that do not. For instance programs that pro- often supermarket-led supply chains. mote the cultivation of home gardens should purpose- fully promote public awareness of the practical utility of Food Marketing Systems. The large-scale consoli- certain garden fruits and vegetables in addressing nutri- dation of food retail and rapid expansion of the food tion issues such as vitamin A deficiency. Communication processing and food service industries have dramatically of information about health issues like appropriate child- influenced the basket of food items available, particularly care and feeding and food preparation practices, water as more and more people work farther from home and sanitation, care giving, and food safety issues carry great are more likely to purchase meals prepared outside the importance for nutrition by addressing health as a neces- 3 sary condition of good nutrition. Throughout most of the that bear heavily on the rationales behind household developing world, and particularly in rural areas, women economic decisions. The subjective reasons that underlie are the principal agents fulfilling these roles. household production and consumption decisions are largely inaccessible to program personnel from outside Empower women as agents of improved nutrition the participating community. Indigenous knowledge and outcomes. The essential role of women in delivering livelihood strategies are very often tacit and may reflect health and nutrition outcomes make them a natural prior- a local understanding of opportunities and risks that ity for programs with nutrition-related targets. Research has important practical implications for nutrition pro- in Africa, Asia, and Latin America has consistently found gramming--implications that may not be obvious to women to be more likely than men to invest additional outside observers. Involving beneficiaries in the design, income in their children's health and nutrition. Experience implementation, monitoring, and evaluation of programs also shows that women who are reached by agricultural improves the likelihood that nutrition objectives will be programs that relay information on nutrition issues are achieved and that they will be sustainable. particularly effective in delivering improved nutrition and health outcomes in their households. The positive effects Provide small producers with support to capital- of increases in women's income on childhood nutrition ize on changing market demand. Anticipating and and dietary practices appear most pronounced among responding to changing demand is a vital imperative for the lowest income groups and among households with farmers in general, but among poor farmers in develop- high dependency ratios--in which a large proportion ing countries the stakes are particularly high. Most of of household members are nonearning dependents. In these farmers produce to meet their household consump- general, women assume disproportionate responsibility tion and, therefore, much of the demand that they are for the care of the most nutritionally vulnerable members satisfying is their own. With respect to the proportion of the household. of food they produce for the market, the changing agri- cultural context has important implications for the prices While women are usually the principal agents of house- that they are paid for their products while increasing hold health and nutrition, they also tend to be exception- demand for high-value food sources represents an impor- ally constrained agents in terms of time and resources. An tant opportunity to earn more income. Yet switching inventory of the roles they play caring for children and the to new and unfamiliar crops and producing for foreign elderly, collecting water and fuel wood, preparing food, markets with stringent food quality and safety require- weeding, working in income-generating activities, etc. ments are also fraught with risk, and both opportunities reveals a picture of people under excruciating pressure. It and risks need to be addressed by agricultural programs. is, therefore, essential that programs that target women The programs that provide these farmers with improved in these roles do not impose additional requirements on access to appropriate technologies and extension ser- their time, and purposefully seek opportunities to relieve vices, adoption of good agronomic practices, and timely them of existing burdens whenever possible. market information would facilitate their ability to make the transition and empower them to produce for and sell Take local contexts into account. Designing programs to large supply and value chains, linking them to food to accommodate prevailing agricultural and nutritional retail and food service concerns. conditions entails developing a sound understanding of producers' priorities, incentives, assets, vulnerabilities, There is good reason to anticipate that nutritional out- and livelihood strategies. Understanding the motives comes will become more prominent in the calculus by and constraints that affect household consumption deci- which the value of agricultural programs is rated. Linking sions is no less important than understanding those that production goals with nutrition-related targets is some- affect production decisions. Local perspectives of socio- thing that agricultural planners are likely to be called economic realities are often shaped by cultural norms upon to do more often. This Note was prepared by Gunnar Larson and Nwanze Okidegbe of the Agriculture and Rural Development Department of the World Bank. The Note is based on the report From Agriculture to Nutrition: Pathways, Synergies and Outcomes prepared by the International Food Policy Research Institute (IFPRI) in collaboration with the World Bank. In addition to the authors, contributors included Mary Arimond, Zeina Sifri, Todd Benson, Devesh Roy and Noora-Lisa Aberman (IFPRI), Peter Berti (HealthBridge, Canada), Jef Leroy (National Institute of Public Health, Mexico), Edward Frongillo (University of South Carolina), Lynn Brown and Chris Delgado (World Bank). THE WORLD BANK 1818 H Street. NW Washington, DC 20433 www.worldbank.org/rural