A Bigger Toolbox

Girl in a blue dress writes in a school notebook

Source: © J. Matthews/Panos

There’s more to fighting malnutrition than just nutrition programs

In the arsenal of tools for fighting malnutrition, some potentially valuable approaches are going unused. With more than 3 million children dying from malnutrition every year, IFPRI researchers Marie Ruel and Harold Alderman argue that the fight against malnutrition needs to go beyond traditional nutrition interventions—such as vitamin and mineral supplements and promotion of breastfeeding—to include interventions that attack the roots of the problem.

Nutrition-specific interventions are those that address nutrition head on, basically by getting more nutrients to people and preventing diseases. In contrast, nutrition-sensitive interventions are designed to alter the conditions that give rise to malnutrition. Behind malnutrition is a whole range of factors—from poverty, to lack of education, to poor caregiving practices, to gender dynamics that give girls and women short shrift when it comes to allocating household resources. These underlying causes are where, according to Ruel and Alderman, more should be done to prevent malnutrition in women and young children.

“We need to integrate nutrition interventions into programs that can improve the overall environment in which children grow and develop, such as agriculture, social safety nets, and education programs,” says Ruel, who directs IFPRI’s Poverty, Health, and Nutrition Division. Ruel and Alderman’s assessment of these nutrition-sensitive interventions appears in a recent issue of The Lancet focused on maternal and child nutrition.

Enlisting Agriculture

Child and woman working in field with hoe

Source: © 2008 J. Matthews/Panos

Many poor countries with serious nutrition problems have large-scale agricultural programs that focus on increasing agricultural production, keeping food prices low, and raising farmers’ incomes. Theoretically, these types of programs should contribute to better nutrition for households and individuals by increasing food supplies and making food more affordable. But, says Ruel, “it’s not just about having more food. It’s about having access to nutritious foods—in sufficient quantities and quality—and to a high-quality diet.” Agricultural programs could do more to improve nutrition if they explicitly included nutrition goals and activities, say Ruel and Alderman. For instance, programs could encourage people to grow fruits and vegetables in their home gardens, promote women’s empowerment in agriculture, and identify points along the agricultural supply chain where the nutritional value of food could be enhanced.

According to Alderman, among the most effective nutrition-sensitive interventions in agriculture are the ones that help people eat a more diverse diet. One proven success has been biofortification of staple foods—that is, breeding nutrients such as iron, zinc, and vitamin A into maize, wheat, cassava, sweet potato, and other crops.

Educating Future Mothers

Education can also incorporate nutrition-sensitive interventions. According to Ruel and Alderman, the biggest bang for the buck may come from reaching out to adolescent girls before they become pregnant. In poor countries, expectant mothers often don’t appear at health clinics until they’re about five months pregnant. By then, the chances of maximizing critical prenatal nutrition are considerably narrowed.

It’s also critical to educate mothers on becoming nutrition-sensitive caregivers. A child’s first thousand days from conception to age two are critical, and a child who does not get adequate food, care, psychosocial stimulation, and health services to prevent and treat illnesses during this period may suffer lifelong physical, cognitive, and psychological deficits. “Combining nutrition-interventions with early childhood education programs could really close the cognitive gaps we see,” says Alderman.

Supporting mothers also means finding the right incentives to keep girls in school and teaching them about their future parenting roles. Studies have shown that higher levels of parental schooling correspond strongly with better child nutrition. “We should be much more aggressive about getting schools to develop nutrition education curricula, especially for adolescent girls,” says Ruel. Increased schooling may also help delay pregnancies and reduce the health risks associated with adolescent pregnancies for both mother and child.

Weaving a Safety Net

Seven children at a long table eating

Source: © 2009 D. Telemans/Panos

Social safety nets—which currently provide cash or food transfers to about a billion poor people and victims of natural disasters and human-caused shocks—offer another avenue for improving nutrition. These programs include food transfers such as school feeding programs, emergency feeding programs, and conditional cash transfers, which require households to invest in the health, education, and nutrition of their children in order to be eligible for program benefits. Evidence on the effects of these programs on the nutritional status of children from beneficiary families is scarce and mixed. Weaknesses in implementation of the nutrition interventions linked to these programs and poor quality of health services are likely the reason these programs have not had the expected impact on nutrition. Ruel and Alderman conclude from their review that safety nets’ potential for enhancing nutrition has yet to be unleashed, but new and improved nutrition-sensitive safety net programs are being tested.

Overall, says Ruel, the potential for nutrition-sensitive development programs to make a difference is enormous. Agricultural, education, and safety-net programs already touch the lives of so many poor and malnourished people around the world. Integrating nutrition into those programs, as well as strengthening nutrition-specific programs, could make a dramatic difference to the lives of billions.

For more information on this topic:

In This Issue

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The grain teff has been consumed as a staple in Ethiopia for centuries but is little known outside the country. Now, researchers are training their attention on this understudied crop.

Untangling the Asian Enigma

Although South Asia has the highest concentration of undernutrition in the world, in the past two decades Bangladesh and Nepal have both achieved striking improvements in the nutrition of their citizens. How did they do it?

Does Money Talk?

FEATURE: Millions of poor people around the world are enrolled in safety net programs that hand out cash or food. What’s the best way to design these transfer programs?

  • Evelyn Banda

    Ruel and Alderman do amazing research, and there is so much more to be contributed to their extensive, and reputable, bodies of work. However, The author is a questionable resource.