Optimizing Nutrition Outcomes from Investments in Agriculture

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Summary of Literature Review
Linking Our Agricultural Development and Nutrition Strategies
Complementary Investments

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At the Bill & Melinda Gates Foundation, we recognize that increasing agricultural productivity and promoting good nutrition are deeply interrelated aspects of addressing hunger and poverty. We believe that we will more effectively reduce the critical problems of hunger and malnutrition among women and children in the developing world if the agriculture and nutrition sectors work together. This has led our Agricultural Development and Nutrition teams to seek complementary and collaborative approaches in these areas.

Together, we have produced a document that explores:

A review of literature examining the linkages between agricultural and nutritional interventions
How the foundation’s agriculture and nutrition strategies intersect
Current and potential future grantmaking in these areas

Summary of Literature Review

In 2011, the foundation’s Agricultural Development and Nutrition teams conducted a review of published and project documents about the linkages between agriculture and nutrition. This review revealed the following key themes and points.

Access to diverse, nutritious foods is fundamental to good health.

Good nutrition is often equated with food consumption, but they are not one and the same. Good nutrition also depends on adequate health and childcare practices. Even if a person consumes enough food, she may be undernourished due to a lack of essential vitamins and minerals provided by a diverse diet or to an illness (such as diarrhea or parasites) that limits the absorption of nutrients.
In sub-Saharan Africa and South Asia, nutritional deficiencies—in energy, vitamins, and minerals—are widespread, particularly among pregnant women and young children.
Eating a diverse diet is fundamental to good health. In many developing countries, as much as 70 percent of an individual’s daily calories come from a single staple food (such as maize or rice), making it difficult to consume enough vitamins and minerals.
Improving the nutrition of women of childbearing age and young children is critical. Poor nutrition during the 1000 day period from conception through the first two years of life adversely affects the development of the child’s brain and body, severely compromising growth, learning, and future health and productivity.
Women are at the nexus of agriculture, nutrition, and health. As smallholder farmers and caretakers of children, women make daily food production and consumption decisions for their families. Women are much more likely than men to spend additional income on food and healthcare, so increasing women’s income is likely to have a proportionally greater impact on children’s health and nutrition than comparable increases in men’s income. Given the significant time constraints on women, interventions that affect women’s time allocation can help improve their own nutrition as well as that of their children.

Income and non-income factors affect improvements in nutrition.

Increased agricultural productivity can improve nutrition in several ways—by generating more income to buy more nutritious food and obtain healthcare, by increasing consumption from one’s own production, and by reducing food prices.
Agriculture-based income growth has contributed to nutritional improvement in many countries over the past several decades, but economic growth alone cannot fully address undernutrition. Other factors are important too, for example, child feeding practices women’s control of economic resources, and an individual’s health status.
Key contributors to success in improving nutrition through agricultural investments include working with women farmers, nutrition education, tailoring projects to the specific needs of each community, and rigorous monitoring and evaluation.
Few studies look at both income and nutrition outcomes of agricultural interventions or attempt to understand the relationship between the two variables.

Linking Our Agricultural Development and Nutrition Strategies

The goal of the Agricultural Development strategy is to help smallholder farmers be more productive, with the larger goal of reducing poverty. The goal of the Nutrition program is to ensure that all children have the nutrition they need for a healthy start in life. The Nutrition strategy recognizes that combating undernutrition requires contributions from many sectors, including agriculture. The agricultural sector can ensure that rural families have access not only to more food but also to a wide variety of nutritious foods.

Increased agricultural productivity can improve nutrition in various ways. At the societal level, agricultural productivity growth leads to greater food availability and lower real food prices. At the smallholder farm level, productivity growth increases rural income and food availability, which enables improvements in diet. Nutrition interventions, such as the promotion of a diverse diet, in turn, ensure that increased income and food availability at the farm level are translated into better nutrition for the whole household. Nutrition interventions delivered through the agricultural sector, can further strengthen the linkages between increasing agricultural production, and improving nutrition outcomes for the most nutritionally vulnerable—women and young children. This concept is increasingly at the heart of renewed efforts to make agricultural policies and programs “nutrition-sensitive.”

Agriculture and nutrition are part of a virtuous cycle. Not only does increasing agricultural productivity have the potential to improve rural families’ nutrition, but healthier and better-nourished smallholder farmers are more productive, earn more income, and contribute to further economic growth.

Complementary Investments

There are many opportunities for improving the nutritional impact of agricultural investments across the entire agricultural value chain—from inputs into the production process through harvest, storage, marketing, processing, retailing, as well as behavior change programs to increase consumer demand for nutritional products. The foundation’s Agricultural Development and Nutrition programs have selected specific focus areas along the value chain and are making complementary investments in the following areas:

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Biofortification
Nutrition Education
Mycotoxins
Policy and Advocacy
Research Goals

Biofortification

The foundation’s work to improve the nutrition of key staple foods by developing enhanced varieties is long-standing and began before the Agricultural Development program was established. This approach, called biofortification, is a sustainable, low-cost means of providing improved access to micronutrients for rural communities that primarily consume non-processed foods. Key investments in this area include nutritionally-enhanced sweet potatoes, maize, beans, cassava, rice, bananas, pearl millet, and wheat (see table below). Our partners have successfully demonstrated that higher levels of nutrients can be achieved through breeding and are now moving into a delivery phase for many of these products. To date, our Agricultural Development, Nutrition, and Global Health Discovery teams have committed nearly $100 million to develop and disseminate nutritionally-enhanced staple foods.

Crop	Nutrients enhanced
Sweet Potato	Vitamin A
Maize	Vitamin A
Bean	Iron
Cassava	Vitamin A, iron, and protein
Rice	Vitamin A, zinc
Banana	Vitamin A, iron
Pearl millet	Zinc
Wheat	Zinc

Nutrition Education

Programs that directly interact with farmers have a significant opportunity to deliver information about practices and behaviors that improve nutrition alongside information on agriculture. Several grantees, including Heifer International’s East Africa Dairy Development Project and Farm Concern International’s Domestic Horticulture Markets program are currently pursuing this approach. We will strengthen and expand this integration of nutrition education into our agricultural programs, incorporating best practices from behavior change programs. We will focus our greatest attention on legumes and livestock because they offer unique opportunities to improve dietary diversity and nutrition at the household level. In particular, we will work to reach women farmers and to ensure that their increased productivity will translate into improved health and nutrition for their families.

Mycotoxins

Harmful aflatoxins and other mycotoxins affect a significant percentage of food crops worldwide and can cause cancer, immune-system suppression, and liver disease in both humans and domestic animals. In 2011, the Agricultural Development team invested in the Partnership for Aflatoxin Control in Africa (PACA) to seek low-cost, effective solutions for this problem. In 2012, the foundation’s Agricultural Development, Enteric Disease, and Nutrition teams jointly hosted a meeting of leading international mycotoxin researchers to discuss the health impact of mycotoxins and control measures. The three teams are working together with stakeholders to understand the burden of the problem and its effects on child growth and development, and generate cost-effective interventions to help control the problem.

Policy and Advocacy

Limited communication between the agriculture and nutrition sectors and inadequate joint planning at the national level has reduced the impact of interventions in both areas. The creation of an enabling environment, encompassing effective national institutions, for the development and implementation of nutrition-sensitive agricultural policies and programming is critical. There is also a need for national data sets which contain agricultural, income, and nutrition variables for the same households and attempt to better understand and strengthen the linkages between them. The foundation has supported global and national platforms for cross-sectoral collaboration and the development and integration of agricultural components into nutrition policy planning in several countries. For example, engaging with the International Food Policy Research Institute’s 2020 Vision and participating in UN REACH. The IFPRI 20/20 conference held in 2011 is an example of a global conference, while UN REACH is an example of a an ongoing cross-sectoral collaboration platform that offers tools and information focused on the country level. We have also backed the global Scaling Up Nutrition movement, which promotes a multi-sectoral collaborative approach to addressing undernutrition.

Research Goals

The foundation recognizes the importance of rigorous research, learning, and evaluation to guide policies and decision-making and to ensure continuous program improvements. We want to ensure that agricultural projects which intend to have a nutritional impact have a robust evaluation design so that we advance our knowledge of how to maximize the impact of agricultural investments on nutritional outcomes.

Broad-based agricultural growth and greater food availability can still fail to produce widespread nutritional improvements. To better understand cases where significant agricultural growth has not resulted in commensurate nutritional gains, such as in India, the foundation has supported in-depth research efforts such as Tackling the Agriculture-Nutrition Disconnect in India (TANDI). Future research and learning priorities to strengthen our work and the work of the broader agriculture-nutrition sector are summarized below.

Understanding the agriculture-nutrition pathway at the population and household levels

How do we measure the broader impact of agriculture projects on consumers, including the effects on price, food expenditures, and food consumption?
What are the quantifiable linkages and leakages in the agriculture-income-nutrition pathway, including household income, agricultural production, agricultural sales, food expenditures, food consumption, feeding practices, intra-household food distribution, child feeding practices, children and women’s morbidity, and children and women’s nutritional status. What linkages in the agriculture-income-nutrition pathway are most critical to improving health outcomes and amenable to intervention?
Under what conditions do increases in agricultural income lead to improved nutritional outcomes?
What is the effect of agricultural labor on women and young children’s health and nutrition?

Improving nutritional outcomes along the agricultural value chain

How can agricultural interventions be designed to improve nutritional outcomes within farm families?
Which entry points along the agricultural value chain have the greatest potential impact for improving women and child’s nutrition?
Can agricultural growth and nutrition be more tightly connected by focusing more on women farmers and their productivity?
What are the best delivery mechanisms for educating farming households about nutrition?

Measuring the nutritional impact of agricultural projects

What are appropriate indicators for measuring the nutritional impact of agricultural interventions?
How should impact indicators and “standards of credible evidence” vary across the value chain for different interventions (e.g., biofortification, improved food processing and storage methods, behavior change, policy change)?
Does greater diversity in household food production lead to more diverse diets consumed by farm households and individual members, such as women and children?

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