Publications

PUBLICATIONS

by IFPRI | June 14, 2019

If you have troubles viewing this page, please visit IFPRI publications repository to browse and access A4NH publications.

Sort by:

Latest

|

Year

|

Title

|

Type

Type

Themes

Regions/Countries

Year

Language

Upside risk, consumption value, and market returns to food safety
Hoffmann, Vivian; Kariuki, Sarah; Pieters, Janneke; Treurniet, Mark. Article in press

Abstract | View

We investigate the effect of a modest food safety premium on semisubsistence farmers' investment in a food safety technology. We demonstrate theoretically that in the face of production uncertainty, a market incentive below the marginal production cost of achieving the safety standard can increase food safety investment among farmers motivated by private health returns. We test this prediction through a randomized controlled trial in Kenya through which members of existing farmer groups were offered an opportunity to purchase a food safety input, and half were offered a 5% market premium for produce that met the associated regulatory standard. Access to the premium more than doubled investment in the food safety technology. In line with the model's prediction, most premium-induced adoption was by farmers motivated by a combination of health and financial rewards.

Trajectories of child growth, child development, and home child-rearing quality during the Covid pandemic in rural Nepal
Miller, Laurie C.; Neupane, Sumanta; Joshi, Neena; Lohani, Mahendra; Shrestha, Bhola. Article in press

Abstract | View

Background: Children, especially disadvantaged children in poor countries, were expected to be among the “biggest victims” of the Covid pandemic. Economic burdens, decreased nutritious foods, reduced medical care, school closures, and ill-health or death of family members were predicted to increase child undernutrition and developmental delays, and diminish home child-rearing quality.
Methods: A planned nutrition intervention could not be implemented due to Covid restrictions. However, three surveys (pre-Covid [December 2019], July 2021, and September 2021) in 280 Nepali households (309 parent-dyads, 368 children, 6-66 months old) collected demographics, child anthropometry and development (Ages and Stages Questionnaire-3 [ASQ-3]), and home child-rearing quality (caregiver engagement, learning resources, adult supervision [UNICEF’s Multiple Indicator Cluster Survey]). Mixed-effect regression models adjusted for household (wealth, maternal education) and child factors (age, gender) and survey round.
Results: Height, mid-upper-arm and head circumference measurements improved over time. Total ASQ-3 score did not change: communication scores increased while fine motor and personal-social scores declined. Girls’ growth and development worsened more than boys. Caregiver engagement (especially mothers’) generally declined, but learning resource availability increased. More children were left unsupervised at Round 2 than Round 1 or 3.
Conclusions: In this sample, some aspects of child growth, development, and home child-rearing quality improved while others declined. Better understanding of these changes in child well-being and the family environment during the pandemic could provide insight on how to protect children during future crises.

Bioaccessibility and bioavailability of biofortified food and food products: Current evidence
Huey, Samantha L.; Mehta, Neel H.; Konieczynski, Elsa M.; Bhargava, Arini; Friesen, Valerie M.; Boy, Erick. Article in press

Abstract | View

Biofortification increases micronutrient content in staple crops through conventional breeding, agronomic methods, or genetic engineering. Bioaccessibility is a prerequisite for a nutrient to fulfill a biological function, e.g., to be bioavailable. The objective of this systematic review is to examine the bioavailability (and bioaccessibility as a proxy via in vitro and animal models) of the target micronutrients enriched in conventionally biofortified crops that have undergone post-harvest storage and/or processing, which has not been systematically reviewed previously, to our knowledge. We searched for articles indexed in MEDLINE, Agricola, AgEcon, and Center for Agriculture and Biosciences International databases, organizational websites, and hand-searched studies’ reference lists to identify 18 studies reporting on bioaccessibility and 58 studies on bioavailability. Conventionally bred biofortified crops overall had higher bioaccessibility and bioavailability than their conventional counterparts, which generally provide more absorbed micronutrient on a fixed ration basis. However, these estimates depended on exact cultivar, processing method, context (crop measured alone or as part of a composite meal), and experimental method used. Measuring bioaccessibility and bioavailability of target micronutrients in biofortified and conventional foods is critical to optimize nutrient availability and absorption, ultimately to improve programs targeting micronutrient deficiency.

The feasibility of implementing food-based dietary guidelines and food graphics in Ethiopia
Bekele, Tesfaye Hailu; Covic, Namukolo; Alemayehu, Dawit; Trijsburg, Laura E.; Brouwer, Inge D.; Feskens, Edith J.; de Vries, Jeanne. Article in press

Abstract | View

This study aimed to test the acceptability, cultural appropriateness, consumers' understanding, and practicality of the Ethiopian food-based dietary guideline's messages, tips, and food graphics. A qualitative study design was applied with focus group discussions and key informant interviews. Four different participant groups were included: 40 consumers, 15 high-level nutrition experts, 30 frontline community health extension workers (HEWs), and 15 agriculture extension workers (AEWs) to incorporate different stakeholder perspectives. Data collection was conducted using 7 focus group discussions (FGDs) and 30 key informant interviews (KIIs). Collected data were coded and analyzed using QSR International NVivo V.11 software. Most of the study participants were highly interested in implementing the dietary guidelines once these guidelines are officially released. Based on the participants' views, most of the messages align with the current nutrition education materials implemented in the country except the messages about physical activity and alcohol intake. However, participants suggested defining technical terms such as ultra-processing, whole grain, safe and balanced diet in simpler terms for a better understanding. Practicality, affordability, availability, and access to the market were the major barriers reported for adherence to the guidelines. To be more inclusive of cultural and religious beliefs, findings show that the guideline should address fasting and traditional cooking methods. In conclusion, the dietary guidelines were well received by most stakeholders. They are thought to be feasible once feedback on wording, affordability, availability, and access is considered in the messages, tips, and graphic designs.

A pre-pandemic nutrition-sensitive social protection program has sustained benefits for food security and diet diversity in Myanmar during a severe economic crisis
Maffioli, Elisa M.; Headey, Derek D.; Lambrecht, Isabel; Oo, Than Zaw; Zaw, Nicholus Tint. Article in press

Abstract | View

Background: One third of pre-school children in Myanmar were stunted in 2015-16, and three quarters of children 6-23 months had inadequate diet diversity. In response, a large-scale nutrition-sensitive social protection program was implemented over 2016-2019. In 2020, however, Myanmar’s economy was hit hard by the COVID-19 pandemic, and harder still by a military takeover in 2021.
Objective: To examine whether former beneficiaries of this program experienced better food security, food consumption, and diet diversity outcomes in the wake of major economic shocks.
Methods: In a previous cluster-randomized controlled trial conducted over 2016-2019, pregnant women and their under-2 children were randomly assigned to either: (1) Cash; (2) Cash + Social and Behavioral Change Communication (SBCC); or (3) a control group. A sub-sample of these former participants were then re-surveyed ten times from June 2020 to December 2021 during Myanmar’s protracted economic crisis. Randomized treatment exposure was used in a regression analysis to test for post-program impacts on Food Insecurity Experience Scale indicators, household food consumption, and maternal and child diet diversity. We also examined the impacts on household income as a secondary outcome and potential impact pathway.
Results: Both intervention arms reported lower food insecurity, more frequent consumption of nutritious foods, and more diverse maternal and child diets compared to households in the control group. However, the improved dietary outcomes were larger for mothers and children exposed to Cash+SBCC compared to Cash, as was their monthly household income.
Conclusions: The findings suggest that a program combining cash transfers with nutrition-related education can yield sustained benefits one to two years after the program was completed. This strengthens the evidence to support the expansion and scale-up of nutrition-sensitive social welfare programs to redress chronic malnutrition and enhance nutritional resilience in the face of a severe economic crisis.

A prepandemic nutrition-sensitive social protection program has sustained benefits for food security and diet diversity in Myanmar during a severe economic crisis
Maffioli, Elisa M.; Headey, Derek D.; Lambrecht, Isabel; Oo, Than Zaw; Zaw, Nicholus Tint. Article in Press

Abstract | View

Background: One-third of preschool children in Myanmar were stunted in 2015–2016, and three-quarters of children 6–23 mo had inadequate diet diversity. In response, a large-scale nutrition-sensitive social protection program was implemented over 2016–2019. In 2020, however, Myanmar’s economy was hit hard by the COVID-19 pandemic and harder still by a military takeover in 2021.
Objective: The objective of this study was to examine whether former beneficiaries of this program experienced better food security, food consumption, and diet diversity outcomes in the wake of major economic shocks.
Methods: In a previous cluster-randomized controlled trial conducted over 2016–2019, pregnant women and their children aged <2 y were randomly assigned to either: 1) CASH; 2) CASH + social and behavioral change communication (SBCC); or 3) a control group. Subsamples of these former participants were then resurveyed 10 times from June 2020 to December 2021 during Myanmar’s protracted economic crisis. Randomized treatment exposure was used in a regression analysis to test for postprogram impacts on Food Insecurity Experience Scale indicators, household food consumption, and maternal and child diet diversity. We also examined the impacts on household income as a secondary outcome and potential impact pathway. Results: Both intervention arms reported lower food insecurity, more frequent consumption of nutritious foods, and more diverse maternal and child diets compared with households in the control group. However, the improved dietary outcomes were larger for mothers and children exposed to CASH+SBCC compared with CASH, as was their monthly household income. Conclusions: The findings suggest that a program combining cash transfers with nutrition-related education can yield sustained benefits 1–2 y after the program was completed. This strengthens the evidence to support the expansion and scale-up of nutrition-sensitive social welfare programs to redress chronic malnutrition and enhance nutritional resilience in the face of a severe economic crisis.

Scale and sustainability: The impact of a women’s self-help group program on household economic well-being in India
Raghunathan, Kalyani; Kumar, Neha; Gupta, Shivani; Thai, Giang; Scott, Samuel; Choudhury, Avijit; Khetan, Madhu; Menon, Purnima; Quisumbing, Agnes R.. 59(4)

Abstract | View

Microfinance groups are a prominent source of small-scale rural credit in many developing countries. In India, evidence of the impact of the now ubiquitous women-only savings and credit self-help groups (SHGs) on household consumption and asset accumulation is inconclusive and based on small-scale interventions. Further, little is known about the sustainability of impacts at scale. We use panel data on close to 2500 households from five states in India to estimate the impact of SHG membership on household expenditure and asset ownership. Over four years, we find small but significant impacts of SHG membership on household expenditure and livestock ownership. Membership duration has a modest effect, suggesting that initial impacts may taper off as the program scales up, though small sample sizes limit our ability to draw inferences. Accompanying evidence on pathways is compelling; related work shows that SHG participation improves information, empowerment, and access to entitlements. While the direct impacts of SHG membership may not suffice to fill gaps in access to credit faced by the rural poor, impacts along these additional pathways could intensify the benefits of these groups.

Trends and patterns in consumption of foods among Indian adults: Insights from National Family Health Surveys, 2005-06 to 2019- 21
Patwardhan, Sharvari; Kapoor, Rati; Scott, Samuel; Nguyen, Phuong Hong; Chamois, Sylvie; Singh, S.K.; Dwivedi, L.K.; Pedgaonkar, Sarang; Puri, Parul; Chauhan, Alka; Laxmaiah, Avula; Menon, Purnima . New Delhi, India 2023

Abstract | View

BACKGROUND| Healthy diets are necessary for optimal growth and to carry out daily mental and physical tasks. Unhealthy diets drive all forms of malnutritionand dietary risks are the number one risk factor globally for deaths and disability (Global Burden of Disease collaborators, 2019). Given the importance of diet as a key driver of health and wellbeing, this Data Note examines available data from three rounds of India’s National Family Health Surveys (NFHS) on food consumption patterns of adult men and women.
MEASUREMENT| NFHS asks women (15-49 years) and men (15-54 years) how frequently (daily, weekly, occasionally or never) they consume nine food groups including two unhealthy food groups (Figure 1). The 2020 Nutrient Requirements for Indiansoutlines the quantity per day of vegetarian foods to be consumed as part of a balanced diet (ICMR-NIN, 2020). The guidelines indicate that pulses can be replaced with animal-source foods for non-vegetarians. Thus, for this Data Note we constructed an additional indicator –daily consumption of pulses or egg or fish or chicken or meat –to estimate any protein consumption (Figure 1). Estimates are first presented at the national levelto provide an overall view of how diets have changed from 2005-06 to 2019-21. On subsequent pages, we show trends between 2015-16 and 2019-21 by stateand district.
USE| This data note provides a broad view of diet patterns among adults and should be used for further inquiry by stakeholders including researchers, policymakers, and program staff at multiple levels. We recognize that NFHS is not a detailed dietary survey and does not ask about individual food items or the quantity of food consumed. Thus, this data note should be used as a starting point for discussion and to identify major areas of improvement in consumption and measurement.

Tracking anemia and its determinants from 2015-16 to 2019-21 in India
Gune, Soyra; Christopher, Anita; Scott, Samuel; Nguyen, Phuong Hong; Joe, William; Singh, S. K.; Dwivedi, L. K.; Pedgaonkar, Sarang; Puri, Parul; Chauhan, Alka; Yadav, Kapil; Chamois, Sylvie . New Delhi, India 2023

Abstract | View

This Data Note provides an update on the prevalence of anemia and its determinants in India at state and districts levels, as well as coverage of a nutrition specific and nutrition sensitive interventions. Data were from the National Family Health Surveys in 2005 06, 2015 2016 and 2019 21. We first report national trends for 8 population groups (Figure 1 below). For each population group, we show anemia prevalence by severity category and at state and district levels using the two latest rounds of data. Lastly, we show recent trends in determinants of anemia and, nutrition and health interventions.

Coverage of nutrition and health interventions in India: Insights from the National Family Health Surveys
Christopher, Anita; Gune, Soyra; Avula, Rasmi; Nguyen, Phuong Hong; Menon, Purnima; Singh, S. K.; Dwivedi, L. K.; Pedgaonkar, Sarang; Puri, Parul; Chauhan, Alka; . New Delhi, India 2023

Abstract | View

Nutrition-specific interventions are aimed at improving the food, health, and care environment for women and children during the first 1000 days. These interventions span pregnancy, postnatal, and early childhood periods and include food and micronutrient supplementation, nutrition education and/or counselling, growth monitoring and promotion, as well as routine immunization, deworming, and care during illness. At 90% coverage, these interventions can contribute to 20% reduction in stunting and 61% reduction in severe wasting. India’s policy framework for health and nutrition is robust and includes most evidence-based nutrition and health interventions. Two large-scale national program platforms – the Integrated Child Development Services and the National Health Mission – together deliver these interventions across the country. India’s efforts at scaling up nutrition interventions are now also bolstered by the National Nutrition Mission. This Data Note describes the coverage of key nutrition and health interventions for which data are available in the National Family Health Surveys for 2015-2016 and 2019-2021. To examine coverage of interventions, indicators were created based on global definitions and making adaptations to Indian policy context where necessary. Data on women of reproductive age (15-49 years) with a child below five years of age from the most recent birth was used to compute these indicators. Indicator definitions are provided in Annex 1 of this Note.

How is India doing on malnutrition and non-communicable diseases? Insights from the National Family Health Surveys (2005-06 to 2019-21)
Kapoor, Rati; Singh, Nishmeet; Nguyen, Phuong Hong; Singh, S. K. ; Dwivedi, L. K.; Pedgaonkar, Sarang; Puri, Parul; Chauhan, Alka; Khandelwal, Shweta; Chamois, Sylvie. New Delhi, India 2023

Abstract | View

A set of global nutrition targets for maternal and child nutrition together with diet related non communicable diseases ( to be achieved by 2025 was endorsed by the World Health Assembly in 2013 These targets provide goals against which progress towards ending malnutrition in all its forms can be measured and contribute to the Sustainable Development Goals This data note describes trends in multiple forms of malnutrition and NCD outcomes at the national, state, and district levels for India using survey data from NFHS 3 2005 06 NFHS 4 2015 2016 and NFHS 5 2019 2021 Insights on other malnutrition targets such as anemia and breastfeeding will be forthcoming

Mitigating poverty and undernutrition through social protection: A simulation analysis of the COVID-19 pandemic in Bangladesh, Myanmar, and Indonesia
Ecker, Olivier; Alderman, Harold; Comstock, Andrew R.; Headey, Derek D.; Mahrt, Kristi; Pradesha, Angga. Washington, DC 2023

Abstract | View

This study addresses the policy-relevant question of how, in the face of major economic shocks, social protection interventions can more effectively mitigate undernutrition. In particular, it considers the scope of scaled-up fortification of staples to avert the “hidden hunger” of micronutrient deficiencies. As a re-cent and still relevant example, it focuses on the kinds of economic shocks brought about by the COVID-19 pandemic which, especially during the first lockdowns of April 2020, resulted in severe job and income losses for the poor and thus reduction and changes in spending, with urban and rural non-farm households typically affected more severely than farm households. However, the findings of this study are relevant for other economic shocks that severely reduce household’s disposable income.
In this study, we examine the effects of stylized economic shocks on household incomes in Bangladesh, Myanmar, and Indonesia, with a focus on the difference between recommended and actual consumption of particular foods and nutrients. To this end, we use a novel combination of three integrated models to examine impacts and experiment with different types of social protection interventions. In Bangladesh and Indonesia, these are stylized models of the COVID-19 shock and government lock-downs; in Myanmar, however, we model the economic instability that took place after the February 2021 military takeover, which – in conjunction with COVID-19 impacts – resulted in an estimated 18 percent contraction in GDP (World Bank 2022).

Measuring empowerment across the value chain: The evolution of the project-level Women’s Empowerment Index for Market Inclusion (pro-WEAI+MI)
Malapit, Hazel J.; Heckert, Jessica; Adegbola, Patrice Ygué; Crinot, Geraud Fabrice; Eissler, Sarah; Faas, Simone; Gantoli, Geoffroy; Kalagho, Kenan; Martinez, Elena; Meinzen-Dick, Ruth Suseela; Mswero, Grace; Myers, Emily; Mzungu, Diston; Pereira, Audrey; Pinkstaff, Crossley; Quisumbing, Agnes R.; Ragasa, Catherine; Rubin, Deborah; Seymour, Greg; Tauseef, Salauddin; GAAP2 Market Inclusion Study Team. Washington, DC 2023

Abstract | View

Many development agencies design and implement interventions that aim to reach, benefit, and empower rural women across the value chain in activities ranging from production, to processing, to marketing. Determining whether and how such interventions empower women, as well as the constraints faced by different value chain actors, requires quantitative and qualitative tools. We describe how we adapted the project-level Women’s Empowerment in Agricultural Index (pro-WEAI), a mixed-methods tool for studying empowerment in development projects, to include aspects of agency relevant for multiple types of value chain actors. The resulting pro-WEAI for market inclusion (pro-WEAI+MI) includes quantitative and qualitative instruments developed over the course of four studies. Studies in the Philippines (2017), Bangladesh (2017), and Malawi (2019) were intended to diagnose areas of disempowerment to inform programming, whereas the Benin (2019) study was an impact assessment of an agricultural training program. The pro-WEAI+MI includes all indicators included in pro-WEAI, plus a dashboard of complementary indicators and recommended qualitative instruments. These tools investigate the empowerment of women in different value chains and nodes and identify barriers to market access and inclusion that may restrict empowerment for different value chain actors. Our findings highlight three lessons. First, the sampling strategy needs to be designed to capture the key actors in a value chain. Second, the market inclusion indicators cannot stand alone; they must be interpreted alongside the core pro-WEAI indicators. Third, not all market inclusion indicators will be relevant for all value chains and contexts. Users should research the experiences of women and men in the target value chains in the context of the programto select priority market inclusion indicators.

Food for thought? Experimental evidence on the learning impacts of a large-scale school feeding program
Aurino, Elisabetta; Gelli, Aulo; Adamba, Clement; Osei-Akoto, Isaac; Alderman, Harold. Madison, WI 2023

Abstract | View

There is limited experimental evidence on the effects of large-scale, government-led interventions on human capital in resource-constrained settings. We report results from a randomized trial of the government of Ghana’s school feeding. After two years, the program led to moderate average increases in math and literacy standardized scores among pupils in treatment communities, and to larger achievement gains for girls and disadvantaged children and regions. Improvements in child schooling, cognition, and nutrition constituted suggestive impact mechanisms, especially for educationally-disadvantaged groups. The program combined equitable human capital accumulation with social protection, contributing to the “learning for all” sustainable development agenda.

Stories of change in nutrition: Lessons from a new generation of studies from Africa, Asia and Europe
Headey, Derek D.; Gillespie, Stuart; Avula, Rasmi; Becquey, Elodie; Nisbett, Nicholas; Harris, Jody. 2023

Abstract | View

How does nutrition improve? We need to understand better what drives both positive and negative change in different contexts, and what more can be done to reduce malnutrition. Since 2015, the Stories of Change in Nutrition studies have analysed and documented experiences in many different African and Asian countries, to foster empirically-grounded experiential learning across contexts. This article provides an overview of findings from 14 studies undertaken in nine countries in South Asia, sub-Saharan Africa, and Europe between 2017 and 2021. The studies used a combination of methods, including regression-decomposition analyses of national datasets to assess determinants of nutritional change; policy process and food environment analyses; and community-level research assessing attitudes to change. This article takes a narrative synthesis approach to identify key themes across the studies, paying particular attention to multisectoral determinants, changes in the food environment, the role of structural factors (including longstanding social inequities), and changes in political commitment, cross-sectoral coherence and capacity. Given the inherent multisectoral nature of nutrition, many countries are experimenting with different models of ensuring coherence across sectors that are captured in this body of work. The relative immaturity of the policy sector in dealing with issues such as obesity and overweight, and associated influences in the wider food environment, adds a further challenge. To address these interrelated issues, policy must simultaneously tackle nutrition’s upstream (social/economic/equity) and downstream (health and dietary) determinants. Studies synthesised here provide empirically-driven inspiration for action.

Changes in women’s empowerment in the household, women’s diet diversity, and their relationship against the background of COVID-19 in southern Bangladesh
Lecoutere, Els; van den Berg, Marrit; de Brauw, Alan. 2023

Abstract | View

The COVID-19 pandemic in Bangladesh, associated public health measures, and people’s reactions were projected to have caused job losses among women, a decline in women’s empowerment and reduced women’s diet diversity. Using a November 2020 telephone survey to re-interview adult female respondents of a November 2019 in-person survey, contrary to expectations we find that more women found than lost jobs, and women’s diet diversity increased over the year partly marked by the COVID-19 pandemic. We did not find evidence of a decline in women’s involvement in food purchase decisions, nor women’s autonomy over use of household income. The change in women’s outside employment is neither statistically related to changes in women’s involvement in food purchase decisions, changes women’s autonomy over use of household income, nor changes in women’s diet diversity. Change in women’s involvement in food purchase decisions is positively related with change in women’s diet diversity and change in women’s autonomy over income use is negatively related with change in women’s diet diversity.

Measuring women’s empowerment and gender equality through the lens of induced innovation
Quisumbing, Agnes R.; Meinzen-Dick, Ruth Suseela; Malapit, Hazel J.. Singapore 2023

Abstract | View

Using the lens of the theory of induced innovation, we reflect on the development of metrics for women’s empowerment and gender equality. The Women’s Empowerment in Agriculture Index (WEAI), launched in 2012, was used to monitor women’s inclusion in agricultural sector growth. Demand by WEAI users and the supply of tools and methods from researchers shaped the ongoing evolution of the tool to a shorter version and to another that reflected what agricultural development projects deemed meaningful to judge project success. Eventual modifications reflected user demand: a greater interest in market inclusion and value chains stimulated the development of specialized modules for market inclusion. WEAI-related metrics have demonstrated the importance of women’s empowerment for development outcomes, helping governments and civil society organizations design and implement gender-sensitive agricultural development programs. Finally, the adoption of SDG5 on women’s empowerment and gender equality created a demand for a measure of women’s empowerment for use by national statistical systems. Whether such a metric will be adopted globally will depend on the demand from, and utility to, stakeholders as well as existing capacity, capacity-building efforts, a belief in the intrinsic value of women’s empowerment, and the commitment of resources to attaining this goal.

Measuring consumption over the phone: Evidence from a survey experiment in urban Ethiopia
Abate, Gashaw Tadesse; de Brauw, Alan; Hirvonen, Kalle; Wolle, Abdulazize. 2023

Abstract | View

The paucity of reliable, timely household consumption data in many low- and middle-income countries have made it difficult to assess how global poverty has evolved during the COVID-19 pandemic. Standard poverty measurement requires collecting household consumption data, which is rarely collected by phone. To test the feasibility of collecting consumption data over the phone, we conducted a survey experiment in urban Ethiopia, randomly assigning households to either phone or in-person interviews. In the phone survey, average per capita consumption is 23 percent lower and the estimated poverty headcount is twice as high than in the in-person survey. We observe evidence of survey fatigue occurring early in phone interviews but not in in-person interviews; the bias is correlated with household characteristics. While the phone survey mode provides comparable estimates when measuring diet-based food security, it is not amenable to measuring consumption using the ‘best practice’ approach originally devised for in-person surveys.

Development and validation of a health and nutrition module for the project-level Women's Empowerment in Agriculture Index (pro-WEAI+HN)
Heckert, Jessica; Martinez, Elena M.; Seymour, Greg; Pereira, Audrey; Roy, Shalini; Kim, Sunny S.; Malapit, Hazel J.. 2023

Abstract | View

Agricultural development projects increasingly aim to improve health and nutrition outcomes, often by engaging women. Although evidence shows such projects can improve women's and children's health and nutrition and empower women, little is known about their impacts on women's health- and nutrition-related agency and the extent to which impacts emerge through women's empowerment, largely due to a lack of instruments that measure the dimensions of women's agency that are directly relevant to health and nutrition outcomes. We developed an optional, complementary module for the project-level women's empowerment in agriculture index (pro-WEAI) to measure health- and nutrition-related agency (pro-WEAI + HN). Our method for developing related indicators used data collected from six agricultural development programmes implemented across Bangladesh, Burkina Faso and Mali (pooled sample = 12,114) and applied psychometric analysis (exploratory and confirmatory factor analysis) and the Alkire−Foster methodology. Results revealed seven indicators covering women's agency in the areas of her own health and diet; her health and diet during pregnancy; her child's diet; breastfeeding and weaning; purchasing food and health products; and acquiring food and health products. Multigroup confirmatory factor analysis revealed measurement invariance across contexts and samples. Tests of association (Cramer's V) and redundancy suggest that the pro-WEAI + HN indicators measured aspects of agency that are distinct from the core pro-WEAI. The uptake of these indicators in studies of nutrition-sensitive agricultural development projects may strengthen the evidence on how such programming can enhance women's empowerment to improve health and nutrition outcomes for themselves and their children.

The burdens of participation: A mixed-methods study of the effects of a nutrition-sensitive agriculture program on women’s time use in Malawi
Margolies, Amy; Colantuoni, Elizabeth; Morgan, Rosemary; Gelli, Aulo; Caulfield, Laura E.. 2023

Abstract | View

Development programs often rely on women’s participation. However, there is little evidence of whether development programs that engage women’s unpaid labor – particularly in care work – add to their time burdens. We tested this hypothesis on a nutrition-sensitive agriculture program delivered through community-based preschools in Malawi. The mixed-methods study was conducted over one year using data from 1,168 female caregivers from a cluster-randomized control trial. A longitudinal binomial logistic regression model was used to estimate the proportion of time spent caregiving in a 24-hour period (expressed as minutes) at baseline and then separately for each treatment group at 6-months and 1-year post-randomization. In addition, two rounds of 38 qualitative in-depth interviews (n = 76) were conducted with women, men and adolescent girls to explore their perceptions of program activities, time use and gender attitudes. We found that the program quantitatively increased daily caregiving time for participating women by approximately 30 min. However, this effect occurred only during the lean season when preschool scale-up investments increased. Qualitatively, program-related tasks were not considered burdensome. Moreover, participants saw contributions as important investments in their children’s development. These findings add to limited evidence of the impacts of nutrition-sensitive agricultural programs and early childhood interventions on women’s time use. Measuring women’s participation through mixed-method evaluations can aid interpretation to avoid harm and to better understand the tradeoffs of women’s time.