Comparing Delivery Channels To Promote Nutrition Sensitive Agriculture A Cluster Randomized Controlled Trial In Bangladesh

We use a randomized controlled trial in rural Bangladesh to compare two models of delivering nutrition content jointly to husbands and wives: deploying female nutrition workers versus mostly male agriculture extension workers. Both approaches increased nutrition knowledge of men and women, household and individual diet quality, and women’s empowerment. Intervention effects on agriculture and nutrition knowledge, agricultural production diversity, dietary diversity, women’s empowerment, and gender parity do not significantly differ between models where nutrition workers versus agriculture extension workers provide the training. The exception is in an attitudes score, where results indicate same-sex agents may affect scores differently than opposite-sex agents. Our results suggest opposite-sex agents may not necessarily be less effective in providing training. In South Asia, where agricultural extension systems and the pipeline to those systems are male-dominated, training men to deliver nutrition messages may offer a temporary solution to the shortage of female extension workers and offer opportunities to scale promote nutrition-sensitive agriculture.

There are few studies that rigorously assess how agricultural and nutrition related interventions enhance resilience and even fewer that incorporate a gendered dimension in their analysis. Mindful of this, we address three knowledge gaps: (1) Whether agricultural interventions aimed at diversifying income sources and improving nutrition have sustainable impacts (on asset bases, consumption, gender-specific outcomes and women’s empowerment, and on diets) that persist after the intervention ends; (2) whether such interventions are protective when shocks occur? and (3) whether these interventions promote gender-sensitive resilience. We answer these questions using unique data, a four-year post-endline follow up survey of households from a cluster-randomized controlled trial of a nutrition-and-gender-sensitive agricultural intervention in Bangladesh. We find that treatment arms that included both agriculture and nutrition training had sustainable effects on real per capita consumption, women’s empowerment (as measured by the pro-WEAI), and asset holdings measured four years after the original intervention ended. Treatment arms that included both agriculture and nutrition training (with or without gender sensitization) reduced the likelihood that households undertook more severe forms of coping strategies and reduced the likelihood that household per capita consumption fell, in real terms, by more than five percent between in the four years following the end of the intervention. The treatment arm that only provided training in agriculture had positive impacts at endline but these had largely faded away four years later. Our results suggest that bundling nutrition and agriculture training may contribute to resilience as well as to sustained impacts on consumption, women’s empowerment, and asset holdings in the medium term. These have implications for the design of future gender- and nutrition-sensitive agricultural programs.

A growing body of evidence indicates that agricultural development programs can potentially improve production diversity and diet quality of poor rural households; however, less is known about which aspects of program design are effective in diverse contexts and feasible to implement at scale. We address this issue through an evaluation of the Agriculture, Gender, and Nutrition Linkages (ANGeL) project. ANGeL is a randomized controlled trial testing what combination of trainings focused on agricultural production, nutrition behavior change communication, and gender sensitization were most effective in improving production diversity and diet quality among rural farm households in Bangladesh. We find that trainings focused on agriculture improved production diversity in terms of greater production of fruits and vegetables grown on the homestead, eggs, dairy, and fish; adding trainings on nutrition and gender did not significantly change these impacts. Trainings focused on both agriculture and nutrition showed the largest impacts on diet quality, with evidence indicating that households in this arm also significantly increased consumption out of homestead production for fruits and vegetables, eggs, dairy, and fish. Findings indicate that agricultural training that promotes production of diverse, high-value, nutrient-rich foods can increase production diversity, and this can improve diet quality, but diet quality impacts are larger when agricultural training is combined with nutrition training. Relative to treatments combining agriculture and nutrition training, we find no significant impact of adding the gender sensitization on our measures of production diversity or diet quality.

The relationships between agricultural diversity, dietary diversity, and gender norms are complex and multi-dimensional. To better understand these links, and how to most effectively promote nutrition- and gender-sensitive agriculture in Bangladesh, the International Food Policy Research Institute (IFPRI) designed the Agriculture, Nutrition, and Gender Linkages (ANGeL) pilot project, implemented by the Ministry of Agriculture, Government of the People’s Republic of Bangladesh. ANGeL aimed to identify actions and investments in agriculture that will help increase farm household income, improve nutrition, and empower women. Using rigorous research, namely, a randomized controlled trial design, IFPRI assessed impacts of the ANGeL project interventions on various outcomes. Over the 17-month implementation period, with no inputs provided to participating farm households besides knowledge from trainings, ANGeL generated useful lessons on strengthening the agriculture-nutrition-gender nexus in the country. Both men and women benefited from agricultural trainings, yet women learned more from the same trainings. Crop diversity increased substantially in homestead gardens, mainly due to ANGeL’s emphasis on homestead food production from nutritious crops. Farmers also adopted improved production practices. We consistently found that women were more likely to apply knowledge gained from agricultural production trainings to adopt various types of improved agriculture production practices, such as pest disease and control, seed production and care, and use of quality fertilizer. Similarly, improvements in nutrition knowledge were far greater for women and when trainings were combined. These improvements in knowledge had impacts on nutrition outcomes, with increases in household diet quality and child dietary diversity over the project period. The strongest improvements in empowerment came when agriculture, nutrition, and gender sensitization trainings were combined. ANGeL’s household approach empowered women and men in unique ways: while women became more empowered in asset ownership and income decisions, men became more empowered in production and income decisions in select interventions. Attitudes related to gender of both women and men also improved, with more women recognizing that they make important contributions to their communities. ANGeL is the first ministry-led initiative that uses a rigorous impact evaluation to develop an evidence base to design and implement a national program. The ANGeL project is a significant step towards filling critical knowledge and action gaps in the country on promoting nutrition-and gender-sensitive agriculture.

The importance of women’s roles for nutrition-sensitive agricultural projects is increasingly recognized, yet little is known about whether such projects improve women’s empowerment and gender equality. We study the Agriculture, Nutrition, and Gender Linkages (ANGeL) pilot project, which was implemented as a cluster-randomized controlled trial by the Government of Bangladesh. The project’s treatment arms included agricultural training, nutrition behavior change communication (BCC), and gender sensitization trainings to husbands and wives together – with these components combined additively, such that the impact of gender sensitization could be distinguished from that of agriculture and nutrition trainings. Empowerment was measured using the internationally-validated project-level Women’s Empowerment in Agriculture Index (pro-WEAI), and attitudes regarding gender roles were elicited from both men and women, to explore potentially gender-transformative impacts. Our study finds that ANGeL increased both women’s and men’s empowerment, raised the prevalence of households achieving gender parity, and led to small improvements in the gender attitudes of both women and men. We find significant increases in women’s empowerment scores and empowerment status from all treatment arms but with no significant differences across these. We find no evidence of unintended impacts on workloads and we note inconclusive evidence of possible increases in intimate partner violence (IPV). Our results also suggest some potential benefits of bundling nutrition and gender components with an agricultural development intervention; however, many of these benefits seem to be driven by bundling nutrition with agriculture. While we cannot assess the extent to which including men and women within the same treatment arms contributed to our results, it is plausible that the positive impacts of all treatment arms on women’s empowerment outcomes may have arisen from implementation modalities that provided information to both husbands and wives when they were together. The role of engaging men and women jointly in interventions is a promising area for future research.

Investments in social assistance programs (SAPs) in low- and middle-income countries (LMICs) are increasing. As investments increase, the objectives of these programs are expanding from focusing on reducing poverty to addressing other social issues such as improving diets and nutrition. At the same time, there is increasing interest in addressing all forms of malnutrition within the framework of food systems. Given the intersections between SAPs and food systems, we reviewed the effectiveness of SAPs (agriculture asset transfers, cash transfers, in-kind transfers, vouchers, public works and school meals programs) for reducing all forms of malnutrition across the lifecycle within a food systems framework. As several programs included multiple treatment arms, each representing a unique program design, we used study arm as the unit of analysis and assessed the proportion of study arms with positive or negative program impacts on diet and nutrition outcomes among men, women and children. The majority of the studies included in this review were from evaluations of agriculture asset, cash and in-kind transfer programs. There was clear evidence of positive impacts on women’s and children’s diet-related outcomes. Very few studies assessed program impact on women’s nutritional status outcomes. However, there was some evidence of impacts on increasing body mass index and hemoglobin concentration (Hb) with in-kind transfer programs. Among children, several study arms across the agriculture asset, cash and in-kind transfer programs found positive impacts on increasing height-for-age Z-score (33%-45% of study arms) and weight-for-height Z-score (33%-50% of study arms) and decreasing the prevalence of wasting (43%-60% of study arms). Cash and in-kind transfer programs also found positive effects on reducing stunting prevalence in 33% and 45% of study arms, respectively. Lastly, a few study arms assessed program impact on increasing Hb with some evidence of positive impacts in in-kind and school feeding programs. There was a paucity of relevant evidence of the effectiveness of voucher and public works programs on diet and nutrition outcomes, for men’s outcomes and on micronutrient status. Several challenges remain in understanding the potential for SAPs to improve diet and nutrition outcomes within food systems including the heterogeneity of program and evaluation designs, populations targeted by the programs and included in evaluations and indicators used to assess impact. Addressing these challenges in future evaluations is important for informing program and policy actions to improve the effectiveness of SAPs within food systems for improving diet and nutrition outcomes across the lifecycle.

New evidence this year corroborates the rise in world hunger observed in this report last year, sending a warning that more action is needed if we aspire to end world hunger and malnutrition in all its forms by 2030. Updated estimates show the number of people who suffer from hunger has been growing over the past three years, returning to prevailing levels from almost a decade ago. Although progress continues to be made in reducing child stunting, over 22 percent of children under five years of age are still affected. Other forms of malnutrition are also growing: adult obesity continues to increase in countries irrespective of their income levels, and many countries are coping with multiple forms of malnutrition at the same time – overweight and obesity, as well as anaemia in women, and child stunting and wasting.