1. This presentation was made possible by the American people through the U.S. Agency for International Development (USAID) under Cooperative Agreement No. AID-OAA-A-11-00031, the Strengthening Partnerships, Results, and Innovations in Nutrition Globally (SPRING) project. Pathways and Principles for Improving Nutrition through Agriculture Sarah Titus and Jessica Tilahun Global Health Mini-University March 2, 2015

2. Cost of Malnutrition Morbidity and Mortality 45% of under-five mortality attributable to undernutrition Underweight is #1 contributor to burden of disease in SSA Economic Lower IQ and school performance Asia and Africa lose 11% of GNP every year b/c of poor nutrition 2 Black et al. Lancet. 2013 Lim et al. 2012 Horton and Steckel 2013 Global Nutrition Report, IFPRI

3. Countries with Multiple Burdens in Children under 5 years Global Nutrition Report, 2014 3

4. We Have Made Significant Progress Ethiopia stunting rate dropped from 57% to 44% in one decade Between 2006 and 2012 stunting went from 29% to 22% in Haiti 4 Peru doubled their EBF rates, with greatest improvements among the poorest children In DRC, coverage of treatment for SAM went from less than 46k in 2007 to greater than 157K in 2011

5. What Works to Reduce Undernutrition? Nutrition-specific interventions address the immediate causes of undernutrition Health Status Nutrient Intake Examples IYCF and ENA Micronutrient Fortification & Supplementation: Iron, Zinc, Vit. A Integrated Management of Child Illness Community Management of Acute Malnutrition 5

6. Is This Enough? Findings from Lancet series 2013 If 90% of the population is reached with 10 key nutrition-specific interventions an estimated 900,000 lives could be saved in 34 high nutrition-burden countries; prevalence of stunting could be reduced by 20%; number of children with stunted growth and development would be reduced by 33 million; estimated cost of $9.6 billion. “We need to find solutions beyond targeted nutrition- specific interventions and beyond the health sector.” Marie Ruel, 2013 6

8. Nutrition-sensitive vs. Nutrition-specific Nutrition-sensitive interventions strive to address the underlying causes of undernutrition Food security and quality: Consistent access to diverse nutritious food Child and family care resources and practices: Supported through women’s empowerment Health services and Water, Sanitation and Hygiene (WASH): Focus on healthy environments 8

9. How Does Agriculture Affect Nutrition? Food Consumed CaloriesProtein Micronutrients Income Invested in Diverse diet, nutrient-rich foods Health care Sustainable livelihood for year-round food and health care access Gender roles within the Food System Maximizing women’s control of income Managing time and energy demands 9

10. Primary Pathways Linking Agriculture and Nutrition

11. Key Principles for Linking Ag/Nut

12. Production Pathway Agriculture as own source of food is most direct pathway Production decisions influenced by market prices, relative costs & risks, productive assets, preferences and cultural norms Processing and storage impact food access and nutrient content 12

13. Production of goat milk 13

14. Production Pathway

15. Agricultural Income Pathway Improved year-round income and cash flows to meet household needs, including diverse foods Assumes nutritious foods are available in markets – reflects the importance of generating demand and need for nutrition education 15

16. Agricultural Income Pathway Netsanet lives in SNNPR, Ethiopia Coffee Value Chain Project 16

17. Income Pathway

18. Women’s Empowerment ? ? ? ? ? ? ? ?

20. In summary: for agriculture to help move the needle on nutrition Ag/VC activities should be designed to include nutrition-sensitive ag activities, outcomes, and indicators Ag/VC activities should link with nutrition-specific activities in co- located areas 20 Frameworks, principles, and pathways should be referenced to help check assumptions and plan If we want to reach the SDG and WHA goals—nutrition- sensitive agriculture will need to be the norm

21. Thank You Sarah Titus MALD, Food Security and Nutrition Manager— stitus@jsi.comstitus@jsi.com Jessica Tilahun MS RD, Food Security and Nutrition Advisor– jtilahun@jsi.comjtilahun@jsi.com www. SPRING-nutrition.org 21