As an introduction to the theme of the workshop, some key facts regarding global trends in nutrition in the developing world will be presented. The possible underlying causes will be briefly analyzed, including the role of technology, resource constraints, information and social norms. Finally, the benefits of rigorous evaluations to shed light on the relative importance of the above causes and help design effective interventions will be discussed.

1. Development and Nutrition
Eliana La Ferrara
Invernizzi Chair in Development Economics
Università Bocconi
ABF Workshop, 24/10/2015

2. The nutrition poverty trap
2
Poor
nutrition
Low
productivity
Low
income

3. What do we know…
Some disturbing facts
 12.5% of the world’s population undernourished
 26% of children are stunted (40% in Sub-
Saharan Africa)
 45% of child deaths <3 yrs due to poor nutrition
3
 About the current state of nutrition
 The causes of undernutrition
 Potential policy responses

4. % of children under 5 who are stunted
4 Source: UNICEF, 2013
Most stunting is in Sub-Saharan
Africa and South Asia

5. Decreasing trends in under-5 stunting, but
not everywhere
5 Source: Black et al. (Lancet 2013)

6. Increasing trends in under-5 overweight
6 Source: Black et al. (Lancet 2013)

7. 7 Source: WHO, 2010
“Double burden”:
underweight & overweight

8. Why are so many people undernourished?
1. Food production
8
2. Food consumption
& caloric intake
3. Distribution of
resources within the
household

9. 1. Do we produce as much
food as we can?
9

10. Agricultural yield gap
10 Source: Deininger and Byerlee (2011)

11. Reasons for low yields: (1) Technology
 More (adequate) technology needed?
Technology exists but farmers do not adopt:
20-30% of farmers report using fertilizers in past
year in Kenya, Ethiopia, Mali
Low adoption of relatively simple and inexpensive
agricultural innovations.
Is this the rational response to low returns on
inputs?
 No: use of fertilizers is low despite returns of
69% per year (Duflo, Kremer, Robinson, 2008)
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12. Factors affecting technology adoption
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Why are farmers not using enough of these
technologies despite high returns?
 Lack of information
 Credit constraints
 Take-up is 50% higher if fertilizer offered with 50% discount
(Duflo, Kremer, Robinson, 2011)
 Time-inconsistent preferences
 Take-up is 50-70% higher if fertilizer offered right after
harvest (Duflo, Kremer, Robinson, 2011)

13. Factors affecting technology adoption (cont’d)
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 Social learning
 Pinapple cultivation in Ghana: adoption higher if
members of social network have adopted (Conley and
Udry 2010)
 Risk aversion
 Buying fertilizer too risky for Ethiopian farmers (Dercon
and Christiaensen 2011)
 Yet rainfall insurance take-up low (Cole et al, 2013; Giné
et al., 2009)
 Gender differences in preferences within hh
 Women choose healthier stoves more often than men
in Bangladesh, only when they are for free (Miller and
Mobarak 2013)

14.  Security of tenure and economic outcomes
 Higher tenure security lower risk of expropriation
higher investments (Besley 1995)
 Historical institutions regarding property rights matter for today’s
economic outcomes (Banerjee and Iyer 2005, Hornbeck 2010)
 Investments and output are higher in plots controlled by
individuals holding powerful positions in local government
(Goldstein and Udry 2008)
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Reasons for low yields: (2) Land rights
 Yields on plots cultivated by women are lower
 Resources are inefficiently allocated across plots (Udry 1996)
 Differences in inputs access or usage (Horrell and Krishnan 2007)
 Women have weaker rights to own and inherit land (Agarwal
1994, Cooper 2012,...)

15. 2. Do we get the max caloric
intake we can?
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16. 16
 Poor people spend a low fraction of their
income on food
 39%-79% among extremely poor in rural areas (Banerjee and
Duflo 2011)
 Food subsidies do not generate higher caloric
intake
 Poor people use them to buy more expensive and better tasting
food
The expenditure choices of the poor do not
always translate into max caloric intake

17. 17
 Deeply rooted cultural norms can affect nutritional
outcomes
 Do food cultures alter people’s caloric intake?
 People make nutritionally suboptimal choices due to preference
for traditional food: they pay a caloric tax (Atkin 2013)
 Evidence on migrants in the United States (McDonald and
Kennedy 2005, Giuntella 2014)
− At time of migration, they have better health than natives
− They cannot afford to maintain their food habits in the host country
− They opt for fast food, with negative effects on their health

18. 3. How is food distributed
within the household?
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19.  Social norms affect distribution of resources
 Decisions on how food is distributed within the family respond to
customary practices
 Son preference generates differences in nutritional outcomes
within a household
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Social norms affect intra-household distribution
3. Distribution within the household

20. Son preference
 Some differences in nutritional status within a household
due to son preference
 Unequal breastfeeding practices (Jayachandran and
Kuziemko 2011)
 Women with a first-born daughter tend to have more
children, are less likely to use contraceptives and have
shorter birth intervals (Milazzo 2014)
 Sibling rivalry: more resources are allocated to male
children (Garg and Morduch 1998)
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21. Importance of pregnant women’s nutrition
Nutrition received in utero has long-lasting effects on
children’s health
 Children in utero during flu pandemics in US had worse
health and higher death rates (Almond)
 Children in utero during Ramadan earn less (Almond)
 Iodine supplementation to pregnant women in Tanzania
improved children’s educational outcomes (Field and
Torero)
Yet, 40% of pregnant women in the world are anemic
(WHO)
 Need to ensure that pregnant women get right
nutrients
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22. Policy responses
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23. 1. Food production
 Interventions to facilitate technology
adoption
 National policies to improve security of
land rights (e.g., titling)
 National policies to improve gender
equality in land rights (e.g., inheritance
reforms such as the Hindu Succession Act)
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24. 2. Consumption of nutrients
 Not only programs that emphasize the
quantity of food (e.g., subsidized rice
distribution)
 Nutrition programs that enrich basic food
with iron, vitamins, etc.
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25. 25
Iron Folate
supple-
mentation
in
pregnancy
for 90+
days
Early
initiation of
breast-
feeding
within 1
hour of birth
Exclusive
breast-
feeding,
<6
months
Minimum
acceptable
diet, 6-23
months
Minimum
dietary
diversity,
6-23
months
Vitamin A
supple-
mentation,
<60
months
Zinc
supple-
mentation
with
Diarrhea,
<60
months
Salt con-
sumption
is Iodized
Nicaragua
Malawi
Rwanda
Honduras
Honduras
Pakistan Georgia
Nutrition programs scaled up at national level
Coverage %
Source: www.globalnutritionreport.org

26. 2. Consumption of nutrients
 Nutrition programs that enrich basic food
with iron, vitamins, etc.
 Information campaigns and media-based
interventions to change people’s
preferences towards certain foods (e.g.,
educational entertainment)
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27. 3. Food distribution within the hh
 Economic empowerment of vulnerable hh
members (e.g., women & microfinance)
 Interventions to change cultural norms
(e.g., media-based)
 Direct targeting by government or NGOs
 Conditional Cash Transfers targeted to women
 School meals programs
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28. Conclusions
 Overall clear need for interventions in this area
 Importance of targeting resources to most
effective programs
 Need for a careful evaluation of program
impact
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