Can Ag/Nutrition Programs Change Gender Norms_Mara Vandenbold_10.16.13

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  • Results from an impact evaluation and qualitative research to evaluate an HFP program carried out by HKI in eastern Burkina Faso.Focus of this presentation is on the results relevant to today’s session, i.e. results in relation to specific gender-related questions we sought to answer.Presentation is based on a paper written by both IFPRI and HKI, which will be out as a IFPRI DP soon.
  • Overview of HKI Homestead Food Production programDiscuss design of the studyGo into the results of the study, specifically in relation to changes in men’s and women’s asset ownership, and changes in norms/opinions on access to / control over these assets.
  • - HKI started HFP programs in the 1980s in Bangladesh; main objective was to reduce vitamin A deficiency.- This original model focused on a combination of i) support for setting up home gardens, and, ii) nutrition education – in order to promote production of vitamin A rich fruits and vegetables throughout the whole year, and to increase HH access to these foods to improve nutrition in vulnerable populations.-The current generation of HFP programs combines: i) home gardening, ii) small animal production, iii) nutrition education through BCC (communication strategies to promote positive behaviors that are appropriate to the context; builds on what people know, do and want, and focuses on identifying motivations for behavior change based on existing practices and beliefs).- HKI has also started to implement these programs in SSA, including in Burkina Faso. - HKI has strengthened the BCC strategy, and has strengthened its focus on targeting women, with the aim of improving child and maternal health and nutrition outcomes. - While there is substantial evidence of the impact of HFP programs on production and consumption of nutrient-rich foods, their impact on maternal and child health outcomes from rigorous randomized control studies is lacking.
  • - To provide some context for the E-HFP program in Burkina Faso, this was implemented in Gourma Province, in the eastern part of the country. - This is a region that is in the Sahel, so fluctuations in food availability are tied to the agricultural season, which falls between May/June and Sept. It is also a region that experiences water shortages, especially in the ‘hungry’ season, which falls between October and April (marked by fall in cereal stores, decrease in energy intake even though DD may go up because of compensatory measures)There is a high prevalence of acute and chronic malnutrition, due to a variety of factors including food insecurity, less than optimal nutrition and health practices, and limited availability of/access to health services.Information gathered as part of baseline revealed: Children under 6 months: 13% stunted or underweight or both, 15% wastedChildren 6-11 months: 24% stunted, 27% underweight, 19% wasted
  • - Main objective of the E-HFP program in BF was to i) improve women’s agricultural production of nutrient-rich foods, to ii) improve women’s health- and nutrition related knowledge and practices – in order to ultimately improve the nutritional status of infants and young children. (This was done through a set of production and nutrition interventions targeted at women with children under 12 months of age.)- These improvements are expected to happen through 3 primary pathways:Increasing the availability of MN-rich foods through increased food production by womenIncome generation through the sale of surplus productionIncrease knowledge and adoption of optimal nutrition practices incl consumption of MN-rich foods.All with the ultimate goal of improving HH food security and child nutritional status
  • The E-HFP program essentially had two main components:Agricultural component – which mean that HKI provided agricultural inputs (seeds, saplings, gardening tools) and training to establish ‘village model farm’s (VMF), to grow MN-rich foods year-round and raise small animals.The VMF functioned as a training site for participating women to learn about home gardening and raising small animalsHKI also provided participating women with agricultural inputs to encourage them to set up their own home gardens based on what they had learned at the VMF Behavior change communication (BCC) strategy – Focused specifically on improving health and nutrition related knowledge, with specific emphasis on consumption of MN-rich foods by women and young children (Essential Nutrition Action Framework)Encouraged participants to carry out optimal practices and help them overcome barriers to adoption of these practices (negotiating for behavior change approach) Combined, these components expected to provide increased access to MN-rich foods, increased income and improved knowledge – improved maternal and child health/nutrition outcomes.
  • The program specifically sought to increase women’s access to and control over physical assets, in two ways:- HKI worked with communities to identify land that could be used by beneficiary women as ‘village model farms’ and also sensitized communities about the program and importance of targeting women- As mentioned in previous slide, HKI provided VMF and beneficiary women with gardening inputs (seeds, saplings, gardening tools) as well as chicks, and encouraged them to set up their own home gardens VMF served as a training site for beneficiary women to learn about HFP and rearing of small animals, and HKI encouraged the set up of personal home gardens
  • Additional pathways through which interventions are presumed to improve nutritional status of children: i) increasing women’s access to/control over productive assetsii) increasing women’s human capital for improved production and optimal nutrition and health care practicesAim of research on gender is to:i) trace pathways to assess program potential to influence women’s accumulation and/or control of productive assets ii) explore how differences in women’s productive assets and/or control of resources are related to child health/nutrition outcomesDirect mechanisms: transfer of resources from project to VFL and to mothers supported by VFL to develop home gardens (seeds, chicks, irrigation kits, other supplies); human capital development through training; social capital through participation in mothers’ groups; through exchanges and support around adoption of HFP techniques and/or new nutrition practices.Indirect mechanisms: improved production techniques they acquire, which should increase HH consumption and health, as well as income. Income can be invested in health care, quality foods, children’s education, material assets etc. that can further improve production and income. Perhaps also increased authority over HH economic decisions.
  • The study design consisted of :- a longitudinal impact evaluation, which looked at a variety of outcomes, such as production, consumption, asset ownership, food security, knowledge and practices related to nutrition and health, and maternal and child health and nutrition outcomes- 2 rounds of qualitative research:-operations research/process evaluation – aimed to investigate program delivery, beneficiary utilization of services, KAP of program implementers and beneficiaries; identify any bottlenecks to implementation and utilization ; if certain components could be strengthened modified-Additional Qualitative research which specifically looked at gender related topics such as ownership and control over agricultural assets
  • Did exposure to nutrition education diffused through village health committee members (HC) increase knowledge and uptake of new practices as compared to that diffused through older women leaders (OWL) or vice versa?X (impact eval)Complete
  • In terms of the qualitative research, we had two rounds:-Operations research – which as mentioned focused on investigating program delivery, beneficiary utilization of services, KAP of program implementers and beneficiaries; identify any bottlenecks to implementation and utilization ; if certain components could be strengthened modified-Additional Qualitative research which specifically looked at gender related topics such as ownership and control over agricultural assets
  • HH durables, agricultural assets and livestock
  • Impact estimates: HH DurablesMen = -0.56 (1.03);n=1380, NSWomen = 2.89 (2.09); n=1380, NSAgricultural assets Men = -1.36 (0.43);n=1380, p=0.003Women = 1.02 (0.30); n=1380, p= 0.001
  • Impact estimates: Men = 3.67 (1.71); n=1380, p=0.036 Women = 2.75 (0.78); n=1380, p=0.001
  • Round 1: 85% of beneficiaries (compared to 4% of non-beneficiaries) had a home garden and for 91% of these women this was new since joining the program.The vast majority of the women credit the program with increasing the increasing production of vegetables and 74% also thought the program had increased production of chickens.
  • Nearly half of respondents in all groups report that men generally inherit land when wife passes; unless children are mature enough to inherit itMore than half of respondents in all groups report that women do not inherit land from their husband after his passing due to tradition and related inheritance and usage rules (depends on whether there are children, age of woman, etc.)
  • To discontinue practices respondents nearly all thought that village chiefs/leaders would need to take the lead.For sensitization and granting land, respondents had more varied opinions stating that traditional leaders, government and local authorities as well as non-governmental organizations should be involved.with the greater proportion of women in control (26%) as compared to intervention villages (7%) stating this as an obstacle to women’s ability to use landFor provision of inputs and sensitization respondents nearly all thought that government or non-governmental organizations would need to take the lead.For granting land, respondents had more varied opinions stating that traditional leaders, husbands, government and local authorities as well as non-governmental organizations should be involved.
  • Women play important roles in planting, weeding, postharvest processing, food preparation etc. (often not formally recognized e.g. firewood, water collection).Time use studies in Africa point to women’s contribution of 60% of total time spent in agricultural activities. Of women in least developed countries, 79% report agriculture as primary economic activity. Approx. 48% of economically active women in the world report that their primary activity is agriculture (Doss 2009; Meinzen-Dick et al. 2011). Despite this, women are generally less well off than men in terms of accessing physical resources (ag inputs, technologies, land), have less capacity to use these assets, are disadvantaged in terms of social/human capital (education, social networks), and have less power to make decisions.Furthermore, there is evidence that men and women have different preferences for allocating resources in a household; and that increasing women’s assets has positive impacts on education and child nutrition outcomes, and their own wellbeing -- so who in the household has control over resources can be very important for improving nutrition. Furthermore, redistributing assets between women and men has the potential to increase productivity (Meinzen-Dick et al. 2011; Udry 1996)Reviews find that different types of women’s empowerment interventions are an important pathway through which agriculture can improve nutrition. Evidence on this is still limited and mixed (Arimond et al. 2010? ; Ruel and Alderman 2013).
  • Arimond and coauthors in a paper in 2010 identified 5 different pathways through which agriculture can impact nutrition outcomes, some of which are especially influenced by gender roles:-Increase availability/access to food for own consumption through improved production – this depends on who decides what types of crops/livestock to grow, and for whom they are intended.- Who controls the income and the increase in income will determine how the income is spent –this may be different for men and women (types/qualities of food and other services that influence nutrition)All the other ones are also mediated through other intra-HH factors like women’s status, education, knowledge, decisionmaking, access to health services etc.- Reductions in market prices associated with increased production will have an impact on the quality and variety of foods that can be purchased- Shifts in consumer preferences may impact what types of foods are bought/produced/consumed (e.g. this where a BCC component to an ag intervention could have influence on preferences)Shifts in the control of resources in the household (time, income, other assets) can impact on what resources are allocated to whom in the HH.Furthermore, there is not much evidence on the impact of agricultural interventions on nutrition outcomes (e.g. stunting) (except in relation to Vitamin A), and there is hardly any evidence on what the pathways of impact may be.Women’s empowerment interventions are considered an important pathway through which agriculture can improve nutrition, but there is limited and mixed evidene for this (Ruel and Alderman 2013; van den Bold et al. 2013).
  • Women are often primary caregivers, and so they can impact their children’s nutrition essentially two ways: i) indirectly through their own nutritional status, and ii) directly through the way in which they care for and feed their child.There have been various studies that have looked at the relationships between nutrition outcomes and dimensions of female empowerment (which is measured in different ways), and they have found positive associations between measures of female empowerment and positive child nutrition outcomes as well as measures of female disempowerment and negative nutrition outcomes.So women’s relationships with men in the HH or community can have an impact on their bargaining power and their ability to direct HH resources to nutrition.
  • Very few children met their minimum dietary diversity requirements (4 out of 7 food groups) at baseline. At endline, although the percentage of children that met this requirement increased in all groups, there were still only 17% of children who had met the minimum requirements across the sample of children who had both baseline and endline data. At endline, children in the two treatment groups were almost twice as likely to have met their requirements for minimum dietary diversity. However, only the difference in the change from baseline to endline between the OWL treatment group and the control group was statistically significant (p< 0.10).
  • At baseline only about 10% of the children between the ages of 6 and 12 months had eaten iron-rich foods during the 24 hours prior to the baseline survey. At the time of the endline survey when these children were between 21 and 40 months of age more than half of them had eaten an iron-rich food during the 24 hours before participating in the endline survey. Children living in OWL villages were the most likely to have eaten an iron-rich food in the previous 24 hours and the change in proportion from baseline to endline was about 15% greater among children living in OWL villages as compared to those living in control villages.
  • After two years of participating in the E-HFP program, children living in HC treatment villages had a higher mean hemoglobin concentration than those living in control villages. The difference in change from baseline to endline was about 0.5 g/L between the control group and the health committee treatment group.
  • The impact of the E-HFP program on improving hemoglobin concentration was even more evident among children who were 3-5.9 months of age at the time of the baseline study. Again children living in HC villages had a significantly higher mean hemoglobin concentration as compared to those living in control villages. Among these younger children the difference in the change of hemoglobin concentration over the two years of program implementation was 0.76 g/dL between the control group and the HC treatment group.
  • The most notable change in knowledge related to important times to wash hands was the change related to washing hands before feeding children. At endline a little less than half of the caregivers interviewed living in HC villages correctly stated this time for hand washing whereas only about 30% of caregivers living in control villages and OWL villages correctly identified this important time to wash hands. There was about a 12% difference in the change proportion from baseline to endline between caregivers living in HC villages as compared to those living in control villages who correctly stated this. About 65% of the caregivers interviewed also knew that hands should be washed before eating. Very few caregivers mentioned that it was also important to wash their hands after using the toilet (about 10%) or after cleaning a child who had defecated (about 5%). This is an area that could be improved in future programs as these are common routes through which children get exposed to infectious agents.
  • Nearly all children who were between the ages of 3 and 12 months at the time of the endline evaluation had been breastfed, as was seen among the children included in the baseline study. A greater proportion of caregivers in all types of villages reported having initiated breastfeeding within the first hour of birth as compared to those interviewed at baseline, and caregivers from both types of treatment villages were more likely than those in the control villages to report having done this ideal practice. The difference between OWL villages and control villages was about 16% and was statistically significant. The proportion of caregivers who had exclusively or predominately breastfed their children < 6 months of age in the previous 24 hours was similar across the control and treatment villages.
  • As is common among young children at-risk for nutritional deficiencies children’s growth was already faltering at 3-12 months of age (at basleine) and declined as children got older. However, there were no significant differences between the control and the treatment groups in the change in HAZ over time. Furthermore, there were no significant differences between the treatment groups in the change in the prevalence of stunting, WAZ scores or the prevalence of underweight among children who were 3-12 months of age at baseline.
  • The improvements in the WHZ scores and decline in the prevalence of wasting are noteworthy. However, again there were no statistically significant differences between the control group and either of the treatment groups for changes in the prevalence of wasting or for the change in WHZ scores from baseline to endline. The changes in prevalence for the three groups was (control = -15%, older women leaders = -17% and health committee –23%). It is possible that we did not have enough power to detect differences between the treatment and control groups for this outcome.
  • Program theory framework, which identifies program components that needed to be in place, program implementers responsible for each of the components, how components were intended to be utilized by program beneficiaries, and how the components were ultimately expected to contribute to overall program impact on MCHN outcomes. Highlighted here are the specific outcomes and impacts related to expected increases in women’s assets and empowerment.
  • Close or equal to 90% of all respondents report nochangesin men’s ability to own land over the past 2 yearsOver 90% of men and women in control villages report no changes in women’s ability to own land. In beneficiary villages however, some change is reported (see next slide), due to land grants by HKI or husbands, and establishment of (community) gardens for women.The changes that were cited in regards to changes in women’s ability to own land primarily had to do with women in intervention villages being granted land by their husbands or HKI, that they now have community gardensThe changes that were mentioned related to changes in women’s ability to use land primarily revolved around increased women’s access to land due to transfers from men and advocacy and to support provided to women in terms of inputs and equipment. Men in beneficiary villages also cited the production trainings provided by HKI as increasing women’s capacity to use land and that the women were now using the land at the VMF for production.
  • Can Ag/Nutrition Programs Change Gender Norms_Mara Vandenbold_10.16.13

    1. 1. Can Integrated Agriculture-Nutrition Programs Change Gender Norms on Land and Asset Ownership? Evidence from Burkina Faso CORE group meeting – Washington DC, October 16 2013 Mara van den Bold | Research Analyst | Poverty, Health and Nutrition Division | IFPRI Abdoulaye Pedehombga | Monitoring and Evaluation Coordinator for E-HFP | HKI Burkina Faso Marcellin Ouedraogo | Program Coordinator for E-HFP | HKI Burkina Faso Deanna Olney | Research Fellow | IFPRI Agnes Quisumbing | Senior Research Fellow | IFPRI
    2. 2. Overview • Background to Helen Keller International’s Enhanced Homestead Food Production (E-HFP) program in Burkina Faso • Motivation for research on gender • Study design • Impact of E-HFP program on key gender-relevant research questions
    3. 3. Context  Burkina Faso • Eastern region, Gourma Province  Sahel • Water shortages, inhibits having a second cultivation season  High prevalence of acute and chronic malnutrition • Food insecurity • Suboptimal maternal and child nutrition and health practices • Limited availability of and access to health services
    4. 4. E-HFP program in Burkina Faso (1)  Overall objective: To improve women’s agricultural production of nutrient-rich foods, as well as their health- and nutrition-related knowledge and practices, to ultimately improve nutritional status of infants and young children  Targeted to women with children between 3 and 12 months of age  Improvements expected through three primary program impact pathways: 1. Increase women’s production of MN-rich foods -> increase availability and consumption of micronutrient-rich foods -> increase HH food security + child nutritional status 2. Income generation through the sale of surplus HH production -> improve HH food security and child nutritional status 3. Increased knowledge and adoption of optimal nutritional practices including consumption of micronutrient-rich foods -> improve child nutritional status
    5. 5. E-HFP program in Burkina Faso (2)  Two primary program components: • Agricultural component • HKI provided agricultural inputs and training to establish ‘village model farms’ (VMF) (training site) to grow micronutrient-rich foods year-round and raise small animals. Led by 4 ‘village farm leaders’. • HKI provided participating women with agricultural inputs and encouraged them to set up their own home gardens and raise small animals based on what they learned at the VMF • Behavior Change Communication (BCC) strategy • Focused on improving health- and nutrition-related knowledge with specific emphasis on encouraging consumption of micronutrient-rich foods by women and young children. • Encourage participants to carry out optimal nutrition and health-related practices and help them overcome barriers to adoption
    6. 6. E-HFP program in Burkina Faso (3)  Program sought to directly increase women’s access to and control over physical assets: • Community level: HKI worked with communities to identify land that could be used by beneficiary women for the ‘village model farm’ (VMF) and sensitized communities about the program and importance of targeting women • Individual: HKI provided VMF and beneficiary women with gardening inputs (saplings, seeds, gardening tools) and chicks and encouraged them to set up of their own home gardens
    7. 7. Motivation for research on gender  Evidence shows: • Positive associations between women’s (dis)empowerment dimensions and (adverse) nutrition outcomes (van den Bold et al. 2013) • Women and men within HH often do not have the same preferences for allocating resources (Alderman et al. 1995; Hoddinott &Haddad 1995; Quisumbing &Maluccio 2003; Quisumbing 2003) • Increasing women’s control over assets (esp. financial/physical) has been shown to positively impact food security, child nutrition, education, women’s own well-being (Quisumbing 2003; Smith et al. 2003; World Bank 2001); gender differences in bargaining power over household resources matter  Women often specifically targeted in agricultural programs, but to date there is limited evidence on the impacts of agricultural interventions on women’s control over and ownership of assets  E-HFP program expected to influence women’s asset holdings through direct (direct transfers of resources) and indirect (improved production techniques) mechanisms
    8. 8. Study design  Longitudinal impact evaluation (baseline 2010, endline 2012)  Operations research (2011)  Qualitative research to examine gender related topics including ownership and control over agricultural assets (2012)
    9. 9. Key gender-related questions Key Questions Impact evaluation Did the EHFP program increase women’s and men’s ownership of assets? x Were women able to maintain control over the EHFP activities and outputs? x Qualitative research Analysis Status Complete x Complete Did the land agreements and/or project activities influence community norms related to women’s land ownership or land rights? x Complete What trade-offs were women required to make in order to participate in the EHFP program? x On-going
    10. 10. Impact evaluation  Cluster randomized design • 30 intervention villages (~1200 households and 120 village farm leaders (VFL)) o o •  15 “older women leader” villages (OWL) 15 “health committee” villages (HC) 25 control villages (~800 households) Longitudinal • •  Baseline Feb-Apr 2010 (target children 3-12 months of age) Endline Feb-Apr 2012 (target children 21-40 months of age) Household interview • Male HH head and female key respondent, including sex disaggregated modules on asset ownership, agricultural production, income, household expenditures, knowledge on nutrition, household food security, dietary diversity, … • Anthropometric measures and hemoglobin status of target children
    11. 11. Qualitative research Operations Research (2011) GAAP* Qualitative Research (2012) Random sample of beneficiaries and nonbeneficiaries Beneficiaries: n=120 Non-beneficiaries: n=60 Beneficiaries: n=145 Non-beneficiaries: n=75 Purposive sample of key informants VFL: n=60 OWL: n=30 HC: n=30 Master agriculture trainers: n=18 Master nutrition trainers: n=24 VFL: n=60 OWL: n=30 HC: n=30 Land owners: n=30 Focus groups: n=24 (6m; 6f) Data collection May-June 2011 May-June 2012 May-June 2011 May-June 2012 Methods Semi-structured interviews Semi-structured interviews and focus group discussions *GAAP: Gender, Agriculture and Assets Project (www.gaap.ifpri.info) *HC: Health committee member *VFL: Village Farm Leader *OWL: Older Women Leader
    12. 12. Results Did the EHFP program increase women’s and/or men’s ownership of assets?
    13. 13. Ownership of assets: Household durables and agricultural assets *** *** Note: Comparison is to a control group that did not receive any program services. All estimates controlled for baseline age, sex, clustering, and attrition. All values are coefficient (SE). *** p <0.01
    14. 14. Ownership of assets: small animals Note: Comparison is to a control group that did not receive any program services. All estimates controlled for baseline age, sex, clustering, and attrition. All values are coefficient (SE). * *p<0.05, *** p <0.01
    15. 15. Were women able to maintain control over the E-HFP activities and outputs?
    16. 16. Control over EHFP activities and outputs: Gardens, vegetables, revenue Operations research: Round 1 (2011) Operations research: Round 2 (2012)
    17. 17. Control over EHFP activities and outputs: Chickens Operations research: Round 1 (2011) Operations research: Round 2 (2012)
    18. 18. Control over EHFP activities and outputs: Goats Operations research: Round 1 (2011) Operations research: Round 2 (2012)
    19. 19. Did the land agreements and/or project activities influence community norms related to women’s land ownership or land rights?
    20. 20. Community norms related to women’s land ownership and land rights: Perceived changes by men and women on women’s ability to own and use land Women Intervention villages Change in own opinion about who can own and/or use land for the production of fruits and vegetables Perceived changes in other people’s opinions about who can own and/or use land for the production of fruits and vegetables Perceived changes related to women’s ability to own land in the village Perceived changes related to women’s ability to use land for growing food in the village Control villages Men Intervention villages Control villages HC n = 70 46 (66) OWL n = 75 49 (68) All n = 145 95 (67) Control n = 75 11 (16) HC n = 57 32 (56) OWL n = 58 36 (62) All n = 114 68 (60) Control n = 60 14 (23) n = 56 24 (43) n = 56 31 (55) n = 112 55 (49) n = 65 8 (12) n = 46 21 (46) n = 51 24 (47) n = 97 45 (46) n = 52 5 (10) n = 69 18 (26) n = 67 15 (22) n = 136 33 (24) n = 73 1 (1) n = 57 16 (28) n = 59 15 (25) n = 116 31 (27) n = 60 2 (3) n = 68 29 (43) n = 70 32 (46) n = 138 61 (44) n = 74 3 (4) n = 55 27 (49) n = 53 21 (40) n = 108 48 (44) n = 61 1 (2)
    21. 21. Trade-offs required for participation in the EHFP program • Only 11% of beneficiaries (13/118) stated that taking care of the garden interferes with their other activities (e.g. outside work and domestic tasks). • None of the beneficiary women interviewed thought that taking care of their chickens interfered with their other activities. • 18% of women (16/89) stated that there were costs to working at the VMF including having to neglect their domestic work, taking care of their children, not being able to go to the market, and that it takes time to go and work at the VMF.
    22. 22. Summary Key Question Summary Did the EHFP program increase women’s ownership of assets? Yes, the E-HFP program had a positive impact on women's ownership of agricultural assets and small livestock. Did the EHFP program also influence men’s asset holdings? Yes, the E-HFP program had a negative impact on men's ownership of agricultural assets which was about equal to the positive impact on women’s ownership of agricultural assets. The program had a positive impact on men’s ownership of small livestock which was larger than that for women. Were women able to maintain control over the EHFP activities and outputs? Yes, especially in regards to the garden activities. Vast majority of women were mainly responsible for decisions related to what to grow and were able to keep income generated from sale of produce.
    23. 23. Summary , cont’d Key Question Summary Did the land agreements and/or project activities influence community norms related to women’s land ownership or land rights? Yes, in beneficiary villages some change was noted in people’s opinions about who could own and use land. Both men and women in beneficiary villages reported that women’s ability to own and use land had changed in the past two years. This was rarely reported in control villages. What trade-offs were women required to make in order to participate in the EHFP program? Only about 11% of respondents reported that taking care of their gardens affected their other activities. 18% said that working at the VMF had costs (e.g. time and neglect of domestic work).
    24. 24. References
    25. 25. EXTRA SLIDES
    26. 26. Why pay attention to gender in leveraging agriculture for nutrition? • “Women are important in agriculture, and agriculture is important for women” (Doss 2009; Meinzen-Dick et al. 2011) • Women are generally disadvantaged as agricultural producers: limited access to physical assets (ag inputs, technological resources, land), lack of capacity to use assets, disadvantaged in terms of non-tangible assets e.g. social/human capital, decisionmaking power • Women and men within HH often do not have the same preferences for allocating resources (Alderman et al. 1995; Hoddinott and Haddad 1995; Quisumbing and Maluccio 2003; Quisumbing 2003) • Increasing women’s control over assets (esp. financial/physical) has been shown to positively impact food security, child nutrition, education, women’s own well-being (Quisumbing 2003; Smith et al. 2003; World Bank 2001); gender differences in bargaining power over HH resources matter.
    27. 27. Agriculture—gender—nutrition pathways Arimond et al. (2010) identified 5 pathways through which agriculture interventions can affect nutrition: i) Increased food for own consumption through production* ii) Increased income through production for sale in markets* iii) Reductions in market prices (increased production) iv) Shifts in consumer preferences v) Shifts in control of resources within households* All mediated by gender roles, especially (*)  Limited evidence of the impact of agricultural interventions on nutrition outcomes (except for Vitamin A); hardly any evidence on impact pathways (Ruel and Alderman 2013).  Women’s empowerment interventions considered an important pathway through which agriculture can improve nutrition. But limited and mixed evidence (Ruel and Alderman 2013; van den Bold et al. 2013).
    28. 28. Linking gender and nutrition  Women are often primary caregivers: they influence their child’s nutrition indirectly through their own nutritional status and directly through child care practices  Various studies have looked at links between nutrition and dimensions of female empowerment (e.g. bargaining power, involvement in decisionmaking, mobility, access to information, control over assets) • Positive associations b/w female empowerment dimensions and nutrition outcomes and b/w dimensions of female disempowerment (e.g. domestic violence) and adverse nutritional outcomes (van den Bold et al. 2013) • Women’s relationships with men in the household (HH) and community can affect their bargaining power and ability to direct HH resources to nutrition
    29. 29. Definitions of Key Terms Undernutrition exists when insufficient food intake and repeated infections result in one or more of the following: underweight for age, short for age (stunted), thin for height (wasted), and functionally deficient in vitamins and/or minerals (micronutrient malnutrition). Malnutrition is a broad term that refers to all forms of poor nutrition. Malnutrition is caused by a complex array of factors including dietary inadequacy (deficiencies, excesses or imbalances in energy, protein and micronutrients), infections and socio-cultural factors. Malnutrition includes undernutrition as well as overweight and obesity (Shakir, 2006a). Food security exists when all people, at all times, have physical, social and economic access to sufficient, safe and nutritious food that meets their dietary needs and food preferences for an active and healthy life. Household food security is the application of this concept to the family level, with individuals within households as the focus of concern (FAO, 2009b). Food insecurity exists when people do not have adequate physical, social or economic access to food as defined above (FAO, 2009b). 35 SCN 6th World Nutrition Situation Report. www.unscn.org/files/Publications/RWNS6/report/chapter4.pdf
    30. 30. Did exposure to nutrition education diffused through village health committee members (HC) increase knowledge and uptake of new practices as compared to that diffused through older women leaders (OWL) or vice versa?
    31. 31. Impact of the EHFP program on nutrition knowledge: IYCF practices Give colostrum to children Children < 6 months of age should not drink any liquids other than breast milk Begin giving liquids other than breast milk at 6 months of age Begin giving semi-solid foods at 6 months of age N=1,138 N=1,144 N=1,129 N=1,142 N=1,149 0.16*** 0.092*** 0.23** 0.13** 0.13** (0.054) (0.029) (0.094) (0.063) (0.055) HC villages 0.17*** 0.080*** 0.23*** 0.19*** 0.17*** p-value (0.052) 0.006 (0.029) 0.009 (0.078) 0.006 (0.059) 0.007 (0.059) 0.011 Give breast milk within the first hour after birth OWL villages
    32. 32. Impact of the EHFP program on IYCF practices: Dietary diversity among children 3-12 months of age at baseline Met minimum dietary diversity requirement n=691 Older women leaders Health committee p-value 0.12* (0.070) 0.098 (0.077) 0.14 Note: Comparison is to a control group that did not receive any program services. All estimates controlled for baseline age, sex, clustering, and attrition. All values are coefficient (SE). * p<0.10
    33. 33. Impact of the EHFP program on infant and young child feeding practices: Intake of iron-rich foods among children 3-12 months of age at baseline Iron-rich foods n=662 Older women leaders Health committee p-value 0.15** (0.072) 0.023 (0.090) 0.13 Note: Comparison is to a control group that did not receive any program services. All estimates controlled for baseline age, sex, clustering, and attrition. All values are coefficient (SE). * *p<0.05
    34. 34. Impact of the EHFP program on nutritional status of children: Hemoglobin among children 3-12 months of age at baseline Hemoglobin (g/dL) Older women leaders Health committee p-value n=1144 0.24 (0.31) 0.49* (0.27) 0.19 Note: Comparison is to a control group that did not receive any program services. All estimates controlled for baseline age, sex, clustering, and attrition. All values are coefficient (SE). * p<0.10
    35. 35. Change in hemoglobin from baseline to endline among children 3-5.9 months of age at baseline Hemoglobin (g/dL) n=449 Older women leaders Health committee p-value 0.044 (0.32) 0.76** (0.30) 0.043 Note: Comparison is to a control group that did not receive any program services. All estimates controlled for baseline age, sex, clustering, and attrition. All values are coefficient (SE). * *p<0.05
    36. 36. Impact of the EHFP program on health-related knowledge: Hand-washing practices ** Note: Comparison is to a control group that did not receive any program services. Estimates controlled for baseline age, sex, clustering, and attrition. * p < 0.1, ** p < 0.05, *** p<0.01
    37. 37. Impact of the EHFP program on IYCF practices: Breastfeeding practices among children 3-12 months of age at endline ** Note: Comparison is to a control group that did not receive any program services. Estimates controlled for baseline age, sex, clustering, and attrition. * p < 0.1, ** p < 0.05, *** p<0.01
    38. 38. Impact of the EHFP program on nutritional status of children: HAZ among children 3-12 months of age at baseline
    39. 39. Impact of the E-HFP program on nutritional status of children: Wasting among children 3-12 months of age at baseline
    40. 40. Program theory framework for HKI’s HFP program in Burkina Faso Process Inputs Agriculture and zoological inputs distributed Village Model Farms (VMF) established HKI, APRG and governmental structures (Ministries of Health, Agriculture, Animals, Environment, and the Promotion of Women, local authorities and officials) work together Training in plant and animal production techniques for master trainers Develop a training strategy in animal; and plant production techniques Develop a behavior change communication (BCC) strategy with regards to Essential Nutrition Actions (ENA) Training in plant and animal production techniques for Village Farm Leaders (VFL) Establishment of individual farms (40 women per village) Increased availability of micronutrient -rich fruits and vegetables Increased availability of food from animal origin BCC training on ENA practices for beneficiaries Adoption of agriculture practices Beneficiaries received and understood BCC training on ENA practices Impact Increased Income Women’s empowerment improved Women’s assets increased Improvements in household consumption Improvements in nutrition and feeding practices for children, pregnant women and breastfeeding mothers Beneficiaries received and understood agriculture training BCC training on ENA practices for master trainers BCC training on ENA practices for village health workers (VHW) Improvements in fruit and vegetable production Improvements in small ruminant and poultry production Training in plant and animal production techniques for beneficiaries Outcomes Outputs Adoption of ENA practices by beneficiaries Improvements in care & hygiene practices for children, pregnant women and breastfeeding mothers Improved maternal and child health and nutrition outcomes
    41. 41. Map of study area
    42. 42. Table 3.1 Overview of methods and participants from health committee and older women leader intervention villages and control villag Impact Evaluation Intervention villages HC villages OWL villages Number of villages Number of households Baseline (2010) Household interview Endline (2012) Household interview Number of villages Number of households First round (2011) Basic semistructured interviews In-depth semistructured interviews Second round (2012) Semistructured interviews 15a 15 Control villages 25 511 512 734 1,757 590 1,470 Total 436 444 Qualitative Research Intervention villages HC villages OWL villages Total 55 14a 15 Control villages 15 70 28 75 30 75 30 220 88 70 75 75 220 44 Note: HC = health committee; OWL = older women leader. a One village from the HC intervention group dropped out of the program and study before the first round of qualitative research, resulting in a total of 14 villages for the first and second rounds of qualitative research and for the endline survey for the impact evaluation.

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