This document summarizes evidence on the impacts of family planning on nutrition and food security. It finds that family planning can positively impact nutrition outcomes like birth weight, stunting, and undernutrition. Short birth spacing and adolescent pregnancy in particular are linked to increased risks of malnutrition. Family planning also indirectly benefits nutrition by reducing maternal mortality and empowering women. Smaller family sizes can help ensure food availability and access by supporting sustainable agricultural production and increasing women's labor participation. The document recommends integrating family planning into nutrition and food security programs and policies to help leverage its benefits.

1. Impacts of family
planning on
nutrition and food
security
Reshma Naik
Ellen Smith
April 14, 2015

2. Background
USAID-funded: Health Policy Project
Collaboration between Futures Group and
Population Reference Bureau
Two evidence reviews: unidirectional impact
of family planning on: 1) nutrition; 2) food
security
Aim to inform policy and programming

3. Methods
Search methods: electronic databases, journal
reviews, USAID resources, organization
websites
Documents reviewed: peer reviewed articles,
technical briefs, guidelines, statements and
strategies, grey literature
Common themes identified

4. Context
Unmet Need
Direct impacts
Indirect impacts

5. Key nutrition outcomes
▪ Low birth weight
▪ Preterm birth
▪ Small-for-gestational age
▪ Breastfeeding*
▪ Stunting
▪ Underweight
▪ Wasting
▪ Body Mass Index
▪ Growth
▪ Micronutrient deficiency

6. Level of evidence varies
Weak Strongest

7. Guidelines
recommend waiting
after having a child
to
become pregnant

8. Illustrative evidence for infants conceived within 6
months of a previous birth:
 Conde-Agudelo (2006): 26% greater odds of
small-for-gestational age (vs. 18-23 months)
 Rutstein (2008). 42% greater odds of low birth
weight (vs. 36 – 47 months).
 Wendt (2012). 41% greater odds of pre-term birth
(vs. > 6 months).
Poor spacing leads to poor
infant nutrition

9. Illustrative evidence. Compared to children
conceived within an interpregnancy interval of 36-47
months:
 Those conceived within 6 months have nearly 40
percent greater odds of stunting and
underweight
 Those conceived within 12-17 months have
about 25 percent greater odds of stunting and
underweight
Poor spacing leads to poor child
nutrition
Rutstein 2014, 45 DHS Surveys

10. Adolescents are vulnerable to
malnutrition
15-20% height and 50%
weight attained during
adolescence
Require more protein,
iron, micronutrients
Pregnancy adds risk

11. Adolescent pregnancy can halt
growth and development
“Pregnancy and lactation during adolescence ceased
linear growth and resulted in weight loss and depletion
of fat and lean body mass of young girls.”
(Rah 2008, Bangladesh)
“Pregnant adolescents appear to adjust their resting
energy needs by ceasing growth.”
(Casanueva 2006, Mexico)
“[Pregnant] adolescents ages 15 years or younger had
higher risks for….anemia compared with women ages
20 to 24.”
(Conde-Agudelo 2005, Latin America)

12. Infants of young mothers are at risk for
undernutrition

13. Finlay et al. 2011, DHS data from 55 low and middle income countries
Compared to children with mothers 27-29 years,
children who have very young mothers (12-17
years) face higher risks of:
 Stunting
 Underweight
 Anemia
Children of mothers ages 12-14 years have a 51
percent greater risk of stunting
Children of mothers ages 15-17 have a 36 percent
greater risk of anemia
Children of adolescent mothers are
at risk for undernutrition

14. Other potential areas of linkage
Weaker Strongest

15. Feeding practices
Time, energy,
resources for optimal
feeding practices
Early weaning
Adolescent
breastfeeding

16. No strong, clear conclusions
More research needed when it comes to
mechanisms of action
Maternal depletion
16

17. Pregnancy intention
Inconclusive evidence about links
between unintended pregnancy and:
Birth outcomes
Exclusive breastfeeding
Stunting

18. Indirect impacts of family
planning on nutrition
Nutrition
Maternal mortality &
Women’s
empowerment

19. Reducing maternal mortality can
improve infant and child nutrition
In developing countries, women
face a 1 in 150 lifetime probability
of dying from maternal causes
Many pregnancies unintended
Family planning can reduce
exposure to risks of pregnancy and
child birth.
When mothers survive, children
survive

20. Increasing women’s empowerment
can improve nutrition
Decreases in fertility are
associated with
empowerment
In turn, empowerment can
improve nutrition

21. Food Security
PhotobyA.Davey

22. Four food security pillars
Food availability: sufficient quantities of
appropriate, necessary types of food are
consistently available or are within reasonable
proximity or are within their reach
Food access: individuals have adequate income or
other resources to obtain levels the amounts of
appropriate foods they need to maintain an
adequate diet/nutrition level.
Food utilization/consumption: individuals meet
the appropriate biophysical conditions to adequately
use food to meet their dietary needs.
Stability: the first three pillars are consistent over
time and are not lost as a consequence of sudden
shocks or cyclical events.

23. Pillar 1: Food availability
Agricultural outputs: increase by 70% by 2050
TFR of 2.1 by 2050 would reduce crop
demand:
 Globally, by 600 trillion kcal
 SSA, by 25%
High fertility can decrease the ability of
women to contribute to food production.
Climate change will decrease agricultural
production; adaptation is easier with fewer
people.

24. Pillar 1: Food availability
Rapidly growing populations and increased food
production demands can:
 Stress water supplies
 Force agricultural production onto marginal lands,
leading to deforestation, land degradation & soil erosion
 Lead to more intensive agriculture and lack of fallow time
 Shrink plot size for small farmers
PhotobyEllenSmith

25. Pillar 2: Food access
 Larger households spend
less per capita on food
 Poorer families spend a
larger percentage of their
expenditures on food; tend
to have higher unmet need
PhotobyEllenSmith

26. Pillar 2: Food access
Fertility can affect female labor force
participation:
 Fertility has “..large negative effect
of the fertility rate on female labor
force participation” (Bloom 2007)
 Women spend 0.5 years out of the
labor force for each child (Ashraft
2012)
 Having fewer, well-spaced
children increases female labor
force participation and educational
attainment (Lee-Rife 2012)
Photo by Oxfam/Aubrey Wade

27. Pillar 2: Food access
Matlab: Women in treatment area earned more for
each year of schooling, weighed more, had higher BMI
than women in comparison area.
Photo by Oxfam/Aubrey Wade

28. Pillar 3: Food Utilization and
Consumption
Pregnancy and breastfeeding
require greater energy and
nutrient intake
First 1000 days of life are
especially vulnerable to food
insecurity
Poor sanitation in high-growth,
poor urban areas can affect
absorption of nutrients.
PhotobyEllenSmith

29. Pillar 4: Food Stability
Women are less likely than men to
be resilient in the face of external
changes and shocks.
Early childbearing and early
departure from school can decrease
ability to adapt to shocks.
Maternal mortality and morbidity can
decrease food stability for entire
household.
PhotobyEllenSmith

30. What next?
Open up the dialogue about the role
family planning can play
Broaden our views on how family
planning can be better leveraged
Start integrating family planning into
nutrition and food security programs and
policies

31. www.healthpolicyproject.com
Thank You!
The Health Policy Project is a five-year cooperative agreement funded by the U.S. Agency for International
Development under Agreement No. AID-OAA-A-10-00067, beginning September 30, 2010. The project’s HIV
activities are supported by the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR). It is implemented by
Futures Group, in collaboration with Plan International USA, Avenir Health (formerly Futures Institute), Partners in
Population and Development, Africa Regional Office (PPD ARO), Population Reference Bureau (PRB), RTI
International, and the White Ribbon Alliance for Safe Motherhood (WRA).