Building Resilience through Nutrition-sensitive Programming in Bangladesh

Calories aren’t everything when it comes to food security. Healthy, diverse diets are critical, but many rural families in low- and middle-income countries can’t access or afford them.

“One way to improve diets is to increase incomes and develop value chains so people can purchase what they need in the market,” said John Hoddinott, an economist at Cornell University. “In the meanwhile, we can use shorter-term measures that encourage people to grow more diverse sets of foods on their own.”

From 2015-2018, Hoddinott took part in the design and testing of a program in rural Bangladesh that sought to improve nutrition. The program provided only information and training but it had real impacts on dietary diversity. Now the team is conducting a new study with MRR Innovation Lab support to learn whether these benefits for rural families sustained through two major shocks.

Two Approaches to Improving Nutrition

Historically, many countries, including the United States focused on addressing hunger and poor diets by providing food and nutritional supplements. This kind of nutrition-specific program dates back to the 1960s near the founding of the United States Agency for International Development (USAID). However, nutrition-specific programs don’t address the underlying causes of poor diets and nutrition.

More recently, interest in “nutrition-sensitive” programs is growing. These kinds of programs link insights from the nutrition sector with work in agriculture or social protection to address the underlying causes of poor nutrition.

“The idea is that you’re interested in improving some dimension of nutrition, such as the quality of people’s diets, and you do it through a related sector that is not nutrition itself,” said Hoddinott.

A 2018 paper co-authored by Agnes Quisumbing, an IFPRI economist and collaborator with Hoddinott, provides a comprehensive review of nutrition-sensitive agricultural programs, including studies on how agriculture can contribute to better nutrition.

Quisumbing and her co-authors wrote, “…nutrition-specific interventions alone, even if implemented at scale, will not meet global targets for improving nutrition. Other sectors need to contribute as well, and agriculture has strong potential due to the many ways in which it can influence the underlying determinants of nutrition outcomes…”

Malnutrition and Poor Diets in Bangladesh

In Bangladesh, dietary diversity is about more than just affordability. In many rural communities, a lack of electricity for cool storage means that fresh fruits and vegetables can quickly spoil.

Akhter Ahmed, also an IFPRI economist and collaborator with Hoddinott and Quisumbing, conducted a study on nutrition in Bangladesh that found people had deficiencies in micronutrients such as iron, zinc and iodine largely because their diets are dominated by rice.  

Ahmed, Quisumbing and Hoddinott came up with a nutrition-sensitive program for rural communities in Bangladesh that they thought would address three separate factors that affect nutrition: agricultural productivity, information about nutrition and gender inequality. They would also test whether combining all three would have bigger impacts than each on its own.

“You take three big themes and say to yourself, in a programmatic sense, is there value in pulling them together?” said Hoddinott. “There you have the genesis of the ANGeL project’s original design.”

Information to Improve Dietary Diversity

Agriculture, Nutrition, and Gender Linkages (ANGeL) was a 2015-2018 IFPRI-led project that put the ability to produce a diverse diet into the hands of households who already grew staple crops. The research team would measure how the three facets of the ANGeL programming—separately and combined—changed people’s diets.

The team developed a nutrition-focused curriculum and trained agricultural extension officers to deliver it. The main outcome would be measured in terms of dietary diversity across seven food groups.

“The program wasn’t telling people to grow everything,” said Hoddinott. “It was offering ideas about what they could do with the land they had available.”

The study found that providing information on nutrition on its own did increase people’s dietary diversity by 1/5 of a food group, on average. Adding information about agricultural productivity and gender sensitivity roughly doubled that effect to nearly half of a food group.

“This particular intervention provided only information,” said Hoddinott. “In that sense, it was a relatively low-cost program which generated modest but still valuable impacts.”

Maintaining Dietary Diversity in Spite of Shocks

Since ANGeL ended in 2018, a lot has happened in Bangladesh. Just a year later, Cyclone Fani struck with heavy rain and widespread flooding. Four of the 16 districts included in the ANGeL study reported damage, primarily to cropland and housing. Then came the COVID-19 pandemic.

Immediately after Cyclone Fani, Hoddinott, Ahmed and Quisumbing submitted a research proposal to the MRR Innovation Lab that would fund their follow-up research with households who took part in ANGeL. They initially planned to learn if the benefits of ANGeL lasted, whether or not households were affected by the cyclone. Since then, the team has added the impacts of the pandemic.

“The follow-on is to find out what happens after the intervention itself ends, particularly in an environment in which people have experienced shocks,” said Hoddinott. “Does this kind of program promote resilience in the longer term?”