Leveraging Agriculture for Nutrition Impact through the Feed the Future Initiative

CHAPTER ONE Leveraging Agriculture for Nutrition Impact through the Feed the Future Initiative Lidan Du*,1, Victor Pinga, Alyssa Klein }, Heather Danton } *Strengthening Partnerships, Results, and Innovations in Nutrition Globally, The SPRING project/helen Keller International SPRING/Save the Children } SPRING/JSI Research & Training Institute, Inc. 1 Corresponding author: e-mail address: lidan_du@jsi.com Contents 1. Background 2 1.1 The nutrition narrative 2 1.2 Renewed focus: Agriculture and nutrition linkages 4 2. Linking Agriculture and Nutrition 6 2.1 Current understanding of the linkages between agriculture and nutrition 6 2.2 The Feed the Future initiative 14 3. The Landscape Analysis of Feed the Future Activities 15 3.1 Background of landscape analysis 16 3.2 Key findings and considerations 18 3.3 Observations and discussion 23 3.4 Recommendations from landscape analysis 32 4. Moving Forward 34 4.1 Technical briefs on the connections between agriculture and nutrition 34 4.2 Understanding the connections between agriculture and nutrition in the food system 38 5. Conclusion 43 Acknowledgment 44 Disclaimer 44 References 44 Abstract Nutrition is a multisectoral problem; current state of empirical evidence for agricultural interventions impacts on nutrition is weak. In the past 10 years, both agriculture and nutrition have risen on the global policy agenda. Several recent international movements have created great momentum for nutrition among global political leaders and policymakers. The 2008 world food price crisis prompted larger investment pledges to agricultural development. Advances in Food and Nutrition Research, Volume 74 ISSN 1043-4526 http://dx.doi.org/10.1016/bs.afnr.2014.11.001 # 2015 Elsevier Inc. All rights reserved. 1

2 Lidan Du et al. The U.S. Government launched the Feed the Future initiative in 2009 to address global hunger and food security, with a primary goal to reduce poverty and undernutrition by simultaneously promoting inclusive agriculture sector growth and improved nutritional status for women and children. With operations in 19 focus countries, Feed the Future provides an important laboratory of learning where efforts can be effective and, once proven, taken to scale to make agriculture work for nutrition. The Strengthening Partnerships, Results, and Innovations in Nutrition Globally (SPRING) project has been conducting a series of research on the Feed the Future initiative. This chapter will first provide a review of the nutrition narrative in relation to food and nutrition, introduce the current understanding of linkages between agriculture and nutrition and the Feed the Future initiative's efforts to strengthen the nutritional impact of agricultural and economic growth activities, and describe an extensive review of how the design and early implementation of Feed the Future activities linked agriculture and nutrition. Finally, the chapter presents an updated framework that incorporates ways to improve nutrition outcomes of agricultural programming in the broader context of food system. 1. BACKGROUND 1.1. The nutrition narrative Every year, undernutrition causes an estimated 3.1 million deaths among children younger than 5 years of age worldwide, representing about 45% of all deaths in this age group. In 2011, there were approximately 165 million chronically malnourished children (as indicated through rates of stunting 1 ) worldwide, whose lifetime developmental potentials (intellectual and economic) would be compromised if no actions were taken (Bhutta et al., 2013). Malnutrition 2 is the result of many causes at different levels most immediately from inadequate dietary intake and diseases that affect the body s abilities to absorb and utilize the nutrients in foods. Three factors that underlie these two immediate causes are inadequate supply of food; inadequate availability and/or utilization of health services, clean water, and sound sanitation; and the lack of proper care for women and children. These are in turn affected by natural resources, sociopolitical, economic, cultural, and institutional factors. The conceptual framework for malnutrition developed by the United Nations Children s Fund (UNICEF) in 1990 illustrates the complexity of the malnutrition problem, and continues to be the 1 Stunting: having a height-for-age (or length, if the child s age is less than 2 years) Z-score that is more than 2 SD (standard deviation) below the median of the international reference. 2 Malnutrition is referring to undernutrition in this chapter unless otherwise indicated.

Leveraging Agriculture for Nutrition Impact through the Feed the Future Initiative 3 principal guidance to the design, implementation, and monitoring and evaluation of applied nutrition research and large-scale programming (UNICEF, 1990). The multisectoral nature of the nutrition problem is long established and widely accepted, but prevailing nutrition narratives varies with time. Malnutrition has been perceived to be primarily a food problem, exemplified by the legacy of the Green Revolution in the 1960s, when new seeds and higher production investments (labor, fertilizer, pesticides, irrigation, and other infrastructure) significantly increased the yields of rice and wheat in Asia (Gaud, 1968). Higher cereal output led to higher returns to land and lowered food prices. It was assumed that the increase in farmers real incomes would contribute to better nutrition by permitting people to consume more calories and a more diversified diet (International Food Policy Research Institute [IFPRI], 2002). However, the malnutrition rates among women and children did not improve substantially. The reasons for this failure are complex. First, the Green Revolution s nearly exclusive focus on production of a few staple crops helped address total calories available for consumption but failed to ensure adequate food access and purchasing power among the poor. In addition, this agricultural development movement could not address the micronutrient and protein deficiencies that continue to affect a majority of poor rural households in the developing world (Negin, Remans, Karuti, & Fanzo, 2009). The 1970s saw attempts to plan nutrition multisectorally (e.g., with health, agriculture, and education) as part of high-level development planning, but these efforts experienced a meteoric rise and fall. (Field, 1987)In taking a multisectoral approach, malnutrition was defined as a structural problem embedded in poverty and development. The attempt to plan for nutrition as a central component of development through multiple changes in socioeconomic conditions was ambitious, and called for a comprehensive and radical strategy that took into account conception, intent, and design and went beyond technical fixes. Such an approach required skills, resources, and data that did not exist in many developing countries. Additionally, planners and scientists seldom had the influence and power to create the political will or allocate resources to implement the comprehensive nutrition plan. In the subsequent 20 years, new nutrition initiatives were more sectorally focused, with nutrition generally considered as part of the health sector. Such interventions were more appealing to policymakers and practitioners alike, as they were simpler, direct, and organizationally more compatible

4 Lidan Du et al. with existing ministerial responsibilities. Since the early 1980s, nutrition has been framed in the context of primary health care, as seen in UNICEF s GOBI approach Growth monitoring, Oral rehydration therapy, Breastfeeding, and Immunization (UNICEF, 1996). Addressing infant and child mortality and malnutrition directly was suggested to be an instrument to assist a country s development process, instead of just a measurement. The proposed positioning of nutrition as central to development was later formally written in a 2006 World Bank document, based on evidence that investing in nutrition has excellent economic returns and is essential to reducing poverty more efficiently (World Bank, 2006). During these decades, rhetoric about the linkage between food and agriculture in the main nutrition narrative also varied. A recent historical World Bank review of agriculture- and food-based approaches to reducing malnutrition described how the perceptions of nutrition within the financial institution shifted from being part of multisectoral programming to a predominantly sectoral (and technical) issue, and then again to a priority item on the development agenda (Herforth & Tanimichi-Hoberg, 2014). The review noted that agriculture and nutrition parted ways in the 1980s after large integrated rural development projects that focused on agricultural development delivered disappointing nutrition results. Due to high food stocks and low food prices in the 1990s and 2000s, agriculture projects supported by the World Bank and across major aid agencies received less funding, and available investments became increasingly and almost singularly focused on productivity enhancement and market-led growth. In the meantime, nutrition-specific interventions aimed at improving nutritional status were showing results, but collaboration with agriculture was ignored and health/nutrition systems worked in isolation of food production systems. 1.2. Renewed focus: Agriculture and nutrition linkages Both agriculture and nutrition have risen on the global policy agenda in the past 10 years. Several recent international movements, such as the Scaling up Nutrition (SUN) movement and 2008 Lancet Series on Maternal and Child Nutrition, have created great momentum and given nutrition unprecedented attention among global political leaders and policymakers. 3 Additionally, the 2008 world food price crisis heightened 3 Such as the Millennium Development Goals (MDGs), the Scaling Up Nutrition (SUN) movement, Zero Hunger Challenge, and USAID s Global Health Initiative.

Leveraging Agriculture for Nutrition Impact through the Feed the Future Initiative 5 attention to agricultural development, and donor agency and country investment pledges to the agriculture sector rapidly increased. Major funding commitments were made through a number of initiatives that aimed to revitalize research and programming to connect agriculture, food security, and nutrition. 4 Against this background, the U.S. Government launched the Feed the Future initiative in 2009 to address global hunger and food security. The primary goal of this U.S. Agency for International Development (USAID)-led initiative is to reduce poverty and undernutrition by simultaneously promoting inclusive agriculture sector growth and improved nutritional status for women and children. As of June 2014, Feed the Future is active in 19 countries across Africa, Asia, and Latin America and the Caribbean (LAC). 5 These focus countries were selected based on five criteria: level of need, opportunity for partnership, potential for agricultural growth, opportunity for regional synergy, and resource availability. 6 The global Feed the Future strategy aims to reduce by 20% the prevalence of both poverty and stunted children under 5 years of age in the areas, known as the zone of influence (ZOI), where Feed the Future activities are concentrated. This chapter presents the findings from research of the Feed the Future initiative that was conducted by the Strengthening Partnerships, Results, and Innovations in Nutrition Globally (SPRING) project, a partner to USAID s Bureau for Global Health (GH) and Bureau for Food Security (BFS). Section 2 introduces the current understanding of linkages between agriculture and nutrition and highlights the Feed the Future initiative s efforts to strengthen the nutritional impact of agricultural and economic growth activities. The chapter then describes an extensive review completed in 2013 of how the design and early implementation of Feed the Future activities in the 19 focus countries linked agriculture and nutrition, based on a set of agriculture-to-nutrition pathways and programming principles. Finally, the chapter presents an updated framework that incorporates ways to improve nutrition outcomes of agricultural programming in the broader context of the food system. 4 USAID Feed the Future Initiative, The Global Agriculture and Food Security Program (GAFSP), Comprehensive Africa Agriculture Development Programme (CADDP). 5 Bangladesh, Cambodia, Ethiopia, Ghana, Guatemala, Haiti, Honduras, Kenya, Liberia, Malawi, Mali, Mozambique, Nepal, Rwanda, Senegal, Tanzania, Tajikistan, Uganda, and Zambia. 6 The criteria are outlined by the US Government on the Feed the Future Website: http://www. feedthefuture.gov/approach/improved Nutrition#focus-areas.

6 Lidan Du et al. 2. LINKING AGRICULTURE AND NUTRITION 2.1. Current understanding of the linkages between agriculture and nutrition The recognition and discussions of nutrition-specific and nutrition-sensitive interventions was a critical difference in the scope and content between the 2008 and 2013 Lancet series on maternal and child nutrition. The 2013 series pointed out that only 20% of stunting in children younger than 5 years can be averted if the 10 evidence-based nutrition (specific) interventions can achieve 90% coverage (Bhutta et al., 2013). The 2013 series goes on to note that in order to reach the other 80% of stunted children, a combination of nutrition-sensitive and nutrition-specific interventions are needed. Nutrition-sensitive interventions address the underlying determinants of malnutrition, such as food, care, and health; whereas nutrition-specific interventions that address the immediate determinants of malnutrition, such as dietary intake and diseases (Ruel, Alderman, & The Maternal and Child Nutrition Study Group, 2013). Clearly, if a larger impact on nutrition is to be made, it would require better integration of agricultural and nutrition activities. Notable research has been conducted to delineate the pathways between agriculture and nutrition, and the results are presented in a series of working papers and briefs by IFPRI (Gillespie, Harris, & Kadiyala, 2012; Hawkes & Ruel, 2006; Headey, Chiu, & Kadiyala, 2011) and a report by the WorldBank(2007). Though the authors present varying numbers of pathways, the iterations can be summarized into the three categories outlined below. 2.1.1 Agriculture and nutrition pathways While agriculture may be seen only as a source of diverse nutritious foods and income, in reality its effect on nutrition is multifaceted, especially considering the critical role women play in agriculture. First, agriculture supports a healthy, active life through foods produced within and for household consumption and by sourcing foods available in markets. Second, agriculture as a livelihood source provides income to purchase food and health care. Third and equally important though less obvious link of agriculture to nutrition is how agricultural livelihoods affect gender relations and the status of women. Women s time availability, energy expenditure, and access to and control over household income affect their own and their

Leveraging Agriculture for Nutrition Impact through the Feed the Future Initiative 7 children s health and nutrition status. These key pathways regularly interact and are not always linear (Fig. 1). 7 2.1.1.1 Production! Consumption pathway Household food production is critically important to the diets and nutrition of individuals in smallholder farmer households. The decisions that farmers make about crop and livestock production are affected by many factors, including potential market prices, relative costs and risks associated with each product, the assets and endowments of the land the household possesses, and family needs and preferences. If preferred foods or varieties are not consistently available, affordable, or accessible in markets, raising or growing them may be the most efficient way to obtain them. Substituting a more nutritious variety of a crop already grown for consumption (e.g., yellow vitamin A maize for white maize, or orange cassava for regular cassava) may be an easy way to improve nutrition as part of the overall set of livelihood decisions. Processing and storage can affect the shelf life, safety, and nutritional content of foods in both positive and negative ways. For example, storage conditions can affect the level of mycotoxin contamination (Yohe & Williams, 2005); drying meats, fruits, vegetables, and fish and producing cheese can reduce losses and make nutritious foods available out-of-season for both home consumption and sale in local markets (Rahman, 2007). In general, however, it is not the primary objective of an agricultural livelihood to produce all of the foods that a family needs; in fact, most poor rural families are net purchasers of food. Food production affects the type, quantity, and seasonality of food available in the household for consumption. Production also influences the availability and prices of diverse foods in local markets. A combination of food produced for consumption and income and local food availability and prices determine a family s food security. 2.1.1.2 Income! Food and health care purchase pathway Establishing and maintaining successful small farming businesses that ensure livelihoods is critical for reducing poverty in rural areas. Therefore, one primary objective of most Feed the Future activities is to increase household income through agriculture. Improved year-round income and cash flow 7 The description of the pathways and the enabling environment is excerpted in part from SPRING s technical brief Understanding and Applying Primary Pathways and Principles. Brief #1. Available at: http:// www.spring-nutrition.org/publications/briefs/understanding-and-applying-primary-pathways-andprinciples.

National economic growth National nutrition outcomes Food prices Social and behavioral change communication Household assets and livelihoods Food production Income (Agricultural and Nonagricultural) Female employment/ resources Food expenditure Nonfood expenditure Food consumption Health care expenditure Caring capacity and practices Nutrient intake Health status Female energy expenditure Child nutrition outcomes Mother s nutrition outcomes Figure 1 Conceptual pathways between agriculture and nutrition. Adapted from Gillespie et al. (2012).

Leveraging Agriculture for Nutrition Impact through the Feed the Future Initiative 9 can be used for immediate or future household needs, including food and nonfood purchases to support a healthy diet and life. The agriculture income pathway assumes that nutrient-dense, diverse foods are available and affordable in local markets, so appropriate inputs must be available and affordable to support local production of these diverse foods. Additionally, market and transportation systems must also be established to enable year-round and/or seasonal supplies based on consumer preferences and purchasing power. The effect of income on nutrition is not direct or easily predictable. It varies based on what is available, affordable, and convenient to purchase; who decides what is purchased, and the myriad factors that drive those decisions. All rural farm households must balance spending decisions between farm production and marketing investments, and the immediate purchase of food, health, and care necessities. Food purchase decisions may prioritize caloric adequacy over nutritional value. Food purchases are also influenced by taste, preference, custom, and norms including food taboos, and by food company marketing strategies. Purchasing power is greatly affected by income, prices, and the quantity and quality of food available in the market. Local supply and demand may also be influenced by social and behavioral change (SBC), nutrition knowledge, and social marketing, which may help drive consumer preferences. At the same time, household investments in health, including potable water sources and toilets, preventive care, and other basic necessities, are crucial to supporting good nutrition, especially for women and young children. 2.1.1.3 Women's empowerment pathway Women s empowerment incorporates multiple aspects including the decision-making power related to income, time, labor, assets, and knowledge and preferences of female community members. Increasing agricultural income that women can control strengthens income pathway to nutrition (described in Section 2.1.1.2). Often, the best way for women to influence how household income is spent is by earning their own income. Women s income enables expenditures on food and health care, affecting diet and health status, as research shows that in many places around the world, income controlled by women is more frequently used on food and health care for the family, particularly for children (Smith, Ramakrishnan, Ndiaye, Haddad, & Martorell, 2003; UNICEF, 2011). Control of household income may be shifted by changing the nature of the household s agricultural livelihood as described above, or by intra-household behavior

10 Lidan Du et al. change that promotes equitable decision-making within the household, leading to food and health care purchase decisions that prioritize maternal and child health and nutrition. Here the influence of other household members, such as that of mothers-in-law, must also be considered. Agricultural development interventions can strongly affect women s use of time as well as their labor burden. Women are typically responsible for a wide range of household and agricultural tasks, including child and infant care and feeding and their own self-care. Activities that influence the amount of time or labor women spend on agriculture-related tasks can affect their own health and energy expenditure, and in turn their capacity to feed and care for infants, young children, and themselves. For this reason, improving nutrition in a household with an agricultural livelihood requires that farming business decisions consider how women are involved in agriculture activities. For example, if agriculture development activities strive to promote the production of various nutritious foods with high market value and increase women s income, they must be designed and monitored to ensure they do not increase women s time and labor burdens. Womenfriendly labor-saving technologies, labor-sharing arrangements to ease the energy and time burdens of pregnant and lactating mothers, and innovations to provide proper child care services while women are at work, can all contribute to improved maternal and child health and nutrition outcomes. 2.1.1.4 The enabling environment for the pathways The three pathways discussed above are conceptualized at the household and individual levels. However, individual and household access to food, health, and care is influenced by an enabling environment surrounding the household. The key components of this enabling environment include the food market; natural resources; health, water, and sanitation; and the community s knowledge and norms regarding health and nutrition (Herforth & Harris, 2014). 2.1.1.4.1 Food market environment Feed the Future promotes inclusive agricultural sector growth that expands markets and trade for smallholder farmers. The food market environment affects the kinds of foods that are available for purchase by consumers, as well as those likely to be produced by farm households as they both respond to price signals and market incentives. The food market environment determines what surplus from household production gets sold and what gets consumed. In addition, the

Leveraging Agriculture for Nutrition Impact through the Feed the Future Initiative 11 physical location of markets may also influence the access of households to diverse, nutritious foods. Government policies and the actions of the private sector affect the availability and affordability of food in the market. For example, open international trade policies increase the availability in local markets of imported food and beverages that can significantly affect local diets. By the same token, favorable tax policies may increase household access to nutrientdense food products. Government market policies and actions, such as incentives to bring safe, nutritious foods to market through public or private channels, nutrition labeling laws, and social marketing, improve household access to diverse, nutritious foods and broader nutrition awareness and knowledge, and therefore household demand for nutrition. Labeling and social marketing, for example, are tools that have been used by the food marketing industry and other value chain actors to influence food purchase decisions and consumption habits. This type of marketing may influence what people eat more extensively than nutrition education. Purchase decisions are affected not only by the relative price of different foods, but also factors such as convenience of purchase and preparation, available information about foods, and related perceptions of quality and safety. The food environment therefore interacts with household decision-making and food purchases in many ways and has a significant influence on household and individual nutrition. 2.1.1.4.2 Natural resources environment The natural resources environment, especially soil, water, and climate, determines the types of crops and livestock produced by households for sale or its own food consumption. This is especially relevant in the context of shortened crop seasons, floods, and premature harvests causing yield declines and greater variability in household agricultural income. The lack of access to productive agricultural lands (those with good soil and access to water) affects household livelihoods and food security status, particularly for women, due to cultural norms and/or political influence that are less supportive of women s share of scarce natural resources. In addition, when women are forced to farm distant or undesirable land, it imposes additional time and labor burdens on them. The natural resources environment may also be the medium for harmful agricultural by-products, such as agrochemicals, microbes from livestock and other pollutants, and disease vectors that have immediate and long-term effects on health and nutrition. The appropriate management of these often

12 Lidan Du et al. scarce natural resources is critical to a successful farming business. For example, rainfall patterns directly affect production cycles of farms with or without access to irrigation. When water is scarce, it can be difficult to balance water for use in agriculture with water for household use and consumption, and the result can have a significant impact on health. Soil quality directly affects the quality and yield of crops, and maintaining fertility over time is a primary consideration in farming as a source of food and income. With changing climate patterns, the predictability of farm production cycles is also affected. Early or late onset of rains, floods, droughts, shortened crops seasons, and premature harvests are causing yield declines. These challenges require farmers to continually adapt their agricultural strategies to maintain the viability of crops and livestock. 2.1.1.4.3 Health, water, and sanitation environment Nutritional status and agricultural production are strongly influenced by the health, water, and sanitation environment and access to health services. Agricultural practices may contaminate water available for household use (e.g., with agrochemicals or microbes from livestock); water management may contribute to waterborne diseases (e.g., when standing water creates reservoirs that harbor disease vectors); and exposure to zoonotic disease or agrochemicals poses risks to human health, particularly during pregnancy. Infants and young children may be at risk of illness when livestock or agricultural production diminishes household sanitary conditions. With compromised systems, children are unable to properly absorb nutrients, thus negating potential positive nutrition outcomes from increases in agricultural production or income. Illness and poor health, whether resulting from agricultural practices or not, may affect household agricultural productivity as a whole. For example, food production and income generation are compromised by a lack of labor in households or communities experiencing chronic or seasonal illness. A key component of nutrition-sensitive agriculture therefore includes consideration of the agricultural activities potential effects on the health, water, and sanitation environment. 2.1.1.4.4 Knowledge and norms Family and community knowledge has a major bearing on household agriculture and nutrition decisions. Feed the Future activities that promote nutrition and health knowledge may affect food production, purchase, and consumption decisions that enhance positive outcomes for both the agriculture and nutrition sectors

Leveraging Agriculture for Nutrition Impact through the Feed the Future Initiative 13 while avoiding negative impacts. An example of this can be seen in activities that promote farm management and business planning skills, as these have proven to be essential for successful farmers (Herforth & Harris, 2014). Business planning should take household expenses and cash flow needs, both planned and unplanned, into account. A smallholder business plans must include costs for the purchase of healthy foods, antenatal care, and unforeseen illness to benefit the family s livelihood, nutrition, health, and well-being. Decisions that result in improved market access and income for farm households require knowledge and skills in production, storage, processing, selling, and marketing, to name a few of the many areas in which farmers are expected to be experts. The knowledge and use of key agricultural practices and skills can easily include information that builds awareness and protects against harm to health and nutrition. For example, nutrition-sensitive livestock-raising practices may change how animals are kept in relation or proximity to the home, and nutrition-sensitive irrigation practices prevent water for agriculture from contaminating household water. SBC activities promoting nutritious diets and healthy practices whether provided within an extension system or as part of a collaboration with other sectors can enhance the impact of agriculture activities on nutrition (Herforth & Harris, 2014). 2.1.2 Guiding principles Researchers and practitioners have recently agreed upon a set of guiding principles for improving nutrition through agriculture. The United Nations Food and Agriculture Organization (FAO) synthesized the recommendations after a review of 20 documents published by 12 different institutions since 2008. The resulting recommendations broadly fit into three categories: planning a program or policy; main program activities; and a supporting set of factors based on governance, policy, and capacity (FAO, 2013a). USAID helped identify and sharpen these recommendations through discussions and country presentations at regional workshops. The collaborative process yielded a consensus list of 10 key principles for programming and five principles for policy (excerpted in Box 1). The 10 programming principles include broadly supported priorities that seem to be common among for nutrition-sensitive agriculture activities that have shown a positive impact.

14 Lidan Du et al. BOX 1 Key Recommendations for Improving Nutrition Through Agriculture Programming principles 1. Incorporate explicit nutrition objectives and indicators into design. 2. Assess the local context. 3. Target the vulnerable and improve equity. 4. Collaborate and coordinate with other sectors. 5. Maintain or improve the natural resource base, particularly water resources. 6. Empower women. 7. Facilitate production diversification, and increase production of nutrientdense crops and livestock. 8. Improve processing, storage, and preservation of nutritious food. 9. Expand market access for vulnerable groups and expand markets for nutritious foods. 10. Incorporate nutrition promotion and education that builds on local knowledge. Policy principles 1. Increase incentives (and decrease disincentives) for availability, access, and consumption of diverse, nutritious, and safe foods. 2. Monitor dietary consumption and access to safe, diverse, and nutritious foods. 3. Include measures that protect and empower the poor and women. 4. Develop capacity to improve nutrition through the food and agriculture sectors. 5. Support multisectoral strategies to improve nutrition. 2.2. The Feed the Future initiative As previously stated, Feed the Future is a U.S. Government initiative that aims to improve nutrition through agriculture-led activities to reduce poverty and undernutrition. Since the inception of the initiative, USAID Missions in all focus countries have developed multiyear strategies that outline plans for focused investments in specific geographic zones, whole-of-government programming, activity implementation, and stakeholder coordination. Most Feed the Future multiyear strategies were approved between February 2011 and March 2012. The Feed the Future Results Framework (Fig. 2) highlights Feed the Future s two main objectives: inclusive agriculture sector growth, and improved nutritional status of women and children.

Leveraging Agriculture for Nutrition Impact through the Feed the Future Initiative 15 Feed the Future Goal Sustainably Reduce Global Poverty and Hunger Indicators: Prevalence of poverty and Prevalence of underweight and stunted children Objective Inclusive agriculture sector growth Objective Improved nutritional status (women and children) Improved agricultural productivity Expanded markets and trade Increased investment in agriculture and nutritionrelated activities Increased employment opportunities in targeted value chains Increased resilience of vulnerable communities and households Improved acces to diverse and quality foods Improved nutrition-related behaviors Improved use of maternal and child health and nutrition services Figure 2 Feed the Future results framework. Feed the Future investments focus on regions, value chains, agricultural research, and technologies that can have the greatest impact on reducing poverty. Working through these investments using a multisectoral approach in partnerships with other global food security actors, Feed the Future aims to reduce the prevalence of both poverty and stunting in children under 5 years of age in the areas where it works by 20% (Feed the Future Progress Scorecard June 2013, 2013). 3. THE LANDSCAPE ANALYSIS OF FEED THE FUTURE ACTIVITIES The Strengthening Partnerships, Results, and Innovations in Nutrition Globally (SPRING) project is a 5-year (2011 2016) USAID-funded project that focuses on preventing stunting and maternal and child anemia in the first 1000 days. To achieve this goal, SPRING is helping USAID Missions make agricultural investments that will contribute to measurable improvements in nutrition, especially in USAID s Feed the Future focus countries. In 2013, SPRING and USAID organized a series of regional Agriculture and Nutrition Global Learning and Evidence Exchange (AgN-GLEE) workshops. These workshops convened USAID staff, national program leaders, implementing partners, and technical assistance providers to focus

16 Lidan Du et al. on links between agriculture, economic growth, and the pathways that can contribute to reducing undernutrition and to better understand current evidence about these linkages. The workshops were informed by findings from a landscape analysis of Feed the Future activities in 19 countries. This section outlines the objectives, the methods used in the landscape analysis, and identifies several challenges and opportunities large-scale Feed the Future programs face that need to be addressed in order to make agriculture work for nutrition outcomes. 3.1. Background of landscape analysis 3.1.1 Objective The purpose of the landscape analysis was to map current interventions in agriculture and economic growth activities and nutrition and health activities under Feed the Future and the linkages between the two sectors. The objective was to understand how these activities affect the nutritional status of target beneficiaries, primarily women of reproductive age and children under 5 years of age. 3.1.2 Scope For each of the 19 focus countries, a comprehensive review of USAIDsupported Feed the Future strategies and activities was conducted to identify the Mission s implementation status and operational approach, including the main interventions supporting agriculture, the direct nutrition and health activities, the integrated multisectoral interventions, and the relevant pathways linking agriculture and nutrition. The landscape analysis was not designed to assess the effectiveness of these activities. 3.1.3 Frameworks for landscape analysis The landscape analysis and the structure of the country portfolios were grounded in two frameworks: the agriculture-to-nutrition pathways and guiding principles as presented in Section 2. As explained earlier, these two frameworks were identified to streamline the data extraction from the documents reviewed and facilitate in-depth analysis of these data because they were developed using the best available global evidence of the linkages between agriculture and nutrition. Six guiding principles were determined to be most relevant to the scope of this landscape analysis. These six principles covered the agriculture nutrition program planning phase (targeting and multisectoral coordination) and action phase (production of diverse

Leveraging Agriculture for Nutrition Impact through the Feed the Future Initiative 17 Nutrition objective M & E to capture and attribute impact Coordinate multisectorally Incorporate nutrition behavior change communication Target the nutritionally vulnerable Empower women Design by context Increase production of diverse, nutrient-dense foods and improve processing Increase market access and opportunities for nutritious foods Activities sustain the natural resource base Figure 3 Key Guiding Principles to Improve Nutrition Impact through Agriculture, adopted from (FAO, 2013a). foods, increasing market access, incorporating SBC, and women s empowerment), as seen in Fig. 3. 3.1.4 Limitations of landscape analysis The landscape analysis had several limitations. First, the exercise had a tightly defined scope to focus on linkages between agriculture (and economic growth) and nutrition, and to inform the AgN-GLEE workshops agenda and discussions. The scope of the landscape analysis did not include assessing activity design and implementation details or indicator selection and monitoring and evaluation plans. Second, the landscape analysis relied primarily on documents supplied by the Missions, which were often not up-to-date because of regulations on sharing procurement-sensitive information and delays between action and reporting. In addition, field research was limited in scale as many Feed the Future activities had just commenced implementation at the time of the review. Therefore, the most-current situation on the ground may not be captured. Finally, staff turnover in some Missions affected the completeness of information collection, especially on the initial design phase of Feed the Future activities and strategies.

18 Lidan Du et al. 3.2. Key findings and considerations In this section, select findings are presented. All information is current as of January 2013 for African countries and April 2013 for LAC and Asian countries, unless otherwise noted. 3.2.1 Activity approaches The landscape analysis found that Feed the Future adopted three main approaches for implementing agriculture and nutrition interventions. A number of Missions used more than one. Integrated and/or flagship activities: Where the Missions take this approach, a leading activity spearheads a Mission s Feed the Future work. Such activities may provide both agriculture and nutrition services through an integrated delivery platform; they may also focus on providing services that are either primarily agricultural or primarily nutrition related. Examples of this approach are found in Honduras and Cambodia. Co-locating activities: This approach involves placing multiple activities each usually focusing on a single intervention type (e.g., health and nutrition, agriculture, or economic growth) in one geographic area. The level of overlap in areas and target population among activities is different. In Bangladesh and Guatemala, all activities work within the same units in the ZOI. Activities in Uganda and Zambia have only partial overlap in geographic area within the ZOI. Retrofitting ongoing activities: Activities following this approach modified activities that were designed and implemented before Feed the Future s inception by incorporating new or strengthened nutrition interventions, indicators, or geographic targeting to respond to Feed the Future mandates. 3.2.2 Target populations The documents reviewed clearly stated that the primary targets of Feed the Future agriculture and economic growth interventions are smallholder farmers, including women, whereas direct nutrition and health activities under Feed the Future mostly target women and young children. Gender: Nearly half of activities specifically target women of reproductive age (including pregnant and lactating women), and children under two (e.g., in Bangladesh, Nepal, Tajikistan, and Zambia) or under 5 years of age (e.g., in Haiti, Ethiopia, and Ghana) with nutrition and health interventions. There was little information about men s participation

Leveraging Agriculture for Nutrition Impact through the Feed the Future Initiative 19 and responsibilities relating to nutrition, except in a few activities that focus on all household members (e.g., Cambodia, Honduras). Vulnerable populations: Activity documents and multiyear strategies often refer to vulnerable farmers as target beneficiaries. However, most activities actual beneficiaries appear to be smallholder farmers who possess or have access to some productive assets, such as farmers who own less than one hectare of land and live at or near the country-defined poverty level, and often exclude the most destitute population in the ZOI. 3.2.3 Value chains and the selection criteria Feed the Future emphasizes a value chain approach to advancing broadbased growth through development of the agriculture sector. A value chain is a supply chain in which value is added to the product as it moves through the chain... described by the series of activities and actors along the supply chain and by what and where value is added along the way for and by these activities and actors (Hawkes & Ruel, 2011). In the documents reviewed, Feed the Future activities identified many potential crops for value chain development, and they are grouped into eight categories (Fig. 4), based on: Relevance to health and nutrition: Four categories grains, roots, and tubers; legumes and nuts; animal-sourced foods (i.e., dairy, eggs, and flesh meats from mostly small animals and aquaculture); and foods from horticulture (i.e., fruits and vegetables) were created to capture the food groups used to measure minimum acceptable diet (MAD) for children aged 6 to 23 months and women s dietary diversity, as listed in the Feed the Future Indicator Handbook (Feed the Future Indicator Handbook: Definition Sheets, September 2013). Relevance to agriculture and economic growth: Four categories (cash crops; conventional fortification of staple crops, biofortified crops; and indigenous foods) were created to capture the interest of Feed the Future investments in agriculture and economic growth, specifically in income generation, agricultural technology, and sustainability. 3.2.3.1 Factors behind value chain selection Documents reviewed for the landscape analysis, especially those outlining the multiyear strategies, cited numerous factors in determining which value chains would be developed under Feed the Future activities. These factors can be grouped into six distinct categories (Fig. 5). Globally, nutrition impact and income growth potential were cited by almost all countries, supporting Feed the Future s twin goals of reducing poverty and eliminating

20 Lidan Du et al. Figure 4 Value chains by country. Note: Value chains mentioned in Feed the Future country strategies and the request for proposal reviewed, but whose production could not be confirmed in other documents at the time of review are included in the table as (X). Number of countries 20 18 16 14 12 10 8 6 4 2 0 Income potential Nutrition impact Gender Figure 5 Value chain selection by factor. Africa LAC Asia Govt/ donor Food security Number of farmers

Leveraging Agriculture for Nutrition Impact through the Feed the Future Initiative 21 hunger. Because gender is a cross-cutting theme of Feed the Future, many countries were explicit about the intention to involve women in value chain activities or to invest in crops traditionally tended by women. 3.2.3.2 Regional emphasis Different regions had varying considerations in the selection of the value chains for development. Africa: Missions commonly cited the interests and opinions of the United States Government, the host country government, external experts, and donor organizations as influential. Asia: Missions were consistent in combining considerations of poverty, undernutrition, and number of farmers already involved in production of specific types of food items when selecting target value chains. LAC: All three focus country Missions selected value chains based on their potential contribution to food security. Multiyear strategies and activity documents described other factors that influenced value chain selection, among them availability of land and water; demographic trends and characteristics; climate issues; and biodiversity threats. A few activity documents also described considering unmet domestic demand for certain crops, including vegetables, and the potential for technical improvement relating to a certain crop or farming type (e.g., seeds and farming technologies for rice and aquaculture). 3.2.4 Integration of nutrition in Feed the Future activities Most multiyear strategy papers and activity documents incorporated or plan to incorporate nutrition and/or health education and communication messages into proposed agriculture and economic growth activities under Feed the Future. These messages are often adapted from the essential nutrition actions (ENAs) or the community feeding package for infants and young children. In a few cases, the education packet also includes materials outlining essential hygiene actions or messages on water, sanitation, and hygiene (WASH). A few documents described plans to include agricultural extension workers in delivering basic nutrition messaging (e.g., in Ethiopia, Haiti, and Nepal). Other activities are already putting such joint and cross-training interventions into place (e.g., in Bangladesh, Liberia, Tajikistan, and Senegal). According to the documents reviewed, several Missions attempted to adapt essential messages to local contexts to enhance uptake and promote

22 Lidan Du et al. changes in behaviors that have nutritional benefits among target populations. The adaptation of these messages was most often facilitated by context analyses of varying levels of scope and depth. Such analyses sought to understand government and private sector capacities, gender concerns, undernutrition, and demographic trends. Recommendations from these assessments particularly in countries such as Bangladesh, Cambodia, Honduras, Kenya, Rwanda, Senegal, Tajikistan, and Uganda often became the basis for interventions that: Aim to change people s decisions and behaviors relating to crop production and marketing and food purchase and consumption. Address the various barriers people face in being able to actually adopt behaviors that are known to support nutritional outcomes. 3.2.5 Agriculture-to-nutrition pathways Although no Feed the Future multiyear strategies or activities were developed before the publication of pathways, ex post analysis uncovered that one or several of these pathways were adopted either explicitly or implicitly in Feed the Future multiyear strategies. 3.2.5.1 Production! Consumption! Nutrition pathway All Missions programming assumed that the Own production! Food consumption! Nutrition pathway would turn investments in agricultural interventions into gains in nutrition outcomes. Overall, in the Feed the Future documents reviewed, the main argument appears to emphasize mostly the consumption of foods produced in smaller scale home and community gardens, such as horticultural crops or animal-sourced foods. Activities promoting the production of staple crop value chains assumed the commodity would contribute to households well-being through both home consumption and sale to generate income. 3.2.5.2 Income! Food and health purchase! Nutrition pathway All Missions designed activities around the Income! Food purchase pathway, assuming that economic gain from on- or off-farm agricultural activities will improve nutrition. Few activities, with the exception of those in Uganda and Honduras, focus on the Income! Health purchase pathway. One document from the Honduras ACCESO project states, Improved household income should increase choices with respect to food purchases, access to health care... Uganda s multiyear strategy describes the rationale

Leveraging Agriculture for Nutrition Impact through the Feed the Future Initiative 23 that farmers will sell maize (depending on price) or coffee to purchase other foods and/or health products. 8 3.2.5.3 Women's empowerment pathway Most activities in the LAC region explicitly emphasized the Women s workload! Energy use! Maternal nutrition pathway and the Women s time use! Care capacity! Child nutrition pathway in their multiyear strategies and procurement documents (such as request for proposals and applications). In particular, when the need for labor-saving technologies (e.g., drip irrigation, eco-stoves, multiple-use water systems), was mentioned, it was implied that women would benefit. However, in the process of turning these concepts into realities, the landscape analysis found that the activity design documents did not always adopt these same ideas, revealing some disconnect between Feed the Future s theory and implementation. 9 In addition, documents from the Asian and LAC Missions had relatively explicit statements and planned and implemented explicit actions to strengthen the Women s control of income! Resource allocation! Nutrition pathway. In African multiyear strategies, discussions about this pathway were more implicit, with less-detailed descriptions of the actions that would be needed to empower women and adjust their roles and responsibilities within agriculture and nutrition activities. 3.3. Observations and discussion Following the key guiding principles (Fig. 3), the landscape analysis identified several challenges and issues common to Feed the Future activities and innovative practices that could affect the nutritional outcomes of agricultural investments. 3.3.1 Inclusion of nutrition objectives and indicators The landscape analysis found that nutrition is explicitly recognized as an important objective in the Feed the Future documents reviewed, though such statements are often qualitative. Nevertheless, some standard nutrition indicators chosen from the Feed the Future Indicator Handbook were included in most countries multiyear strategies. In addition, many activities 8 Maize and coffee are two of the three value chains the Feed the Future activity in Uganda selected. 9 There has been increased attention on the roles of women in these activities and indicators related to women s empowerment since the initiation of Feed the Future. In 2012, USAID partnered with IFPRI and the Oxford Poverty and Human Development Initiative of Oxford University to introduce the Women s Empowerment in Agriculture Index (WEAI). Available at: http://www.ifpri.org/ publication/womens-empowerment-agriculture-index.

24 Lidan Du et al. Number of countries 20 18 16 14 12 10 8 6 4 2 0 Stunting Child MAD Maternal anemia Africa LAC Asia Hunger Child anemia Figure 6 Commonly selected nutrition indicators in FTF activities. Women s DD also included custom nutrition indicators. The most commonly used standard indicator is the prevalence of stunted children under 5 years of age (n ¼ 16; Fig. 6). However, some agriculture and economic growth activities that claim to work toward nutrition outcomes have no nutrition-specific activities or indicators. 3.3.2 Monitoring intermediate steps along agriculture-to-nutrition pathways Review of Feed the Future monitoring and evaluation plans was not in the scope of the landscape analysis. It is worth noting, however, that few documents reviewed discussed monitoring intermediate steps along the agriculture-to-nutrition pathways, such as the quantities sold and consumed of the selected value chain crops, in addition to the total production output. Taking measurement on a series of intermediate indicators is critical to generating much-needed evidence on whether and how agriculture contributes to nutrition and to help track progress on how Feed the Future investments in agriculture are working on nutrition. Furthermore, due to the existence of non-feed the Future activities in Feed the Future ZOI, nutrition improvements in the ZOI are unlikely to be attributed to Feed the Future interventions alone. Therefore, documenting status and changes of indicators along agriculture nutrition pathways would help establish the plausibility argument that observed nutrition impacts are indeed due to Feed the Future investments in agriculture and economic growth. Box 2 illustrates examples of intermediate results to be monitored.

Leveraging Agriculture for Nutrition Impact through the Feed the Future Initiative 25 BOX 2 Illustrative Intermediate Results to be Monitored Along Agriculture Nutrition Pathways Production! Consumption: Crop yield, number of animals raised and butchered for home consumption, varieties grown in gardens, quality (varieties) and quantity of foods stored at home, varieties and quantity of foods prepared and served. Income! Food purchase: A viable market accessible to target population where local producers sell nutritious foods. Income! Health care purchase: Availability of and access to quality facilityand community-based health services, types of services provided and used by target population, stock management, care-seeking behaviors (time waited before taking children to care, demand for preventive services). Food prices! Food purchase: Supply and demand statistics, food price information. Women's workload!maternal energy use: Women's body mass index, micronutrient status, weight gain, resting time during pregnancy, birthweight. Women's time use! Care capacity: Time spent on farm and nonfarm labor and child care (hygiene, interaction, playtime), feeding practices (breastfeeding, complementary feeding frequency, kinds and quantities of food fed to children, feeding styles), contribution of other caregivers to child care demands. Women's control of income! Resource allocation: Income controlled by women, food intake of women and children versus men (sequence, variety, quantity). 3.3.3 Tackling women's roles and gender norms Gender is a cross-cutting theme of Feed the Future and mentioned in documents reviewed from all Missions. Observations related to three specifically gender-related agriculture-to-nutrition pathways in the documents reviewed follow. 3.3.3.1 Women's time and workload constraints Nearly every Feed the Future activity targets women for participation in nutrition education sessions and other interventions, while recognizing to varying degrees that women s time and workload constraints are documented determinants of undernutrition. A number of Feed the Future activities have proposed and/or implemented activities to mitigate these constraints. In Honduras, eco-stoves were introduced to save women from the need to spend time and labor fetching fuel. Nepal s multiyear strategy

26 Lidan Du et al. paper stresses the importance of specific female-friendly farming practices and explicitly considers child care, transportation, and labor-saving technologies (e.g., corn huskers and small tractors) to promote women s inclusion in activities. In Uganda, Feed the Future activities introduced composite flour mixes, made with locally available ingredients, that can be quickly cooked as complementary foods. 3.3.3.2 Gender roles and norms Several Missions have also demonstrated efforts to understand the gender roles and norms of people living in the ZOI to improve nutrition by increasing women s participation in agricultural activities and control of income and resources. For instance, activities in Honduras and Bangladesh have created on- and off-farm income-generation opportunities (e.g., sales of handicrafts and home garden produce), to allow women to work close to home, thus accommodating their childcare duties. This approach takes into account the importance of cultural and social norms that may limit women s abilities to work outside the homestead. In Tajikistan, Feed the Future activities include husbands and in-laws in the targeted SBC messaging to empower women by facilitating changes in intra-household decisionmaking processes and power dynamics. Several Feed the Future activities in Africa selected value chains based in part on their potential impact on women, especially crops in whose cultivation women were already involved, including ground nuts and soy in Malawi and horticulture and maize in Tanzania. The Tanzania Mission s procurement documents also specifically require implementers to consider how interventions will improve women s control of resources without negatively impacting infant and young child feeding and care practices. 3.3.4 Targeting Analysis of the targeting approaches focused on the ways in which Feed the Future strives to engage both men and women in different types of interventions, to involve people of different levels of readiness to participate, and to increase coverage and impact of co-located activities. 3.3.4.1 Inclusion of both men and women in agriculture and nutrition interventions Women s potential economic contribution in agriculture remains underdeveloped. Empirical studies have shown that female heads of households

Leveraging Agriculture for Nutrition Impact through the Feed the Future Initiative 27 and plot managers are less likely to get extension services and less likely to access quality services than their male counterparts (Ragasa, Berhane, Tadesse, & Taffesse, 2012). Research in the agricultural sector has also found that women lag behind men in land ownership, access to finance, access to machinery and other inputs, and educational achievements (Dangour, Diaz, & Sullivan, 2012). Although Feed the Future activities aim to reach smallholder farmers of both sexes, documents reviewed show that a gender bias persists in current activities, as demonstrated by the fact that direct nutrition interventions target women and children almost exclusively. Separating gender roles in agriculture and nutrition may diminish the benefits that a family could draw from the full range of Feed the Future activities. A whole-of-household approach helps integrate activities aimed at increasing production and income along with those aimed at improving knowledge and practices relating to food purchase and consumption. Such household-level integration ultimately benefits the entire family women and children as well as men. 3.3.4.2 Working with more vulnerable beneficiaries in zones of influence Since Feed the Future agriculture and economic growth activities focus on value chain development and strengthening, primary targets of these activities are smallholder farmers who possess basic resources to invest in commercial activities. The most vulnerable populations in the ZOI people who are landless and ultra-poor with no productive assets are usually left out. Some Missions explicitly place destitute farmers outside the scope of the agriculture and economic growth interventions and leave them to be covered by other health and nutrition and development activities, such as Food for Peace programming, 10 if such activities exist. Other Missions designed specific activities such as basic literacy and numeracy training (Nepal) and basic health and nutrition education and home improvements (Honduras) to improve the abilities and readiness of the most vulnerable households in the ZOI to participate in Feed the Future activities. 3.3.4.3 Communications for better coverage in co-located activities The landscape analysis found that many co-located activities have not yet established information-sharing mechanisms or coordinated work plans to ensure good coverage of beneficiaries in the same targeted geographic area. 10 The Food for Peace program (P.L. 480), part of the United States food assistance programs, was established in 1954. P.L. 480 comprises three different programs; Title II of P.L. 480 is the Emergency and Private Assistance Programs that are administered by USAID.

28 Lidan Du et al. Lack of such coordination challenges the program assumptions underlying the co-location approach and may affect activity impact. Promising models exist. The SPRING/Bangladesh project is leading homestead food production and nutrition training for governmentsupported field agents and agents of other USAID-funded activities operating in the ZOI. Through its interaction with many implementing stakeholders, SPRING shares information on land or water access of beneficiary households with other activities that work on aquaculture and horticulture. Another example is in Guatemala, where the Mission created department-level coordination bodies to facilitate communication among partner activities that in turn are meant to facilitate cross-sector coordination and communication within and across relevant Mission offices. 3.3.5 Value chain selection The landscape analysis yielded two key observations on value chain selection. 3.3.5.1 Investing in nutrient-dense value chains The documents reviewed cited nutrition content as among the most common considerations in value chain selection. Yet starchy staple crops that have lower nutrient density are promoted in 18 of 19 strategies, and of those, maize is the most popular (selected by 8 of 12 Feed the Future portfolios in Africa and 11 overall). It is understandable that staple crops are needed to help meet dietary energy requirements. However, this focus on staple crops often means that more nutritious value chains that may support dietary diversity, supply more bioavailable micronutrients, and/or improve animal source protein consumption by target groups are neglected. Therefore, investment in crop diversity may help Feed the Future meet nutritional goals with the limited resources available. Lessons from Feed the Future activities in Asia, which focused on more diverse and nutrient-dense crops than their LAC or African counterparts, might be learned. 11 3.3.5.2 Potential unintended consequences on market prices Aside from nutritional concerns, focusing value chain development on a limited number of crops may affect their supply, demand, and pricing. These 11 Feed the Future has a global strategy to strengthen production and nutritional impact of diverse products. Through its Innovations Labs, Feed the Future is partnering with U.S. universities and developing country research institutes to support a range of solutions to increase dietary diversity and promote more nutritious foods. For more on the Innovation Labs, see: http://feedthefuture.gov/ article/feed-future-innovation-labs.

Leveraging Agriculture for Nutrition Impact through the Feed the Future Initiative 29 unintended consequences do not seem to be explored at the local market level, as only a few Missions activities proposed or conducted market analyses. An exception is the ACCESO project in Honduras, which regularly assesses market prices and constraints to determine the number of farmers targeted to grow a particular crop. Another example is in Rwanda, where supply and demand for beans and maize were analyzed before they were selected for value chain development. 3.3.6 Market access to diverse, nutrient-dense foods Feed the Future activity documents in all countries commit to promoting improved market linkages that will help targeted farmers sell their produce. Typically, this promotion involves linking producers of value chain crops that are geared for sale (which could be staple grains, horticulture crops, cash crops, or animal products) to external markets in order to generate income. Activity documents, however, do not explicitly state plans to create or strengthen local markets where growers of more diverse and nutrient-dense value chain items, particularly those who operate in a smaller scale, can sell for income. Yet local markets are important because people (including many commercial producers) source their foods and receive potential nutritional benefits there. A main assumption of Feed the Future is that increased agricultural income will enable target households to improve their nutrition by purchasing more higher quality (nutritionally dense and diverse) foods via the income food purchase pathway. But this key premise may never be realized if healthier dietary options are not made readily available to consumers in local markets. In addition, creating and maintaining local markets has other benefits it builds viable livelihoods for smallholder farmers, energizes the economic system in activity areas, and supports sustainable agricultural practices. 3.3.7 Social and behavioral change along value chains and agriculture-to-nutrition pathways 3.3.7.1 Messaging Nutrition education is included in all Feed the Future activity designs, but often focuses on teaching basic nutrition and health information and knowledge based on the generic ENA framework messages. The audience of such education is mostly women of reproductive age and mothers with young children. In the documents reviewed, nutrition education is generally not distinguished from SBC programming, which focuses on changing behaviors, such as dietary practices, that affect nutritional outcomes.

30 Lidan Du et al. Some of the more innovative approaches found in the review to change behaviors are those that attempt to guide nutrition-related behaviors of all household members (e.g., Bangladesh, Cambodia, Honduras, and Tajikistan) and/or tie the educational messages directly to selected Feed the Future agriculture value chains (e.g., Malawi and Kenya). Some current activity designs extend the reach of SBC to behaviors of various value chain players. For example, in Senegal, one Feed the Future activity targets all community members with SBC activities that promote local food production while supporting linkages to markets through local private sector players such as processors and retailers to add value to the products. SBC programming can be useful through the whole spectrum of activities along the agriculture-to-nutrition pathways (Fig. 7). Traditionally, SBC interventions focus on the individual and household levels to promote equitable intra-household food distribution among family members, maternal nutrition, appropriate feeding practices for infants and young children, and food preparation techniques that conserve nutrients. Within the two most commonly adopted pathways (Own production! Food consumption and income! Food purchase), SBC programming has the potential to achieve better household nutrition. It can do this by improving household ability to identify and decide what to produce for home consumption and how to store and process foods to minimize spoilage and safety threats. It can also influence food purchasing, which is particularly important where agricultural activities are increasing household incomes. Figure 7 Social and behavioral change linking agriculture and nutrition.