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DATA, POLICY, AND PRACTICE Using Evidence to Guide Nutrition-Sensitive
Investments in Bangladesh
Presented by: Akhter Ahmed
Country Representative for Bangladesh
International Food Policy Research Institute
Venue: Delegation of the European Union to Bangladesh
24 May 2017
IFPRI has created a comprehensive database for food policy analysis in Bangladesh IFPRI-PRSSP’s Bangladesh Integrated Household Survey
(BIHS): most comprehensive, nationally representative rural household survey to date. Largest panel survey.
4 unique features of data collection:
1. plot-level agricultural production
2. individual food intakes of all HH members
3. anthropometry measurements of all HH members
4. data to measure women’s empowerment in agriculture index (WEAI)
BIHS sampling is statistically representative
nationally of rural Bangladesh
rural areas for each of the 7 administrative divisions
USAID-supported Feed the Future Zone in southern Bangladesh
BIHS: Big data, big impact
Downloads of 2011 BIHS dataset: 600 (2013) 15,000 (now)
Downloads of 2015 BIHS dataset: 93,384 (now)
Diverse users across 6 continents
Food Consumption and Nutrition Situation
Results from IFPRI Surveys
Overwhelming dominance of rice in dietShare of rice in total nutrient intake
71
5762
44
78
6770
52
63
4652
36
0
10
20
30
40
50
60
70
80
90
Food energy (calorie) Protein Zinc Iron
Pe
rce
nta
ge
of
tota
l n
utr
ien
t in
tak
e
All Poorest 20% Richest 20%
Source: IFPRI 2012 Bangladesh Integrated Household Survey (BIHS)
Most farmers grow one crop – Rice
6
54.4
20.1
12.5
5.93.9
51.0
0
10
20
30
40
50
60
1 2 3 4 5 Only rice
Perc
enta
ge o
f fa
rmer
s
Number of crops grown in 2011
Source: IFPRI 2012 Bangladesh Integrated Household Survey (BIHS)
Agricultural diversity increases dietary diversity, but there are challenges
Year-to-year price fluctuations are much larger for non-rice crops than for rice, indicating relatively high levels of market-induced risks for production of non-rice crops
High-value crops, especially fruits and vegetables, have thin domestic markets owing to relatively low levels of demand for them
Horticultural crops, milk, and fish also face special problems related to perishability, which increases the risks of marketing
The interplay of these factors contributes to the low level of agricultural diversity in Bangladesh.
7
Calculation of the WFP Food Consumption Score to measure diet quality(# of days consumed of each food group in past 7 days, weighted by “nutritional importance”)
Household diet quality improved(IFPRI BIHS data, estimated WFP’s Food Consumption Score: 0-112)
Average FCS Percentage of households with low FCS (<42)
23.1
8.4
0
5
10
15
20
25
2011/12 Baseline 2015 Midline
Pe
rce
nt
56.4
66.7
0
10
20
30
40
50
60
70
80
2011/12 Baseline 2015 Midline
Foo
d c
on
sum
pti
on
sco
re
9
Frequency of food groups consumed in past 7 daysIFPRI BIHS data
10
7.0 6.9
1.61.2
1.6
4.8
6.9
2.7
7.0 7.0
2.32.1
2.4
5.5
6.9
3.5
0
1
2
3
4
5
6
7
8
Fre
qu
en
cy o
f fo
od
s co
nsu
me
d in
pas
t 7
day
s
2011/12 Baseline 2015 Midline
11
Despite decline, more than 1/3 of
children are still stunted (DHS, various years)
55
18
56
43
17
41
36
14
33
0
10
20
30
40
50
60
Stunting (moderate or severe) Wasting (moderate or severe) Underweight (moderate orsevere)
Per
cen
t
1996-1997 2007 2014
A paradox: stunting is highest in regions of lowest poverty, and vice versa
Source: WFP 2012
12
Child stunting Poverty
Sylhet Division: lowest women’s empowerment, second highest income
Barisal Division: second highest women’s empowerment, second lowest income
Paradox is partly explained by regional difference in women’s empowermentEstimated using IFPRI BIHS data
61.3
47.2 46.8
42.3 41.738.3
23.2
0
10
20
30
40
50
60
70
Wo
men
’s e
mp
ow
erm
ent
(WEA
I) h
ead
cou
nt
(%)
Source: IFPRI 2015 BIHS
13
48% of girls in rural areas get married before age 19
Adolescent girls aged <19 account for 36% of all child births in rural Bangladesh
Early marriage Early pregnancy Low birthweight Stunting
High rate of adolescent pregnancies is associated with stunting in Bangladesh
58.3
40.8 39.8
34.2
0
10
20
30
40
50
60
70
<15 15-16 17-18 19-20
Stu
nti
ng
pre
vale
nce
(%
)
Age at child birth (years)
Age at child birth and rate of stunting
Source: 2014 DHSSource: IFPRI 2015 BIHS
14
Social Protection in Bangladesh
What role for improving nutrition?
Page 16
Safety Nets in Bangladesh
Formal safety nets redistribute resources to poor people to reduce their economic hardship.
Bangladesh has made significant progress in strengthening social safety nets to assist the poor. Notable changes over the years include:
Converting ration price subsidies to targeted food distribution for the poor
Shifting the focus from relief to development
Engaging NGOs in program implementation
Percentage distribution of safety net programs by FY2013 SSN budget allocation: $2.7 billion, 12% of national budget Top 10 programs account for 62% of total budget
17
0.50.50.70.70.8
1.41.41.51.51.61.81.9
2.22.32.3
2.73.1
3.84.7
5.05.35.4
7.07.0
7.48.8
10.3
0 2 4 6 8 10 12
Disaster ManagementAllowance for Disabled
Economic Empowerment of Poor (EEP)Ashrayan-2 Project
Maternal, Child and Adolescent HealthResidence for poor freedom fighters
Food Assistance for Chittagong Hill TractsRural Employment and Road Maintenance Program
Gratuitous ReliefSocial Development Foundation
National ServiceAllowances for Destitute WomenHonorarium for Freedom Fighters
Revitalization of Community Healthcare InitiativeFund for climate changeSchool Feeding Program
One Household One FarmSecondary School Stipend
Allocation for various programsVulnerable Group Development
Old Age AllowancePrimary Education Stipend
Employment Generation Program for the PoorVulnerable Group Feeding
Test ReliefFood for Work
Open Market Sales
Source: General Economics Division, Ministry of Planning
Distribution of all safety net participants by income groupsIFPRI BIHS data
18
28.8
23.7
21.2
17.1
9.3
0
5
10
15
20
25
30
35
1 (poorest) 2 3 4 5 (richest)
Perc
enta
ge o
f al
l par
tici
pan
ts
Per capita expenditure quintile
Targeting effectiveness of major safety net programsIFPRI BIHS data
19
31
2422
16
8
1819
26
22
15
27
2422
19
8
31
2625
14
4
35
2325
13
3
37
23
16
20
5
37
24
18
14
7
49
2321
6
2
0
10
20
30
40
50
60
1 (poorest) 2 3 4 5 (richest)
Pe
rce
nt
of
ho
use
ho
lds
Primary School Stipend Secondary education stipend Old Age Allowance
GR OMS VGD
VGF EGPP
Page 20
Limited impact of safety nets on nutrition
Most existing evidence from evaluations (by IFPRI and others) of major safety nets in Bangladesh show reduced household poverty and improved food security but few improvements in child nutritional status.
This leads to two key questions:
1. Are large-scale social protection interventions that increase resources sufficient to improve child nutrition?
2. Are there constraints other than resources, such as nutrition knowledge, that also need to be addressed?
This is one of the focal set of issues addressed by the Transfer Modality Research Initiative (TMRI) in Bangladesh.
IFPRI’s TMRI research shows safety net cash transfer + nutrition BCC has greatest impact on child nutrition
IFPRI designed an experimental (RCT) program in Bangladesh called the Transfer Modality Research Initiative (TMRI).
WFP implemented TMRI from 2012 to 2014 to determine what combination of cash, food, and nutrition behavior change communication (BCC) in safety nets brings the greatest benefits for ultra-poor rural households.
Cash + nutrition BCC led to a 7.3 percentage points decrease in child stunting over the project period—almost three times greater than national average decline in stunting.
46.0
38.7
34
36
38
40
42
44
46
48
Control Cash + BCC
Stu
nti
ng
rate
fo
r ch
ildre
n <
5 y
ear
s (%
)
In TMRI, child stunting reduced by 7.3 percentage points in two years
All TMRI modalities significantly increased household diet “quantity” and “quality”: Adding BCC gives a greater impact
6.9
9.1
6.9
23.7
0
5
10
15
20
25
Cash only Food only Cash+Food Cash+BCC
Foo
d c
on
sum
pti
on
sco
re
Food consumption score (baseline: 43.7)
75
143
83
282
0
50
100
150
200
250
300
Cash only Food only Cash+Food Cash+BCC
Incr
ease
in c
alo
rie
(kca
l/p
erso
n/d
ay)
Household calorie intake
Adding BCC to safety net cash transfers increases children’s diet diversity(RCT with DID impacts relative to control, significant at ≤10% level)
6.1 7.3
11.7
6.4
24.6
10.9
22.8
36.0
15.1
0
5
10
15
20
25
30
35
40
Eggs Legumes Legumes Eggs Legumes Dairyproducts
Fleshfoods
Eggs Vit Afruit and
veg
Cash Food Cash & Food Cash & BCC
Pe
rce
nt
of
child
ren
<4
2 m
on
ths
wh
o c
on
sum
ed
in p
ast
24
ho
urs
Source: Ahmed et al. 2016 (IFPRI and WFP)
Nutrition-Sensitive Agriculture
Agriculture, Nutrition, and Gender Linkages (ANGeL)
Demand side
effects
Sectoral
linkages
Supply side
effects
Food
prices
National Level
Household Level
Food output
Nonfood
output
Nutrient
consumption
Food
expenditure
Non-food
expenditure
Individual Level
Nutrient intake Child
nutrition
outcomes
Ho
use
ho
ld a
ssets
an
d l
ivelih
oo
ds
Drivers of “taste”: Intrahousehold inequality Public health
Food imports
Policy drivers of inequality Policy drivers of nutrition
Interacting
socioeconomic
factors
Interhousehold inequality
Health status
Mother’s
nutrition
outcomes
Health care
expenditure
Women’s
empowerment
status
National
nutrition
outcomes
Food produced
and consumed
Income from
food sales
Non-food
income
Farm/nonfarm
employment
Caring capacity
& practices
Po
licy d
rivers
of
gro
wth
Female energy
expenditure
Food production/consumptionIncome-food expenditure
Food Price – expenditure/
buying power
Women’s status
- decision making power
Pathways from Agriculture to Nutrition
ANGeL Project: Background
• IFPRI research in Bangladesh shows:
• Agricultural diversity increases household and child dietary diversity
• Women’s empowerment improves household, child, and maternal dietary diversity
• Women’s empowerment increases agricultural diversity
• June 2014: Motivated by research findings, IFPRI developed a concept note for Ministry of Agriculture to strengthen the agriculture-nutrition-gender nexus.
• October 2015: Government approved Agriculture, Nutrition, and Gender Linkages (ANGeL) project for implementation by Ministry of Agriculture; Minister Matia Chowdhury launched project on 29 October 2015.
ANGeL project design
• ANGeL is an experimental project in 16 of 64 districts in Bangladesh
• IFPRI evaluates impacts of 3 interventions and their 5 combinations using clustered RCT method. Interventions are:
• Agricultural Production training to farm HHs (men and women, together)
• Nutrition BCC training to farm HHs (men and women, together)
• Gender Sensitization activities for farm HHs (men and women, together). Designed to improve status of women and gender parity between women and men.
• ANGeL Project draws on the government’s nationwide agricultural extension network, ‘topping-up’ their portfolio with nutrition activities and messages.
ANGeL – Way forward
• After 2 years, the ANGeL experimental research will identify which interventions most effectively increase agricultural diversity, increase farmers’ income, improve nutrition, and promote women’s empowerment.
• The Ministry of Agriculture plans to use the research-based evidence to scale up the most effective interventions all over Bangladesh.
• ANGeL is the first ministry-led initiative that uses a rigorous impact evaluation, the randomized controlled trial (RCT), to develop an evidence base to design and implement a national program.
Some Results from IFPRI’s 2015 Household Survey in Chittagong Hill Tracts
Distance to facilities
30
7.5
1.7 1.7
0.7
1.5
9.6
3.3 3.4
0.9
2.5
0
4
8
12
Healthcenter/hospital
Main road Weekly/periodicbazaar
Primary school Secondary school
Dis
tan
ce (
km)
Bangladesh CHT
Access to Electricity & mobile phone
31
59.8
48.8
0
20
40
60
Access to Electricity
Pe
rce
nta
ge o
f h
ou
seh
old
s
Bangladesh CHT
88.284.5
0
20
40
60
80
100
Owns mobile phoneP
erce
nta
ge o
f h
ou
seh
old
s
Bangladesh CHT
Structure of house wall
32
19.7
52.6
1.7
16.1
6.0 3.9
9.8
2.3 1.8
12.3
73.5
0.5 0
10
20
30
40
50
60
70
80
90
Brick Tin/CI Sheet Wood Mud Bamboo Other
Pe
rce
nt
Bangladesh CHT
Primary school enrolment (net)
33
94.897.4 96.1
98.8 97.7 98.2
0
10
20
30
40
50
60
70
80
90
100
110
120
Male Female All
Pe
rce
nt
Bangladesh CHT
Secondary school enrolment (net)
34
76.880.0 78.4
88.1 86.9 87.4
0
10
20
30
40
50
60
70
80
90
100
110
120
Male Female All
Pe
rce
nt
Bangladesh CHT
Dietary diversity
35
7.7
4.6
7.8
4.7
0
2
4
6
8
10
Household DietaryDiversity (HDD)
Women's DietaryDiversity (WDD)
Die
tary
Sco
re
Bangladesh CHT
66.770.0
0
20
40
60
80
100
Average FCSFC
S
Bangladesh CHT
Place of birth for the youngest child (under 2 years)
36
42.1
22.9
34.3
64.1
7.8
28.1
0
20
40
60
Own house Natal house Gov hospital/upazila heathcenter
Per
cen
t
Bangladesh CHT
Incidence of mothers receiving care during pregnancy
37
85.8
63.1
47.8
17.6
32.8
56.3
35.9
14.8
0
20
40
60
80
Received prenatalhealth care
Received iron tabletduring pregnancy
Received tetanusvaccine during
pregnancy
Household visited byhealth worker
Per
cen
t
Bangladesh CHT
Exclusive breastfeeding & Vitamin A dosage
38
54.4
75.0
0
20
40
60
80
Exclusive breastfeeding (0-59 months)
Pe
rce
nt
Exclusive breastfeeding Practices
Bangladesh CHT
64.1
73.0
0
20
40
60
80
100
Vitamen A given (7-23 months)P
erc
ent
Vitamin A for 7 to 23 months old
Bangladesh CHT
Hygiene
39
6.1 4.3
89.7
23.3
9.5
67.2
0
20
40
60
80
100
Disposable pad Cotton pad(disposable)
Cloth pad(reusable)
Pe
rce
nt
Type of sanitary napkin used
Bangladesh CHT
2.9
7.0
0
2
4
6
8
10
Open defecationP
erce
nt
No latrine – Open defecation
Bangladesh CHT
Child stunting (0-59 months)
40
37.139.1
34.9
28.4
23.9
32.4
0
10
20
30
40
50
All Male Female
Per
cen
tage
of
un
de
r 5
ch
ildre
n b
elo
w -
2 Z
-sco
re
Bangladesh CHT
Women’s empowerment status
41
47.2
59.8
18.9 18.9
35.7
46.1
16.6 16.6
0
10
20
30
40
50
60
70
Women's Empowermentheadcount
Women with genderparity
Empowerment gap Empowerment gap
Pe
rce
nt
Bangladesh CHT
Women’s empowerment headcount in 10 sub-domain indicators
42
93.6
86.1 90.7
71.6 66.7
95.1
53.4
72.1
84.5 79.7
96.3 92.0
82.7
64.7
47.7
99.0
47.3
62.0
78.7 76.3
0
20
40
60
80
100
120
Input inproductivedecisions
Autonomyin
production
Ownershipof assets
Purchase,sale or
transfer ofassets
Access toand
decisionson credit
Controlover use of
income
Groupmember
Speaking inpublic
Workload Leisure
Pe
rce
nt
Bangladesh CHT
Policy Considerations
Policy considerations
Links between early marriage and nutrition: Pregnancy in girls who are still growing leads to
competition between the mother and the fetus for access to nutrients, a battle which the fetus invariably loses.
IFPRI’s qualitative results found that girls marry early due to (1) harassment by male youth, and (2) avoid paying higher dowry.
A massive social campaign is needed to increase the age of marriage, as well as to postpone pregnancy of those girls who do marry early.
To delay pregnancy after marriage, promote effective family planning
44
Policy considerations
Accelerate agricultural diversity:
Reduce risk of high-value, high nutritive value food production via contract farming, agricultural credit, etc.
Create an enabling policy environment for the private sector for agricultural value chains development
Invest in research on productivity of rice, non-rice crops, livestock, and fisheries
Promote rice intensification and agricultural diversification via agricultural extension
45
Policy considerations
Improve diet quality:
Develop value chains for nutrient-dense foods
Promote nutrition knowledge among consumers, farmers, and women and men
Add nutrition BCC to social protection programs
Improve adolescent girls’ nutrition:
Consider introducing school feeding program in secondary school
Support women’s empowerment:
Women’s empowerment in agriculture improves dietary diversity, increases agricultural diversity, and helps households move out of poverty. Therefore, promoting women’s empowerment remains paramount to attain complementary development goals.
46
Policy considerations
Revamp social safety nets to reach the most vulnerable to improve their livelihoods
• Improve the targeting performance
• Scale up effective programs
• Ensure sustainability of program benefits
• Integrate nutrition BCC into social safety nets
• Introduce school feeding program in secondary school
• Increase the size of transfers to generate sizable impacts on food security and nutritional outcomes
• Consolidate and simplify programs and phase out high-cost, inefficient programs
• Improve monitoring, evaluation, and learning
• Move beyond coping approaches (safety nets) to risk-reduction approaches (social protection)
47
