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Development and Nutrition
Eliana La Ferrara
Invernizzi Chair in Development Economics
Università Bocconi
ABF Workshop, 24/10/2015
The nutrition poverty trap
2
Poornutrition
Low productivity
Low income
What do we know…
Some disturbing facts
12.5% of the world’s population undernourished
26% of children are stunted (40% in Sub-Saharan Africa)
45% of child deaths <3 yrs due to poor nutrition
3
About the current state of nutrition
The causes of undernutrition
Potential policy responses
% of children under 5 who are stunted
4 Source: UNICEF, 2013
Most stunting is in Sub-Saharan
Africa and South Asia
Decreasing trends in under-5 stunting, butnot everywhere
5 Source: Black et al. (Lancet 2013)
Increasing trends in under-5 overweight
6 Source: Black et al. (Lancet 2013)
7 Source: WHO, 2010
“Double burden”: underweight & overweight
Why are so many people undernourished?
1. Food production
8
2. Food consumption
& caloric intake
3. Distribution of resources within the household
1. Do we produce as much food as we can?
9
Agricultural yield gap
10 Source: Deininger and Byerlee (2011)
Reasons for low yields: (1) Technology
More (adequate) technology needed?
Technology exists but farmers do not adopt:
20-30% of farmers report using fertilizers in pastyear in Kenya, Ethiopia, Mali
Low adoption of relatively simple and inexpensiveagricultural innovations.
Is this the rational response to low returns on inputs?
No: use of fertilizers is low despite returns of69% per year (Duflo, Kremer, Robinson, 2008)
11
Factors affecting technology adoption
12
Why are farmers not using enough of thesetechnologies despite high returns?
Lack of information
Credit constraints
Take-up is 50% higher if fertilizer offered with 50% discount (Duflo, Kremer, Robinson, 2011)
Time-inconsistent preferences
Take-up is 50-70% higher if fertilizer offered right afterharvest (Duflo, Kremer, Robinson, 2011)
Factors affecting technology adoption (cont’d)
13
Social learning
Pinapple cultivation in Ghana: adoption higher ifmembers of social network have adopted (Conley and Udry 2010)
Risk aversion
Buying fertilizer too risky for Ethiopian farmers (Derconand Christiaensen 2011)
Yet rainfall insurance take-up low (Cole et al, 2013; Ginéet al., 2009)
Gender differences in preferences within hh
Women choose healthier stoves more often than menin Bangladesh, only when they are for free (Miller and Mobarak 2013)
Security of tenure and economic outcomes
Higher tenure security lower risk of expropriation higher investments (Besley 1995)
Historical institutions regarding property rights matter for today’s economic outcomes (Banerjee and Iyer 2005, Hornbeck 2010)
Investments and output are higher in plots controlled by individuals holding powerful positions in local government (Goldstein and Udry 2008)
14
Reasons for low yields: (2) Land rights
Yields on plots cultivated by women are lower
Resources are inefficiently allocated across plots (Udry 1996)
Differences in inputs access or usage (Horrell and Krishnan 2007)
Women have weaker rights to own and inherit land (Agarwal1994, Cooper 2012,...)
2. Do we get the max caloric intake we can?
15
16
Poor people spend a low fraction of their income on food
39%-79% among extremely poor in rural areas (Banerjee and Duflo 2011)
Food subsidies do not generate higher caloric intake
Poor people use them to buy more expensive and better tasting food
The expenditure choices of the poor do not always translate into max caloric intake
17
Deeply rooted cultural norms can affect nutritional outcomes
Do food cultures alter people’s caloric intake?
People make nutritionally suboptimal choices due to preference for traditional food: they pay a caloric tax (Atkin 2013)
Evidence on migrants in the United States (McDonald and Kennedy 2005, Giuntella 2014)
− At time of migration, they have better health than natives
− They cannot afford to maintain their food habits in the host country
− They opt for fast food, with negative effects on their health
3. How is food distributedwithin the household?
18
Social norms affect distribution of resources
Decisions on how food is distributed within the family respond to customary practices
Son preference generates differences in nutritional outcomes within a household
19
Social norms affect intra-household distribution
3. Distribution within the household
Son preference
Some differences in nutritional status within a household due to son preference
Unequal breastfeeding practices (Jayachandran and Kuziemko 2011)
Women with a first-born daughter tend to have more children, are less likely to use contraceptives and have shorter birth intervals (Milazzo 2014)
Sibling rivalry: more resources are allocated to male children (Garg and Morduch 1998)
20
Importance of pregnant women’s nutrition
Nutrition received in utero has long-lasting effects on children’s health
Children in utero during flu pandemics in US had worsehealth and higher death rates (Almond)
Children in utero during Ramadan earn less (Almond)
Iodine supplementation to pregnant women in Tanzania improved children’s educational outcomes (Field and Torero)
Yet, 40% of pregnant women in the world are anemic(WHO)
Need to ensure that pregnant women get right nutrients
21
Policy responses
22
1. Food production
Interventions to facilitate technologyadoption
National policies to improve security ofland rights (e.g., titling)
National policies to improve gender equality in land rights (e.g., inheritancereforms such as the Hindu Succession Act)
23
2. Consumption of nutrients
Not only programs that emphasize the quantity of food (e.g., subsidized ricedistribution)
Nutrition programs that enrich basic foodwith iron, vitamins, etc.
24
25
Iron Folate
supple-
mentation
in
pregnancy
for 90+
days
Early
initiation of
breast-
feeding
within 1
hour of birth
Exclusive
breast-
feeding,
<6
months
Minimum
acceptable
diet, 6-23
months
Minimum
dietary
diversity,
6-23
months
Vitamin A
supple-
mentation,
<60
months
Zinc
supple-
mentation
with
Diarrhea,
<60
months
Salt con-
sumption
is Iodized
Nicaragua
MalawiRwanda
Honduras
Honduras
Pakistan Georgia
Nutrition programs scaled up at national level
Coverage %Source: www.globalnutritionreport.org
2. Consumption of nutrients
Nutrition programs that enrich basic foodwith iron, vitamins, etc.
Information campaigns and media-basedinterventions to change people’s preferences towards certain foods (e.g., educational entertainment)
26
3. Food distribution within the hh
Economic empowerment of vulnerable hhmembers (e.g., women & microfinance)
Interventions to change cultural norms(e.g., media-based)
Direct targeting by government or NGOs
Conditional Cash Transfers targeted to women
School meals programs
27
Conclusions
Overall clear need for interventions in this area
Importance of targeting resources to mosteffective programs
Need for a careful evaluation of programimpact
28