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Can Ag/Nutrition Programs Change Gender Norms_Mara Vandenbold_10.16.13
1. Can Integrated Agriculture-Nutrition
Programs Change Gender Norms on
Land and Asset Ownership?
Evidence from Burkina Faso
CORE group meeting â Washington DC, October 16 2013
Mara van den Bold | Research Analyst | Poverty, Health and Nutrition Division | IFPRI
Abdoulaye Pedehombga | Monitoring and Evaluation Coordinator for E-HFP | HKI Burkina Faso
Marcellin Ouedraogo | Program Coordinator for E-HFP | HKI Burkina Faso
Deanna Olney | Research Fellow | IFPRI
Agnes Quisumbing | Senior Research Fellow | IFPRI
2. Overview
⢠Background to Helen Keller Internationalâs Enhanced
Homestead Food Production (E-HFP) program in Burkina Faso
⢠Motivation for research on gender
⢠Study design
⢠Impact of E-HFP program on key gender-relevant research
questions
3. Context
ď§ Burkina Faso
⢠Eastern region, Gourma Province
ď§ Sahel
⢠Water shortages, inhibits having a second cultivation season
ď§ High prevalence of acute and chronic malnutrition
⢠Food insecurity
⢠Suboptimal maternal and child nutrition and health practices
⢠Limited availability of and access to health services
4. E-HFP program in Burkina Faso (1)
ď§
Overall objective: To improve womenâs agricultural production of nutrient-rich foods, as
well as their health- and nutrition-related knowledge and practices, to ultimately improve
nutritional status of infants and young children
ď§
Targeted to women with children between 3 and 12 months of age
ď§
Improvements expected through three primary program impact pathways:
1.
Increase womenâs production of MN-rich foods -> increase availability and
consumption of micronutrient-rich foods -> increase HH food security + child
nutritional status
2.
Income generation through the sale of surplus HH production -> improve HH food
security and child nutritional status
3.
Increased knowledge and adoption of optimal nutritional practices including
consumption of micronutrient-rich foods -> improve child nutritional status
5. E-HFP program in Burkina Faso (2)
ď§ Two primary program components:
⢠Agricultural component
⢠HKI provided agricultural inputs and training to establish âvillage model farmsâ
(VMF) (training site) to grow micronutrient-rich foods year-round and raise
small animals. Led by 4 âvillage farm leadersâ.
⢠HKI provided participating women with agricultural inputs and encouraged
them to set up their own home gardens and raise small animals based on what
they learned at the VMF
⢠Behavior Change Communication (BCC) strategy
⢠Focused on improving health- and nutrition-related knowledge with specific
emphasis on encouraging consumption of micronutrient-rich foods by women
and young children.
⢠Encourage participants to carry out optimal nutrition and health-related
practices and help them overcome barriers to adoption
6. E-HFP program in Burkina Faso (3)
ď§ Program sought to directly increase womenâs access to and control over
physical assets:
⢠Community level: HKI worked with communities to identify land that could
be used by beneficiary women for the âvillage model farmâ (VMF) and
sensitized communities about the program and importance of targeting
women
⢠Individual: HKI provided VMF and beneficiary women with gardening inputs
(saplings, seeds, gardening tools) and chicks and encouraged them to set up
of their own home gardens
7. Motivation for research on gender
ď§
Evidence shows:
⢠Positive associations between womenâs (dis)empowerment dimensions and
(adverse) nutrition outcomes (van den Bold et al. 2013)
⢠Women and men within HH often do not have the same preferences for allocating
resources (Alderman et al. 1995; Hoddinott &Haddad 1995; Quisumbing &Maluccio
2003; Quisumbing 2003)
⢠Increasing womenâs control over assets (esp. financial/physical) has been shown to
positively impact food security, child nutrition, education, womenâs own well-being
(Quisumbing 2003; Smith et al. 2003; World Bank 2001); gender differences in
bargaining power over household resources matter
ď§
Women often specifically targeted in agricultural programs, but to date there is limited
evidence on the impacts of agricultural interventions on womenâs control over and
ownership of assets
ď§
E-HFP program expected to influence womenâs asset holdings through direct (direct
transfers of resources) and indirect (improved production techniques) mechanisms
8. Study design
ď§ Longitudinal impact evaluation (baseline 2010, endline 2012)
ď§ Operations research (2011)
ď§ Qualitative research to examine gender related topics including
ownership and control over agricultural assets (2012)
9. Key gender-related questions
Key Questions
Impact
evaluation
Did the EHFP program increase womenâs and menâs ownership of
assets?
x
Were women able to maintain control over the EHFP activities
and outputs?
x
Qualitative
research
Analysis
Status
Complete
x
Complete
Did the land agreements and/or project activities influence
community norms related to womenâs land ownership or land
rights?
x
Complete
What trade-offs were women required to make in order to
participate in the EHFP program?
x
On-going
10. Impact evaluation
ď§
Cluster randomized design
â˘
30 intervention villages (~1200 households and 120 village farm leaders (VFL))
o
o
â˘
ď§
15 âolder women leaderâ villages (OWL)
15 âhealth committeeâ villages (HC)
25 control villages (~800 households)
Longitudinal
â˘
â˘
ď§
Baseline Feb-Apr 2010 (target children 3-12 months of age)
Endline Feb-Apr 2012 (target children 21-40 months of age)
Household interview
â˘
Male HH head and female key respondent, including sex disaggregated modules on
asset ownership, agricultural production, income, household
expenditures, knowledge on nutrition, household food security, dietary diversity, âŚ
â˘
Anthropometric measures and hemoglobin status of target children
11. Qualitative research
Operations Research (2011)
GAAP* Qualitative Research (2012)
Random sample of
beneficiaries and nonbeneficiaries
Beneficiaries: n=120
Non-beneficiaries: n=60
Beneficiaries: n=145
Non-beneficiaries: n=75
Purposive sample of
key informants
VFL: n=60
OWL: n=30
HC: n=30
Master agriculture trainers: n=18
Master nutrition trainers: n=24
VFL: n=60
OWL: n=30
HC: n=30
Land owners: n=30
Focus groups: n=24 (6m; 6f)
Data collection
May-June 2011
May-June 2012
May-June 2011
May-June 2012
Methods
Semi-structured interviews
Semi-structured interviews and
focus group discussions
*GAAP: Gender, Agriculture and Assets Project (www.gaap.ifpri.info)
*HC: Health committee member
*VFL: Village Farm Leader
*OWL: Older Women Leader
12. Results
Did the EHFP program increase womenâs and/or
menâs ownership of assets?
13. Ownership of assets:
Household durables and agricultural assets
***
***
Note: Comparison is to a control group that did not receive any program services. All estimates controlled for baseline
age, sex, clustering, and attrition. All values are coefficient (SE). *** p <0.01
14. Ownership of assets: small animals
Note: Comparison is to a control group that did not receive any program services. All estimates controlled for baseline
age, sex, clustering, and attrition. All values are coefficient (SE). * *p<0.05, *** p <0.01
15. Were women able to maintain control over the
E-HFP activities and outputs?
16. Control over EHFP activities and outputs:
Gardens, vegetables, revenue
Operations research: Round 1
(2011)
Operations research: Round 2
(2012)
17. Control over EHFP activities and outputs:
Chickens
Operations research: Round 1
(2011)
Operations research: Round 2
(2012)
18. Control over EHFP activities and outputs:
Goats
Operations research: Round 1
(2011)
Operations research: Round 2
(2012)
19. Did the land agreements and/or project
activities influence community norms related
to womenâs land ownership or land rights?
20. Community norms related to womenâs land ownership and
land rights: Perceived changes by men and women on
womenâs ability to own and use land
Women
Intervention villages
Change in own opinion
about who can own
and/or use land for the
production of fruits and
vegetables
Perceived changes in
other peopleâs opinions
about who can own
and/or use land for the
production of fruits and
vegetables
Perceived changes related
to womenâs ability to own
land in the village
Perceived changes related
to womenâs ability to use
land for growing food in
the village
Control
villages
Men
Intervention villages
Control
villages
HC
n = 70
46 (66)
OWL
n = 75
49 (68)
All
n = 145
95 (67)
Control
n = 75
11 (16)
HC
n = 57
32 (56)
OWL
n = 58
36 (62)
All
n = 114
68 (60)
Control
n = 60
14 (23)
n = 56
24 (43)
n = 56
31 (55)
n = 112
55 (49)
n = 65
8 (12)
n = 46
21 (46)
n = 51
24 (47)
n = 97
45 (46)
n = 52
5 (10)
n = 69
18 (26)
n = 67
15 (22)
n = 136
33 (24)
n = 73
1 (1)
n = 57
16 (28)
n = 59
15 (25)
n = 116
31 (27)
n = 60
2 (3)
n = 68
29 (43)
n = 70
32 (46)
n = 138
61 (44)
n = 74
3 (4)
n = 55
27 (49)
n = 53
21 (40)
n = 108
48 (44)
n = 61
1 (2)
21. Trade-offs required for participation in the
EHFP program
⢠Only 11% of beneficiaries (13/118) stated that taking care of the garden
interferes with their other activities (e.g. outside work and domestic
tasks).
⢠None of the beneficiary women interviewed thought that taking care of
their chickens interfered with their other activities.
⢠18% of women (16/89) stated that there were costs to working at the
VMF including having to neglect their domestic work, taking care of their
children, not being able to go to the market, and that it takes time to go
and work at the VMF.
22. Summary
Key Question
Summary
Did the EHFP program increase
womenâs ownership of assets?
Yes, the E-HFP program had a positive impact on
women's ownership of agricultural assets and small
livestock.
Did the EHFP program also
influence menâs asset holdings?
Yes, the E-HFP program had a negative impact on
men's ownership of agricultural assets which was
about equal to the positive impact on womenâs
ownership of agricultural assets.
The program had a positive impact on menâs
ownership of small livestock which was larger than
that for women.
Were women able to maintain
control over the EHFP activities
and outputs?
Yes, especially in regards to the garden activities. Vast
majority of women were mainly responsible for
decisions related to what to grow and were able to
keep income generated from sale of produce.
23. Summary , contâd
Key Question
Summary
Did the land agreements and/or
project activities influence
community norms related to
womenâs land ownership or land
rights?
Yes, in beneficiary villages some change was noted in
peopleâs opinions about who could own and use
land.
Both men and women in beneficiary villages
reported that womenâs ability to own and use land
had changed in the past two years. This was rarely
reported in control villages.
What trade-offs were women
required to make in order to
participate in the EHFP program?
Only about 11% of respondents reported that taking
care of their gardens affected their other activities.
18% said that working at the VMF had costs (e.g.
time and neglect of domestic work).
27. Why pay attention to gender in leveraging
agriculture for nutrition?
â˘
âWomen are important in agriculture, and agriculture is important for womenâ (Doss
2009; Meinzen-Dick et al. 2011)
â˘
Women are generally disadvantaged as agricultural producers: limited access to physical
assets (ag inputs, technological resources, land), lack of capacity to use
assets, disadvantaged in terms of non-tangible assets e.g. social/human
capital, decisionmaking power
â˘
Women and men within HH often do not have the same preferences for allocating
resources (Alderman et al. 1995; Hoddinott and Haddad 1995; Quisumbing and Maluccio
2003; Quisumbing 2003)
â˘
Increasing womenâs control over assets (esp. financial/physical) has been shown to
positively impact food security, child nutrition, education, womenâs own well-being
(Quisumbing 2003; Smith et al. 2003; World Bank 2001); gender differences in bargaining
power over HH resources matter.
28. Agricultureâgenderânutrition pathways
Arimond et al. (2010) identified 5 pathways through which agriculture
interventions can affect nutrition:
i)
Increased food for own consumption through production*
ii) Increased income through production for sale in markets*
iii) Reductions in market prices (increased production)
iv) Shifts in consumer preferences
v) Shifts in control of resources within households*
All mediated
by
gender roles,
especially (*)
ď§ Limited evidence of the impact of agricultural interventions on nutrition
outcomes (except for Vitamin A); hardly any evidence on impact pathways
(Ruel and Alderman 2013).
ď§ Womenâs empowerment interventions considered an important pathway
through which agriculture can improve nutrition. But limited and mixed
evidence (Ruel and Alderman 2013; van den Bold et al. 2013).
29. Linking gender and nutrition
ď§
Women are often primary caregivers: they influence their childâs nutrition indirectly
through their own nutritional status and directly through child care practices
ď§
Various studies have looked at links between nutrition and dimensions of female
empowerment (e.g. bargaining power, involvement in decisionmaking, mobility,
access to information, control over assets)
⢠Positive associations b/w female empowerment dimensions and nutrition
outcomes and b/w dimensions of female disempowerment (e.g. domestic
violence) and adverse nutritional outcomes (van den Bold et al. 2013)
â˘
Womenâs relationships with men in the household (HH) and community can affect
their bargaining power and ability to direct HH resources to nutrition
30. Definitions of Key Terms
Undernutrition exists when insufficient food intake and repeated infections result in
one or more of the following: underweight for age, short for age (stunted), thin for height
(wasted), and functionally deficient in vitamins and/or minerals (micronutrient
malnutrition).
Malnutrition is a broad term that refers to all forms of poor nutrition. Malnutrition is
caused by a complex array of factors including dietary inadequacy (deficiencies, excesses
or imbalances in energy, protein and micronutrients), infections and socio-cultural
factors. Malnutrition includes undernutrition as well as overweight and obesity (Shakir,
2006a).
Food security exists when all people, at all times, have physical, social and economic
access to sufficient, safe and nutritious food that meets their dietary needs and food
preferences for an active and healthy life. Household food security is the application of
this concept to the family level, with individuals within households as the focus of
concern (FAO, 2009b).
Food insecurity exists when people do not have adequate physical, social or economic
access to food as defined above (FAO, 2009b).
35
SCN 6th World Nutrition Situation Report. www.unscn.org/files/Publications/RWNS6/report/chapter4.pdf
31. Did exposure to nutrition education diffused through village health
committee members (HC) increase knowledge and uptake of new
practices as compared to that diffused through older women leaders
(OWL) or vice versa?
32. Impact of the EHFP program on nutrition
knowledge: IYCF practices
Give
colostrum to
children
Children < 6
months of age
should not drink
any liquids other
than breast milk
Begin giving
liquids other
than breast milk
at 6 months of
age
Begin giving
semi-solid
foods at 6
months of age
N=1,138
N=1,144
N=1,129
N=1,142
N=1,149
0.16***
0.092***
0.23**
0.13**
0.13**
(0.054)
(0.029)
(0.094)
(0.063)
(0.055)
HC villages
0.17***
0.080***
0.23***
0.19***
0.17***
p-value
(0.052)
0.006
(0.029)
0.009
(0.078)
0.006
(0.059)
0.007
(0.059)
0.011
Give breast
milk within the
first hour after
birth
OWL villages
33. Impact of the EHFP program on IYCF practices: Dietary
diversity among children 3-12 months of age at baseline
Met minimum
dietary diversity
requirement
n=691
Older women leaders
Health committee
p-value
0.12*
(0.070)
0.098
(0.077)
0.14
Note: Comparison is to a control group that did
not receive any program services. All
estimates controlled for baseline age, sex,
clustering, and attrition. All values are
coefficient (SE). * p<0.10
34. Impact of the EHFP program on infant and young
child feeding practices: Intake of iron-rich foods
among children 3-12 months of age at baseline
Iron-rich foods
n=662
Older women leaders
Health committee
p-value
0.15**
(0.072)
0.023
(0.090)
0.13
Note: Comparison is to a control group that did
not receive any program services. All
estimates controlled for baseline age, sex,
clustering, and attrition. All values are
coefficient (SE). * *p<0.05
35. Impact of the EHFP program on nutritional status
of children: Hemoglobin among children 3-12
months of age at baseline
Hemoglobin
(g/dL)
Older women leaders
Health committee
p-value
n=1144
0.24
(0.31)
0.49*
(0.27)
0.19
Note: Comparison is to a control group that did
not receive any program services. All
estimates controlled for baseline age, sex,
clustering, and attrition. All values are
coefficient (SE). * p<0.10
36. Change in hemoglobin from baseline to endline
among children 3-5.9 months of age at baseline
Hemoglobin
(g/dL)
n=449
Older women
leaders
Health committee
p-value
0.044
(0.32)
0.76**
(0.30)
0.043
Note: Comparison is to a control group that did
not receive any program services. All
estimates controlled for baseline age, sex,
clustering, and attrition. All values are
coefficient (SE). * *p<0.05
37. Impact of the EHFP program on health-related
knowledge: Hand-washing practices
**
Note: Comparison is to a control group that did not receive any program services. Estimates
controlled for baseline age, sex, clustering, and attrition. * p < 0.1, ** p < 0.05, *** p<0.01
38. Impact of the EHFP program on IYCF practices:
Breastfeeding practices among children 3-12
months of age at endline
**
Note: Comparison is to a control group that did not receive any program services. Estimates
controlled for baseline age, sex, clustering, and attrition. * p < 0.1, ** p < 0.05, *** p<0.01
39. Impact of the EHFP program on nutritional status
of children: HAZ among children 3-12 months of
age at baseline
40. Impact of the E-HFP program on nutritional status of
children: Wasting among children 3-12 months of
age at baseline
41. Program theory framework for HKIâs HFP
program in Burkina Faso
Process
Inputs
Agriculture and
zoological inputs
distributed
Village Model
Farms (VMF)
established
HKI, APRG and
governmental
structures
(Ministries of
Health,
Agriculture,
Animals,
Environment, and
the Promotion of
Women, local
authorities and
officials) work
together
Training in
plant and
animal
production
techniques for
master trainers
Develop a training
strategy in animal;
and plant
production
techniques
Develop a
behavior change
communication
(BCC) strategy
with regards to
Essential
Nutrition Actions
(ENA)
Training in
plant and
animal
production
techniques for
Village Farm
Leaders (VFL)
Establishment
of individual
farms (40
women per
village)
Increased
availability of
micronutrient
-rich fruits
and
vegetables
Increased
availability of
food from
animal origin
BCC training
on ENA
practices for
beneficiaries
Adoption of
agriculture
practices
Beneficiaries
received and
understood
BCC training
on ENA
practices
Impact
Increased Income
Womenâs
empowerment
improved
Womenâs assets
increased
Improvements in
household
consumption
Improvements in
nutrition and
feeding practices
for children,
pregnant women
and breastfeeding
mothers
Beneficiaries
received and
understood
agriculture
training
BCC training
on ENA
practices for
master trainers
BCC training
on ENA
practices for
village health
workers
(VHW)
Improvements
in fruit and
vegetable
production
Improvements
in small
ruminant and
poultry
production
Training in
plant and
animal
production
techniques for
beneficiaries
Outcomes
Outputs
Adoption of
ENA
practices by
beneficiaries
Improvements in
care & hygiene
practices for
children, pregnant
women and
breastfeeding
mothers
Improved
maternal and
child health
and nutrition
outcomes
43. Table 3.1 Overview of methods and participants from health committee and older women leader intervention villages and control villag
Impact Evaluation
Intervention villages
HC villages
OWL villages
Number of villages
Number of households
Baseline (2010)
Household interview
Endline (2012)
Household interview
Number of villages
Number of households
First round (2011)
Basic semistructured interviews
In-depth semistructured interviews
Second round (2012)
Semistructured interviews
15a
15
Control
villages
25
511
512
734
1,757
590
1,470
Total
436
444
Qualitative Research
Intervention villages
HC villages
OWL villages
Total
55
14a
15
Control
villages
15
70
28
75
30
75
30
220
88
70
75
75
220
44
Note: HC = health committee; OWL = older women leader.
a One village from the HC intervention group dropped out of the program and study before the first round of qualitative research,
resulting in a total of 14 villages for the first and second rounds of qualitative research and for the endline survey for the impact
evaluation.
Editor's Notes
Results from an impact evaluation and qualitative research to evaluate an HFP program carried out by HKI in eastern Burkina Faso.Focus of this presentation is on the results relevant to todayâs session, i.e. results in relation to specific gender-related questions we sought to answer.Presentation is based on a paper written by both IFPRI and HKI, which will be out as a IFPRI DP soon.
Overview of HKI Homestead Food Production programDiscuss design of the studyGo into the results of the study, specifically in relation to changes in menâs and womenâs asset ownership, and changes in norms/opinions on access to / control over these assets.
- HKI started HFP programs in the 1980s in Bangladesh; main objective was to reduce vitamin A deficiency.- This original model focused on a combination of i) support for setting up home gardens, and, ii) nutrition education â in order to promote production of vitamin A rich fruits and vegetables throughout the whole year, and to increase HH access to these foods to improve nutrition in vulnerable populations.-The current generation of HFP programs combines: i) home gardening, ii) small animal production, iii) nutrition education through BCC (communication strategies to promote positive behaviors that are appropriate to the context; builds on what people know, do and want, and focuses on identifying motivations for behavior change based on existing practices and beliefs).- HKI has also started to implement these programs in SSA, including in Burkina Faso. - HKI has strengthened the BCC strategy, and has strengthened its focus on targeting women, with the aim of improving child and maternal health and nutrition outcomes. - While there is substantial evidence of the impact of HFP programs on production and consumption of nutrient-rich foods, their impact on maternal and child health outcomes from rigorous randomized control studies is lacking.
- To provide some context for the E-HFP program in Burkina Faso, this was implemented in Gourma Province, in the eastern part of the country. - This is a region that is in the Sahel, so fluctuations in food availability are tied to the agricultural season, which falls between May/June and Sept. It is also a region that experiences water shortages, especially in the âhungryâ season, which falls between October and April (marked by fall in cereal stores, decrease in energy intake even though DD may go up because of compensatory measures)There is a high prevalence of acute and chronic malnutrition, due to a variety of factors including food insecurity, less than optimal nutrition and health practices, and limited availability of/access to health services.Information gathered as part of baseline revealed: Children under 6 months: 13% stunted or underweight or both, 15% wastedChildren 6-11 months: 24% stunted, 27% underweight, 19% wasted
- Main objective of the E-HFP program in BF was to i) improve womenâs agricultural production of nutrient-rich foods, to ii) improve womenâs health- and nutrition related knowledge and practices â in order to ultimately improve the nutritional status of infants and young children. (This was done through a set of production and nutrition interventions targeted at women with children under 12 months of age.)- These improvements are expected to happen through 3 primary pathways:Increasing the availability of MN-rich foods through increased food production by womenIncome generation through the sale of surplus productionIncrease knowledge and adoption of optimal nutrition practices incl consumption of MN-rich foods.All with the ultimate goal of improving HH food security and child nutritional status
The E-HFP program essentially had two main components:Agricultural component â which mean that HKI provided agricultural inputs (seeds, saplings, gardening tools) and training to establish âvillage model farmâs (VMF), to grow MN-rich foods year-round and raise small animals.The VMF functioned as a training site for participating women to learn about home gardening and raising small animalsHKI also provided participating women with agricultural inputs to encourage them to set up their own home gardens based on what they had learned at the VMFÂ Behavior change communication (BCC) strategy â Focused specifically on improving health and nutrition related knowledge, with specific emphasis on consumption of MN-rich foods by women and young children (Essential Nutrition Action Framework)Encouraged participants to carry out optimal practices and help them overcome barriers to adoption of these practices (negotiating for behavior change approach)Â Combined, these components expected to provide increased access to MN-rich foods, increased income and improved knowledge â improved maternal and child health/nutrition outcomes.
The program specifically sought to increase womenâs access to and control over physical assets, in two ways:- HKI worked with communities to identify land that could be used by beneficiary women as âvillage model farmsâ and also sensitized communities about the program and importance of targeting women- As mentioned in previous slide, HKI provided VMF and beneficiary women with gardening inputs (seeds, saplings, gardening tools) as well as chicks, and encouraged them to set up their own home gardens VMF served as a training site for beneficiary women to learn about HFP and rearing of small animals, and HKI encouraged the set up of personal home gardens
Additional pathways through which interventions are presumed to improve nutritional status of children: i) increasing womenâs access to/control over productive assetsii) increasing womenâs human capital for improved production and optimal nutrition and health care practicesAim of research on gender is to:i) trace pathways to assess program potential to influence womenâs accumulation and/or control of productive assets ii) explore how differences in womenâs productive assets and/or control of resources are related to child health/nutrition outcomesDirect mechanisms: transfer of resources from project to VFL and to mothers supported by VFL to develop home gardens (seeds, chicks, irrigation kits, other supplies); human capital development through training; social capital through participation in mothersâ groups; through exchanges and support around adoption of HFP techniques and/or new nutrition practices.Indirect mechanisms: improved production techniques they acquire, which should increase HH consumption and health, as well as income. Income can be invested in health care, quality foods, childrenâs education, material assets etc. that can further improve production and income. Perhaps also increased authority over HH economic decisions.
The study design consisted of :- a longitudinal impact evaluation, which looked at a variety of outcomes, such as production, consumption, asset ownership, food security, knowledge and practices related to nutrition and health, and maternal and child health and nutrition outcomes- 2 rounds of qualitative research:-operations research/process evaluation â aimed to investigate program delivery, beneficiary utilization of services, KAP of program implementers and beneficiaries; identify any bottlenecks to implementation and utilization ; if certain components could be strengthened modified-Additional Qualitative research which specifically looked at gender related topics such as ownership and control over agricultural assets
Did exposure to nutrition education diffused through village health committee members (HC) increase knowledge and uptake of new practices as compared to that diffused through older women leaders (OWL) or vice versa?X (impact eval)Complete
In terms of the qualitative research, we had two rounds:-Operations research â which as mentioned focused on investigating program delivery, beneficiary utilization of services, KAP of program implementers and beneficiaries; identify any bottlenecks to implementation and utilization ; if certain components could be strengthened modified-Additional Qualitative research which specifically looked at gender related topics such as ownership and control over agricultural assets
Impact estimates: Men = 3.67 (1.71); n=1380, p=0.036 Women = 2.75 (0.78); n=1380, p=0.001
Round 1: 85% of beneficiaries (compared to 4% of non-beneficiaries) had a home garden and for 91% of these women this was new since joining the program.The vast majority of the women credit the program with increasing the increasing production of vegetables and 74% also thought the program had increased production of chickens.
Nearly half of respondents in all groups report that men generally inherit land when wife passes; unless children are mature enough to inherit itMore than half of respondents in all groups report that women do not inherit land from their husband after his passing due to tradition and related inheritance and usage rules (depends on whether there are children, age of woman, etc.)
To discontinue practices respondents nearly all thought that village chiefs/leaders would need to take the lead.For sensitization and granting land, respondents had more varied opinions stating that traditional leaders, government and local authorities as well as non-governmental organizations should be involved.with the greater proportion of women in control (26%) as compared to intervention villages (7%) stating this as an obstacle to womenâs ability to use landFor provision of inputs and sensitization respondents nearly all thought that government or non-governmental organizations would need to take the lead.For granting land, respondents had more varied opinions stating that traditional leaders, husbands, government and local authorities as well as non-governmental organizations should be involved.
Women play important roles in planting, weeding, postharvest processing, food preparation etc. (often not formally recognized e.g. firewood, water collection).Time use studies in Africa point to womenâs contribution of 60% of total time spent in agricultural activities. Of women in least developed countries, 79% report agriculture as primary economic activity. Approx. 48% of economically active women in the world report that their primary activity is agriculture (Doss 2009; Meinzen-Dick et al. 2011). Despite this, women are generally less well off than men in terms of accessing physical resources (ag inputs, technologies, land), have less capacity to use these assets, are disadvantaged in terms of social/human capital (education, social networks), and have less power to make decisions.Furthermore, there is evidence that men and women have different preferences for allocating resources in a household; and that increasing womenâs assets has positive impacts on education and child nutrition outcomes, and their own wellbeing -- so who in the household has control over resources can be very important for improving nutrition. Furthermore, redistributing assets between women and men has the potential to increase productivity (Meinzen-Dick et al. 2011; Udry 1996)Reviews find that different types of womenâs empowerment interventions are an important pathway through which agriculture can improve nutrition. Evidence on this is still limited and mixed (Arimond et al. 2010? ; Ruel and Alderman 2013).
Arimond and coauthors in a paper in 2010 identified 5 different pathways through which agriculture can impact nutrition outcomes, some of which are especially influenced by gender roles:-Increase availability/access to food for own consumption through improved production â this depends on who decides what types of crops/livestock to grow, and for whom they are intended.- Who controls the income and the increase in income will determine how the income is spent âthis may be different for men and women (types/qualities of food and other services that influence nutrition)All the other ones are also mediated through other intra-HH factors like womenâs status, education, knowledge, decisionmaking, access to health services etc.- Reductions in market prices associated with increased production will have an impact on the quality and variety of foods that can be purchased- Shifts in consumer preferences may impact what types of foods are bought/produced/consumed (e.g. this where a BCC component to an ag intervention could have influence on preferences)Shifts in the control of resources in the household (time, income, other assets) can impact on what resources are allocated to whom in the HH.Furthermore, there is not much evidence on the impact of agricultural interventions on nutrition outcomes (e.g. stunting) (except in relation to Vitamin A), and there is hardly any evidence on what the pathways of impact may be.Womenâs empowerment interventions are considered an important pathway through which agriculture can improve nutrition, but there is limited and mixed evidene for this (Ruel and Alderman 2013; van den Bold et al. 2013).
Women are often primary caregivers, and so they can impact their childrenâs nutrition essentially two ways: i) indirectly through their own nutritional status, and ii) directly through the way in which they care for and feed their child.There have been various studies that have looked at the relationships between nutrition outcomes and dimensions of female empowerment (which is measured in different ways), and they have found positive associations between measures of female empowerment and positive child nutrition outcomes as well as measures of female disempowerment and negative nutrition outcomes.So womenâs relationships with men in the HH or community can have an impact on their bargaining power and their ability to direct HH resources to nutrition.
Very few children met their minimum dietary diversity requirements (4 out of 7 food groups) at baseline. At endline, although the percentage of children that met this requirement increased in all groups, there were still only 17% of children who had met the minimum requirements across the sample of children who had both baseline and endline data. At endline, children in the two treatment groups were almost twice as likely to have met their requirements for minimum dietary diversity. However, only the difference in the change from baseline to endline between the OWL treatment group and the control group was statistically significant (p< 0.10).
At baseline only about 10% of the children between the ages of 6 and 12 months had eaten iron-rich foods during the 24 hours prior to the baseline survey. At the time of the endline survey when these children were between 21 and 40 months of age more than half of them had eaten an iron-rich food during the 24 hours before participating in the endline survey. Children living in OWL villages were the most likely to have eaten an iron-rich food in the previous 24 hours and the change in proportion from baseline to endline was about 15% greater among children living in OWL villages as compared to those living in control villages.
After two years of participating in the E-HFP program, children living in HC treatment villages had a higher mean hemoglobin concentration than those living in control villages. The difference in change from baseline to endline was about 0.5 g/L between the control group and the health committee treatment group.
The impact of the E-HFP program on improving hemoglobin concentration was even more evident among children who were 3-5.9 months of age at the time of the baseline study. Again children living in HC villages had a significantly higher mean hemoglobin concentration as compared to those living in control villages. Among these younger children the difference in the change of hemoglobin concentration over the two years of program implementation was 0.76 g/dL between the control group and the HC treatment group.
The most notable change in knowledge related to important times to wash hands was the change related to washing hands before feeding children. At endline a little less than half of the caregivers interviewed living in HC villages correctly stated this time for hand washing whereas only about 30% of caregivers living in control villages and OWL villages correctly identified this important time to wash hands. There was about a 12% difference in the change proportion from baseline to endline between caregivers living in HC villages as compared to those living in control villages who correctly stated this. About 65% of the caregivers interviewed also knew that hands should be washed before eating. Very few caregivers mentioned that it was also important to wash their hands after using the toilet (about 10%) or after cleaning a child who had defecated (about 5%). This is an area that could be improved in future programs as these are common routes through which children get exposed to infectious agents.
Nearly all children who were between the ages of 3 and 12 months at the time of the endline evaluation had been breastfed, as was seen among the children included in the baseline study. A greater proportion of caregivers in all types of villages reported having initiated breastfeeding within the first hour of birth as compared to those interviewed at baseline, and caregivers from both types of treatment villages were more likely than those in the control villages to report having done this ideal practice. The difference between OWL villages and control villages was about 16% and was statistically significant. The proportion of caregivers who had exclusively or predominately breastfed their children < 6 months of age in the previous 24 hours was similar across the control and treatment villages.
As is common among young children at-risk for nutritional deficiencies childrenâs growth was already faltering at 3-12 months of age (at basleine) and declined as children got older. However, there were no significant differences between the control and the treatment groups in the change in HAZ over time. Furthermore, there were no significant differences between the treatment groups in the change in the prevalence of stunting, WAZ scores or the prevalence of underweight among children who were 3-12 months of age at baseline.
The improvements in the WHZ scores and decline in the prevalence of wasting are noteworthy. However, again there were no statistically significant differences between the control group and either of the treatment groups for changes in the prevalence of wasting or for the change in WHZ scores from baseline to endline. The changes in prevalence for the three groups was (control = -15%, older women leaders = -17% and health committee â23%). It is possible that we did not have enough power to detect differences between the treatment and control groups for this outcome.
Program theory framework, which identifies program components that needed to be in place, program implementers responsible for each of the components, how components were intended to be utilized by program beneficiaries, and how the components were ultimately expected to contribute to overall program impact on MCHN outcomes. Highlighted here are the specific outcomes and impacts related to expected increases in womenâs assets and empowerment.
Close or equal to 90% of all respondents report nochangesin menâs ability to own land over the past 2 yearsOver 90% of men and women in control villages report no changes in womenâs ability to own land. In beneficiary villages however, some change is reported (see next slide), due to land grants by HKI or husbands, and establishment of (community) gardens for women.The changes that were cited in regards to changes in womenâs ability to own land primarily had to do with women in intervention villages being granted land by their husbands or HKI, that they now have community gardensThe changes that were mentioned related to changes in womenâs ability to use land primarily revolved around increased womenâs access to land due to transfers from men and advocacy and to support provided to women in terms of inputs and equipment. Men in beneficiary villages also cited the production trainings provided by HKI as increasing womenâs capacity to use land and that the women were now using the land at the VMF for production.