By Annie S. Wesley

 

Introduction
Measures of child undernutrition are used to track development progress because nutrition is Mcentral to better health, improved income and poverty reduction. An estimated 165 million children below 5 years of age suffer from stunting or chronic forms of malnutrition of which 85 million (more than half) live in Asia. The loss of human capital resulting from undernutrition in childhood, reflected in poorer health, cognitive and socioemotional development, and schooling outcomes leading to lower economic productivity in adulthood is estimated to reduce a nation's
economic advancement by at least 8 per cent (in terms of GDP). As emphasized in the Global Nutrition Report (2015), accelerating progress against malnutrition will require investment in both proven nutrition interventions and research to understand how to bring promising solutions to scale in a costeffective manner (IFPRI, 2015).

Asia and the Pacific is a region of significant diversity encompassing a wide range of states in relation to economic development, political stability and urbanization, in addition to variations in geography, culture, religion and ethnicity. Livelihoods of the majority depend on subsistence farming. The agricultural sector has contributed strongly to economic growth in the region over the past several decades. However, improvements in nutrition indicators did not have the same rate of positive change. For example, while countries such as China, Japan and South Korea have made significant strides in economic and health indicators, India continues to be an enigma in terms of nutritional indicators. Furthermore, stunting among children under 5 has been declining in Myanmar, Cambodia, and Viet Nam since 2000 but in Indonesia and Lao PDR the rates have not changed much. 

With increasing recognition of the inter-linkages between agriculture and nutrition, this paper attempts to explore the role of research for development in understanding the pathways from agriculture to nutrition.

Nutrition-sensitive agriculture
Nutritional well-being of an individual is complex and influenced by many factors. Interventions to reduce malnutrition can only be effective if they also deal with the underlying causes requiring both long term and short term strategies. Recently the terms 'nutrition-specific' and 'nutrition-sensitive' interventions have gained recognition in the literature. What do they mean? As summarized in the Lancet Series on Maternal Health and Nutrition (Ruel et al., 2013), nutrition specific interventions or programmes address the immediate determinants of fetal and child nutrition and development (including adequate food and nutrient intake, feeding, caregiving and parenting practices) whereas nutrition-sensitive interventions or programmes address the underlying determinants of fetal and child nutrition and development (such as food security;
adequate caregiving resources at the maternal, household and community levels; and access to health services and a safe and hygienic
environment).

Among the multiple sectors that can be platforms for nutrition-sensitive programming, agriculture is an important sector given the close relationship between the production of food and its utilization, and also because a large proportion of malnourished people live in rural areas where agriculture, particularly subsistence farming, is the main source of livelihood (Herforth et al., 2012). The question of how exactly agriculture can most effectively contribute to improved nutritional outcomes remains the subject of uncertainty mainly because there are a number of pathways. This complexity is one of the reasons for insufficient evidence on impacts of agriculture interventions on core nutrition indicators such as stunting rates in children. Identifying the most suitable outcomes and indicators to track progress is an important ongoing debate which requiresconsensus among experts in the light of increasing interest from national and international stakeholders (McDermott et al., 2015). 

Global commitments for research on agriculture, food security and nutrition
The second International Conference on Nutrition in November 2014 reviewed the progress made towards reducing undernutrition since the first
Conference held in 1992 and highlighted the renewed focus on the role of agriculture. Global leaders at the Conference identified sustainable
agriculture development and agriculture policy as key components in addressing the persistent problem of undernutrition (FAO, 2015). This
priority is also reflected in the second Sustainable Development Goal (SDG) to 'End hunger, achieve food security and improved nutrition and promote sustainable agriculture'.

For several years leading up to the articulation of the SDGs, the global response to the food price volatility during 2007-2008 kindled a collective
determination among multiple stakeholders to tackle food security challenges. This led to concrete investments in agricultural research and
development within which achieving nutrition security has been central. Building on the commitment of the G8 and specifically in response
to the need for investments in research, several collaborative international efforts were initiated. One example is the Canadian International Food
Security Research Fund established by Global Affairs Canada (formerly Canadian International Development Agency) and the International
Development Research Centre. With a CA$ 124 million funding commitment between 2010 and 2018, two phases of the programme have brought together Canadian and developing-country researchers, policymakers, and the private sector. Emerging results demonstrate improved crop productivity, income and nutrition as well as creation of new markets and scaling up of innovations for maximum impact1. Other
international research organizations including the Australian Centre for International Agricultural Research, Feed the Future's Innovation Lab for
Nutrition and the Consortium of International Agricultural Research Centers are also supporting agriculture, food and nutrition security research
(Wesley and Faminow, 2014). Several recent international movements such as 'Scaling Up Nutrition' along with increasing private sector
investments have culminated into a much needed momentum for nutrition as a priority. 

Pathways from agriculture to nutrition
It is now well established that producing more food does not necessarily ensure improved nutrition. Understanding the potential of promoting
food production to improve nutritional outcomes requires consideration of the pathways and linkages between agriculture and nutrition. Research plays a key role in establishing this understanding as well as in identifying key drivers. It is critical to answer questions such as when, where, why and which interventions connect the dots towards improved nutrition.

During the last five years several conceptual frameworks and potential pathways through which agriculture can influence nutrition were developed, many of which highlight three key entry points. These are food production, income and gender, each with several possible pathways to nutritional outcomes. Among the different conceptual frameworks, the one in Figure 1 by Herforth and Harris (2014) best captures these potential pathways and will be further explored in this paper. 
 

Food production pathway
Food production, the core purpose of smallholder farming, influences nutritional outcomes through several means. Increased production of fruits, vegetables, legumes, and animalsourced foods has a direct influence on the consumption of these foods within the household, contributing to improved dietary diversity, a proxy indicator for meeting nutritional needs.

Home and community gardens have been reported to play an important role in South-East Asia by providing increased dietary diversity, especially for the poor (Weinberger, 2013). The 'Enhanced Homestead Food Production' programme of Helen Keller International is considered a model of agriculture interventions that carefully target nutritional outcomes. In Cambodia, innovations tested through randomized control
research that demonstrated improvements in household food security, nutrition, income and women's empowerment are now being scaled up
and tested for sustainability by applying business strategies and consumer 'pull' mechanisms to reduce reliance on external donor support2.

Another promising food production entry point is school gardens. In the Philippines a combination of strategies including biointensive school gardens, fortified rice and nutrition education demonstrated the potential of this approach through significant reduction in severe malnutrition and anemia among children3.

Researchers in Asia are also exploring promising agriculture innovations targeting specific crops for their nutritional benefits. Among single crops with nutritional benefits, pulses (also commonly known as legumes and lentils) have the potential to improve diet quality along with positive agricultural benefits such as water conservation and soil nitrogen fixing properties (Jha, 2014; Weinberger, 2005). Since pulses are the primary source of protein in countries with a large vegetarian population like India, their role in nutrition becomes all the more important. Farmers in Nepal who intercropped with cowpeas at lower altitudes showed an economic gain of 44 per cent (IDRC, 2015). The importance of pulses both as a component of climate smart agriculture and a powerhouse for nutritional benefits received due recognition when 2016 was declared as the
International Year of Pulses. This in turn stimulatedalliances such as the 'Pulse Innovation' partnership committed to improving the nutritional quality and health benefits of pulse-based foods. A survey on investment in pulse crop research highlighted agreement among global funding agencies that pulse crops are strategic to ending chronic hunger and malnutrition, and addressing maternal health and the gender gap (Murrell, 2016).

Another innovation linking agriculture to nutrition is biofortification - the process of breeding high nutrient traits into crops that already have preferred agronomic and consumption traits. Nutrients suitable for this approach are iron, zinc and provitamin A (beta carotene) for crops such as rice, millets, pulses and root vegetables (sweet potato and cassava). Though steadily growing evidence points to this being a relatively cost-effective means of improving diet quality (Bouis et al., 2013), biofortification needs to be considered a complementary approach to other strategies to increase dietary diversity including home gardens, food fortification and nutrition counseling (FAO, 2013).

From the food production and nutrition angle, livestock, poultry and fish also play an important role in filling the nutritional gap. 

Income pathway
Although it was assumed for a long time, and even appears logical, that higher income and economic development translate into better nutrition, it is not always the case. For example, analysis of 10 year data from China on the trends in socioeconomic development and malnutrition levels showed a plateau effect of economic development on nutritional improvement of children after an initial steep decline in malnutrition prevalence
attributable to the country's remarkable economic growth (Wu, 2015).

Ideally, additional income is used to purchase higher-quality or nutrient-dense foods. However, this is variable depending on the dynamics and
decision-making within the household. In Cambodia, researchers found that when rural households had the benefit of an integrated approach of dietary diversity, income generation and empowerment of women, households used income (saved from eating their own produce and
additional income from sale of surplus produce) to purchase high quality nutrient-rich food items such as beef/pork, iodized salt and oil. Not surprisingly, among the intervention households, 75 per cent of women reported having money they could spend at their discretion which again demonstrates the power of nutrition education and income managed by women (Talukder and Green, 2014). 

Another domain within agriculture that has been targeted for income generation and also has a high potential to improve nutrition is aquaculture. A cost-benefit model of an aquaculture food-based approach in Bangladesh shows positive long-term returns on investments for nutrition and health (Fiedler et al., 2016). Studies from Sri Lanka (DeJager et al., 2014) and other parts of the world (Kawarazuka, 2010) document increased income as well as consumption of high quality protein from fish, shrimp and other forms of aquatic produce but as with agriculture interventions, few studies measured impact on nutritional status. Overall, the linkages relating to indirect effects on nutrition mediated through changes in income are not clearly understood, and this is an area that needs more research.

On the other side of the spectrum, income growth can have unintended consequences on risks of overweight and obesity. A 10 per cent increase in Gross Domestic Product Per Capita leads to a 7 per cent increase in incidence of overweight and obesity in women (Ng, 2015). Because of this, programmes that intend to use the income pathway to influence nutritional outcomes require deliberate integration of nutrition counseling.

Gender pathway
A number of studies clearly demonstrate that empowerment of women is central to reap nutritional benefits (UNICEF, 2011). The agriculture to nutrition pathway through the women's empowerment entry point consists of three interrelated components including women's use of income for food and non-food expenditures, the ability of women to care for themselves and their families, and women's energy expenditure. The pathway is influenced by factors such as social norms, knowledge, skills, and how decisionmaking power is shared within households. For example, in Bangladesh, measurement of the Women's Empowerment in Agriculture Index combined with nutritional indicators showed that women with more bargaining power within their households (owing to greater schooling or assets brought to marriage) make choices that promote better nutrition for their children, but cultural barriers still come in the way (Saraboni et al., 2014). The need to unpack this topic through research becomes clear from the finding that women's empowerment in agriculture is more strongly associated with the quality of infant and young child feeding practices but only weakly associated with child nutrition status. As another example, women's empowerment in credit decisions is positively correlated with women's dietary diversity, but not body mass index (Malapit et al., 2015). 

Agriculture can also pose threats to family nutrition, especially when women must work at times and in places that interfere with the feeding of their infants and young children. A powerful example is the finding that over 12,400 preventable child and maternal deaths per year in seven countries in South-East Asia could be attributed to inadequate breastfeeding. The loss exceeds 0.5 per cent of Gross National Income in Thailand, the country with the lowest exclusive breastfeeding rate (Walters et al., 2016). 

In deciding the best pathway from agriculture to nutrition, 'do no harm' should be central to the considerations. Thus, it is all the more important that empowerment of women also ensure attention to nutrition education, opportunities to practise the knowledge and an enabling environment. 

How to decide which pathway to promote? 
Though there is increasing understanding about the importance of agriculture interventions for nutritional benefits, it is still not clear how to select appropriate interventions for any given situation. A project led by HealthBridge in upland areas of Viet Nam and Thailand developed a framework building upon existing descriptions of the pathways between agriculture and nutrition but also considering local power structures, gender and family, and community factors related to agricultural production. Additionally, project-specific factors, such as the research and implementation team's capacity and the project budget played a role. Although initially time consuming, the research team systematically analysed options along the pathways and found home gardens and poultry rearing feasible for one location whereas conventional agriculture interventions involving staple crops with diversification into perennial vegetable and fruit crops on underused sloping lands were found feasible for another location. Both sites maintained a focus on training for infant and child feeding and gender considerations (Berti et al., 2015). This exercise demonstrates the need for a combination of strategies that respond to the local situation. 

Conclusion
With increased interest from donors and national governments to include nutrition-sensitive agriculture as a means to address the pervasive problem of child undernutrition, the timing seems to be right to scale up proven interventions while also advancing planning to gather stronger evidence through research and innovation.

Along with the nutrition-sensitive interventions described in this paper, nutrition specific interventions such as micronutrient supplementation and food fortification combined with addressing the underlying causes of malnutrition should be part of the overall strategy. For achieving best effects on nutritional outcomes, programmes should be coordinated across multiple sectors including health, food security, agriculture, water, sanitation and hygiene, education and social protection.

(List of references can be made available upon request)  
 

1 https://www.idrc.ca/en/initiative/canadian-international-food-security-r.... Accessed June 22, 2016. 
2 Scaling up of enhanced homestead food production for improved household food security and nutrition in Cambodia.
http://fishonfarms.landfood.ubc.ca/. Accessed May 5, 2016.
3 Strengthening the school nutrition program in the Philippines. https://schoolnutritionphils.wordpress.com/. Accessed May 5, 2016.