Nutrition Security for the Poor Professor Nazma Shaheen Institute of Nutrition and Food Science University of Dhaka

Nutrition Security for the Poor Food Security Vs Nutrition Security Current Nutrition Situation in Bangladesh Poverty and Nutrition Security Policy Challenges Approaches Nutrition Security for the Poor

Nutrition Security Nutrition Security A condition which combines Having access to a stable supply of adequate food. Being well cared for. Enjoying a healthy environment. IFAD (1996) Nutrition Security for the Poor

Food Security Vs Nutrition Security Food intake Stability Food availability Food accessibility Nutrition Security Food intake Food availability Caring capacity Health service Environment Nutrition Security for the Poor

Conceptual Framework of the Nutritional Status Nutrition Security Food Security Food Intake Health Status Food access Health Status Health Services Environmental condition Nutrition Security for the Poor

Bangladesh: Nutrition Security Scenario Chronic and acute malnutrition Micronutrient malnutrition Consumption Pattern Nutrition Security for the Poor

Current Nutrition Situation in Bangladesh Malnutrition, in Children (birth to 59 months) 2011/12 2012/13 Stunting 41.3% (BDHS) 38.7% (UESD) Underweight 36.4% (BDHS) 35.1% (UESD) Wasting 15.7% (BDHS) 16.3% (UESD) Low birth weight 26% (BDHS)   Exclusive breastfeeding (6 -59 months) 64% (BDHS) 95.3% (MICS) Breast feeding until 2 years 90% (BDHS) 87.5% (MICS) Anemia, in children (6-23 months) 51% (BDHS) Iodine deficiency, in children (6-11 years) and (12-14 years) 3.9% and 9.5 % respectively (BDHS) Zinc deficiency, in pre-school age children 44.6% (BDHS) Nutrition Security for the Poor

Prevalence of Underweight (<-2 z) Among U-5 Children in Bangladesh Nutrition Security for the Poor

Trends of Nutritional Status of Bangladeshi Children Nutrition Security for the Poor

Maternal Nutritional Status Nutrition Security for the Poor

Micronutrient Deficiency A persisting problem of micronutrient deficiencies. 2/3 of preschool children and1/3 of mothers and school going children are still iodine deficient. Iron deficiency anemia is prevalent in 2/3 of under-five children and 1/3 of pregnant women and overall anemia in 93.5% of adolescent girls. 1/5 of under-five children suffer from vitamin A deficiency. Nutrition Security for the Poor

Consumption Pattern in Bangladesh Survey Years Food items, g 1995-96 2000 2005 2010 Poor Non-poor Total 913.8 893.06 947.75 816.22 1084.53 999.99 Rice 464.3 458.54 439.64 406.19 420.52 416.01 Wheat 33.7 17.24 12.08 20.36 28.73 26.09 Potato 49.5 55.45 63.30 63.44 73.78 70.52 Pulses 13.9 15.77 14.19 10.15 16.22 14.30 Vegetables 152.5 140.47 157.02 141.8 177.25 166.08 Edible oil 9.80 12.82 16.45 14.20 23.41 20.51 Onion 11.6 15.41 18.37 15.69 24.74 21.89 Beef 6.60 8.30 7.78 1.55 9.27 6.84 Mutton 1.00 0.49 0.59 0.11 0.83 0.60 Nutrition Security for the Poor

Consumption Pattern in Bangladesh Survey Years Food items, g 1995-96 2000 2005 2010 Poor Non-poor Total Chicken/Duck 4.00 4.50 6.85 4.11 15.09 11.22 Eggs 3.20 5.27 5.15 3.40 9.02 7.25 Fish 43.80 38.45 42.14 31.16 57.81 49.41 Milk & milk products 32.60 29.71 32.40 12.18 43.63 33.72 Fruits 27.60 28.35 32.54 20.46 56.0 44.80 Sugar/ Gur 9.20 8.08 3.32 10.88 8.50 Food taken outside - 24.76 17.70 35.41 29.83 Miscellaneous 50.90 55.42 48.38 50.28 81.81 72.41 Nutrition Security for the Poor

Consumption by Ultra Poor Food group Intake (g/per capita/day) (BIGH, 2013)* Desirable (g/per capita/day) ((DDP,2013) Total Cereal 337.3 400 Fruits 50 100 Non-leafy Vegetables 68.1 200 Leafy Vegetables 43.8 Pulses 4.60 All animal foods 64.9 260 Fish 36.8 60 Meat 10.2 40 Egg 7.5 30 Milk and Milk products 32.4 130 Roots & tubers 48.3 * Baseline Survey Report On Integrated Agriculture And Health Based Intervention For Improved Food And Nutrition Security In Selected Districts Of Southern Bangladesh by BRAC Institute of Global health (BIGH). Nutrition Security for the Poor

Gap Between Original Intake and Desirable Intake* * Baseline Survey Report On Integrated Agriculture And Health Based Intervention For Improved Food And Nutrition Security In Selected Districts Of Southern Bangladesh by BRAC Institute of Global health (BIGH). Nutrition Security for the Poor

Trend of Cereals Intake Over Years in Bangladesh (BBS) Nutrition Security for the Poor

UNICEF Model of Malnutrition Nutrition Security for the Poor

Underlying Causes Malnutrition Poverty Disease Inadequate Food Intake Household Food Insecurity Poor Social and Care Environment Poor Access to Health care and Unhealthy Environment Poverty Nutrition Security for the Poor

Poverty and Nutrition Insecurity Unavailability of food Inadequate food intake Unhygienic Environment Poverty Nutrition Insecurity Increased infection Poor health service Improper care Poor Education Loss of resources due to health cost Decreased Productivity Nutrition Security for the Poor

Policy and Planning Frameworks in Bangladesh Since the World Food Summit of 1996, the Government of Bangladesh has undertaken an in-depth and consultative process of food security policy reform. This has provided the Government with: The National Food Policy (NFP) (2006) a comprehensive food security policy framework The National Food Policy Plan of Action (NFP PoA) (2008-2015) a programming document The Bangladesh Country Investment Plan (CIP) an investment plan for food security and nutrition. Nutrition Security for the Poor

Policy and Planning Frameworks in Bangladesh Other policy documents that are relevant for food security in Bangladesh: Roadmap for producing the CIP and NFP PoA Monitoring Report 2014 NFP PoA and CIP Monitoring Report 2013 Roadmap for producing the CIP and NFP PoA Monitoring Report NFP PoA and CIP Monitoring Report 2012 National Strategy for Accelerated Poverty Reduction II (Revised) (2009-11) Outline of Perspective Plan (2010-2021) National Agricultural Policy (2013) Nutrition Security for the Poor

Objective 1: Adequate and stable supply of safe and nutritious food National Food Policy Objective 1: Adequate and stable supply of safe and nutritious food   POLICIES Agricultural research and extension Use and management of water resources Adequate supply and sustainable use of agricultural inputs Agricultural diversification Agricultural credit and insurance Physical market infrastructure development Agricultural marketing and trade Policy and regulatory environment Early warning system development Producer price support Public stock management / price stabilization Nutrition Security for the Poor

National Food Policy POLICIES Objective 2: Increased purchasing power and access to food of the people   POLICIES Agricultural disaster management Emergency distribution from public stock Enabling environment for private food trade and stock Effectiveness of targeted food security programs and other safety nets Income generation for Women and the Disabled Promotion of Agro-based/ Agro-processing and Micro/Small Rural Enterprises Market-driven skill Development Nutrition Security for the Poor

National Food Policy POLICIES Objective 3: Adequate nutrition for all individuals, especially women and children   POLICIES Long-term planning for Balanced nutrition Balanced and nutritious food at Minimal Costs for Vulnerable Groups Nutrition education for dietary diversification Supplementation and fortification for balanced nutrition Safe drinking water and improved sanitation Safe, quality food supply Women and children’s health Promotion and Protection of Breastfeeding and Complementary Feeding Nutrition Security for the Poor

Challenges Nutrition Improvements not keeping pace with poverty situation (BBS, BDHS,2011) Year Poverty Stunting Underweight 2000 48.9% 50.8% 42.3% 2010 31.5% 41.0% 36% Change/year -4.30% -1.86% -1.36% Income poverty improved faster than stunting and underweight Nutrition Security for the Poor

Consumption is Diversifying Faster Than Production (FPMU,2014) Production diversification could accelerate consumption diversification in rural areas Nutrition Security for the Poor

Issues and Policy Challenges Average calorie intake well below the FAO recommended level; rural urban divide U5 underweight almost stagnant >>> specific program intervention Calorie intake from cereal still very high >>> food and diet diversification cereals and other foods Still 1/4 of adult women suffer from CED Anemia prevalence among women increasing (!!) People suffering from FBD and WBD still significant (around 9% for diarrhea only) Data heterogeneity; non-availability Nutrition Security for the Poor

Strategies for Improvement of Nutrition Situation Specific Action for Nutrition Feeding practices & behaviors Fortification of foods Micronutrient supplementation Treatment of acute malnutrition Nutrition-Sensitive Strategies Agriculture Clean water & sanitation Education Employment & social protection Health care Support for resilience Nutrition Security for the Poor

Approaches to Ensure Nutrition Security in Poor To ensure adequate intake Food based approach Non-food based approach To ensure care and health Improvement of local health services Ensuring proper access to health services Education on Mother and child care Education on proper sanitation Nutrition Security for the Poor

Approaches to Ensure Nutrition Security in Poor Food based approach Increasing agriculture productivity Local level Interventions in largely non-commercial agricultural systems, where large part of the produce is consumed by producer, may result in diversified diets. Mitigation of extreme poverty by increasing productivity Ensuring accessibility through policy Nutrition Security for the Poor

Agriculture-Nutrition-Health Horticulture Pisiculture Agriculture Health Food Productivity Risk taking Education Cognition Endurance Physical- strength Livelihoods Income Employment Food Security Dietary diversity Income Equity Nutrition Nutrition Security for the Poor

Approaches To Ensure Nutrition Security Non-food based approach Identification of most vulnerable group. Supplementation program to manage extreme condition. Fortification of staple foods with required nutrient. Ensuring proper utilization and minimizing loss by providing proper health care services and proper education. Nutrition Security for the Poor

Recommendation Achieving nutrition security requires a multi- sectoral approach Nutrition Security for the Poor

The Way Forward and Implementation Challenges The CIP is a tool in the hand of the Government to increase and improve investment in food security, i.e. agriculture, fisheries and livestock, food access and safety nets and nutrition activities. Resource mobilization activities capacity development activities strong momentum strong dialogue Policy dialogue Knowledge sharing and effective learning Nutrition Security for the Poor

The Way Forward and Implementation Challenges Strong momentum developed with all actors involved, including consumer groups, farmer and producer organizations, private sector, NGOs, Government and development partners to ensure their support of the CIP, including its financing and implementation. A strong dialogue on investment in food and nutrition security using the CIP as the key strategic and collaborative instrument for creating a more enabling framework for increased investments from both the public and the private sector. The policy dialogue on investment should be mainstreamed in the National Food Policy, focused on the critical elements for the CIP Nutrition Security for the Poor

Thank you