Seed to Stomach: Advancing Positive Nutrition Habits in Developing Nationsby Kathy Spahn, President and CEO of Helen Keller International.
Increasing access to nutritious foods is a challenge worldwide, but so is increasing demand for these foods, especially in developing nations.
The fact is that poor nutrition is still the underlying cause of nearly half of the deaths of all children under five. This could be avoided if, for example, more mothers were made aware of the importance of exclusive breastfeeding during the first six months of life. Or had the right information about what foods can help bolster their child’s immune system and promote healthy growth. Even armed with this knowledge, too often mothers in developing countries do not have the means to feed their children more than a plain bowl of rice each day – empty calories with few of the nutrients necessary for health and growth.
Earlier this month, a panel entitled “Seed to Stomach” was convened by the Global Alliance for Improved Nutrition (GAIN) to explore ways to increase demand for nutritious foods through market-based approaches. While no one would expect all the answers to come out of a single day of meetings, this gathering of top experts yielded some robust conversations and was valuable in highlighting some of the best approaches already in practice, as well as identifying needs for the future.
As a panel participant, I shared lessons learned through Helen Keller International’s Enhanced Homestead Food Production programs, which use a multi-pronged approach to encourage better nutrition and feeding practices in developing countries. The programs provide women with the training, tools and resources needed to cultivate small home gardens and livestock farms, along with education about good nutrition. Women are also given a means of contributing to their household income through the sale of their surplus produce. This gives them more power in making household financial decisions, including how money is spent and on what kinds of foods. As our program evaluations have shown, this can help to ensure their children get the right foods at every stage of development.
Since our first pilot in Bangladesh 25 years ago, we now reach more than one million households in 10 countries in Africa and Asia and the results are very positive. We’ve seen improved access to and consumption of nutritious foods for target households in communities with high malnutrition rates. Participating families in Bangladesh, for example, produce three times as much in their gardens and farms as non-participating families. We’ve also seen reductions in night blindness and anemia in participating communities.
But as anyone working in development and program design will tell you, it’s not as simple as “build it and they will come.” During those 25 years, we have learned a great deal about not only the importance of the education and tools provided, but how critical it is to generate demand for this support from families so that the techniques learned through the programs are adopted and sustained.
Through our experience, we have identified three critical elements needed to achieve real and sustainable change in what products make it from farm to market to mouth, and in how and what those most in need feed themselves and their families:
1. Investment in effective communications tools to change behaviors.How we convey health and nutrition messages greatly impacts whether – and how deeply – families embrace and adopt these new behaviors. Models with one-on-one counseling with mothers and child caregivers, while time consuming, have proven to be the best way to share knowledge and generate buy-in. To be successful at this, we need to improve how we train the trainers – the health workers and community influencers who are most likely to have these personal interactions with women and other family members.
The information on good nutrition practices that these key influencers have is only as valuable as their ability to communicate and persuade mothers to adopt them. Messages need to be presented as clearly and simply as possible and within the context of the local community’s cultural traditions. Information about how to feed their families, especially infants and young children, which crops to grow at home, and how to process, cook and store these foods must be also be shared – and shared again – in a way that is convincing, relevant and trustworthy to ensure women implement these practices in their daily routines.
We should also take care that tailor-made messages reach other key family members, especially the men and the mothers-in-law, powerful figures with great influence on how babies are fed and what care is given to pregnant and lactating women.
More investment is also needed in reaching and saturating the entire community with clear messages promoting small, doable actions that families have the means to take to improve the health and nutrition of their children. Interactive activities like healthy baby contests and village dramas are fun and effective ways to reinforce what is learned during the one-on-one counseling sessions, as are traditional PR strategies like radio call-in shows and other mass media. The more these messages are heard by women and other family members, the better the chance they will ‘stick’ for the longer term.
2. Government policies designed to improve the production and consumption of more nutritious foods. While NGOs such as Helen Keller International cannot control these policies, there is much to be gained from combining our voices to urge governments to use policy levers to complement grassroots efforts. Their impact on the purchasing power of families can lead to better nutrition outcomes.
For example, government subsidies on crops with high nutritional value can encourage more farmers to grow and sell these crops at a lower price which could help change consumption behaviors for the better. Taxes on sugars, sweeteners and high fat products are also great incentives that have the potential to influence eating habits. Regulations on advertising and promoting unhealthy foods can also be effective.
Mandating the fortification of staple foods like wheat flour and cooking oil with essential vitamins and minerals – and keeping these products affordable – have also been proven drivers in increasing intake of essential nutrients in target populations. In addition to reaching millions, it has been found to be the most cost-effective and sustainable approach to preventing and managing micronutrient deficiencies.
3. Private sector support for government nutrition policies. While we advocate for governments to enact national policies to sustainably improve nutrition habits in the developing world, we must also engage the private sector to play an active role in supporting those policies.
We need to appeal to the moral imperative of improving the well-being of those most in need. Beyond this, the experience and expertise of the private sector should be leveraged to help scale up efforts in making these foods more accessible and affordable. This, in turn, can provide a competitive advantage to food companies in an expanding consumer marketplace. As long as this is done responsibly, with the needs of the most vulnerable kept in focus, there is a great opportunity to significantly impact instances of malnutrition in the developing world.
Bringing to bear these three strategies in an integrated fashion within a country has the highest likelihood of achieving significant change in healthy eating habits as compared to a siloed approach. To influence nutrition for the better, and make real strides in the fight against hunger, our messages and support need to come from every possible corner – from the field to the market, from village crier to the radio, from the rural health center to the Ministry of Health. We are all in this together and can achieve the most impact by fostering health nutrition messages at every level. Or, as Helen Keller so wisely put it, “Alone we can do so little; together we can do so much.”Kathy Spahn, President and Chief Executive Officer of Helen Keller International, is responsible for all operations, programs, finances, communications and public policy initiatives of HKI. Ms. Spahn works closely with the Board of Trustees, global leaders in public health, staff members throughout the agency, partner organizations, and HKI supporters in carrying out her responsibilities. Prior to joining HKI, Ms. Spahn was President and Executive Director of ORBIS, a global non-profit organization dedicated to the prevention and treatment of blindness in the developing world. As President and Executive Director, she provided overall direction and management for this $30 million organization with four affiliates and five country programs, and a medical volunteer corps of 370. Ms. Spahn serves as Chair of the board of directors of InterAction. She is also a member of the boards of directors of the International Agency for the Prevention of Blindness (IAPB) and The Bernadotte Foundation for Children’s Eyecare. She is a Founding Board member of both the North America chapter of IAPB and the Association of Nutrition Services Agencies (ANSA), and a founding partner of the Global Network for Neglected Tropical Disease Control. She also serves on the Partnership Council of GAIN and on the 2020 and Strategic Advisory Council of the International Food Policy Research Institute (IFPRI). She joined HKI in March 2005 and is located at headquarters in New York City.
This post does not reflect the views or opinion of the Zero Hunger Challenge and does not imply endorsement by the United Nations.