Development and Nutrition

Eliana La Ferrara

Invernizzi Chair in Development Economics

Università Bocconi

ABF Workshop, 24/10/2015

The nutrition poverty trap

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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

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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

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2. Food consumption

& caloric intake

3. Distribution of resources within the household

1. Do we produce as much food as we can?

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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)

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Factors affecting technology adoption

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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)

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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)

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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?

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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

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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?

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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

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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)

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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

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Policy responses

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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)

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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.

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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)

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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

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Conclusions

Overall clear need for interventions in this area

Importance of targeting resources to mosteffective programs

Need for a careful evaluation of programimpact

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