Can Ag/Nutrition Programs Change Gender Norms_Mara Vandenbold_10.16.13

Overview

• Background to Helen Keller International’s 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

Context

Burkina Faso• Eastern region, Gourma Province

Sahel• Water shortages, inhibits having a second cultivation season

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

E-HFP program in Burkina Faso (1)

Overall objective: To improve women’s 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

Targeted to women with children between 3 and 12 months of age

Improvements expected through three primary program impact pathways:

1. Increase women’s 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

Two primary program components:

• Agricultural component• HKI provided agricultural inputs and training to establish ‘village model farms’

(VMF) (training site) to grow micronutrient-rich foods year-round and raise small animals. Led by 4 ‘village farm leaders’.

• 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



Program sought to directly increase women’s 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 ‘village model farm’ (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

Motivation for research on gender

Evidence shows:• Positive associations between women’s (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 women’s control over assets (esp. financial/physical) has been shown to positively impact food security, child nutrition, education, women’s own well-being (Quisumbing 2003; Smith et al. 2003; World Bank 2001); gender differences in bargaining power over household resources matter

Women often specifically targeted in agricultural programs, but to date there is limited evidence on the impacts of agricultural interventions on women’s control over and ownership of assets

E-HFP program expected to influence women’s asset holdings through direct (direct transfers of resources) and indirect (improved production techniques) mechanisms

Study design

Longitudinal impact evaluation (baseline 2010, endline 2012)

Operations research (2011)

Qualitative research to examine gender related topics including ownership and control over agricultural assets (2012)

Key gender-related questions

Key Questions Impact evaluation

Qualitative research

Analysis Status

Did the EHFP program increase women’s and men’s ownership of assets?

x Complete

Were women able to maintain control over the EHFP activities and outputs?

x x Complete

Did the land agreements and/or project activities influence community norms related to women’s 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

Impact evaluation

Cluster randomized design• 30 intervention villages (~1200 households and 120 village farm leaders (VFL))

o 15 “older women leader” villages (OWL)o 15 “health committee” villages (HC)

• 25 control villages (~800 households)

Longitudinal• Baseline Feb-Apr 2010 (target children 3-12 months of age)• Endline Feb-Apr 2012 (target children 21-40 months of age)

Household interview• 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, …

• Anthropometric measures and hemoglobin status of target children

Qualitative research

Operations Research (2011) GAAP* Qualitative Research (2012)

Random sample of beneficiaries and non-beneficiaries

Beneficiaries: n=120Non-beneficiaries: n=60

Beneficiaries: n=145Non-beneficiaries: n=75

Purposive sample of key informants

VFL: n=60 OWL: n=30HC: n=30Master agriculture trainers: n=18 Master nutrition trainers: n=24

VFL: n=60OWL: n=30HC: n=30Land owners: n=30Focus groups: n=24 (6m; 6f)

Data collection May-June 2011May-June 2012

May-June 2011May-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

http://www.gaap.ifpri.info/

ResultsDid the EHFP program increase women’s and/or

men’s ownership of assets?

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

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

Were women able to maintain control over the E-HFP activities and outputs?

Control over EHFP activities and outputs: Gardens, vegetables, revenue

Operations research: Round 1 (2011) Operations research: Round 2 (2012)

Control over EHFP activities and outputs: Chickens


Control over EHFP activities and outputs: Goats


Did the land agreements and/or project activities influence community norms related

to women’s land ownership or land rights?

Women MenIntervention villages Control

villagesIntervention villages Control

villages

HC OWL All Control HC OWL All Control n = 70 n = 75 n = 145 n = 75 n = 57 n = 58 n = 114 n = 60

Change in own opinion about who can own and/or use land for the production of fruits and vegetables

46 (66) 49 (68) 95 (67) 11 (16) 32 (56) 36 (62) 68 (60) 14 (23)

n = 56 n = 56 n = 112 n = 65 n = 46 n = 51 n = 97 n = 52Perceived changes in other people’s opinions about who can own and/or use land for the production of fruits and vegetables

24 (43) 31 (55) 55 (49) 8 (12) 21 (46) 24 (47) 45 (46) 5 (10)

n = 69 n = 67 n = 136 n = 73 n = 57 n = 59 n = 116 n = 60Perceived changes related to women’s ability to own land in the village

18 (26) 15 (22) 33 (24) 1 (1) 16 (28) 15 (25) 31 (27) 2 (3)

n = 68 n = 70 n = 138 n = 74 n = 55 n = 53 n = 108 n = 61Perceived changes related to women’s ability to use land for growing food in the village

29 (43) 32 (46) 61 (44) 3 (4) 27 (49) 21 (40) 48 (44) 1 (2)

Community norms related to women’s land ownership and land rights: Perceived changes by men and women on

women’s ability to own and use land

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.

Summary

Key Question Summary

Did the EHFP program increase women’s 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 men’s 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 women’s ownership of agricultural assets. The program had a positive impact on men’s 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.

Summary , cont’d

Key Question Summary

Did the land agreements and/or project activities influence community norms related to women’s land ownership or land rights?

Yes, in beneficiary villages some change was noted in people’s opinions about who could own and use land. Both men and women in beneficiary villages reported that women’s 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).

References

EXTRA SLIDES

Why pay attention to gender in leveraging agriculture for nutrition?

• “Women are important in agriculture, and agriculture is important for women” (Doss 2009; Meinzen-Dick et al. 2011)

• 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

• 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)

• Increasing women’s control over assets (esp. financial/physical) has been shown to positively impact food security, child nutrition, education, women’s own well-being (Quisumbing 2003; Smith et al. 2003; World Bank 2001); gender differences in bargaining power over HH resources matter.

Agriculture—gender—nutrition 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 preferencesv) Shifts in control of resources within households*

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).

Women’s 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).

All mediated by gender roles, especially (*)

Linking gender and nutrition

Women are often primary caregivers: they influence their child’s nutrition indirectly through their own nutritional status and directly through child care practices

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)

• Women’s relationships with men in the household (HH) and community can affect their bargaining power and ability to direct HH resources to nutrition

Quisumbing, Agnes (IFPRI)

important to note that gender does not only mean women!

35

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).

SCN 6th World Nutrition Situation Report. www.unscn.org/files/Publications/RWNS6/report/chapter4.pdf

Definitions of Key Terms

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?

Impact of the EHFP program on nutrition knowledge: IYCF practices

Give breast milk within the first hour after

birth

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=1,149OWL villages 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***

(0.052) (0.029) (0.078) (0.059) (0.059)p-value 0.006 0.009 0.006 0.007 0.011

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 0.12*

(0.070)Health committee 0.098

(0.077)p-value 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

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 0.15**

(0.072)Health committee 0.023

(0.090)p-value 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

Impact of the EHFP program on nutritional status of children: Hemoglobin among children 3-12

months of age at baseline

Hemoglobin(g/dL)

n=1144Older women leaders 0.24

(0.31)Health committee 0.49*

(0.27)p-value 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

Change in hemoglobin from baseline to endline among children 3-5.9 months of age at baseline

Hemoglobin(g/dL)

n=449Older women leaders 0.044

(0.32)Health committee 0.76**

(0.30)p-value 0.043Note: 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

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

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

Impact of the EHFP program on nutritional status of children: HAZ among children 3-12 months of

age at baseline

Impact of the E-HFP program on nutritional status of children: Wasting among children 3-12 months of age at baseline

Program theory framework for HKI’s HFP program in Burkina Faso

HKI, APRG and governmental

structures (Ministries of

Health, Agriculture,

Animals, Environment, and the Promotion of

Women, local authorities and officials) work

together

Village Model Farms (VMF)

established

Improvements in small

ruminant and poultry

production

Improvements in fruit and vegetable

production

Training in plant and animal

production techniques for

master trainers

BCC training on ENA

practices for village health

workers (VHW)


production techniques for beneficiaries

BCC training on ENA

practices for beneficiaries

Establishment of individual

farms (40 women per

village)

Improvements in household

consumption

Increased Income

Improved maternal and child health and nutrition

outcomes

Beneficiaries received and understood

BCC training on ENA practices

Improvements in nutrition and

feeding practices for children,

pregnant women and breastfeeding

mothers

Outcomes

Adoption of agriculture practices

Develop a training strategy in animal;

and plant production techniques

BCC training on ENA

practices for master trainers

Women’s empowerment

improved

Women’s assets increased

Increased availability of micronutrient

-rich fruits and

vegetables

Impact Inputs Process Outputs

Agriculture and zoological inputs

distributed

Develop a behavior change communication (BCC) strategy with regards to

Essential Nutrition Actions

(ENA)


production techniques for Village Farm

Leaders (VFL)

Adoption of ENA

practices by beneficiaries

Improvements in care & hygiene

practices for children, pregnant

women and breastfeeding

mothers

Beneficiaries received and understood agriculture

training

Increased availability of

food from animal origin

Map of study area

Impact Evaluation Intervention villages HC villages OWL villages Control

villagesTotal

Number of villages 15a 15 25 55Number of households Baseline (2010) Household interview 511 512 734 1,757 Endline (2012) Household interview 436 444 590 1,470

Qualitative Research Intervention villages HC villages OWL villages Control

villagesTotal

Number of villages 14a 15 15 44Number of households First round (2011) Basic semistructured interviews 70 75 75 220 In-depth semistructured interviews 28 30 30 88 Second round (2012) Semistructured interviews 70 75 75 220

Table 3.1 Overview of methods and participants from health committee and older women leader intervention villages and control villages

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.

Can Ag/Nutrition Programs Change Gender Norms_Mara Vandenbold_10.16.13

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