Chapter 3 - The food system and factors affecting household food security and nutrition
The perception underlying the systems approach is that the whole is greater than the sum of its parts. In this approach any situation is viewed in terms of relationships and integration. A food system may thus include all activities related to the production, distribution and consumption of food that affect human nutrition and health (see Figure 7).
Food production comprises such factors as land use and tenure, soil management, crop breeding and selection, crop management, livestock breeding and management and harvesting. Food distribution involves a series of post-harvest activities including the processing, transportation, storage, packaging and marketing of food as well as activities related to household purchasing power, traditions of food use (including child feeding practices), food exchanges and gift giving and public food distribution. Activities related to food utilization and consumption include those involved in the preparation, processing and cooking of food at both the home and community levels, as well as household decision-making regarding food, household food distribution practices, cultural and individual food choices and access to health care, sanitation and knowledge.
Among the components of the food system, e.g. food processing, communication and education, there is substantial overlap and interlinkage. For example, household decision-making behaviour with regard to food is influenced by nutrition knowledge and by cultural practices with regard to food allocation within the household as well as by purchasing power and market prices.
FIGURE 7 - The food system
Source: Combs et al., 1996.
Food systems are further embedded in environments which differ according to a variety of factors such as agro-ecology, climate, social aspects, economics, health and policy. The model presented in Figure 8 is useful in conceptualizing the various activities that determine food security and nutritional well-being and the interactions within the food system. The food systems approach can also be expanded to address such issues as the impact of agricultural interventions on health or the extent to which improved and accessible health services and construction of wells that provide a safe water supply influence women's workload and their ability to provide care.
FIGURE 8 - Interactions within the food system
Source: Combs et al., 1996.
Food security is one of the important conditions that must be achieved for an individual to be nutritionally secure and to maintain good health. As presented in Box 2, the definition of food security has changed since the early 1970s, but there is now general agreement among the development agencies that food security must entail "secure access to adequate food at all times". Chapter 2 examined food security at the national, community and household levels. At the national level it was perceived mainly in terms of food available for consumption, as derived from food balance sheets. At the household or individual level, the emphasis has shifted from simple "availability of food" to a more complex system of "food access". As expressed by FAO's Committee on World Food Security (FAO, 1983a), this system consists of three components: adequate access, stability of food supplies and sustainability of food procurement. In order to operationalize the concept of household food security, it is useful to consider one by one the defining characteristics of adequacy, access, stability and sustainability.
The concept of adequate food is an important part of the current definition of household food security. Clearly, what is adequate for one member is not adequate for another. A person's requirements for different nutrients depend on many factors including age, sex, level of activity and physiological status. However, adequacy of diets should not be considered only in quantitative terms (i.e. caloric sufficiency), but also in qualitative terms (i.e. variety, safety and cultural acceptability).
Several major conditions define an adequate diet, necessary for an individual to stay active and healthy:
· It should provide adequate energy and protein.
· It should provide micronutrients (vitamins and minerals) in sufficient quantities to maintain good health.
· It should be safe and free from contaminants, parasites and toxins which may be injurious to health.
· It should be culturally acceptable and, in addition, should satisfy the palate and be capable of providing pleasure to the consumer.
Box 2 - Changing concepts of food security
Food security has been a global concern since the 1974 World Food Conference, held at a time when world food supplies were tight and large-scale food shortages and starvation appeared imminent. In response to the perceived crisis, such bodies as the World Food Council, the FAO Committee on World Food Security (with its Food Security Assistance Scheme) and the Committee on Food Aid Policies and Programmes were formed. Their activities focused on increasing domestic agricultural production and creating international grain reserves. Food security was identified with commercial food prices and physical food availability, rather than with demand and consumption by poor people or nutritionally vulnerable groups.
By the early 1980s many of the assumptions underlying the 1974 conference proved to be unfounded. Increased food production was not the simple answer to the hunger problem. The problem became recognized as one of distribution to reach the population. In 1983, FAO's Committee on World Food Security expanded the concept of food security to its current definition, encompassing three specific goals: ensuring adequacy of food supplies; optimizing stability of supplies; and securing access to available supplies for all who need them. The ultimate objective of this enlarged concept of food security is to ensure that all people at all times have both physical and economic access to the basic food they need.
This definition was adapted readily by other major bodies (e.g. the World Food Council, the Economic and Social Council of the United Nations and the Council and Conference of FAO) and formed the basis of the international consensus of actions required at the global, regional and national levels to achieve world food security. In 1986, the World Bank's position paper on poverty and hunger added the concept of activity level to these goals, stating that food security must assure "access by all people at all times to enough food for an active and healthy life". Food insecurity, in turn, was defined as the lack of access to enough food for a healthy, active life. The World Bank described food security as essentially a matter of ensuring effective demand rather than a question of food supply. The relationship among poverty, hunger and the food problem was gaining recognition, and vulnerable groups were beginning to be defined.
Source: Adapted from FAO, 1992b.
The diet can meet all these requirements when it is diversified and constituted in the right proportions and when it can satisfy the preferences and food habits of the consumer.
Whereas before the 1990s food security was equated primarily with energy sufficiency, the current approach to food security emphasizes the composition of the diet, especially with respect to micronutrients. The emphasis on micronutrients can be attributed to two factors: increased understanding of the extent and the far-reaching consequences of micronutrient deficiencies, especially iron, iodine and vitamin A deficiencies; and the availability of proven and low-cost methods of preventing these deficiencies. For more information on micronutrients and strategies to prevent micronutrient deficiencies see Chapters 5, 7 and 8.
Access to food
Household food security, as noted earlier, depends not only on the availability of an adequate and sustainable supply of food, but also on the strategies employed by households for its acquisition. The ability of different households to establish access to the food supply can be considered both in terms of production and in terms of the people's ability to exchange their assets for food, for example through bartering, purchase or food-for-work. People's assets may include their income; their access to, use of and/or ownership of land; their livestock; their labour and the products of their labour; their inheritance; and gifts and transfers. The value of the exchange for individuals or households will vary with market forces, including wages and prices.
Food enters a household in a variety of ways. A household may produce food when it has the human and material resources to do so; such households have direct access to food. The ability of farmers to produce food in adequate amounts and sufficient variety depends to a large extent on their access to resources - chiefly sufficient and fertile land, labour, tools, seeds, draught power, credit and other essential agricultural services - as well as the knowledge to grow crops and raise animals that provide beneficial nutritional outcomes and sustain the household's livelihood on a continuous basis. In many rural communities, gathering of wild foods and non-wood forest resources also makes an important contribution to family food supplies.
Poor farmers, including women farmers, often lack access to adequate resources (such as land, improved technology, credit, extension advice and training) and to markets. Box 3 provides a case-study from Zambia on some of the problems and constraints and their underlying causes -experienced by different economic groups in meeting their food needs. Decision-makers in agriculture, extension services, the private sector and agricultural investment projects need to address urgently the special production constraints of poor farmers and women farmers to assist them in enhancing their productive capacity and raising crops and animals for household consumption and sale.
Food is also purchased. Indeed, most households purchase a portion of their dietary requirements depending on need and affordability. This type of food acquisition represents economic access. Rural farming households regularly purchase a proportion of food commodities which they do not produce themselves. In addition, during seasonal troughs households that do not have sufficient food stocks may have to borrow money, sell assets such as small livestock or engage in wage labour to buy food to replenish family supplies until the next harvest season. Urban households purchase most of their food commodities. They may also receive food as gifts or transfers from rural relatives. These means of access are also prone to risk, especially if jobs are lost, incomes fall, food prices rise, harvests in the rural areas are hampered or relatives move into town.
The interest in whether and how people acquire food is closely associated with the concept of vulnerability as connected with the relative distribution and control over resources or access to employment. Thus different groups of individuals in a population, such as the rural landless, small marginal farmers or the urban poor, may be defined as vulnerable based on their specific socio-economic characteristics. Women-headed households in particular are often vulnerable to food insecurity as, even if they do have access to sufficient land, they often lack the labour and other essential inputs to achieve adequate production. Box 4 describes some of the groups most vulnerable to food insecurity and malnutrition. However, it is important to note that vulnerability to food insecurity is location specific and must therefore be assessed independently in each community or district.
Box 3 - Household food security for different wealth groups in the Luapula Valley, Zambia
A rapid rural appraisal showed that in the Luapula Valley women tend to dominate subsistence farming activities and are therefore extremely important in maintaining the household food security in terms of staple foods. Men, on the other hand, are the main providers of cash income, from fishing, sawing, charcoal cutting, casual labour, etc. Income is vital to household food security, as cash is needed to purchase essentials such as salt, oil and relish foods that are not home produced or bartered. As men are the providers of income, their food preferences are paramount in determining what the family eats or does not eat. The women also generate some income, but considerably less than men, given their overriding responsibilities for subsistence agriculture.
A wealth-ranking exercise showed that only the poor groups experience shortages of food during the year. The wealthier groups were seen to be able to secure their food needs throughout the year. Characteristics of the poor groups show clearly why they have difficulties: they have on average smaller farms; the number of people per household tends to be less, possibly indicating a shortage of labour; and very importantly, they have few if any alternative sources of income, in contrast to the wealthier groups which have invested capital and diversified their activities to include several sources of income. The poor groups also contained a high proportion of women-headed households and also elderly people, some of whom were responsible for the care of their grandchildren. Women in the focus groups also ascribed poverty to social factors, such as men neglecting their families by not giving them sufficient income, by not helping with agricultural activities or because of drinking problems.
Shortages of staple foods, mainly cassava, are obviously the most pressing nutritional problem among the poor. The limiting constraint for poor households is labour, particularly of women, who are responsible for planting, weeding and harvesting. In women-headed households, women on their own have to undertake all the work including the land clearing and preparation. It is therefore not surprising that little or no time is left for other activities.
Apart from staple foods, other foods also make an important contribution to household food security, particularly sources of oil and relish foods (i.e. fish, vegetables, groundnuts). No household is self-sufficient in any of these items, and households will be dependent to some extent on either barter or purchase.
Source: Adapted from FAO, 1992g.
Box 4 - Groups most vulnerable to food insecurity and malnutrition
Broadly speaking, those who are nutritionally insecure share common socio-economic, agro-ecological, demographic and educational characteristics. Usually these vulnerability factors operate simultaneously in combination to increase the risk. For example, rural and urban households vulnerable to malnutritional insecurity are precisely those most vulnerable to environmental degradation, poor sanitation, pollution, overpopulation and disentitlement to education, training and employment opportunities needed to improve their nutritional situation in the long term. With regional and local variations, the following types of household are likely to be most vulnerable to food insecurity and malnutrition:
· subsistence farmers who produce marginal or inadequate amounts of food;
· landless wage earners lacking adequate resources to produce food or income to obtain to food;
· households headed by women;
· households with a large number of dependents;
· households situated on marginal lands (e.g. drought-prone areas or steep slopes adversely affected by erosion);
· households with insufficient income to enable continued access to adequate supplies of safe and good-quality food.
Among these households the most vulnerable groups are children under five years of age and women of child-bearing age. Their risk is increased by inadequate access to health services and by unstable environmental and political factors.
Sources: Adapted from FAO, 1992b.
Typical sources of risks of household food insecurity for population groups are shown in Table 11. Conflict is an increasingly common source of risk to people's ability to meet their nutritional needs and maintain their livelihoods, and in Africa it has taken over from drought to become the primary cause of famine and human displacement in the 1990s. Box 5 describes the disruption that can be caused by conflict and the devastating effects on agricultural production and economic life that can result.
Diversity of food and income sources is considered to be one of the main practices against risk in agrarian communities. Understanding of the relative importance of different income sources and their characteristics and seasonal fluctuations is vital, therefore, to any understanding of household coping and survival strategies and ultimately to the effective design of food security and nutrition strategies. A better understanding of the risks to food security will also help in identifying the links between food security and adequate dietary intake.
Stability of household food supplies refers to the ability of a household to procure, through income, production and/or transfers, adequate food supplies on a continuing basis, even when the household is faced with situations of unpredictable stress, shocks or crises. Such situations could include crop failure resulting from drought, market fluctuations such as sudden price rises, the decline or loss of employment and loss of productive capacity because of sudden illness.
The concept also denotes an ability to stabilize food supplies through seasonal fluctuations of production or income. It also implies the household's ability to cope with or minimize the extent and duration of the effects of food deficits. The critical test of stability is the ability to bounce back or to regain quickly an adequate food supply For this to be a possibility, safety-net mechanisms are needed such as community grain stores or labour-intensive public works to support the purchasing power of the poor temporarily and to absorb the effects of short-term production or income losses that adversely affect the food supply of households.
Table 11 - Sources of risks of household food insecurity and affected populations
Area of risk
Households and people at risk
Crop production (pests, drought, etc.)
Smallholders with little income diversification and limited access to improved technology (e.g. improved seeds, fertilizer, irrigation, pest control)
Landless term labourers
Agricultural trade (disruption of exports or imports)
Smallholders who are highly specialized in an export crop
Poor households that are highly dependent on imported food
Food prices (large, sudden price rises)
Poor, net food-purchasing households
Informal-sector employees in pert-urban areas
Informal-sector employees in rural areas when there is a sudden crop production failure
Health (infectious diseases, for example, resulting in labour productivity decline)
Entire communities, but especially those households that cannot afford preventive or curative care and vulnerable members of those households
Politics and policy failure
Households in war zones and areas of civil unrest
Households in low-potential areas that are not connected to growth centres via infrastructure
Demography (individual risks affecting large groups)
Women, especially when they have little or no access to education
Children at weaning age
Source: FAO/WHO, 1992b.
Households may suffer from transitory food insecurity as a result of unpredictable circumstances such as sudden price rises. They may suffer from seasonal food insecurity when there is a regular pattern in the recurrence of inadequate access to food. Chronic food insecurity, by contrast, occurs when households run a continual risk of being unable to meet the food needs of all the household members. In practice, of course, chronic and transitory insecurity are linked. Recurrent exposure to temporary but severe stress may increase the vulnerability of the household to chronic food insecurity.
Box 5 - The impact of conflict on agricultural production and household food security in the Juba Valley, Somalia
In 1991, the Juba Valley was badly affected. A large proportion of the population was displaced to Mogadishu and Kismayo and to refugee camps in northeastern Kenya. From 1993 onwards, people started to return to their villages. However, the effects of previous displacement, the prevailing insecurity and low-level conflict continued to hamper people's ability to cultivate and produce sufficient food. Production levels for the main harvest in 1995 were estimated to be 40 to 50 percent less than pre-war levels.
When families returned to their land, it was overgrown with bushes. Clearing the land was time-consuming and difficult, so the land area that could be planted in the first year was reduced. Insecurity, particularly for the Bantu population, led to more cautious planting strategies. Farmers planted closer to their villages for fear that they might be attacked and looted, and they were unable to take advantage of the different types of land in the area.
Many of the flood-control systems and canals in the area were destroyed and looted or fell into disrepair. Some repair work was done by the World Food Programme and nongovernmental organizations (NGOs), but this was limited. This meant that the Juba River was no longer controlled and crops in many places were destroyed either by a lack or an excess of water. There was also limited access to tools and seeds. Extension advice and inputs previously provided by the Ministry of Agriculture were no longer available.
Many of the grinding mills in the area prior to the war were either stolen, looted or damaged, and in many villages several families now shared one grinding stone. This was one of the factors that had contributed to an increase in women's workload.
Opportunities for off-farm employment and income generation used to be available on banana plantations and in packing factories in the area, but following the collapse of the irrigation system the banana trees died, and larger landowners in the Juba Valley have not been able to re-establish their plantations. Loss of transport and insecurity have reduced access to markets in Kismayo town as well. Purchasing power within the town was also low.
Source: FAO, 1996d.
Seasonal changes in food supplies, food prices and employment opportunities often place severe stress on the ability of households to maintain nutritionally adequate food intakes. This difficulty is often reflected in seasonal changes in the body weight and health of vulnerable household members, especially women (see Figure 9) and children.
Seasonal constraints for household food security in agricultural and fishing communities often occur just before the harvest, when agricultural labour is at its peak, stocks from the previous year's harvest are nearly exhausted, and cash is running out. Shortages of food usually give rise to high market prices, which decline following the harvest. Women, who tend to perform a large proportion of the agricultural labour, have less time available for meal preparation and child care. The hungry season also frequently coincides with the rainy season, especially where the rains are confined to a single season and are accompanied by an increased incidence of infectious diseases, particularly diarrhoea, respiratory diseases and malaria (see Figure 10). In combination, these factors often contribute to raised levels of malnutrition among vulnerable groups. In a study carried out in the Gambia it was observed that child morbidity and mortality tended to reach their peak in the pre-harvest period and that women whose last trimester of pregnancy coincided with this period tended to deliver babies whose birth weight was significantly lower than normal (Lawrence et al., 1989). The effects of low birth weight on children's capacity for survival and development are discussed in Chapter 8.
Communities that have lived under difficult climatic conditions for many generations develop management strategies to lessen the impact of drought or other environmental and climatic stresses on household food security. These fall-back mechanisms, i.e. permanent changes in the mix of ways in which food is acquired, may include alternative cropping patterns and food access systems involving numerous strategies to reduce nutritional risk. Often farmers will select and plant those crops and varieties that provide the best risk spread (see Box 6). Sorghum and millets are typical examples of crops that even in areas with erratic rainfall still produce a minimum yield. In areas where seasonality results in regular annual hungry periods among households such responses become a permanent feature of the farming system.
FIGURE 9 - Seasonal body weight changes of rural Beninese women, December 1985 to November 1986
Source: Schultink et al, 1990.
Note: n = 130; weight changes expressed as mean ± standard error of the mean.
During more serious or prolonged food shortages caused by loss of employment or illness of an adult in the family, people may resort to mortgaging or selling their assets, migrating for wage labour or taking on extra loans and going deeper into debt in order to survive. Women in particular may be inclined to convert assets they possess (e.g. jewellery) directly into food products for short-term consumption purposes.
The situation of pastoralists and semi-pastoralists is often complex and especially interesting. In areas where animal and population densities are not extreme, these communities have developed their own strategies to stabilize their food supplies (see Box 7).
FIGURE 10 - Nutritional stress calendar for small-scale fish smokers in two coastal villages in Ghana
Source: FAO, 1993f.
Note: The calendar was prepared during a participatory rapid appraisal carried out in January 1992 in Chokomey and Oshiyie, Ghana. The calendar starts in September in order to follow the traditional time frame of the community
Box 6 - Farmers' coping strategies to stabilize food supplies
Seasonal fluctuations in food supplies occur in many African countries. Rural people and farmers are well aware of the recurring periods of seasonal stress and of their damaging consequences. Within their limited resources they try to minimize their effect on household food security with a variety of strategies.
Farmers' strategies such as serial cropping, intercropping, mixed cropping, varietal selection and staggered planting dates all have a seasonal rationale. A close examination of intercropping techniques shows that farmers time their planting and arrange the spacing of crops to create complementarities in growth and canopy cover. In this way a continuous flow of food is produced; some crops are harvested green for early consumption, and unavoidable gaps in food supplies are filled by a crop such as cassava, which can be stored in the ground.
Such strategies by farmers to sustain themselves should be complemented by government interventions such as irrigation and water management schemes to extend and increase production; price regulation to ensure security of access for the poor; and the provision of storage centres at the local level.
Source: Adapted from Longhurst, 1985.
It is important to distinguish these management strategies from what are referred to as coping strategies, i.e. short-term responses to an immediate and irregular decline in access to food (Maxwell and Frankenberger, 1992). Under conditions of extreme food insecurity, whether caused by climatic stress such as drought or floods or by civil conflict, households will adopt a different set of measures, which are increasingly threatening to their livelihood, to attempt to maintain minimum levels of nutritional intake. Such strategies usually follow a sequence: reduction of the number of meals eaten, with particularly severe consequences for child nutrition, and increased consumption of wild and famine foods, such as leaves, berries and rodents, is followed by labour migration and the sale of bigger assets such as livestock, tools, housing and fields. This sequence of responses has been observed to occur in severely drought-affected countries in the period leading to a famine in the absence of timely preventive action and provision of external aid to protect people's resource base and nutritional security.
Box 7 - Stabilizing household food supplies in semi-pastoralist societies
Semi-pastoralists who keep sheep, goats and camels gain a considerable degree of flexibility in coping with seasonal food deficits. Goats and camels are browsers and thrive on bushland not well suited to cattle. They can utilize African bushland plant species that retain their nutritive value into the dry season, when grassland forage is exhausted. Goats and sheep give milk, of course, but they are also the pastoralists' main source of meat. (This dietary preference accounts for the widespread misconception that African pastoralists avoid slaughtering their stock, which is true mainly in respect of female cattle.) They represent a convenient store of savings, easily converted into either grain or cash. Indeed, field observation has suggested that they constitute the main option for increasing the liquidity of household income in most African settings where banking is not yet effective. Small stock are often left under the control of women, and the possibility of trading a goat or two could make a huge difference in a household's food situation at the end of a long dry season. These advantages explain the persistence and expansion of small-stock production even in environments that are favourable to cattle (such as at Ngorongoro in northern Tanzania).
The conversion of livestock into grain remains a necessity for the survival of African pastoralism. Even with mixed herds, the milk supply is extremely variable over the season. A fairly substantial herd must be accumulated before a family can sustain itself on livestock products over the entire year.
The ability to rely on grain foods during the period of milk deficit is crucial to producers with insufficient milking animals. If, however, the usual seasonal shortfall extends into a major drought, animals begin to die, prices plummet, and grain supplies disappear from local markets. Thus the very success of conversion from small stock to grain in normal seasons leaves livestock producers overextended and vulnerable in major droughts.
Source: Adapted from Moris, 1989.
Mechanisms to stabilize food
Mechanisms to reduce fluctuations in food supplies may operate at the regional, national and household levels. The typical scenario of poor households, that of combined transitory and chronic food security problems, requires a well-designed portfolio of food security policy actions based on relevant, accurate and timely information to ensure precise and efficient targeting of support initiatives. These policy actions should be complemented by actions to facilitate physical access to food supplies through improved agricultural technology, food production and nutrition diversification programmes, improved market infrastructure, transportation and road extension and the provision of local storage and processing facilities in rural areas. Poor availability of marketing facilities has been found to correlate positively with malnutrition. Families living in the vicinity of food markets have steady and easy access to cheaper foods and have greater dietary diversity.
The development of labour-intensive food processing industries in rural areas is another option that can help stabilize food supplies, provide employment opportunities and raise incomes, in addition to reducing the massive post-harvest losses that occur in perishable commodities in many African countries. Figure 11 illustrates the source and nature of some of these food losses occurring between producer and consumer. Improvements in post-harvest management at the village and household levels can often significantly reduce food losses and increase overall food availability. An additional gain is that a reduction of losses leads to lower costs for producers and distributors, as well as lower prices for consumers. Food storage and processing and the effects of improvements in this sector on household food security are discussed in more detail in Chapter 6.
Famine prevention and preparedness. Areas and countries that are particularly at risk of recurrent and severe harvest failure because of their agro-climatic and infrastructural circumstances as well as their poverty need to adopt a variety of famine prevention and preparedness measures, to support people's livelihoods and to improve their access to food or income. Sometimes these measures can also contribute towards creating the infrastructure for facilitating future development. In Ethiopia and Burkina Faso attempts have been made to mobilize labour for environmental conservation and production enhancement activities (mainly soil and water conservation), while at the same time the food security of the poor has been improved through payment in food aid, constituting a direct income transfer (FAO/WHO, 1992h). Other income or livelihood support measures include the sale of food aid on local markets to generate local currency for development projects or the release of international or locally available stocks of food on the market to prevent sudden price fluctuations (see Box 8).
FIGURE 11 - The food pipeline
Source: Adapted from Pariser, 1987.
Box 8 - Examples of intervention strategies intended to support livelihoods and improve access to food or income
· General food subsidies
· Management of food reserves to prevent fluctuating food prices
· Subsidized weaning foods
· Food tokens
· Fair price shops
Income support programmes
· Employment schemes: food-for-work or cash-for-work on local construction projects (housing, roads, dams, wells, well protection, local amenities)
· Income-generating activities: production of useful local articles (rugs, mats, pottery)
· Exchange of livestock for cash, food or more drought-resistant animals
· Direct cash support
· Industrial projects: food processing (meat from destocking projects, production of weaning food or high-protein biscuits)
Agricultural support projects
· Crop diversification and improvement: distribution of drought-resistant seeds and appropriate tools
· Storage and transport
· Marketing of produce
· Horticulture, kitchen gardens
Livestock support projects
· Veterinary care
· Fodder distribution
· Water schemes
Source: Young and Jaspars, 1995.
Funds generated by food aid sales should be appropriately directed and targeted towards reducing malnutrition among disadvantaged groups in the recipient communities. Non-food inputs and measures which reinforce people's own coping strategies can include the timely distribution of agricultural inputs such as seeds, tools and/or credit to enable farmers to replant their fields following crop destruction caused by pests, diseases or heavy rainfall, or the provision of fodder to pastoralists for their livestock when grazing is insufficient.
Food aid has a role in the prevention of emergencies as well as during them. However, it is used in different ways depending on the stage and particular circumstances of the food security situation. Many labour-intensive public work programmes have successfully integrated the use of food aid as part of measures to provide income and livelihood support to people threatened by temporary food shortages. Food aid in kind is most appropriate if a large public works scheme induces an increased demand for food that cannot be met from local resources. Short-term food aid also continues to be an essential element of an overall food security strategy in emergency relief operations such as those engendered by ecological and sociopolitical stress. In the late stages of famine, people who have been displaced from their homes are often entirely dependent on food assistance, and the priority is then to alleviate malnutrition and to save lives.
A pre-condition for the effective use and management of food aid for disaster prevention, preparedness and mitigation is the operation of appropriate early warning and information systems. Much effort has been put into developing and fine-tuning information systems relevant to crisis prediction and prevention in a number of African countries. Early warning systems typically depend on rainfall, agricultural and market data used to monitor crop production, crop deficits and market prices. Sometimes, as is the case in Ethiopia and Botswana, they incorporate nutritional status data as the main outcome indicator. Such systems usually focus on predicting acute food shortages to trigger a timely response in the form of emergency relief. Other early warning systems adopt a more localized response mechanism and attempt to monitor increased vulnerabilities and risks to livelihood by examining the possible causes of food insecurity. The emphasis in data collection is on finding out how people feed themselves; thus a wide variety of socio-economic indicators and qualitative data are gathered to assist in the early identification and implementation of appropriate interventions that will support people's own coping strategies (e.g. food- or cash-for-work). Ideally, central and local-level early warning systems should operate side by side in the same country to constitute a comprehensive system.
Agriculture is essentially an environmental activity. One of its basic functions is the modification and adaptation of natural ecosystems in order to channel energy to consumers in the form of food. Each agricultural project takes place within a complex system of social attitudes, cultural patterns and practices, economic networks and physical, chemical and biological factors, which comprise the setting for agricultural productivity. Access to adequate food and physical well-being are crucial to the ability of farm households to perform work and consequently to sustain and increase food production and ultimately nutritional well-being.
Sustainability of food supplies refers to the capacity to ensure the long-term stability of the household food supply and the ability of households to meet consumption and livelihood needs on a continuous basis. Sustainability has many dimensions, and means of food procurement must meet a set of multiple conditions if it is to be achieved.
One of the main requirements is a sustainable food production system. Where households depend on natural resources for their income and food (i.e. agriculture, fishing and forest products), it is important that production practices do not conflict with or damage the environment, undermining future production. Environmental degradation is often closely linked with the perpetuation of poverty and food insecurity. To meet their survival needs. especially in areas with rapidly increasing populations, the rural poor may be forced to cultivate fragile, steep and/or marginal lands that are highly susceptible to erosion. In times of stress they may be compelled to reduce stocks of seed varieties in order to sustain household food needs and to use crop and animal residues in less than optimal ways. However, people can be assisted to manage their natural resources more effectively. For example, they can be encouraged to adopt appropriate soil conservation practices or given food-for-work opportunities to help them conserve their seed stocks.
For improved resource management to be realized by the poorest and most vulnerable groups, however, such strategies must be within the limits of time, labour and income constraints and must be perceived by the target beneficiaries as offering short-term as well as long-term gains. Without suitable inducements, including security of land tenure, small-scale producers have little incentive to invest in long-term activities such as land improvement, tree-planting and forest conservation.
A second requirement is the protection of future productivity. If food procurement methods involve disposal of productive assets (e.g. land, production equipment and draught animals), as could be the case during famine or conflict situations, households can suffer a loss of their future productive capacity. Current food consumption would then be achieved at the cost of future consumption. Hence, sustainability requires that food be procured in a manner that does not lead to a loss in the productive capacity of the household. As already discussed in the previous section, emergency preparedness and mitigation policies and actions are required to strengthen people's own coping strategies and protect their resource base, particularly in countries and areas that are vulnerable to climatic stress.
A third requirement is that food be procured through self-reliance, i.e. through dependence on one's own efforts and resources, self-help, exchange or market processes rather than on charity, aid, philanthropy or the benevolence of others. Dependency is unsustainable as a procurement method in the long term, and it also conflicts with human dignity and self-respect. People whose resource base is adequate to enable them to procure sufficient amounts of food should not depend on direct food hand-outs beyond times of real need and should rely on them only until their production has been safely re-established. With regard to the poorest segment of society, direct welfare or well-targeted income-generating activities may be appropriate.
The last requirement is that efforts by households to achieve food security must be understood and placed in the context of a wider overall framework of basic household needs in which resources are limited and there is competition among needs and priorities. It is important that an adequate and stable food supply be achieved without compromising the fulfilment of other basic needs considered important by households such as education, health, drinking-water and housing. A household that has to spend a large proportion of its resources to obtain adequate food may find it difficult to meet basic needs and thus may find it difficult to sustain itself in the long term. This factor highlights the critical importance of enhancing the real incomes of households for them to be able to meet total livelihood needs. Nutritional well-being at the household level depends on the sustainability of agricultural productivity and on the concurrent sustainability of access for all household members to sufficient food of adequate quantity, quality and safety to meet their nutritional requirements.
A food-secure environment is clearly an important determinant of dietary intake. Whether this translates into good nutritional status, however, will depend on a range of other factors such as health and sanitation, methods of food preparation, the adequacy of general child care and the knowledge, education and skills needed by different family members to use available human, organizational and economic resources for the benefit of the household and its vulnerable members in particular.
The malnutrition-infection complex: health/nutrition synergism
The healthfulness of the environment influences exposure to infectious diseases, while the provision of health services and access to them influence treatment of infection. Poor population groups are particularly affected by environmental factors that increase exposure to infectious disease such as limited water supply, inadequate sewage disposal and general sanitation, contaminated surface water, overcrowded and poor housing and unhygienic food preparation.
The poor are also at a particularly serious disadvantage where infection is concerned because of their frequently limited access to health care, inability to pay for needed medications and services including immunization and family planning, and insufficient time and other resources to care adequately for family members during periods of acute illness or to promote their nutritional recovery during convalescence. As a consequence, treatment of infection is often inadequate or late, and the resulting prolonging of the disease places children at increased nutritional risk. Local health services are often understaffed or have limited supplies of essential drugs. Attitudes to health care and education are also important factors affecting mothers' willingness to make use of available services.
Infectious diseases constitute one of the major factors contributing to child malnutrition; conversely, malnutrition makes a child more susceptible to these infectious diseases. The interaction between nutrition and infection, known as the malnutrition-infection complex, accounts for the severity of many infections and the high mortality rate associated with diarrhoea, respiratory infections, measles, worm infestations and malaria. The burden of these largely preventable or inexpensively curable diseases of children is very high in sub-Saharan Africa.
Several factors may contribute to deteriorating nutritional status during severe and prolonged infection. These include decreased food intake, inefficient nutrient absorption, losses of body nutrient stores and increased nutritional requirements. People who are sick frequently lose their appetite and are thus unlikely to maintain their dietary intake unless encouraged to do so. The range of possible outcomes is quite broad, from weight loss to an increased incidence of growth faltering (i.e. inadequate skeletal growth), protein-energy malnutrition, low birth weight and micronutrient deficiency diseases, especially vitamin A deficiency. These forms of malnutrition are described in detail in Chapter 8.
Malnutrition, on the other hand, both reduces resistance to infection and disease and increases the severity and duration of illness. Increasing evidence suggests that even minor degrees of growth faltering and micronutrient deficiencies, especially vitamin A deficiency, are associated with increased risk of infection and mortality from infection (FAO/WHO, 1992d). Figure 12 shows some of the interactions among variables that influence the cycle of infection and malnutrition.
While the malnutrition-infection complex most commonly affects children, it is also significant where adult morbidity is concerned. Infections and parasitic diseases have a major role in loss of productivity through their impact on adult physical performance and work capacity, often entailing serious consequences for the food security of affected households. Such health hazards include malaria, intestinal parasites, onchocerciasis or river blindness (a type of filariasis involving a parasitic worm and causing blindness) and schistosomiasis or bilharzia (a disease caused by river flukes and involving freshwater snails as intermediate hosts, which can lead to bladder tumours and cirrhosis or scarring of the liver, finally causing liver failure). The potential effects of human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) on people's productive capacities and ability to meet their families' food needs were discussed in Chapter 2.
In all countries, successful implementation of policies and programmes to improve health and nutrition requires action from many sectors. Health actions should include the establishment of adequate, accessible and affordable health services at the village, community and national levels to provide medical treatment. Public health measures involving improved housing, water supply, sewage disposal and personal hygiene, as well as food safety measures such as promotion of appropriate food storage and preparation techniques, food quality control and legislation, need to be implemented to control and prevent infection. These measures have the potential to reduce significantly morbidity from various water- and faeces-borne infectious diseases. Providing and improving sanitation and water supply near the home can enhance people's health and raise productivity not only by diminishing days of sickness but also by saving time and energy for women who would otherwise have to collect water from distant sources.
FIGURE 12 - Simplified model of the malnutrition-infection cycle
Source: FAO/WHO, 1992d.
Other measures that have an important role in the prevention, control and management of infectious diseases include: immunization; early recognition of growth faltering through growth monitoring, and early intervention; breastfeeding; promotion of locally appropriate mixes for the dietary management of infection and encouragement of appropriate feeding during illness and rehabilitation; and family planning. Primary education can have an equally important role, through emphasis on rudimentary nutrition principles and health. However, it is a fundamental fact that nutrition and health improvements cannot be sustained without concurrent improvements in food and agricultural systems and socioeconomic status.
Actions outside the health sector are also essential, as each infection has its own transmission mechanism and many are related to the environment. The transmission of malaria and schistosomiasis, for example, is facilitated by vectors which are permitted to thrive by their environmental conditions, either naturally occurring or designed by humans. Strategies such as the elimination of breeding sites can successfully decrease malaria transmission and lower the incidence of the disease. The use of insecticide-impregnated bed nets for self-protection has also been successful. Good engineering of dams and irrigation systems can avoid the dangers of the spread of schistosomiasis.
In most instances, specific health programmes aimed at preventing or reducing the reproduction or transmission of the infecting agent are needed. However, precautions are necessary to ensure that new or existing projects or development activities do not create additional health hazards. A nutrition or health impact statement should be included in the documentation of all proposed development projects.
Other important factors influencing dietary intake and nutritional status are those conditions and activities that have been grouped under the category of "care". Care has been defined as the provision in the household and community of time, attention, support and skills to meet the physical, mental and social needs of nutritionally vulnerable groups. Care can be provided within families and communities or by external institutions. Among the nutritionally vulnerable groups, attention is often focused on preschool children, but other vulnerable groups include school-age children, mothers, the elderly, the disabled, the landless and the unemployed, as well as refugees and displaced persons.
Caring capacity is the ability to use human, economic and organizational resources for the benefit of the household. It therefore involves issues of education, knowledge, culture, time and control over resources, including income. In the context of nutrition, it involves facilitating the optimal use of household food resources for family feeding and of parental resources to protect the family from infection and to care for a sick child or other vulnerable member of the household. More generally, it includes responding promptly to nutrition needs and nurturing physical, psychological and emotional well-being, which in turn will benefit nutrition and health.
Specific care-giving for children includes breastfeeding; providing security and reducing child stress; providing shelter and clothing; feeding, bathing and supervision of toilet; preventing and treating illness; showing affection; interaction and stimulation; playing and socializing; and providing a safe environment for exploration. It also includes the use of resources outside the home, such as curative and preventive health facilities, prenatal care, traditional healers or members of the extended family network. Breastfeeding is a prime example of care, since it combines food security, caring and a healthy environment in one action. The way in which the care-giving activities are performed is an important aspect of care: the care-giver's motivation, skill, physical capacity, consistency and responsiveness to the child's needs are all related to child survival, health and development. Some common constraints to providing care and ways to address them are described in Box 9.
Box 9 - Some common constraints to providing care, and how they may be addressed
Low levels of education, lack of support for traditional wisdom, and beliefs about care
The demand for care, or the perception of the importance of early and intense investment in the child, varies from culture to culture and among individuals, as does the understanding of the meaning of mothering, fathering and care. Education and literacy are fundamental to achieving benefits from other policies. Adult education and literacy classes are important, as are carefully tailored education on child care, which should communicate the importance of exclusive breastfeeding in the early months of life, increasing the energy density and quality of complementary foods, decreasing contamination and maintaining frequent feedings.
Lack of support from family or community
Family or community support can increase the care for children and women through reduction of workload, economic assistance, knowledge or emotional support. Many societies have traditional mother's helpers who provide assistance during childbirth and the post-partum period, including advice and emotional support. Community groups can also provide support for children and women. Programmes can increase support by forming women's organizations, increasing the support provided by older siblings or encouraging the father's support in child care. Social security systems for women can be expanded in those countries that can afford them.
Heavy workload in income generation and household production tasks
Heavy workloads, particularly during the agricultural season, place a physical and emotional burden on women and thus reduce their ability to provide care for themselves and their families. Technology and infrastructure can relieve demands on women's time and efforts. Possible areas for assistance include water collection and fuel gathering, access to health services and technologies for improving hygiene and sanitation.
Poor physical and mental health
Physical health needs include nutrition, medical care services, prenatal care and care for the child. Mental health needs of women include self-confidence, absence of depression and reasonable levels of stress. Programmes can be designed to empower women to use their own skills and to learn new ones that allow them to feel confident in a larger sphere. Access to publicly provided health and related services is essential, including general health, prenatal, obstetric and family planning services. Better birth spacing and weaning practices will improve the health of women and children. Education on the value of family planning also needs to be targeted towards men.
Source: FAO/WHO, 1992c.
Women's work load and the consequences for nutrition
The responsibility for providing care often falls disproportionately on women. As a result of their multiple responsibilities, women are often unable to spend sufficient time on food preparation, child feeding and other caring activities that have beneficial nutritional outcomes. Studies undertaken by the International Food Policy Research Institute (IFPRI) in Botswana, Ghana and Kenya (Brown and Haddad, 1994) and in Zambia (Kumar, 1994) pointed out that considering that children are valuable resources in terms of their contribution to productive activities, very little is invested in them in terms of direct care time. Time recorded in direct child care was generally less than one hour per day.
Women often face difficult choices in their time allocation decisions. Although caution is needed in generalizing about people's time allocation patterns and burdens, recent data from different African countries support the popularly held belief that women not only work longer hours than men but also spend more hours in productive activities per day than men. Data from the region of Mbeya in the United Republic of Tanzania, a largely agricultural area, revealed that women worked 12 to 14 hours during the dry season and 14 to 17 hours during the wet season, without rest, whereas men worked eight to ten hours in the dry season and ten hours in the wet season, with a rest period of three to four hours (Mwalemba, 1995).
In rural areas women are often major producers and processors of family food; in urban areas women are involved in both the marketing and purchasing of food supplies, as well as in the "fast-food" sector of street food production and sales. In certain cities in Africa, as much as 90 percent of the street food trade is conducted by women. Urban women prepare and market street foods to augment their household income, to ensure domestic self-sufficiency and to improve the food security and welfare of their families.
Women's activities in the food chain influence their resource situation in two ways. On the one hand, food and cash are generated through these activities; on the other hand, the labour and time spent in the process are diverted from food preparation and child care activities. The necessity for many women to play a dual role in the household - in production (food production and income generation, for example) and in reproduction (activities related to nurturing and attending to basic family needs) - imposes immense pressure on women's time, labour and attitudes. Often the physical labour involved may be so heavy that it is detrimental to the woman's health, especially during pregnancy and lactation. In such households, nutrition insecurity will be reflected also in higher levels of stunting and wasting among infants and preschool children. This is particularly the case when access to basic necessities such as water and fuelwood for cooking involves carrying heavy loads and walking long distances every day. Table 12 shows that rural women in several African countries spend considerable time working in both home production and agricultural activities. Box 10 presents an example of household division of labour between men and women.
Water collection, in particular, is frequently a time-intensive task for women. Women in all rural areas would benefit in various ways from investment in provision of and access to safe water. It would do much to relieve women's time burden by enabling them to spend less time in water collection, therefore relieving physical stress and improving women's nutritional status. The freeing of women's time would also open up possibilities for income generation. Greater water availability will also have positive effects on child health by enabling improved hygiene and sanitation practices within the home.
Table 12 - Rural women's daily work patterns (hours)
Number of households
Hauling fuel and water
Kenya (dry season)
Kenya (wet season)
Source: McGuire and Popkin, 1990.
a Includes other housework activities in addition to cooking.
b Data are averaged over the eight villages.
Box 10 - Division of household labour between the sexes in Chibate, Zambia
Tasks usually done by women
· Picking and heaping branches
· Planting cassava
· Planting other crops
· Harvesting crops other than cassava
· Taking care of children
· Fetching water and fuelwood
· Digging cassava, peeling, soaking, drying, pounding, winnowing
· Searching for relish/wild vegetables
· Cleaning yard, house and plates
· Washing clothes
Tasks usually done by men
· Cutting trees
· Preparing the fields
· Digging holes for cassava plants
· Growing vegetables
· Building and roofing houses
· Building bath shelters
· Making drums
Tasks done by either men or women
· Harvesting maize
· Making ridges
Note that weeding, sowing and harvesting are basically female activities. Men engage in building houses, but the roofing grass is cut by women. Male activities are fewer than female, more spaced out and less repetitive.
Source: Adapted from FAO, 1991b.
The adoption of labour-saving techniques may be useful in lessening women's workload. However, often the fundamental need is to promote equitable sharing of responsibilities for care and the burdens of work in general among household members. Care of the mother, either by herself or by her family, assisted by social support in the community and by the social services network, will have a direct effect on her ability to care for her children.
Box 11 outlines some appropriate strategies to assist women and their families to improve their nutritional well-being.
Women's control over resources and the consequences for nutrition
Available evidence from different African countries shows that the effect of income on family nutritional well-being and health depends largely on who controls the income and takes decisions on its disposal. Often the income controlled by women has greater immediate benefits for the family's nutritional well-being than male-controlled income. One way of increasing women's economic influence and their ability to enhance the family's food security is through increasing their participation in income-earning activities. Unfortunately, there are still many stumbling blocks preventing women's enhanced control over economic resources and their more active involvement in income-generating activities.
In a study in Zambia it was found that in contributing to household food security, men prioritized their time between producing food or earning income from more lucrative occupations such as fishing or sawing wood. Very often? men chose the short-term benefits of income at the expense of the nutritional well-being of their wives and children. The high costs of fishing made loans necessary, but a rapid turnover made it possible to pay the loans off quickly, and the high incomes that were generated were usually reinvested in fishing. Thus the additional income was rarely used to hire agricultural labour, although the use of hired labour for fishing was common. In other words, the men were prepared to hire labour to replace themselves but not to replace their wives, despite the potential economic and other benefits for their families if the wives could be freed from agricultural duties to engage in income-generating activities (FAO, 1992g).
Box 11 - Strategies to assist women to improve nutritional well-being
A major review of the roles and responsibilities of women in providing and sustaining family nutritional levels recommended five major groups of strategies to assist women to fulfill these roles more efficiently and equitably.
The first involves reducing the burdens of reproduction. The two most successful strategies for accomplishing this include efforts to increase the age at which women begin to have children and efforts to lengthen the time intervals between births. Both of these strategies entail increasing educational opportunities for girls, implementing information campaigns and altering the factors that favour the formation of large families (for example, reducing productive time and labour requirements, lowering poverty and lessening environmental degradation).
The second group of strategies includes methods to reduce the burdens of child care. Strategies for accomplishing this objective include increasing educational opportunities, improving health and nutrition information, providing more access to time- and labour-saving technologies, securing more equitable wage scales for women and initiating innovative child care systems such as mobile creches and community-sponsored day-care centres.
The third set of strategies involves the improvement of access to maternal health and nutrition care. The strategies include renewing the focus on maternal as well as child health, especially in terms of broadening knowledge about and availability of pre- and postnatal care and birth attendance, expanding outreach and extension services, particularly in rural areas, and improving the quality of the services offered.
The fourth group of strategies involves enhancing the position of women in food production and farming. To achieve this, the visibility of the economic contributions of women in food production should be increased through improved databases and national statistics, and women's access to productive resources such as land, technology, credit, training and extension needs to be improved.
Finally, the fifth set of strategies involves the elevation and improvement of the position of women in society. The strategies for achieving this include increasing educational and training opportunities for girls and women, increasing the opportunities for women to generate income and to control the use of income, empowering women through organizational and political participation and altering social and cultural attitudes in favour of women's equality through educational, political and legal institutions.
Source: Adapted from UN ACC/SCN, 1990.
In many countries in Africa, women's access to support services including access to improved technology, credit, extension advice, training and markets - is still very limited compared with that of men. Most services, especially credit and extension, tend to be biased towards cash crops whose production is dominated by men, at the expense of crops in the traditional production sector, mainly for family consumption, that are usually grown and controlled by women.
Another factor limiting women's access to extension is the predominance of male extension workers in the extension system. Culturally determined norms often do not allow a male extension worker to approach another man's wife or to deal directly with female heads of household. A strategy of working through groups of female farmers, rather than individual women, may be considered culturally more acceptable. Residential extension courses also tend to alienate women; they are likely to find it difficult to leave behind their domestic responsibilities and to secure the cooperation of their husbands, who may not be in favour of their wives attending residential courses or going to meetings unaccompanied.
In order for women farmers to enhance their productive capacities, play a more active part in economically productive activities and improve household food security, their special needs and priorities need to be addressed in development interventions. In view of the tremendous costs incurred in terms of agricultural and food production by failing to address this problem, there is an urgent need for extension services to give more attention to women farmers to enable them to overcome the production constraints they continue to face in many countries. However, this need calls for strategies that are sensitive to both men's and women's socio-economic circumstances in rural areas, and consideration of how they may be changed by specific interventions. It is also critical that men's social circumstances and women's socio-economic roles be made clear to policy-makers, grassroots workers and the rural people themselves. This clarification is commonly known as gender sensitization.
Cultural patterns and food distribution within the family
In addition to the above factors of women's workload and their control over resources, socio-cultural beliefs and customs can also have a significant influence on family nutritional well-being in terms of food choice and food-sharing behaviour within the family. In many societies some foods are more prized than others and no meal is considered complete without them. When the favoured food is a root or tuber (e.g. cassava or plantain), this custom may be disadvantageous to young children. A weaning diet based on roots or tubers is bulky and has a low concentration of nutrients, especially energy and protein. Young children with limited stomach capacity are unable to consume sufficient quantities of such foods to cover their energy and nutrient requirements, unless the staple is enriched with additional foods, preferably fats or oils, mashed legumes and vegetables or fruits. Cultural food beliefs and taboos are often related to foods of animal origin and frequently apply to women and young children. Culture can be a strong behavioural determinant and can dictate preference or avoidance of certain foods, especially during illness and pregnancy. While some cultural beliefs and habits are nutritionally harmful, others which are beneficial should be promoted through positive messages to raise household members' and especially women's knowledge and awareness of the benefits of a nutritious diet using locally available foods.
Cultural influences may also include customary systems of food-sharing and food distribution within the family and cultural attitudes towards food preparation, breastfeeding and child feeding. Intrafamily food distribution is often related to hierarchical position, with the head of the family and the income-earning members of the household receiving priority in eating. In such families mothers and young children may receive a smaller share of the family's food relative to their nutritional needs. To raise awareness among all family members and to convince fathers of the benefits of adequate nutritional intake for the nutritional well-being and productive capacities of all household members, the social and cultural background of such customs which are potentially harmful to nutritional well-being need to be well understood. More details on nutrition education programmes that address the social and cultural factors determining eating patterns and that promote healthy diets are discussed in Chapter 9.