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Re: Nutrition-enhancing agriculture and food systems

Ellen Anneliese Muehlhoff

Contribution by Ellen A. Muehlhoff and Ramani Wijesinha-Bettoni

Dear Moderators,

We would like to comment on the core paper “Challenges and issues in nutrition education” by Judiann McNulty ( These comments are also relevant to the question Partnerships: How can we work across sectors and build strong linkages between food and agriculture, social protection, employment, health, education and other key sectors?, and to the expert paper Case Study of Participatory Agriculture and Nutrition Program in Malawi by Rachel Bezner Kerr et al. ( The latter demonstrates the essential contribution of nutrition education to an agriculture-nutrition project in Malawi, which has successfully improved under-five nutritional status growth and household food security through the use of farmer-led participatory research, a transformational education approach, agroecological interventions and attention to gender inequality and other social inequalities at the household and community level.

Comment 1: re. The need for nutrition education (Chapter 2 of McNulty paper)

The increasing recognition that nutrition education is essential for enhancing agriculture's impact on nutrition is highlighted in this chapter, which summarizes the conclusions of recent review studies that examine the effectiveness of nutrition-enhancing food and nutrition security actions. Many such reviews conclude that nutrition education is an essential component for success. Two of the reviews mentioned in this chapter are the Sixth Report on the World Nutrition Situation (UNSCN, 2010), which concluded that “for all populations, [nutrition] education and social marketing are crucial components of national, municipal and community efforts for sustained improvements in food and nutrition security. These activities are often essential to realizing the potential for nutrition improvement of many agricultural development projects and programmes. They are also important in countries where obesity and NCDs are increasing.”  The 2011 IFPRI-sponsored conference “Leveraging Agriculture for Nutrition”, Ecker et al. (2012) conclude that “addressing the causes of micronutrient malnutrition inevitably requires programs that support dietary diversification by providing education on nutritious, balanced diets. Without this understanding, the nutritional impact of programs that increase people’s economic access to improved nutrition will be strictly limited.

A few other studies that are not explicitly mentioned in the Chapter (perhaps due to lack of space) and could have been worth citing are the following:

  • Girard et al (2011): concluded that agricultural strategies improve intakes of micronutrient-rich foods by women and young children when nutrition education, gender and nutrition objectives were explicitly stated.
  • Reviews by Leroy and Frongillo (2007), Berti et al (2003) and Ruel (2001) stress the important role played by both gender considerations and communication and nutrition education activities involving behaviour change in homestead gardening interventions that succeeded in improving diets, nutrient intakes and/or child nutritional status. For example, Ruel (2001) states “A key to success appears to be the inclusion of a strong nutrition education and behavior change intervention. For example, strategies to promote increased production of micronutrient-rich foods are more effective when combined with a nutrition education intervention, which ensures that increased household food supply and income translates into improved dietary quality.”
  • The World Bank (2007) review is mentioned, but we would add that it specifically states the following: “Agricultural interventions that include a nutrition education component will increase the likelihood of positive nutritional outcomes. Those who are armed with information and knowledge about the nutritional significance of the foods they produce and eat are able to make better production and consumption decisions

To the above, we would add that the need for nutrition education has also been strongly reinforced by the concept of the Right to Food. Parties to the International Covenant on Economic, Social and Cultural Rights are under an obligation to provide information and education on good diet, food safety, food-borne diseases, food labelling and processing, production and preparation; while in the school curriculum integrating agriculture, food safety, environment, nutrition and health education builds citizens’ capacity to achieve and maintain their own food security. Hence nutrition education is an essential vehicle for establishing food rights (Refs 5 and 6 below).


Comment 2: re. Professional capacity [in nutrition education] (Chapter 6 of McNulty paper)

The main issues facing capacity development in nutrition education are given are:
•       Do governments have the interest, commitment and resources to support professional development in nutrition education?
•       Will there be sufficient employment opportunities, particularly in the public sector, to attract people into a career as nutrition educators?
•       Where will academic institutions and other programs find expertise in-country to teach nutrition education or develop training materials for in-service training?

Re. the 3rd issue, we would like to mention that the FAO ENACT project, funded by the German Ministry of Food, Agriculture and Consumer Protection, (the ENACT project is referred to earlier in the chapter) will be helping to fill this gap, at least in six African countries for the time being. Tutors (who are nutrition lecturers/professors at university, a few of whom are already nutrition educators), will receive on-the-job training during the piloting. They have already received training on using the materials and methodology at a pre-piloting workshop held in Uganda in April this year, while piloting students who successfully complete the course will themselves be able to carry out nutrition education. A minimum of 60 students will be trained in the piloting phase alone. Training materials for in-service training is also included in the ENACT project, where a training-of-trainers course named the EAT course, which covers the processes of formative enquiry (E), Adaptation (A) and tutor training (T), is being developed. The challenge remains to find a suitable regional partner for hosting the EAT course, in order to ensure its sustainability.

Some news for the forum: Piloting of the ENACT module is nearing completion in Makerere University Uganda, the first of the partners to pilot the material. The feedback received from students thus far via the Facebook page they have set up has been very positive and enthusiastic.. For example, one of the students posted: “The ENACT units are very interesting, I have actually realized the need for intensive nutrition education, the cultural practices. Gender factors, ignorance…etc. are actually in existence, we’ve done the outside activities and this is REAL. Nutrition education is a very important strategy to address most of these issues.” We would encourage all those interested in nutrition education to visit their Facebook page ( and make a posting!


Best regards,
Ellen Muehlhoff (Senior Officer/Group Leader
Nutrition Education and Consumer Awareness Group
Nutrition Division, FAO


Ramani Wijesinha-Bettoni (Consultant, FAO), on behalf of the FAO ENACT Team



  1. Berti P, Krasevec J, Fitzgerald S (2003) A review of the effectiveness of agricultural interventions in improving nutrition outcomes. Public Health Nutrition 7: 599-609
  2. Ecker O, Breisinger C, Pauw K. 2012. Growth Is Good, but Is Not Enough to Improve Nutrition. In: Fan S and Pandya-Lorch R, editors. Reshaping Agriculture for Nutrition and Health. Washington, DC: International Food Policy Research Institute. Available at:
  3. Girard AW, Self JL, McAuliffe C, Olude O. 2012. The Effects of Household Food Production Strategies on the Health and Nutrition Outcomes of Women and Young Children: A Systematic Review. Paediatr Perinat Epidemiol. 26, Suppl 1:205-22. doi: 10.1111/j.1365-3016.2012.01282.x.Suppl.1, 205-222.
  4. Leroy, J.L. and Frongillo, E.A. (2007) Can interventions to promote animal production ameliorate undernutrition? Journal of Nutrition 137, 2311–2316.
  5. Ruel MT (2001) Can Food-Based Strategies Help Reduce Vitamin A and Iron Deficiencies? A Review of Recent Evidence. Washington DC: IFPRI.
  6. Right to Food Brief No. 6. Education and awareness-raising. Available at
  7. UN Committee on Economic, Social and Cultural Rights (CESCR), General Comment No. 12: The Right to Adequate Food (Art. 11 of the Covenant), 12 May 1999, available at:
  8. UNSCN. 2010. Progress in Nutrition: 6th Report on the World Nutrition Situation. Geneva: United Nations Standing Committee on Nutrition.
  9. World Bank 2007: From Agriculture to Nutrition: Pathways, Synergies and Outcomes. The International Bank for Reconstruction and Development / The World BankAvailable at