Dear all,
Thank you for the opportunity to contribute to an interesting thread. I will respond to the facilitator by question, in italics.
· Studies have shown that the first 1000 days of life are a crucial window for preventing irreversible undernutrition like stunting. Yet other research rebuts this position by showing that catch-up growth is still possible even after the first 1000 days of life. From your experiences, who should we target when implementing nutrition enhancing social protection measures? Under 3 years? Over 3 years?
There is emerging consensus that the greatest gains may come from linking targeted nutrition interventions in the 1000 day window to Early Childhood Development programmes, as stunting and impaired cognitive development share many of the same risk factors. This means going beyond the 1000 days, and the World Bank has informally suggested that they are moving in the direction of always ensure their funding links nutrition-specific to ECD. However, it is quite clear that the primary target should be women and children in the 1000 day window, as well as women pre-conception (e.g. adolescent girls, in order to reach women before pregnancy)
· Should we only always give cash or food transfers to women?
The high commitment of women to the diets and health of young children has been well documented. Social safety nets often have multiple objectives, and the sex-selective targeting or lack thereof may support an objective other than enhanced nutritional outcomes. The balance of these multiple objectives should inform targeting, but what matters for nutrition may well be the household’s commitment to the diets of pregnant and lactating women and young children. If the commitment exists, the control of the transfer would be dependent more on the additional objectives of the social safety net programme (such as women’s empowerment, self-confidence, etc)
· Should we only always target the poorest? Rural households? Or should we consider universal social protection schemes?
Social safety nets are a poverty reduction tool. As such, they should by definition target the poorest. This may well be those least able to access goods and services (which may be rural households, but this not a general rule as urban populations can be greatly affected by inequitable access or lack of quality services).
· Recent research shows that stunting has far reaching consequences even affecting income earning capacities in adulthood and on a national scale leading to two –three percent losses in GDP (Bhutta, Sachdev et al. 2008). In that case, should we prioritize eliminating stunting over wasting or underweight? Or we should not prioritize one over the other?
I can only interpret this question in the context of the discussion theme related to social safety nets, which are a broader poverty reduction tool. The 2013 Lancet Series (Ruel et al- Paper 2) suggest that social safety nets and other nutrition-sensitive interventions can be used as a platform for the delivery of nutrition-specific programmes. Social safety nets operate at scale and target the poorest, making them ideal platforms for expanding the coverage of nutrition-specific interventions as needed. The nutrition-specific programme will depend on the objective (reduce stunting, wasting). This will be informed by a detailed analysis of the nutrition situation to understand the causes of nutrition issues that are present. As this will be context specific, it doesn’t seem appropriate to suggest prioritization of one over the other. While children with acute malnutrition are at a greater immediate risk of mortality, the mortality attributed to stunting is greater in absolute terms because of the number of individuals affected.
· What are some of the lessons you have learned, best practices concerning social protection measures implemented to enhance food security and nutrition? E,g cash transfers, food transfers, school feeding, vouchers etc.
The evidence suggests that the positive impact comes to younger children and children exposed to the transfers for a longer period during the 1000 days. Experience from CCT in Latin America suggests that positive nutrition outcomes may be greater when the social safety transfers cash and a fortified food for groups with high nutrient needs (PLWs and young children). Linking the transfer to health and/or education conditions may also increase the impact. Including clear nutrition goals and actions is essential. Finally, ensuring nutrition-sensitive programmes do no harm is crucial. This could mean re-designing school feeding programmes to take into account the growing risk of obesity.
Thank you again for the opportunity to share some thoughts for discussion. I’ll add a final caveat that the views expressed are my own, and do not necessarily represent those of any organization.
Natalie Aldern