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The State of Food Security and Nutrition in the World 2023

Chapter 4 THE INTERPLAY OF FOOD SUPPLY AND DEMAND AND THE COST AND AFFORDABILITY OF HEALTHY DIETS ACROSS THE RURAL–URBAN CONTINUUM

4.2 Cost and affordability of a healthy diet, and food security and nutrition across the rural–urban continuum

KEY MESSAGES
  • In the 11 African countries analysed, the cost of a healthy diet in urban areas is much higher (on average 1.2 times higher) than in peri-urban areas, and it then decreases the smaller the city size and moving closer to rural areas. This trend is less pronounced in high-food-budget countries, which show similar costs across all urban areas.
  • The higher cost of animal source foods, compared to the other food groups, drives up the cost of a healthy diet across the rural–urban continuum, especially in urban areas and remote rural areas.
  • The lower cost of a healthy diet in peri-urban areas of the 11 countries analysed compared to urban areas does not translate into more affordable healthy diets, as income levels are a considerable factor. The percentage of the population unable to afford a healthy diet in peri-urban areas is higher than in urban areas and similar to rural areas.
  • In the 11 countries in Africa, the cost of a healthy diet exceeds average food expenditure for low- and middle-income households in both high- and low-food-budget countries. Low-income households living in peri-urban and rural areas are especially disadvantaged, as they would need to more than double what they currently spend on food to secure a healthy diet.
  • In many of these African countries studied, the prevalence of moderate or severe food insecurity in urban and peri-urban areas is similar to that in rural areas, and in some cases, slightly higher, indicating that food insecurity is not exclusively a rural problem in most of the countries analysed.
  • In the three countries analysed in Africa, the prevalence of child stunting generally increases as cities become smaller and as one moves away from urban centres. Child wasting and overweight are lower and exhibit less evident trends across the rural–urban continuum.

Based on the latest estimates (Chapter 2), we are not on track to end all forms of malnutrition by 2030. For instance, still 148.1 million children under five years of age were stunted in 2022, while 45 million were wasted and 37 million were overweight. According to the Global Burden of Disease Study, in 2019 dietary risk was the second largest Level 2 risk factoraa for attributable deaths among females and the third among males.20

All forms of malnutrition have multiple causes, but healthy diets can help reduce the risk of malnutrition in all its forms, including micronutrient deficiency, stunting, wasting, overweight and obesity, as well as diet-related NCDs.21 The determinants of consumption of healthy diets are similarly highly complex and include behavioural and cultural factors, food placement and promotion within the food environment. It is clear, however, that to ensure access to healthy diets, nutritious foods must be both available and affordable. Availability refers to the existence of food coming from either own production or the market, while affordability refers to people’s financial capacity to acquire sufficient food, which in turn depends on household income and food prices. Low incomes constrain how much food households can economically access, but relative prices and systematic food price dispersionab will greatly influence the types of foods selected and, as a result, may influence diet-related nutrition outcomes.22

It is worth recalling that the affordability indicator is a measure of economic access. It measures not the number of people not eating a healthy diet, but rather the number who do not have enough resources to acquire a healthy diet. As such, the contribution of social protection programmes such as school feeding programmes are not taken into consideration. On the other hand, social programmes such as cash-based transfers, whether in-kind or monetary, or food donation programmes, are considered part of the household income.

The 2020 edition of this report showed the existence of within-country variations in the cost and affordability of a healthy diet, but it did not cover variations across the rural–urban continuum. Studies suggest that urbanization may directly exert upward pressure on food prices in poor countries.18 This is because most households now depend on food supplied by markets rather than their own production. This is particularly true in urban areas where – as shown in Figure 24 in Section 4.1 – food purchases constitute more than 78 percent of household consumption in the 11 sub-Saharan African countries analysed. However, it also holds true in peri-urban and rural areas, where households of almost all countries analysed acquire more than 50 percent of the food consumed in markets. Such high shares increase the risk of food hoarding when prices are expected to rise, which itself can contribute to higher prices.

This section presents a new descriptive analysis of indicators of healthy diet access, food security and nutrition for selected countries. The analysis relies on the geospatial URCA dataset (see Box 2 and Box 3 in Chapter 3, and Annex 4, Section A); while there is no comparable global dataset to support the analysis, there are microlevel national survey data that, once merged with the URCA dataset, could provide insights on differences across the rural–urban continuum. The analysis focuses on the 11 sub-Saharan countries covered in Section 4.1, using the same household survey data (see Table A5.1 in Annex 5), and still grouping them into high-food-budget countries (2.3 PPP dollars per capita per day) and low-food-budget countries (1.6 PPP dollars per capita per day) (see Table 10 for the list of countries by category). Similar to Section 4.1, patterns, differences and similarities are also analysed across ten URCA categories of the rural–urban continuum, as well as a further aggregation into urban, peri-urban and rural categories (see Table 9 and Annex 5, Section B for further details).

Cost and affordability of a healthy diet across the rural–urban continuum

The calculation of subnational cost and affordability of a healthy diet follows the same methodology as the global monitoring CoAHD indicators presented in Chapter 2. However, national estimates derived from the aggregation of subnational indicators are not comparable with global CoAHD indicators due to differences in data sources. For further information and the full description of the data sources and methodology, see Annex 8.

Cost of a healthy diet

Across the 11 African countries analysed, the cost of a healthy diet in urban centres is much higher (on average 1.2 times higher) than in peri-urban areas and it then decreases the smaller the city size and moving closer to rural areas. The higher cost of a healthy diet in urban centres in almost all countries analysed may be associated with the widespread diffusion of supermarkets in cities. While diffusion of supermarkets may increase access to a more diverse diet (see Chapter 3), it may also push the cost of a healthy diet up, making it less affordable for poorer households in urban centres.

However, there are exceptions to this cost pattern. For example, in Guinea-Bissau, the cost in peri-urban areas is slightly higher than in urban areas. This is likely attributed to the unique geographic concentration of cities in the south around the port of Bissau and to poor infrastructure, particularly in ferry and road transport systems linking urban and peri-urban areas that are 1 hour away or less (Figure A6.1D in Annex 6).23 In Ethiopia and Togo, the other exceptions, the cost is higher in rural areas than in peri-urban areas; this is directly related to the dispersed urbanization pattern in these countries (see Figure A6.1C in Annex 6), with poor rural areas inadequately connected to urban areas due to poor and limited road infrastructure.24 Generally, in these three exceptional cases, poor transport infrastructure is a major factor hampering availability of nutritious foods (often highly perishable) and pushing up their cost in rural areas.

Average values across countries also hide differences between high- and low-food-budget countries as shown in Figure 30A. The cost of a healthy diet in high-food-budget countries is 23 percent – 22 percent and 28 percent higher than in low-food-budget countries, comparing urban, peri-urban and rural areas. The higher cost in high-food-budget countries is mainly due to the higher cost of vegetables and animal source foods (29 percent and 32 percent higher than in low-food-budget countries, respectively). For both country food-budget groups, the largest decrease in the cost occurs moving from urban to peri-urban areas, while in rural areas the cost is similar to (in high-food-budget countries) or only slightly lower than (in low-food-budget countries) that in peri-urban areas.

FIGURE 30 In the 11 countries in Africa, the cost of a healthy diet in urban areas is much higher than in peri-urban areas, and it decreases the smaller the city size and moving closer to rural areas; this trend is less pronounced in high-food-budget countries, which show similar costs across all urban areas

SOURCE: Holleman, C. & Latino, L. 2023. Variations in the subnational cost and affordability of a healthy diet for selected countries in Africa. Background paper for The State of Food Security and Nutrition in the World 2023. FAO Agricultural Development Economics Working Paper 23-10. Rome, FAO.
NOTES: Figure A shows the cost of a healthy diet in urban, peri-urban and rural areas (URCA). In Figure B, each bar visualizes the median, 25th and 75th percentile range, and whiskers of 1.5 times that range of the cost of a healthy diet for the 11 countries analysed across the rural–urban continuum (URCA) by high- and low-food-budget countries, in PPP dollars per person per day (PPP = purchasing power parity). Crosses in the high-food-budget figure are cost of healthy diet in urban centres in Ethiopia, classified as outlier compared to the values of other countries in the same URCAs. All surveys are for 2018/19, except Malawi (2019/20). See Table 10 for the definition and list of high- and low-food-budget countries.
SOURCE: Holleman, C. & Latino, L. 2023. Variations in the subnational cost and affordability of a healthy diet for selected countries in Africa. Background paper for The State of Food Security and Nutrition in the World 2023. FAO Agricultural Development Economics Working Paper 23-10. Rome, FAO.

A more disaggregated view of the rural–urban continuum (i.e. considering the ten URCA categories) reveals a much closer convergence in the cost of a healthy diet in high-food-budget countries, particularly in urban areas (Figure 30B). On the other hand, the range in the cost is wider for low-food-budget countries. The greater convergence in the cost of a healthy diet in high-food-budget countries points to their better connectivity in food supply chains across the rural–urban continuum compared to low-food-budget countries.

Looking at the cost pattern across the rural–urban continuum for individual countries also provides further insights (Table A9.2 in Annex 9). For example, in Benin and Togo, households living in urban centres face a cost, respectively, 1.4 and 1.7 times higher than households living in peri-urban areas – and most of the population of these countries is concentrated in peri-urban areas of small cities. This suggests that a more dispersed urbanization pattern, likely involving decentralized markets served by local producers, may significantly drive the cost of healthy diets down.

Finally, and differently from that seen for low-food-budget countries, the cost of a healthy diet basket is particularly high in very remote rural areas, more than 2 hours from any urban centre in high-food-budget countries (Table A9.2 in Annex 9). Among the high-food budget countries, the cost difference between these remote areas and rural areas 1 to 2 hours from any urban centre is particularly high in Nigeria. This may be a reflection of the different urbanization patterns in those countries, which have undergone a metropolitan expansion process with most of the population living in large and/or intermediate cities and in peri-urban areas 1 hour away or less. In this situation, a more abrupt separation from more remote rural areas can be expected, with disruption in the food supply chain and higher prices.

The cost structure by food group of a healthy diet does not present any striking differences across URCAs, with each of the six food groups contributing to the total cost of a healthy diet in about the same percentage, independently of the catchment area for both high- and low-food-budget countries (Figure A9.1 in Annex 9). The largest cost contribution by food group to a healthy diet comes from animal source foods (31–41 percent), followed by vegetables (17–22 percent), staple foods (16–21 percent), fruits (10–18 percent), fats and oils (6–8 percent), and pulses, seeds and nuts (6–8 percent).

However, it is worth noting the higher cost share of animal source foods in all urban centres and peri-urban areas of high-food-budget countries, compared to low-food-budget countries (between 2 and 6 percentage points difference) (Figure A9.1 in Annex 9). The largest cost difference is found in towns, where households in high-food-budget countries spend USD 0.29 more per person per day on animal source foods than do households in low-food-budget countries (Figure 31).

FIGURE 31 In the 11 countries in Africa, the higher cost of animal source foods drives the high cost of a healthy diet across the rural–urban continuum, especially in urban and remote rural areas

SOURCE: Holleman, C. & Latino, L. 2023. Variations in the subnational cost and affordability of a healthy diet for selected countries in Africa. Background paper for The State of Food Security and Nutrition in the World 2023. FAO Agricultural Development Economics Working Paper 23-10. Rome, FAO.
NOTES: The figures show the average cost of each food group in a healthy diet across the rural–urban continuum (URCA), for high-food-budget (Figure A) and low-food-budget (Figure B) countries. The cost of a healthy diet is expressed in PPP dollars per person per day (PPP = purchasing power parity). All surveys are for 2018/19, except Malawi (2019/20). See Table 10 for the definition and list of high- and low-food-budget countries.
SOURCE: Holleman, C. & Latino, L. 2023. Variations in the subnational cost and affordability of a healthy diet for selected countries in Africa. Background paper for The State of Food Security and Nutrition in the World 2023. FAO Agricultural Development Economics Working Paper 23-10. Rome, FAO.

The other trend to highlight is the higher cost contribution of animal source foods compared to all other food groups, even vegetables and fruits combined, in almost all URCAs in both country food-budget groups. The main outliers are large cities of low-food-budget countries, due to the higher share of fruits in the cost of a healthy diet (Figure A9.1 in Annex 9).

Finally, the cost contribution of animal source foods in the total cost of a healthy diet (both as share and in terms of money value) is also high in more remote areas (more than 2 hours travel to a city or town) in both high- and low-food-budget countries. On the other hand, it is lower in peri-urban areas of intermediate and small cities, as well as in areas 1 to 2 hours from a city of any size (Figure 31 and Figure A9.1 in Annex 9).

The lower cost of animal source foods in peri-urban areas, coupled with the high cost of fruits and vegetables in large cities, particularly in low-food-budget countries, explains the decrease in the overall cost of a healthy diet basket from urban to rural areas across the continuum (Figure 31). The lower cost of fruits, vegetables and animal source foods in the outskirts of cities is clearly a consequence of the proximity to the production site of these perishable products. In fact, the increasing demand for animal source foods from better-off urban dwellers is attracting more medium- and large-scale livestock operators to urban and peri-urban areas (such operators had moved farther away when urbanization first began to intensify).25 Furthermore, the wider cost difference for animal source foods across the rural–urban continuum of low-food-budget countries is likely due to the higher constraints in the cold supply chain.

Cost of a healthy diet compared to actual household food expenditure

The food demand analysis in Section 4.1 shows the patterns of food consumption across the rural–urban continuum, including the market value of the foods consumed by food group. From this analysis, however, it is not possible to determine whether the consumed diet provides the quantity of calories and nutrients, and the diverse intake of foods from different food groups that would constitute a healthy diet. This would require a different set of data and information, which is not available. On the other hand, it is possible to compare the cost of a healthy diet to what households are actually spending on food (including market value of own food production), in order to determine whether they would have to spend more or less of the income they have available to secure a healthy diet. This is a useful comparison, especially as estimates can be disaggregated by URCA category and household income level.

On average at the national level, the cost of a healthy diet is lower than the amount households spend on food in the high-food-budget countries analysed (see Table A9.1 in Annex 9). For high-food-budget countries, the cost of a healthy diet is 86 percent of average food consumption, varying from 74 percent to 97 percent among the countries in this group. For low-food-budget countries, there is more variability. In two countries (Burkina Faso and the Niger), the cost of a healthy diet is almost 40 percent greater than average food consumption. However, in the others, the cost of a healthy diet is lower than the actual amount spent on food.

The national averages, however, obscure the fact that for low- and middle-income households in both country food-budget groups, the cost of a healthy diet actually exceeds average expenditure on food (Figure 32A). For low-income households, the cost of a healthy diet basket is about twice the amount that households spend on food: specifically, 2.3 times higher in low-food-budget countries and 2 times higher in high-food-budget countries. Middle-income households would also need to increase current spending to have access to a healthy diet (i.e. by 34 percent in low-food-budget countries and 17 percent in high-food-budget countries).

FIGURE 32 The cost of a healthy diet exceeds average food consumption for low- and middle-income households in both high- and low-food-budget countries in the 11 countries analysed in Africa

SOURCE: Holleman, C. & Latino, L. 2023. Variations in the subnational cost and affordability of a healthy diet for selected countries in Africa. Background paper for The State of Food Security and Nutrition in the World 2023. FAO Agricultural Development Economics Working Paper 23-10. Rome, FAO.
NOTES: In the figures, total household consumption (at market value) serves as a proxy for household income, and terciles are calculated to classify low-, middle- and high-income households. A ratio greater than 1 shows how many times a healthy diet is more expensive than average household food consumption. All surveys are for 2018/19, except Malawi (2019/20). See Table 10 for the definition and list of high- and low-food-budget countries.
SOURCE: Holleman, C. & Latino, L. 2023. Variations in the subnational cost and affordability of a healthy diet for selected countries in Africa. Background paper for The State of Food Security and Nutrition in the World 2023. FAO Agricultural Development Economics Working Paper 23-10. Rome, FAO.

This problem is seen for all low- and middle-income households in both high- and low-food-budget countries across the rural–urban continuum, although it becomes particularly acute moving from urban to peri-urban areas (Figure 32B). Low-income households living in peri-urban and rural areas are especially disadvantaged, as they would need to more than double what they currently spend on food to secure a healthy diet.

Affordability of a healthy diet across the rural–urban continuum

Affordability, or the cost of a healthy diet relative to income that households can credibly reserve for food, reflects the ability to access a healthy diet. Tracing this affordability across each URCA in the 11 countries analysed shows how economic access to a healthy diet follows different paths in countries with different levels of development and urbanization. Importantly, high costs do not necessarily translate into greater unaffordability, and vice versa, as this depends on the level of income relative to the cost.

Indeed, this is a key finding from the analysis. Although the cost of a healthy diet in peri-urban areas is lower than in urban areas (Figure 30A), this does not translate into a more affordable healthy diet in the former (Figure 33). On average, the percentage of the population unable to afford a healthy diet in peri-urban areas is 1.5 times higher than in urban centres and similar to rural areas.

FIGURE 33 In the 11 countries in Africa, the percentage of the population UNABLE TO afford a healthy diet in peri-urban areas is higher than in urban centres and similar to rural areas

SOURCE: Holleman, C. & Latino, L. 2023. Variations in the subnational cost and affordability of a healthy diet for selected countries in Africa. Background paper for The State of Food Security and Nutrition in the World 2023. FAO Agricultural Development Economics Working Paper 23-10. Rome, FAO.
NOTES: All surveys are for 2018/19, except Malawi (2019/20). See Table 10 for the definition and list of high- and low-food-budget countries.
SOURCE: Holleman, C. & Latino, L. 2023. Variations in the subnational cost and affordability of a healthy diet for selected countries in Africa. Background paper for The State of Food Security and Nutrition in the World 2023. FAO Agricultural Development Economics Working Paper 23-10. Rome, FAO.

In the Niger, a low-food-budget country with the highest percentage of population living in areas more than 1 hour from any urban centre among the 11 countries analysed, the percentage of population unable to afford a healthy diet grows as cities get smaller and as one moves into rural areas. In this case, there is an increase of 52 percentage points between large cities and towns (Figure 33 and Table A9.3 in Annex 9). Surprisingly, Burkina Faso and Guinea-Bissau, both low-food-budget countries, follow a pattern similar to that of high-food-budget countries, with affordability levels within each country remaining more or less constant across urban centres.

In low-food-budget countries (except Benin and Togo), moving away from urban centres introduces a structural change, with the percentage of population unable to access a healthy diet increasing significantly. In high-food-budget countries (except Ethiopia), this jump occurs one step farther along the continuum, crossing peri-urban areas of large and intermediate cities. Finally, in high-food-budget countries, the percentage of the population unable to afford a healthy diet increases across peri-urban areas as the size of the closest urban centre decreases (Figure 33).

Food insecurity across the rural–urban continuum

The comparison of food insecurity among rural, peri-urban and urban populations at the global and regional levels based on the Degree of Urbanization (DEGURBA) classification,ac presented in Chapter 2, indicates that food insecurity is lower in urban areas at the global level. At the regional level, Africa and Latin America and the Caribbean follow this pattern, but not Asia nor Northern America and Europe, revealing context-specific differences that defy generalization. An analysis of patterns of the prevalence of moderate or severe food insecurity based on the Food Insecurity Experience Scale (FIES), using household survey data for 9 of the 11 countries studied up until now, grouped by food budget (see Table 10) and according to the URCA-defined rural–urban continuum (see Table 9), sheds light on some context-specific differences and has the potential to complement the analysis in Chapter 2.

In many of the analysed countries, the prevalence of moderate or severe food insecurity in urban and peri-urban areas is similar to that in rural areas (e.g. Côte d’Ivoire, Senegal) or sometimes even slightly higher (e.g. Niger, Nigeria) (Figure 34). This suggests that food insecurity is not exclusively a rural problem in most of the countries analysed.

FIGURE 34 In many of the nine countries analysed in Africa, the prevalence of moderate or severe food insecurity in urban and peri-urban areas is similar to that in rural areas, and in some cases, slightly higher, indicating that food insecurity is not exclusively a rural problem in most of the countries analysed

SOURCE: Authors’ (FAO) own elaboration.
NOTES: All surveys are for 2018/19, except Malawi (2019/20). See Table 10 for the definition and list of high- and low-food-budget countries.
SOURCE: Authors’ (FAO) own elaboration.

The FIES analysis shows a different pattern across the rural–urban continuum in high- and low-food-budget countries. In general, low-food-budget countries show larger differences and varying patterns in food insecurity (Figure 34A). In Malawi, moderate or severe food insecurity is much lower in urban areas and increases significantly moving to peri-urban and rural areas, with extremely high levels of severe food insecurity in both areas. Moderate or severe food insecurity in urban and peri-urban areas is about the same in Benin, but in Burkina Faso it is higher in urban areas than in peri-urban areas. Only in Guinea-Bissau and Togo is there a gradual increase moving from urban to rural areas.

In contrast, in high-food-budget countries, the prevalence of moderate or severe food insecurity is about the same across the rural–urban continuum (Figure 34A). In the case of Nigeria, there is some indication that moderate or severe food insecurity may be highest in peri-urban areas and lowest in rural areas (Figure 34A).

Further disaggregation reveals some additional differences. However, the sample sizes in each category are small and the margins of error are very large, so the observed patterns must be interpreted with caution (see the full set of results in Table A10.1 and Table A10.2 in Annex 10). For example, in Nigeria, a high-food-budget country, the prevalence of food insecurity is positively associated with city size: the bigger the city, the higher the prevalence of food insecurity (Figure 34B). Moreover, levels of severe food insecurity in large and intermediate cities (15 percent and 14 percent, respectively) are even higher than in more remote areas (10 percent in areas more than 2 hours travel to any urban centre). This is likely related to the presence of slums outside the larger cities. A similar pattern is also observed in Burkina Faso, a low-food-budget country with a more dispersed urbanization pattern.

In the Niger, the pattern is reversed: the prevalence of moderate or severe food insecurity increases as the size of the city decreases (Figure 34B) – similar to the pattern found for the percentage of the population unable to afford a healthy diet basket in those countries – but then begins to fall moving into peri-urban areas, with the exception of a sharp uptick in areas less than 1 hour from a town. Malawi, on the other hand, presents evidence of a structural change: a sudden worsening of food insecurity, most notably severe food insecurity, for households living in areas less than 1 hour travel to an intermediate city, with high levels of food insecurity moving to remote rural areas more than 2 hours travel to any city or town (Figure 34B).

Another analysis of food insecurity based on FIES from 21 rural development projects worldwide, looking at the ten URCA categories of the rural–urban continuum, is presented in Box 6. While this analysis is not nationally representative, it provides some perspective beyond the nine African countries analysed above, even if at project level.

BOX 6Food security across the rural–urban continuum: evidence from 21 rural development projects worldwide

Between 2019 and 2021, household-level data with GPS coordinates were collected from 21 rural development projects supported by IFAD and implemented in most regions of the world. This includes five countries in Asia and the Pacific; six in Eastern and Southern Africa; four in Latin America and the Caribbean; four in Near East, Northern Africa, Europe and Central Asia; and three in Western and Central Africa (see Annex 5, Section D for the full list of countries and projects). These datasets contain information from more than 41 000 households and are representative of small-scale producers who are engaged in projects financed by international financial organizations. The data were merged with the Urban Rural Catchment Areas (URCA) dataset (using GPS coordinates), and households were thereby classified across the ten URCA categories of the rural–urban continuum.

Figure A shows the prevalence of moderate or severe food insecurity across the rural–urban continuum using the pooled sample of the 21 rural development projects. It is important to clarify that for some URCA categories, the sample size is too small to draw any statistically significant inference, thus the results are presented and interpreted in terms of a description of food insecurity across the rural–urban continuum.

Results show that the prevalence of food insecurity varies across the rural–urban continuum. There is a higher prevalence of moderate or severe food insecurity in areas close to towns (less than 1 hour travel) compared to areas more than 1 hour from a city or town. In addition, there is a much higher prevalence of moderate or severe food insecurity in larger cities compared to smaller cities or towns, and it is even higher than those living 1 to 2 hours or more than 2 hours from a city or town. This bears some similarity to findings shown in Figure 34B. On the other hand, severe food insecurity is highest in rural areas that are less than 1 hour to a town and more than 2 hours to a city or town. However, of surprise is that severe food insecurity is also very high in large cities, as well as high in peri-urban areas of large and intermediate cities. This analysis adds information on food insecurity patterns that could be more specifically addressed and targeted, but which are generally not visible when looking at only the three urban, peri-urban and rural categories.

In summary, the prevalence of moderate or severe food insecurity among a selected number of small-scale producers in urban and peri-urban areas is high – in some cases as high or even higher than in rural areas. This is similar to the findings for many of the nine African countries analysed (Figure 34).

Figure A Prevalence of moderate or severe food insecurity among households of 21 rural development projects across the rural–urban continuum (URCA)

SOURCE: Authors’ (IFAD) own elaboration.
NOTES: The figure shows the prevalence of moderate or severe food insecurity based on the Food Insecurity Experience Scale (FIES) across the rural–urban continuum for 21 rural development projects implemented in countries from all regions of the world. See Annex 5, Section D for the list of countries and projects, data sources and methodology.
SOURCE: Authors’ (IFAD) own elaboration.

In summary, the results of the analysis of nationally representative FIES datasets from the nine African countries, as well as of the FIES data collected in the context of these rural development projects, tend to indicate that food insecurity is not exclusively a rural problem in many places. While it is not possible to draw general conclusions given the limited number of countries in this chapter’s FIES analysis (all from one region), the results – including those from the 21 rural development projects – signal that further research is needed to guide more targeted policies and investments across the rural–urban continuum.

Nutritional status across the rural–urban continuum

The prevalence of malnutrition across the ten URCA categories was also estimated only for 3 of the 11 countries of the sections above (i.e. Benin, Nigeria and Senegal),ad due to data limitations. The analysis is based on 2018 data from demographic and health surveys (Table A5.1). See Table A10.3 in Annex 10 for the full table of results.

In the three countries, generally the prevalence of stunting in children under five years of age gradually increases as cities become smaller and as one moves away from urban centres. The biggest increase in Nigeria occurs moving to areas less than 1 hour travel to a small city, while in Benin it is seen moving into more remote rural areas (i.e. more than 2 hours travel to an urban centre). The prevalence of stunting is notably lower in Senegal, and while there is a general pattern of increases, with some variations as one moves away from urban areas, the increases are smaller with some variations (e.g. there is a notable decrease in areas less than 1 hour travel to large and intermediate cities, as well as to a town).

Furthermore, as already emerged in the analysis of the cost and affordability of a healthy diet across URCAs, the data suggest that the size of the closest urban centre plays a role in the prevalence of stunting in peri-urban areas, with the prevalence being higher in areas closest to small cities and towns in Benin and Nigeria. This result is aligned with other studies that find high levels of food insecurity and malnutrition in the sprawling poverty-stricken areas surrounding many cities in Africa. Food access is limited, and many of these peri-urban slums are food deserts, where residents’ access to diverse, fresh or nutritious foods is limited or even non-existent due to the absence or low density of food entry points (see Box 4 in Chapter 3) and inadequate access to services, including health and education.

The prevalence of wasting in children under five years of age is lower than that of stunting in all three countries and exhibits less evident trends across the rural–urban continuum (Figure 35B). Nevertheless, there are hints of increased wasting in some peri-urban and rural areas in Nigeria and Senegal. Similarly, the prevalence of overweight in children is low in all countries and does not present a clear trend across the rural–urban continuum (Figure 35C). However, it is worth noting there is a suggestion towards lower overweight in peri-urban areas and higher overweight in some rural areas compared to urban areas.

FIGURE 35 The prevalence of child stunting generally increases as cities become smaller and moving away from urban centres; Child wasting and overweight are lower and exhibit less evident trends across the rural–urban continuum

SOURCE: Authors’ (UNICEF) own elaboration.
NOTES: Figures show the prevalence of malnutrition in children under five years of age in three Western African countries, by URCA category (2018). Gaps in URCA indicate missing data.
SOURCE: Authors’ (UNICEF) own elaboration.
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