VANCOUVER — Sociocultural and traditional norms mean women often have less to eat than men, said experts on a panel at this week’s Women Deliver conference, adding that when implementing nutrition-focused programs, a gender lens must be applied.
“We've acknowledged for decades now that women have very special challenges and constraints in relation to nutrition,” said Dan Irvine, senior director for sustainable health at World Vision International.
Women and girls are more likely to present with iron deficiencies because of their higher iron needs, have a higher prevalence of obesity at 15% compared with 11% for men, while millions of women are underweight.
A gender transformative approach is key, Irvine said, blaming a lack of work on the power imbalances behind women’s malnutrition for the stunted progress.
“We've treated women typically as beneficiaries of projects. We've tried to address distribution of resources and allocated more resources to women, but we didn't change the fundamental underlying drivers of autonomy,” he said, adding that, as a result, when previous programs have ended, women have been left in the same position without further control over their own nutrition needs.
“We've done good things historically, but we know that we have to do much more now,” Irvine added.
1. Elevate women’s role in decision-making
Irvine believes that placing women at the center of decision-making around food systems, dietary practices, and their own personal nutrition can improve overall health. “We've long recognized that women are extremely important contributors in agricultural systems and production yet they have no decision rights in the supply chain because the market and the income-generating activities are generally controlled by men in many cultures.”
For women to be able to garner some power within agriculture and food systems, organizations need to elevate an agenda that caters for women’s agency and autonomy, and invest in that while also doing more to understand the basis for the power imbalances, Irvine said.
For example, World Vision identified that at the household level in certain low- and middle-income contexts, grandmothers have an influence, but are rooted in traditional practices that are not always good for nutrition outcomes. To remedy this, the organization adopted the “Grandmother-inclusive Approach,” which empowers grandmothers to be champions of improved nutrition practices for infant and young child feeding practices and then communicate that to the younger generations.
Since its implementation in Sierra Leone, there have been improvements in maternal nutrition practices, birth weight, and infant and young child feeding practices.
“Where you see that there's a lack of dietary diversity, of household food security, where you see that behavioral practices are not conducive to good nutrition outcomes, it's not enough to distribute ... or allocate resources,” Irvine said, adding that organizations need to invest in women’s autonomy.
2. Provide education through a gender lens
Increased education around nutrition is critical to ensuring the next generation is healthier and that there is a decrease in obesity rates and malnutrition, panelists agreed. While many programs are dedicating resources to provide such education in schools, Marion Roche, senior technical adviser at Nutrition International, told the room that it was important to address activities through both a gender and a nutrition lens.
“Taking the time to consider gender may reveal gaps that need to be addressed in order to adequately deliver that education,” she said, explaining that there are often barriers to reaching girls via schools given many don’t attend.
To address this, Nutrition International is working with youth leaders and peers to reach girls outside of schools with their messaging and have partnered with U.N. Population Fund in northern Nigeria to encourage young married girls and mothers back into school where they can receive nutrition education via existing lifestyle education. The organization has also collaborated with the World Association of Girl Guides and Girl Scouts on a nutrition badge as a means of creating an education tool around nutrition in a youth-friendly setting.
“ENRICH” — a nutrition program focused on strengthening health systems, implemented by World Vision Canada and Nutrition International and operating in Bangladesh, Kenya, Myanmar, Pakistan, and Tanzania — is also providing women with education on their rights and building advocacy skills so they might engage decision-makers to improve policy around agriculture and nutrition. As of 2018, they had trained almost 3,000 men and women on nutrition.
3. Focus on adolescents
The numbers show that without a significant reversal of current trends, the world will not be able to meet SDG 2 of zero hunger by 2030, nor WHO's global nutrition targets by 2025.
According to the 2018 Global Nutrition Report, it is important to adopt healthy dietary habits during adolescence in order to complete growth, improve cognition, and reduce the risk of developing a noncommunicable disease. Yet this period of development exacerbates malnutrition differences between men and women, such as iron deficiencies, Roche said.
Education and awareness raising is a core part of tackling malnutrition among teenagers, which is why Nutrition International trains peer educators to share key messages around physical activity, diet, growth, puberty, and menstrual hygiene management. But rather than young people solely acting as the recipients of malnutrition messaging, the engagement of youth as active leaders is the answer to better integrating nutrition and gender, said Frances Mason, senior nutrition adviser at Save the Children UK.
“They have both the understanding of the needs of their peer groups and are aware of getting to grips with where those issues lie,” she said. “It’s [asking] ‘who is the voice for those necessary interventions?’ that’s really critical here.”
4. Measure household decision-making and autonomy
Access to better data and analysis that looks beyond sex segregation is also key to integrating gender equality into nutrition programs, said Abena Thomas, monitoring and evaluation adviser at ENRICH.
“When you think of terms like ‘gender transformative’ or ‘agency,’ we have to move beyond simply sex segregation and talk about the barriers to access, decision-making, and autonomy within the household for a woman or girl,” Thomas said, adding that there is an increasing shift to incorporate such measures into health and nutrition surveys in order to identify the status of women — 276 ENRICH health facilities have reported sex-disaggregated nutrition data to better identify priority intervention areas.
However, there are challenges to doing this.
“It’s such a complex concept and construct in and of itself to define decision-making power that looks different from one context to the next, that looks different within the same context from point A to point B,” Thomas said, explaining that this type of analysis takes time, which isn’t often available when there are funding constraints.
“We have to be able to measure earlier and more frequently, and be able to invest in more developmental evaluation style programming to look at frequently measuring the health outcomes themselves, but then add that to the issues of power and influence.”
In a working session following the panel, nutrition and gender experts also suggested having men and boys involved in the conversations, finding an additional way to communicate nutrition to donors, and investing in multisectoral programming.
“Nutrition can’t be in a silo. It has to be seen and understood with the impact and interactions it has with child marriage, education, water, and sanitation programs etc.,” Mason said.
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