Advance Equitable Livelihoods : A paper on Action Track 4

Food systems transformation provides the opportunity to shift current trends in all forms of malnutrition, prioritizing nutritious food availability and affordability for all – from shifting priorities in agricultural production, to improved food systems that favour nutrition and sustainability. The task of Action Track 4 is to explore approaches to doing so that will ensure equitable livelihoods for producers, businesses, workers across the food system and consumers, with particular emphasis on addressing inequalities and power imbalances. As the Science Group for AT 4, we explore the nature of these issues, using the drivers of food systems as articulated by the High Level Panel of Experts of the UN Committee on World Food Security1 as framing. Small and medium sized producers and people living on the food system in rural and urban areas are disproportionately affected by all biophysical and environmental drivers including soil and water resources, and climate change. Unequal opportunity in access to all types of resources reduces overall production, resilience, rural transformation. Advances in innovation, technology and infrastructure have had important impacts on food production and sustainability, transportation and processing along food value chains, marketing, and ultimately diets, including consumption of both nutritious and unhealthy foods. But achievement of equitable livelihoods in food systems will require that issues of access to contextually suitable innovation and technology be substantially enhanced, and that such advances better build on and learn from indigenous knowledge. Many economic and political factors are essential causes of inequality and power imbalances at house- hold, community, national and global levels, which constrain the ability of food systems transformation to deliver poverty reduction and sustainable, equitable livelihoods. Finally, vast evidence illustrates that several socio-cultural and demographic drivers underpin inequalities among and within societies and constrain the potential for some to benefit from actions to improve livelihoods, particularly women, youth, disabled, elderly, and indigenous peoples. These issues are exacerbated by the COVID-19 pandemic. The pandemic is having a significant impact on the global commodity markets and trading systems, economic growth, incomes, and poverty levels, with likely disproportionate burden on the vulnerable communities in both urban and rural areas. This is likely to worsen inequalities and under- nutrition including child wasting. To address these issues, we must transform not only food systems, but the structures and systems that continue to enable and exacerbate inequities. Drivers of food systems inequities are highly interconnected and progress to address one will likely require change across several. For example, globalization and trade interact with other powerful drivers, especially technology resource mobilization, and demographic trends, which shape food production, distribution, and consumption. Drawing of this evidence review, in the final section we reflect on several factors that should be part of effective solutions, including grounding in rights-based approaches. We then share a series of recommendations aimed to enhance inclusive decision making, protect the livelihoods of those living in situations of vulnerability while creating opportunities, adapting institutions and policies to favour equitable food systems livelihoods, and increasing investment to realize the potential of improved institutional and policy actions. We invite governments, businesses, and organizations to hold themselves and others to account for ensuring equitable livelihoods, and open avenues to realize the potential of science, innovation, technology, and evidence to favour equitable livelihoods

Advance equitable livelihoods

Food system transformation provides the opportunity to shift current trends in all forms of malnutrition, prioritizing the availability and affordability of nutritious food for all – from shifting priorities in agricultural production, to improved food systems that favor nutrition and sustainability. The task of Action Track 4 is to explore approaches to doing so that will advance equitable livelihoods for producers, businesses, workers across the food system and consumers, with a particular emphasis on addressing inequalities and power imbalances. As the Science Group for AT 4, we explore the nature of these issues, using the drivers of food systems as articulated by the High Level Panel of Experts of the UN Committee on World Food Security (HLPE 2020) as framing. Small and medium-sized producers and people who rely on food systems in rural and urban areas for livelihoods are disproportionately affected by all biophysical and environmental drivers, including soil and water resources and climate change. Unequal opportunity in access to all types of resources reduces overall production, resilience and rural transformation. Advances in innovation, technology and infrastructure have had important impacts on food production and sustainability, transportation and processing along food value chains, marketing, and, ultimately, diets, including the consumption of both nutritious and unhealthy foods. However, achievement of equitable livelihoods in food systems will require that issues of access to contextually suitable innovation and technology, inclusive of indigenous knowledge, be substantially enhanced. Many economic and political factors can be essential causes of inequality and power imbalances at the household, community, national and global levels, which may constrain the ability of food system transformation to deliver poverty reduction and sustainable, equitable livelihoods. Finally, vast evidence illustrates that several socio-cultural and demographic drivers underpin inequalities among and within societies and constrain the potential for some to benefit from actions to improve their livelihoods, particularly women, youths, the disabled, the elderly and indigenous peoples. These issues have been exacerbated by the COVID-19 pandemic. The pandemic is having a significant impact on global commodity markets and trading systems, economic growth, incomes, and poverty levels, with a likely disproportionate burden falling on vulnerable communities in both urban and rural areas. This is likely to worsen inequalities and set back progress against poverty and hunger goals. To address these issues, we must transform not only food systems, but the structures and systems that continue to enable and exacerbate inequities. Drivers of food system inequities are highly interconnected, and progress in addressing one will likely require change across several. For example, globalization and trade interact with other powerful drivers, especially technology resource mobilization and demographic trends, which shape food production, distribution, and consumption. Hence, in the final section, we reflect on several factors that should be part of effective solutions for combating inequalities in food systems, including rights-based approaches. We then share a series of recommendations aimed at enhancing inclusive decision-making, protecting the livelihoods of those living in situations of vulnerability while creating opportunities, adapting institutions and policies to favor equitable food system livelihoods, and increasing investment so as to realize the potential of improved institutional and policy actions. We invite governments, businesses, and organizations to hold themselves and others to account in advancing equitable livelihoods, and open avenues towards realizing the potential of science, innovation, technology, and evidence to favor equitable livelihoods

Healthy diet : a definition for the United Nations Food Systems Summit 2021

The aim of this chapter is to propose a definition of “healthy diets” and provide related evidence, thus permitting the alignment of terminology for the Food Systems Summit and beyond. Diets are combinations of foods and beverages (referred to as foods hereafter, for simplicity) consumed by individuals. However, the specific combination of foods that make up healthy diets is context-specific and depends on many cultural, economic, and other factors. We provide a definition and overview of approaches that have been used to translate this into food-based recommendations. We also provide a brief review highlighting evidence, gaps and controversies related to defining healthy diets. The evidence for potential solutions to making healthy diets more available, affordable, and their production environmentally sustainable is the subject of much literature (Herforth 2020; Chaudhary et al. 2018; Smetana et al. 2019; Badiane and Makombe 2020; Program of Accompanying Research for Agricultural Innovation 2020), and is not discussed here in detail.https://link.springer.com/book/10.1007/978-3-031-15703-5hj2024Agricultural Economics, Extension and Rural DevelopmentSDG-02:Zero HungerSDG-03:Good heatlh and well-bein

Maternal Pre‐Pregnancy Body Mass Index Is Not Associated With Infant and Young Child Feeding in Low‐Income Mexican Children 1–24 Months Old

Pre-pregnancy overweight and obesity is associated with shorter breastfeeding (BF) duration. Whether pre-pregnancy overweight and obesity is associated with other aspects of infant and young child feeding (IYCF) hasnot been investigated. We used data from 370 children born January 1999–September 2001 in a semi-urbancommunity in Morelos, Mexico, where information on how they were fed was available at 1, 3, 6, 9, 12, 18 and 24months of age. We modified the World Health Organization’s dietary diversity indicator to assess the quality ofthe complementary foods. An index that included BF, quality of complementary foods and other behaviours wasconstructed to measure IYCF. We used survival analysis to examine the association of pre-pregnancy body massindex (pBMI) category and BF duration and mixed models for quality of complementary food and IYCF index.Mean maternal pBMI was 24.44.1; 31% were overweight, and 9% were obese. pBMI was not associated with BF duration. Quality of complementary food improved over time (6 months, 1.3 1.3; 24 months, 3.8 1.04).Compared with normal-weight women, overweight and obese women were more likely to feed from more foodgroups (0.24 0.11 point,P=0.03), but this did not improve diet diversity from 6 to 24 months. IYCF indexdecreased throughout follow-up (1 month, 7.8 2.4; 24 months, 5.5 1.8), and pBMI was not associated withIYCF (-0.11 0.13 point,P=0.4). We conclude that heavier women were not engaging in IYCF behaviours thatwere distinct from those of normal-weight women from 1 to 24 months post-partum

Perspective: Challenges in Use of Adolescent Anthropometry for Understanding the Burden of Malnutrition

Improving nutritional status during adolescence is an opportunity to improve the lives of this generation and the next. Estimating the burden of malnutrition at a population level is fundamental to targeting interventions and measuring progress over time, and for adolescents, we usually depend on survey data and the 2007 WHO Growth Reference to do so. There is substantial risk of misguided conclusions regarding adolescent prevalence estimates, however, when underlying methodological limitations of the indicators and reference are not adequately considered. We use national prevalence estimates among girls and young women 10-22 y of age from the 2014 State of Food Security and Nutrition in Bangladesh report as an example to demonstrate that determining the true prevalence of undernutrition, overweight, and obesity is complicated by racial/ethnic variation across populations in timing of the adolescent growth spurt, growth potential, and body build. Further challenging the task are inherent limitations of the body mass index as an indicator of thinness and adiposity, and cutoffs that poorly distinguish a well-nourished population from a malnourished one. We provide recommendations for adolescent nutrition policy and program decision-making, emphasizing the importance of 1) critically interpreting indicators and distributions by age when using the 2007 WHO Growth Reference; 2) examining what is happening before and after adolescence, when interpretation of anthropometry is more straightforward, as well as trends over time; and 3) complementing anthropometry with other information, particularly dietary intake. Finally, we advocate that nutrition researchers prioritize exploration of better methods to predict peak height velocity, for development of standardized indicators to measure dietary quality among adolescents, and for studies that will illuminate causal paths so that we can effectively improve adolescent dietary intake and nutritional status

Promotion of Zinc Tablets with ORS through Child Health Weeks Improves Caregiver Knowledge, Attitudes, and Practice on Treatment of Diarrhoea in Nigeria

We examined whether the Maternal, Newborn and Child Health Weeks (MNCHW) in Nigeria would present an opportunity to raise awareness of and demand for the use of zinc and ORS in the treatment for diarrhoea, guided by a conceptual framework designed to assess three theoretical underpinnings (characteristics and performance standard of the health workers, potential reach, and intensity of the intervention), along the impact pathway. Zinc and ORS with education for their appropriate use during the next diarrhoeal episode were delivered as part of the November 2010 and May 2011 MNCHW. On the day of but before participating in MNCHW activities, semi-structured interviews were used for collecting information on knowledge, attitudes, and practice (KAP) relating to diarrhoea from 602 caregivers with children aged less than five years. Forty-eight health workers were also interviewed. Nearly all health workers (98%) correctly mentioned the dosage of zinc while only 58% correctly stated the preparation of ORS. The proportion of caregivers with knowledge on the treatment for diarrhoea increased from 46.4% in November 2010 pre-MNCHW to 71.3% in May 2011 pre-MNCHW interviews (p<0.001). More caregivers correctly mentioned the dosage of zinc (80.9%) and stated the preparation of ORS (88.8%) in the November 2010 exit interview immediately after the MNCHW encounter compared to the levels a few months later in the home follow-up visit (53.1% and 37.4% respectively). After attending both rounds of November 2010 and May 2011 MNCHW, caregivers\u2019 knowledge on the treatment of diarrhoea increased seven times compared to the caregivers who attended the May 2011 MNCHW only (OR=7.0, p<0.001). Additionally, caregivers were 40% less likely to seek advice outside the home in the treatment for diarrhoea if they had attended both the MNCHWs than if they had attended the May 2011 MNCHW only (OR=0.6, p<0.029). We conclude that providing opportunities for caregivers to receive a sample of zinc and ORS and to learn about its use in the treatment for diarrhoea, from trained health workers during MNCHW, has the potential to increase KAP relating to the use of zinc and ORS in the treatment for diarrhoea and for future diarrhoeal episodes

Maternal Depressive Symptoms and Physical Activity in Very Low-Income Children

To test the contribution of maternal depression during late infancy to physical activity in children five years later

Data collection and analysis tools for food security and nutrition. Towards enhancing effective, inclusive, evidence-informed, decision making

Throughout the world, high-quality, timely and relevant data are key to inform actions that promote better access to food and improved nutrition. • Despite the abundant and growing availability of data and information relevant to food security and nutrition, often policymakers are not aware of the existence and relevance of such data or do not use them appropriately, due to challenges at each step of the data cycle, which includes: defining priorities and data needs; reviewing, consolidating, collecting and curating data; analyzing the data using appropriate tools; translating data into relevant insights to be disseminated and discussed; and, finally, using data for decision-making. • Fundamental data gaps still exist to correctly guide action and inform policymaking, especially in terms of timely and sufficiently granular data on people’s ability to locally produce and access food, on their actual food and nutrient consumption, and on their nutritional status. Increased and sustained financial investment is needed to overcome these gaps. • Several other constraints limit the effectiveness of data-informed policy action, especially in low-resource countries. Key among them is the low level of data literacy and analysis skills (for both qualitative and quantitative data) on the part of data and information users at all levels – from data collectors and analysts, to decision-makers, and to the people, as the ultimate beneficiaries of food security and nutrition policies. • The complexity of the system of public and private actors and institutions involved in food security and nutrition data, coupled with the rapidly changing characteristics of today’s data ecosystems due to the digital revolution and the pervasiveness of the internet, brings to centre stage the need for global coordination to improve data governance. Particularly urgent is the need to reach agreement on the nature of FSN data and information as a public good, and, on that basis, to establish a global legal framework that allows for the broadest possible circulation of relevant information, while preserving the rights of the people to whom the data ultimately belongs

Rationale, design, methodology and sample characteristics for the Vietnam pre-conceptual micronutrient supplementation trial (PRECONCEPT): a randomized controlled study

BACKGROUND: Low birth weight and maternal anemia remain intractable problems in many developing countries. The adequacy of the current strategy of providing iron-folic acid (IFA) supplements only during pregnancy has been questioned given many women enter pregnancy with poor iron stores, the substantial micronutrient demand by maternal and fetal tissues, and programmatic issues related to timing and coverage of prenatal care. Weekly IFA supplementation for women of reproductive age (WRA) improves iron status and reduces the burden of anemia in the short term, but few studies have evaluated subsequent pregnancy and birth outcomes. The Preconcept trial aims to determine whether pre-pregnancy weekly IFA or multiple micronutrient (MM) supplementation will improve birth outcomes and maternal and infant iron status compared to the current practice of prenatal IFA supplementation only. This paper provides an overview of study design, methodology and sample characteristics from baseline survey data and key lessons learned. METHODS/DESIGN: We have recruited 5011 WRA in a double-blind stratified randomized controlled trial in rural Vietnam and randomly assigned them to receive weekly supplements containing either: 1) 2800 μg folic acid 2) 60 mg iron and 2800 μg folic acid or 3) MM. Women who become pregnant receive daily IFA, and are being followed through pregnancy, delivery, and up to three months post-partum. Study outcomes include birth outcomes and maternal and infant iron status. Data are being collected on household characteristics, maternal diet and mental health, anthropometry, infant feeding practices, morbidity and compliance. DISCUSSION: The study is timely and responds to the WHO Global Expert Consultation which identified the need to evaluate the long term benefits of weekly IFA and MM supplementation in WRA. Findings will generate new information to help guide policy and programs designed to reduce the burden of anemia in women and children and improve maternal and child health outcomes in resource poor settings. TRIAL REGISTRATION: NCT0166537

current evidence and programmatic considerations

Funding Information: We are thankful to Ann Prentice for her critical review of the section ?Concerns in populations with low calcium intake.? The convenings of the Calcium Task Force and the development of this paper and its open access were supported by funding from The Children's Investment Fund Foundation to the Nutrition Science Program of the New York Academy of Sciences. Publisher Copyright: © 2022 The Authors. Annals of the New York Academy of Sciences published by Wiley Periodicals LLC on behalf of New York Academy of Sciences.Most low- and middle-income countries present suboptimal intakes of calcium during pregnancy and high rates of mortality due to maternal hypertensive disorders. Calcium supplementation during pregnancy is known to reduce the risk of these disorders and associated complications, including preeclampsia, maternal morbidity, and preterm birth, and is, therefore, a recommended intervention for pregnant women in populations with low dietary calcium intake (e.g., where ≥25% of individuals in the population have intakes less than 800 mg calcium/day). However, this intervention is not widely implemented in part due to cost and logistical issues related to the large dose and burdensome dosing schedule (three to four 500-mg doses/day). WHO recommends 1.5–2 g/day but limited evidence suggests that less than 1 g/day may be sufficient and ongoing trials with low-dose calcium supplementation (500 mg/day) may point a path toward simplifying supplementation regimens. Calcium carbonate is likely to be the most cost-effective choice, and it is not necessary to counsel women to take calcium supplements separately from iron-containing supplements. In populations at highest risk for preeclampsia, a combination of calcium supplementation and food-based approaches, such as food fortification with calcium, may be required to improve calcium intakes before pregnancy and in early gestation.publishersversionpublishe