PRB

Improving Agriculture, Nutrition, and Women’s Reproductive Health

Multi-sector investments in women and girls are critical to increasing food production and reducing hunger.

(March 2012) Almost two of every three people in sub-Saharan Africa live in a rural area, relying principally on small-scale agriculture for their livelihood. Improving agriculture on small farms is critical to reducing hunger.¹ According to the FAO, women will play a key role since they perform half of agricultural labor in the region and contribute even more in many countries. Consistent and compelling evidence shows that when the status of women is improved, agricultural productivity increases, poverty is reduced, and nutrition improves. Improving women’s prospects in agriculture, however, faces many obstacles. Women often lack land and do not have access to credit and agricultural extension services.² Furthermore, they face special burdens related to their traditional roles of childbearing, caring for the family, and fetching water and firewood.

Farm size and land rights. About 80 percent of farms in Africa are less than 2 hectares, and while the region is becoming more urban, the rural population is still expected to grow by more than 150 million people over the next 40 years.³ Farms will likely get smaller as farmers subdivide agricultural land among their children. In the Democratic Republic of Congo, rural population almost doubled from 1970 to 1990, and average farm size declined from 1.5 hectares to 0.5 hectares.⁴ There is evidence that declining farm size is making it more difficult for farmers to grow enough food to have a secure livelihood and feed their families. In a recent national survey in Kenya, the majority of farmers reported that their land’s production is not sufficient to support their families, and two out of three felt that there is not available land for their children to stay in the community and farm.⁵ Women face even greater land constraints than men and are less likely to own land or to have access to rented land; and the land women do have access to is often of poorer quality and in smaller plots.⁶ Improving women’s access to land will improve agricultural productivity in the region.⁷

Inputs for agriculture. Agricultural yields in sub-Saharan Africa remain lower than other developing regions. Agricultural inputs and the techniques and technologies needed to boost production are lagging far behind the rest of the developing world.⁸ Organic and inorganic fertilizers remain prohibitively expensive for most African farmers, although efforts are underway to improve access. Greater poverty, lower levels of education, and lack of credit among women prohibit them from using fertilizers and improved seeds or mechanical tools and equipment. In many countries, women are only half as likely as men to use fertilizers, contributing to low agricultural yields on their plots.⁹

Women’s health and food production. Women also face gender-related constraints that may limit the labor they are able to put into their farms.¹⁰ They are usually responsible for domestic work such as collecting water and firewood and preparing meals for the household. In addition, pregnancy, breastfeeding, and child care may limit women’s mobility and the time they are able to spend laboring on their farms. Poor access to reproductive health information and services often leads to adolescent pregnancies, girls dropping out of school, and frequent pregnancies—all of which negatively affect women’s health and economic opportunity. Low levels of schooling, poor health, and compromised nutritional status constrain poor rural women in their multiple roles as agricultural producers, workers, mothers, and caregivers.¹¹

The complex development challenges women, families, and their communities face require multi-sector investments in women’s agriculture, education, and health. Integrated approaches will improve prospects for women, increase food production, and improve the well-being of households.

Recommended Policy and Program Actions

SUPPORT VOLUNTARY FAMILY PLANNING PROGRAMS

Reducing hunger in sub-Saharan Africa will depend on the size of the future population and thus on increased investments in family planning. Almost two out of three women in the region who want to avoid pregnancy or delay or space their births are not using a modern method of contraception.¹² Providing family planning information and services to these women would reduce unintended pregnancies by 77 percent and cost US$2.4 billion annually. These investments would reduce high-risk births that result in infant and maternal deaths. Smaller, healthier families also demand less from education, health, and other services, including agricultural extension.¹³ Unfortunately, family planning programs remain underfunded and do not meet current needs, much less future needs, and support for population policies and family planning programs is often isolated in the health sector. Slowing population growth through voluntary family planning programs demands stronger support from a variety of development sectors, including finance, agriculture, water, and the environment.

EMPOWER WOMEN AND GIRLS TO IMPROVE HEALTH AND ELIMINATE HUNGER

In many parts of sub-Saharan Africa, women lack decisionmaking power, especially on reproductive health, farming, or basic household spending. Programs that help women complete their education benefit both agriculture and health.¹⁴ Girls who complete a secondary education and who are empowered to participate in household decisionmaking choose smaller families, are healthier, and have healthier children. These same women then can better invest in the health and nutrition of their families and in the necessary improvements in agriculture.¹⁵ Agriculture and health programs must continue to focus on investments in women and girls, particularly their education, thus giving them the resources, information, and services they need to play an effective role in meeting future agricultural and nutrition challenges. USAID’s Feed the Future Initiative is developing a Women’s Empowerment in Agriculture Index to help programs gauge needed investments (see Box 2).

SUPPORT RESEARCH AND PROGRAMS THAT LINK AGRICULTURE, NUTRITION, AND REPRODUCTIVE HEALTH

Donors and development agencies are making great strides in linking agriculture, nutrition, and health programs, but many funders still hesitate to address population and family planning. Innovative examples from the field, however, show that beneficiaries, community leaders, and practitioners recognize the benefits of programs that integrate health needs, including family planning, into efforts to improve agricultural systems.¹⁶ These programs represent a potential win-win solution for some of the long-term challenges to reducing hunger. Integrated programs, through agricultural extension, may be more successful at reaching rural people who have no access to health systems; engaging men who receive little information about family planning; and reaching women more efficiently with health, nutrition, and agriculture services. Families receive a more holistic package of services aimed at improving their crops and livelihoods, and at creating stronger, smaller, and healthier families (see Box 3). There is little research, however, on the effects of pregnancy, the postpartum period, and lack of child care on agricultural productivity, women’s mobility, and the ability of women to work or go to market.¹⁷ Increasing support for innovative research and programs that bridge the divide between the agriculture and health sectors will lead to a new generation of programs for reducing hunger.

Conclusion

Investments in women’s agriculture, education, and health are critical to improving food security in sub-Saharan Africa. Improving access to family planning is a critical piece of fulfilling future food needs, and food security and nutrition advocates must add their voices to support investments in women and girls and voluntary family planning as essential complements to agriculture and food policy solutions.

Part 1:

Rising Hunger; Population and Future Food Needs; Population Projections

This policy brief was written by Jason Bremner, program director, Population Health and Environment, at the Population Reference Bureau; with guidance from Lori Ashford, James Gribble, and Charlotte Feldman-Jacobs of PRB. Special thanks to Heather D’Agnes, Irene Kitzantides, Shelley Snyder, Gloria Coe, Sally Abbot, Emily Hogue, and Maura Mack of the U.S. Agency for International Development (USAID) who provided input. This publication is made possible by the generous support of the American people through USAID under the terms of the IDEA Project (No. AID-OAA-A-10-00009). The contents are the responsibility of the Population Reference Bureau and do not necessarily reflect the views of USAID or the United States government.

Box 2: Women’s Empowerment in Agriculture Index

USAID’s Feed the Future (FTF) initiative recognizes that empowering women is vital to achieve FTF’s first-level objective, “Inclusive Agricultural Sector Growth,” particularly in areas like decisionmaking and leadership. The concept of empowerment is both broad and multi-dimensional; to simplify its measurement, FTF has defined and operationalized the concept into five dimensions:

• Women’s role in household decisionmaking around agricultural production.
• Women’s access to productive capital.
• Women’s income and expenditures.
• Women’s individual leadership and influence in the community.
• Women’s time allocations.

To measure changes in women’s empowerment in agriculture along these dimensions, USAID’s Bureau for Food Security is developing an index in partnership with the USAID Planning, Policy, and Learning Bureau, International Food Policy and Research Institute (IFPRI), and the Oxford Poverty and Human Development Initiative (OPHI), Oxford Department of International Development at the University of Oxford. The innovative Index is currently under development and is expected to be available to the public in spring 2012.

Box 3: Combining Coffee Agribusiness and Community Health

Rwanda’s farming families need more than increased incomes to improve their lives; they also need better health care and services. Recognizing that the coffee sector provides an ideal opportunity to reach a sizable segment of the population, USAID added a health component to the Sustaining Partnerships to enhance Rural Enterprise and Agribusiness Development (SPREAD), an existing agribusiness project aimed at improving Rwanda’s specialty coffee sector.

SPREAD focused on improving the specialty coffee value chain, including forming and strengthening coffee cooperatives, improving coffee quality, establishing long-term relationships between Rwandan producers and specialty importers and roasters, and building capacity of the National Coffee Board. The project built upon its coffee cooperative structures to deliver an innovative health component, which includes:

• Training and mentoring coffee extension agents to act also as community health agents. They conduct health outreach and education on a range of basic health topics including HIV prevention, reproductive health and family planning, safe births, nutrition, and water and sanitation. Male and female coffee/health extension agents educate households, distribute condoms and water purification solution, and refer community members to local health services. These activities save time and resources as they occur during agricultural meetings, coffee processing activities, and visits to farmers’ homes and fields, and serve as a forum to meet both agribusiness and health objectives.
• Training and mentoring a network of peer educators to conduct behavior change communication activities such as community theater with farmers and their families. These activities serve as a forum for dialogue around community issues involving coffee farming, and family health and well-being.
• Facilitating discussions about gender-related issues such as how coffee revenue is used within households, alcohol and gender-based violence, condom use, and decisions about family size and contraception.
• Coordinating with local health centers to provide HIV counseling and testing and intestinal parasite treatment at coffee-washing stations during harvest season, where farmers bring coffee cherries daily for processing.
• Building relationships between coffee cooperatives and local health NGOs, such as the International Planned Parenthood Federation of Rwanda and Population Services International, to stock and sell branded condoms and water purification solution at coffee-washing stations and administrative offices.
• Supplying clean drinking water and hand washing at coffee-washing stations and offices, and setting up rainwater catchment tanks in pyrethrum growing areas, where potable drinking water is extremely scarce.

Results of SPREAD’s health program show the benefits of an integrated approach. Local health officials and NGOs appreciate the easy access to farmers that the coffee cooperatives provide, especially to rural men, who are often difficult to reach with reproductive health information. SPREAD’s agribusiness staff and coffee cooperative managers support health activities because they recognize the links between farmers’ health, coffee quality, and successful cooperatives. The health program, through its consistent dialogue, capacity building, and contact with farmers, is able to address some of the broader cultural and behavioral factors affecting agribusiness activities and farmers’ welfare. The farmers, peer educators, cooperative managers, and health extension agents appreciate the services, citing increased knowledge and acceptance of family planning, HIV testing, and condom use, and positive changes in gender roles and resource use in their communities.

Reference: Irene Kitzantides, USAID Sustaining Partnerships to Enhance Rural Enterprise and Agribusiness Development (SPREAD) Project: Integrated Community Health Program Mid-Term Program Evaluation (Washington, DC: USAID Public Health Institute, Global Health Fellows Program, 2010): 48, accessed at www.k4health.org.

References

1. FAO, “The Special Challenge for sub-Saharan Africa,” presentation at the high-level expert forum “How to Feed the World 2050,” Rome, October 2009.
2. FAO, The State of Food and Agriculture—Women in Agriculture, Closing the Gender Gap for Development (Rome: Food and Agriculture Organization of the United States, 2011).
3. Oksana Nagayets, “Small Farms: Current Status and Key Trends,” presentation delivered at “The Future of Small Farms” workshop, IFPRI, Imperial College, and ODI, June 2005; and UN Population Division, World Urbanization Prospects: The 2009 Revision (New York: United Nations, 2010).
4. Nagayets, “Small Farms: Current Status and Key Trends.”
5. Kenya National Bureau of Statistics et al., Kenya Demographic and Health Survey 2008-09 (Calverton, MD: ICF Macro, 2010), accessed at www.measuredhs.com/pubs/pdf/FR229/FR229.pdf, on Jan. 23, 2012.
6. FAO, The State of Food and Agriculture.
7. Agnes Quisumbing and Lauren Pandolfelli, “Promising Approaches to Address the Needs of Poor Female Farmers: Resources, Constraints, and Interventions,” International Food Policy Research Institute Discussion Paper 00882 (2009).
8. Michael Morris et al., Fertilizer Use in African Agriculture, Lessons Learned and Good Practice Guidelines (Washington, DC: The World Bank, 2007); and Mark Rosegrant et al., “Looking Ahead: Long-Term Prospects for Africa’s Agricultural Development and Food Security,” International Food Policy Research Institute 20/20 Discussion Paper 41 (2005).
9. FAO, The State of Food and Agriculture.
10. Amber Peterman, Julia Behrman, and Agnes Quisumbing, “A Review of Empirical Evidence on Gender Differences in non-Land Agricultural Inputs, Technology, and Services in Developing Countries,” ESA Working Paper 11-11 (2011).
11. Quisumbing and Pandelfelli, “Promising Approaches to Address the Needs of Poor Female Farmers.”
12. Singh et al., Adding It Up.
13. USAID Health Policy Initiative, Family Planning and the MDGs: Saving Lives, Saving Resources (Washington, DC: Futures Group International, 2009).
14. Quisumbing and Pandelfelli, “Promising Approaches to Address the Needs of Poor Female Farmers.”
15. May Rihani, Lisa Kays, and Stephanie Psaki, Keeping the Promise: Five Benefits of Girls’ Secondary Education (Washington, DC: AED, 2006).
16. Leona D’Agnes et al., “Integrated Management of Coastal Resources and Human Health Yields Added Value: A Comparative Study in Palawan (Philippines),” Environmental Conservation 37, no. 4 (2010): 398-409.
17. Peterman, Behrman, and Quisumbing, “A Review of Empirical Evidence on Gender Differences in Non-Land Agricultural Inputs, Technology, and Services in Developing Countries.”