Professor Nazma Shaheen
Institute of Nutrition and Food Science
University of Dhaka


Nutrition Security

Food Security Vs Nutrition Security

Current Nutrition Situation in Bangladesh

Poverty and Nutrition Security

Policy

Challenges

Approaches
Nutrition Security for the Poor

A condition which combines

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Having access to a stable supply of adequate food.
Being well cared for.
Enjoying a healthy environment.
IFAD (1996)
Nutrition Security for the Poor

Food Security Vs Nutrition Security
Food Security

Food intake
 Stability

Food availability

Food accessibility
Nutrition Security

Food intake
 Food availability

Caring capacity

Health service

Environment
Nutrition Security for the Poor

Conceptual Framework of the Nutritional
Status
Nutritional status
Nutrition Security
Food Security
Food Intake
Health
Status
Food access
Health
Status
Health
Services
Environment al condition
Nutrition Security for the Poor

 Chronic and acute malnutrition
 Micronutrient malnutrition
 Consumption Pattern
Nutrition Security for the Poor

Current Nutrition Situation in Bangladesh
2012/13 Malnutrition, in Children
(birth to 59 months)
Stunting
Underweight
2011/12
41.3% (BDHS)
36.4% (BDHS)
Wasting
Low birth weight
Exclusive breastfeeding (6 -
59 months)
15.7% (BDHS)
26% (BDHS)
64% (BDHS)
Breast feeding until 2 years 90% (BDHS)
Anemia, in children (6-23 months)
51% (BDHS)
Iodine deficiency, in children (6-11 years) and
(12-14 years)
Zinc deficiency, in preschool age children
3.9% and 9.5 % respectively (BDHS)
44.6% (BDHS)
38.7% (UESD)
35.1% (UESD)
16.3% (UESD)
95.3% (MICS)
87.5% (MICS)
Nutrition Security for the Poor

Prevalence of Underweight (<-2 z) Among U-5
Children in Bangladesh
Nutrition Security for the Poor

Trends of Nutritional Status of
Bangladeshi Children
Nutrition Security for the Poor

60%
50%
40%
30%
20%
10%
0%
1996 BDHS
CED BMI<18.5
OVERWEIGHT BMI>23
1999 BDHS 2004 BDHS
Year
2005 CMNS 2007 BDHS 2010 FSNSP
Nutrition Security for the Poor

 A persisting problem of micronutrient deficiencies.
 2/3 of preschool children and1/3 of mothers and school going children are still iodine deficient.
 Iron deficiency anemia is prevalent in 2/3 of underfive children and 1/3 of pregnant women and overall anemia in 93.5% of adolescent girls.
 1/5 of under-five children suffer from vitamin A deficiency.
Nutrition Security for the Poor

Consumption Pattern in Bangladesh
SurveyYears
Food items, g
Total
Rice
Wheat
Potato
Pulses
1995-96 2000 2005 2010
Poor Non-poor Total
913.8
893.06
947.75
816.22 1084.53
999.99
464.3
458.54
439.64
406.19 420.52
33.7
17.24
12.08
20.36
28.73
49.5
13.9
55.45
63.30
15.77
14.19
63.44
73.78
10.15
16.22
416.01
26.09
70.52
14.30
Vegetables 152.5
140.47
157.02
141.8
177.25
Edible oil 9.80
12.82
16.45
14.20
23.41
Onion
Beef
Mutton
11.6
6.60
1.00
15.41
8.30
0.49
18.37
7.78
0.59
15.69
1.55
0.11
24.74
9.27
0.83
166.08
20.51
21.89
6.84
0.60
Nutrition Security for the Poor

Consumption Pattern in Bangladesh
Food items, g 1995-96 2000
Chicken/Duck 4.00
4.50
SurveyYears
2005 2010
Poor Nonpoor
6.85
4.11
15.09
Eggs
Fish
Milk & milk products
3.20
43.80
32.60
5.27
38.45
29.71
5.15
42.14
32.40
3.40
31.16
12.18
9.02
57.81
43.63
Fruits
Sugar/ Gur
Food taken outside
27.60
28.35
32.54
20.46
56.0
9.20
6.85
8.08
3.32
10.88
-
Miscellaneous 50.90
-
55.42
24.76
48.38
17.70
50.28
35.41
81.81
Total
11.22
7.25
49.41
33.72
44.80
8.50
29.83
72.41
Nutrition Security for the Poor

Food group
Total Cereal
Fruits
Intake (g/per capita/day)
(BIGH, 2013)*
337.3
50
Desirable (g/per capita/day)
((DDP,2013)
400
100
Non-leafy Vegetables
Leafy Vegetables
68.1
43.8
200
100
Pulses
All animal foods
Fish
Meat
Egg
Milk and Milk products
Roots & tubers
4.60
64.9
36.8
10.2
7.5
32.4
48.3
50
260
60
40
30
130
100
* Baseline Survey Report On Integrated Agriculture And Health Based
Intervention For Improved Food And Nutrition Security In Selected Districts Of
Southern Bangladesh by BRAC Institute of Global health (BIGH).
Nutrition Security for the Poor

Gap Between Original Intake and Desirable
Intake*
450
400
350
300
250
200
150
100
50
0
Intake by Ultra Poor
Desirable (DDP,2013)
* Baseline Survey Report On Integrated Agriculture And Health Based
Intervention For Improved Food And Nutrition Security In Selected Districts Of
Southern Bangladesh by BRAC Institute of Global health (BIGH).
Nutrition Security for the Poor

Trend of Cereals Intake Over Years in
Bangladesh (BBS)
Nutrition Security for the Poor

UNICEF Model of Malnutrition
Nutrition Security for the Poor

Malnutrition
Inadequate Food
Intake
Household Food
Insecurity
Poor Social and
Care
Environment
Disease
Poor Access to
Health care and
Unhealthy
Environment
Poverty
Nutrition Security for the Poor

Poverty
Unavailability of food
Unhygienic
Environment
Poor health service
Poor
Education
Inadequate food intake
Increased infection
Improper care
Nutrition
Insecurity
Loss of resources due to health cost
Decreased Productivity
Nutrition Security for the Poor

Policy and Planning Frameworks in
Bangladesh
Since the World Food Summit of 1996, the Government of
Bangladesh has undertaken an in-depth and consultative process of food security policy reform. This has provided the
Government with:
The National Food Policy
(NFP) (2006) a comprehensive food security policy framework
The National Food Policy
Plan of Action (NFP PoA)
(2008-2015)
The Bangladesh Country
Investment Plan (CIP) a programming document an investment plan for food security and nutrition.
Nutrition Security for the Poor

Policy and Planning Frameworks in
Bangladesh
Other policy documents that are relevant for food security in Bangladesh:
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Roadmap for producing the CIP and NFP PoA
Monitoring Report 2014
NFP PoA and CIP Monitoring Report 2013
Roadmap for producing the CIP and NFP PoA
Monitoring Report NFP PoA and CIP Monitoring
Report 2012
National Strategy for Accelerated Poverty Reduction
II (Revised) (2009-11)
Outline of Perspective Plan (2010-2021)
National Agricultural Policy (2013)
Nutrition Security for the Poor

POLICIES
• Agricultural research and extension
• Use and management of water resources
• Adequate supply and sustainable use of agricultural inputs
• Agricultural diversification
• Agricultural credit and insurance
• Physical market infrastructure development
• Agricultural marketing and trade
• Policy and regulatory environment
• Early warning system development
• Producer price support
• Public stock management / price stabilization
Nutrition Security for the Poor

POLICIES
• Agricultural disaster management
• Emergency distribution from public stock
• Enabling environment for private food trade and stock
• Effectiveness of targeted food security programs and other safety nets
• Income generation for Women and the Disabled
• Promotion of Agro-based/ Agro-processing and Micro/Small Rural
Enterprises
• Market-driven skill Development
• Agricultural disaster management
• Emergency distribution from public stock
• Enabling environment for private food trade and stock
• Effectiveness of targeted food security programs and other safety nets
• Income generation for Women and the Disabled
• Promotion of Agro-based/ Agro-processing and Micro/Small Rural
Enterprises
• Market-driven skill Development
Nutrition Security for the Poor

POLICIES
• Long-term planning for Balanced nutrition
• Balanced and nutritious food at Minimal Costs for Vulnerable
Groups
• Nutrition education for dietary diversification
• Supplementation and fortification for balanced nutrition
• Safe drinking water and improved sanitation
• Safe, quality food supply
• Women and children’s health
• Promotion and Protection of Breastfeeding and
Complementary Feeding
Nutrition Security for the Poor

Nutrition Improvements not keeping pace with poverty situation
(BBS, BDHS,2011)
Year
2000
2010
Change/year
Poverty
48.9%
31.5%
-4.30%
Stunting
50.8%
41.0%
-1.86%
Underweight
42.3%
36%
-1.36%
 Income poverty improved faster than stunting and underweight
Nutrition Security for the Poor

Consumption is Diversifying Faster
Than Production (FPMU,2014)
 Production diversification could accelerate consumption diversification in rural areas
Nutrition Security for the Poor

 Average calorie intake well below the FAO recommended level; rural urban divide

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U5 underweight almost stagnant >>> specific program intervention
Calorie intake from cereal still very high >>> food and diet diversification cereals and other foods
Still 1/4 of adult women suffer from CED
Anemia prevalence among women increasing (!!)

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People suffering from FBD and WBD still significant
(around 9% for diarrhea only)
Data heterogeneity; non-availability
Nutrition Security for the Poor

Strategies for Improvement of
Nutrition Situation
Specific Action for
Nutrition
 Feeding practices & behaviors

Fortification of foods

Micronutrient supplementation
 Treatment of acute malnutrition
Nutrition-Sensitive
Strategies
 Agriculture

Clean water & sanitation

Education

Employment & social protection

Health care
 Support for resilience
Nutrition Security for the Poor

Approaches to Ensure Nutrition
Security in Poor
Approaches to ensure nutrition security
To ensure adequate intake

Food based approach
 Non-food based approach
To ensure care and health

Improvement of local health services



Ensuring proper access to health services
Education on Mother and child care
Education on proper sanitation
Nutrition Security for the Poor

Approaches to Ensure Nutrition
Security in Poor
Food based approach
 Increasing agriculture productivity
 Local level Interventions in largely non-commercial agricultural systems, where large part of the produce is consumed by producer, may result in diversified diets.
 Mitigation of extreme poverty by increasing productivity

Ensuring accessibility through policy
Nutrition Security for the Poor

Productivity
Risk taking
Education
Cognition
Endurance
Physicalstrength
Agriculture
Horticulture
Pisiculture
Livelihoods
Income
Employment
Food Security
Dietary diversity
Income Equity
Food Health
Nutrition Security for the Poor

Approaches To Ensure Nutrition
Security
Non-food based approach

Identification of most vulnerable group.
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Supplementation program to manage extreme condition.
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Fortification of staple foods with required nutrient.

Ensuring proper utilization and minimizing loss by providing proper health care services and proper education.
Nutrition Security for the Poor

Achieving nutrition security requires a multisectoral approach
Nutrition Security for the Poor

The Way Forward and Implementation
Challenges
The CIP is a tool in the hand of the Government to increase and improve investment in food security, i.e. agriculture, fisheries and livestock, food access and safety nets and nutrition activities.
 Resource mobilization activities
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 capacity development activities strong momentum strong dialogue
Policy dialogue
Knowledge sharing and effective learning
Nutrition Security for the Poor

The Way Forward and Implementation
Challenges
 Strong momentum developed with all actors involved, including consumer groups, farmer and producer organizations, private sector, NGOs, Government and development partners to ensure their support of the CIP, including its financing and implementation.
 A strong dialogue on investment in food and nutrition security using the CIP as the key strategic and collaborative instrument for creating a more enabling framework for increased investments from both the public and the private sector.
 The policy dialogue on investment should be mainstreamed in the National Food Policy, focused on the critical elements for the CIP
Nutrition Security for the Poor