MODULE 22
Gender-Responsive Nutrition in Emergencies
PART 1: FACT SHEET
The fact sheet is the first of four parts contained in this module. It provides an overview of
gender and nutrition in emergencies. Detailed technical information is covered in Part 2.
Introduction
There is overwhelming evidence that gender inequality such as discrimination between women
and men, and girls and boys in their food entitlements, and the marginalization of women
farmers exacerbates food insecurity, malnutrition and poverty in humanitarian crises.1 An
estimated 60 per cent of the world’s chronically hungry people are women and girls, and 20 per
cent are children under five years of age.2 Gender inequality is both a major cause as well as an
effect of hunger, malnutrition and poverty.
In emergencies, a high prevalence of acute malnutrition and micronutrient deficiency diseases is
often observed, which leads to an increased deterioration of their nutritional status among the
affected population, in particular vulnerable groups. Women, girls, men and boys face different
risks: their distinct vulnerabilities are related to their different nutritional requirements and to
socio-cultural factors related to gender. Good nutrition programming in emergencies must take
gender equality into account at all stages of the project cycle – from participatory assessment and
analysis to surveillance, programming, implementation, monitoring and evaluation.
Gender-responsive programming in humanitarian nutrition response aims to effectively reach all
segments of the affected population. To achieve this, all groups must be consulted and actively
participate in needs assessments and decision-making in order to design evidence-based nutrition
programmes that meet the needs of the young and the old, men and women, and that ensure safe
and equal access for all to humanitarian assistance.
Targeted actions usually focus on women and girls; however, in order to improve gender
equality, boys and men must also be engaged; failing to involve them carries risks and reduces
effectiveness. Threats or risks facing men may not be adequately understood or addressed. Men
1
2
FAO, Bridging the Gap, FAO’s Programme for Gender Equality in Agriculture and Rural Development, 2009.
WFP Gender Policy, 2009. See www.wfp.org/content/wfp-gender-policy
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may lose some of their status and authority because emergencies disrupt traditional family and
clan structures. It is important to obtain their support for women’s involvement in nutrition
interventions.
Understanding gender differences, inequalities and capacities, and responding accordingly
improves the effectiveness of humanitarian nutrition interventions and ensures equal access to
food and nutrition programmes.
International human rights law and various United Nations resolutions support gender-responsive
programming that is based on justice and human rights, and that improves the effectiveness and
sustainability of humanitarian nutrition interventions by better addressing gender-related
different needs and risks. Such programme capitalizes on the different capabilities of women,
men, girls and boys in support interventions.
This module adapts Inter-Agency Standing Committee’s (IASC) ADAPT and ACT Framework
for gender equality programming in emergencies,3 which guides nutrition professionals in
mainstreaming gender in the project cycle in nutrition emergencies. This framework serves as a
tool for project staff working at the sector level to review their projects or programmes with a
gender equality lens. The order of the points in the framework may vary from one situation to
another; all of them should be taken into account by deliverers of humanitarian protection and
assistance to validate that they provide their services and support in emergencies to equally meet
the needs and concerns of women, girls, boys and men.
The elements of the framework are as follows:
Analyse gender differences
 Use participatory assessments to gather information on the nutritional needs and cooking
skills of women, girls, boys and men, and on the resources that they control.
 Analyse the reasons for inequalities in malnutrition rates between women, girls, boys and
men and then address them through programming.
 Collect information on cultural, practical and security-related obstacles that women, girls,
boys and men face in accessing nutritional assistance and take measures to overcome
them.
 Integrate the gender analysis in planning documents and situation reports.
Design services to meet the needs of all
 Design nutritional support programmes according to food culture and nutritional needs of
women (including pregnant and lactating women), girls, boys and men in the target
population.
 Ensure that the design of programmes and services capitalizes on available local capacity,
including public services and community-based centres.
The design and implementation of nutrition support programmes should equally involve women,
girls, boys and men and should ensure access for all. If, for example, malnutrition prevalence
data indicate that girls are more affected than boys, the causes should be identified and
3
IASC Gender Handbook in Humanitarian Action: ADAPT and ACT Framework for Gender Equality Programming in
Humanitarian Action. See http://www.ungei.org/resources/files/Gender.pdf
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addressed. Discrimination of girls in terms of their food entitlements in the household may be
deeply rooted in culture, but should nevertheless be addressed in community meetings and other
social and behaviour change communication (SBCC) activities.
Ensure access for all
 Routinely monitor access to services by women, girls, boys and men through spot checks
and discussions with communities, and promptly address the obstacles to equal access.
Even when targeting is adequately gender-responsive, the actual use of services may not be.
Therefore, the design of interventions should take into account gender sensitivities, such as the
sex of the service providers. For example, in Islamic cultures, women cannot visit male health
workers. In addition, the distance of services to houses or markets, their location and opening
hours should be considered in order to prevent gender-based violence (GBV) and improve access
by women and children.
Ensure equal participation
 Involve women and men equally and meaningfully in decision-making and programme
design, implementation and monitoring.
Participation is key to all the steps in gender-responsive programming and starts with the genderresponsive needs assessment, as the next chapter will emphasize.
Train all equally
 Provide training on nutrition and gender issues for women, girls, boys and men.
 Train an equal number of women and men from the community on nutrition
programming.
 Employ an equal number of women and men in nutrition programmes.
To facilitate women’s participation in training, the course schedule should not coincide with
other important activities or household chores, and child care solutions should be encouraged.
Health and nutrition staff should be trained in gender-sensitive service delivery (e.g. equal
access, participation, benefits). While training nutrition staff, it is important to pay attention to
gender inequalities in the community that negatively impact on nutrition, as follows:
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Ask the trainees in an interactive discussion what the prevailing gender inequalities are
and their consequences for nutrition.
Discuss the causes of these inequalities and how the intervention may address them.
Address strategic needs as much as possible in all training.
Address gender-based violence
 Include both women and men in the selection of safe food distribution points.
 Ensure that a gender-balanced team distributes the food.
 Create ‘safe spaces’ at distribution points and ‘safe passage’ schedules for women and
children heads of households.
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Make special arrangements to safeguard women and girls to and from the distribution
points (e.g. providing an armed escort if necessary).
Monitor security and instances of abuse.
“The participation of women in decisions about how to best implement food security and
nutrition programmes is critical to reducing the risks women and girls face in emergency
situations.”
– IASC Guidelines for Gender-based Violence Interventions in Humanitarian Settings: Focusing on
Prevention of and Response to Sexual Violence in Emergencies, 2005.
Inter-cluster linkages are important to systematically address GBV. Nutrition staff should
participate in multi-sectoral working groups on GBV prevention and protection to support the
development of codes of conduct and disciplinary measures for violations. Nutrition
interventions can also integrate protection and prevention, and staff training on how to refer and
report cases. Coordination of GBV and child protection issues in emergencies fall under the
Protection Cluster.
Collect and report programme monitoring data
 Collect sex- and age-disaggregated data on nutrition programme coverage, including:
- percentage of girls and boys aged 6-59 months treated for SAM;
- percentage of girls and boys under five, PLW in the target group covered by
supplementary feeding programmes and treatment for moderate acute malnutrition;
- percentage of women, girls, boys and men who are still unable to meet nutritional
requirements in spite of ongoing programming;
- exclusive breastfeeding rates for girls and boys.
- timely introduction of complementary food by age and sex
- percentage of men and women benefitting from nutritional behaviour change
interventions
 Implement plans to address inequalities and ensure access and safety for the entire target
population.
Target actions based on analysis
 Ensure that programmes address the underlying reasons for discrimination.
 Empower those discriminated against and educate the whole community.
Collectively coordinate actions
 Ensure that actors in nutrition liaise with actors in other areas to coordinate on gender
issues, including participating in regular meetings of the gender network.
 Ensure that the nutrition intervention has a gender action plan and routinely measures
project-specific indicators based on the checklist provided in the IASC Gender
Handbook.
 Work with other sectors/clusters to ensure gender-sensitive humanitarian programming.
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Key messages
1. All humanitarian agencies, including the Global Nutrition Cluster, should ensure that a gender
perspective is fully integrated into humanitarian activities and policies in order to more
effectively respond to crises.
2. All sectors, including nutrition, are required to cooperate and take specific actions to prevent
and respond to gender-based violence (GBV) in humanitarian crises under the coordination of
the Global Protection Cluster.
3. Gender-responsive programming in humanitarian situation aims at effectively reaching all
segments of the affected population.
4. Women, girls, boys and men face distinct nutritional risks and vulnerabilities in humanitarian
crises and have distinct opportunities to support the nutritional needs of their families and
communities.
5. Nutritional need assessments should include a gender analysis because an improved
understanding of the gender dimensions of malnutrition leads to more effective humanitarian
nutrition interventions. The collection and presentation of sex-disaggregated data in nutritional
needs assessments provide information on gender inequality and enable the monitoring of
gender-responsive targeting and service provision.
6. Consideration should be given of gender dynamics and power relationships between women
and men, in the communities since feeding practices are not always determined by the mothers,
but rather by their mothers, husbands and mothers-in-law.
7. Effectively address the gender dimensions of nutrition in emergencies, the local population –
women, girls, boys and men – should be involved in all stages of the project cycle, from decision
making and needs assessment to evaluation.
8. Special nutrition interventions are required to meet the needs of pregnant and lactating
women, infants and young children, older people, the chronically ill and those with disabilities.
9. The active participation of women and representatives of disadvantaged groups in establishing
and implementing monitoring and evaluation improves the quality and accountability of nutrition
interventions in humanitarian crises.
10. There is a need to collect sex- and age-disaggregated data (SADD), even for children under
five, because this allows to map and/or identify trends and in terms of differential feeding
practices, malnutrition, etc. between boys and girls.
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MODULE 22
Gender-Responsive Nutrition in Emergencies
PART 2: TECHNICAL NOTES
The technical notes are the second of four parts contained in this module. They provide an
overview of the steps needed for gender-responsive programming in humanitarian nutrition
interventions. Information in this module was drawn from key resources including: the IASC
Gender Handbook in Humanitarian Action; the UNICEF Operational Guidance on Gender; and
the Sphere Handbook: Humanitarian Charter and Minimum Standards in Disaster Response
(Sphere Handbook) developed by a group of NGOs, the Red Cross/Red Crescent Movement.
Summary
This module, Gender-responsive nutrition in emergencies, aims to contribute to improved
gender-responsive programming in nutrition emergency response. It explains why genderresponsive programming is needed and how it can be implemented to improve the effectiveness
of nutrition interventions.
The Sphere Handbook explicitly recognizes the rights of women and men, and boys and girls in
its Humanitarian Charter. The Charter applies to all the nutrition-related standards that have been
addressed throughout this Harmonized Training Package (HTP).
Introduction
“Gender equality in humanitarian action is simply about good, common-sense programming.”
Jan Egeland, Emergency Relief Coordinator,
IASC Gender Handbook in Humanitarian Action, Women, Girls, Boys and Men – Different Needs, Equal
Opportunities (2006)
The core message of this module is that Gender equality in humanitarian action is simply about
good, common-sense programming. It demystifies and simplifies the concept of gender, which
many of the actors involved in humanitarian action still find unclear and/or uncomfortable. Some
Module 22: Gender-responsive Nutrition in Emergencies/Part 2 Technical Notes
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of these actors believe that gender concerns women only or is synonymous with women, or that
it addresses their reproductive needs; others believe that gender roles are an integral cultural part
of a society that outsiders should not try to change, even if they lead to an unequal balance of
privileges and power, which is usually to the detriment of women. Definitions of gender and
related terminology used in this module are presented in Annex 1.
Gender equality does not require that girls and boys, and women and men, be the same,
eat the same, or that they be treated exactly alike, but rather implies an absence of bias or
discrimination and therefore equal access to food and nutrition services. Equality between
women and men is both a human rights issue and a precondition for, and indicator of,
sustainable, people-centered development.
Source: Adapted from the Office of the Special Adviser on Gender Issues and Advancement of Women,
Gender Mainstreaming: Strategy for Promoting Gender Equality, United Nations, New York, 2001.
Gender equality in nutrition emergencies ensures that women, girls, boys and men have equal
access to nutrition services and the foods they need to live a healthy life.
Gender-responsive programming for an adequate response
During humanitarian crises, promoting and protecting gender equality through gender-responsive
programming should not be considered an option that can be postponed, but rather, a requirement
for an adequate humanitarian nutrition response. Gender-responsive programming improves the
effectiveness and sustainability of nutrition interventions in humanitarian emergencies. It better
addresses the distinct nutritional risks and vulnerabilities that women, girls, boys and men face in
humanitarian crises. To achieve this, all groups must be consulted and actively participate in
needs assessments and decision-making. Accordingly, evidence-based nutrition programmes can
be designed to meet the needs of all, ensuring their safe and equal access to effective
humanitarian nutrition assistance.
Failing to address gender in emergencies
Nutrition interventions may fail to reach the most vulnerable and, in some cases, may actually
lead to further harm. For example, if sanitation facilities or water points are poorly lit or situated
in a remote location, the vulnerability of girls and women to sexual violence could increase, or
water use may be limited, which could cause problems in hygiene and food safety. If food
distribution systems do not have a provision for unaccompanied adolescent boys, who may not
have cooking skills, these boys may be at risk of malnutrition. Failing to address gender may also
lead to reduced access to nutrition services, which results in lower admission and attendance
rates. The range of humanitarian action must be designed to meet the different needs of women,
girls, boys and men, and also to ensure their equal access to relevant services.
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Source: Adapted from Promoting Gender Equality through UNICEF-Supported Programming: Special
Considerations in Humanitarian Action. Available at:
http://www.unicef.org/mdg/files/Emergency_2Pager_Web.pdf
Targeted actions usually focus on women and girls; however, in order to improve gender
equality, boys and men must also be considered because boys and men may also be negatively
affected by their gender roles. For example, in some communities, boys are expected to herd
animals all day far away from home and may be without food or water, which places them at
more risk of malnutrition than girls.
Boys and men should also be engaged in nutrition related projects because they have a role to
play in influencing attitudes and shaping gender roles and power relations between men and
women, and boys and girls. Failing to involve them carries risks and reduces effectiveness.
Threats or risks facing men may not be adequately understood or addressed. Men may lose some
of their status and authority because emergencies destroy traditional family and clan structures. It
is important to obtain their support for women’s involvement in nutrition interventions.
2. Rationale
In the context of humanitarian crises, women, girls, boys and men face distinct risks with respect
to a deterioration of their nutritional status. This is linked to their different age- and sex-related
nutritional requirements as well as to gender-related socio-economic and cultural factors.
The gender dimensions of malnutrition
Taking the UNICEF conceptual framework (Figure 1) as a starting point, the immediate causes
of malnutrition are disease or inadequate dietary intake, which in turn are caused by household
food insecurity and/or inadequate care, preferential feeding practices that favour males within
households, and/or an unhealthy environment or insufficient access to health services.
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Figure 1: UNICEF Conceptual Framework of Malnutrition
These partly overlapping and interacting underlying causal factors are gender-sensitive and
negatively affect nutritional status during humanitarian crises. Cultural factors impact on these
underlying causes, as the framework shows; for example, the tradition in some cultures that
women and girls eat their meals only after the men and boys do, places them at an increased risk
of malnutrition, particularly in emergencies when quality and quantities of food distribution
rations are limited. In Yemen, children with severe acute malnutrition (SAM) with complications
are denied treatment in inpatient stabilization centres, since cultural norms do not allow mothers
to spend the night away from home. (See Annex 2 for more information on the role of culture.)
Household food insecurity
Livelihoods may be destroyed or undermined by natural or man-made disasters that reduce both
food availability and access to food. Women and girls, who are usually the main food providers,
have more constraints to accessing food security than men and boys because they are subject to
the increased risk of GBV. They may also face cultural discrimination, which reduces their
access to productive resources and limits their mobility.
Women of child-bearing age require more dietary iron than men, and when pregnant or
breastfeeding, should also consume more protein. Still, they typically eat a lower quantity and a
Module 22: Gender-responsive Nutrition in Emergencies/Part 2 Technical Notes
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limited variety of nutritious foods than men. Furthermore, men and boys are favoured and eat
better than women and girls in many societies. There are cultural practices, for example, that
deny women and girls the right to eat food with the necessary nutritional value; some cultures
prohibit them from consuming liver/gizzards or dictate that women and girls should eat last after
everyone else has eaten, thus limiting their access to nutritious and protein-rich foods.
“Women eat last. In almost every society in the world, women gather the food, prepare the food, serve the food. Yet
most of the time, women eat last. A woman feeds her husband, then her children, and, finally – with
whatever is left – she feeds herself. Even pregnant women and breast feeding women often eat last when, of all
times, they should eat first.”
– Statement by Catherine Bertini, Executive Director of World Food Programme, Fourth World Conference on
Women, September 1995, Beijing, China.
Iron-deficiency anemia increases maternal mortality, and a general lack of nutrients during
pregnancy leads to increased numbers of babies with low birth weight who start their lives
malnourished. When food is in short supply during emergencies, women and girls may reduce
their intake even further as a coping strategy in support of other household members. Some
individuals have special nutritional needs, which are exacerbated in crises. PLW as well as
children and the chronically ill may be disproportionately affected by undernutrition due to their
increased physiological requirements. If the household depends on general food distribution
(GFD), the rations may not provide all the nutrients to meet the requirements of all household
members, and opportunities to access additional and fresh foods for supplementary feeding and
for pregnant and lactating women may be limited. Ready to use food e.g. ready-to-use
therapeutic foods (RUTFs) for children with severe acute malnutrition, ready-to-use
supplementary food (RUSFs) for moderately malnourished children as well as blended foods
such as Corn Soya Blend (CSB) and other products for acutely malnourished children, PLW and
chronically ill individuals may not be available at the onset of an emergency. In addition, another
issue to take into consideration is whether the rations are packaged in such a way that women,
PLW and children are able to carry them.
Also, people living with HIV/AIDS (PLWHA) are of special concern since their nutritional
requirements increase by 10 per cent before they display any symptoms of HIV. In addition,
during the illness, these requirements increase to 50–100 per cent and they also suffer from
severe weight loss (see HTP Module 18). Moreover, the chronically ill may not be able to eat
normal foods due to reduced appetite and/or mouth or throat problems.
Care practices
Care practices may be compromised by women’s lack of time and impaired health during crises,
as well as their reduced access to support services, networks and information. Thus, their
livelihoods opportunities can be affected, which may result in lower pay for more working hours
and/or reduced production. Their well-being can be affected by the crisis and GBV incidents,
which may leave them depressed and unable to fulfill their normal caregiving role, with a
possible negative impact on nutrition including breastfeeding practices. In emergency situations,
women may need to dedicate more time to collect food, water and cooking fuel, which
negatively affects the well-being and nutritional status of infants and children, older people, the
disabled and chronically ill people who all depend on their care.
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During emergencies, if men who are single heads of households do not know how to cook or
care for young children and are removed from their normal social support structures, their
children will be at a greater risk of undernutrition. Also, adolescent males who have lost their
families may be at risk if they do not know how to cook. Similarly, older, disabled, and
chronically ill people may not be able to collect food, water and cooking fuel to cook for
themselves.
The health environment and access to health care services
When water, sanitation and hygiene are negatively affected, the health environment may be
compromised, especially at the onset of humanitarian crises and in protracted emergencies. In
emergencies, in particular, women and girls may spend long hours to fetch water or may have to
use less clean water sources when the distances are too great, which has detrimental effects on
nutrition and health. Women are often not consulted when decisions are taken on the location
and type of water points. In addition, health care may be lacking or disrupted, or become less
accessible or inaccessible due to displacement.
Pregnant women as well as young children, older people and the chronically ill may be
disproportionately affected by inadequate health services due to their increased health care
needs.
Socio-economic and cultural factors underlying causes of malnutrition
The social, cultural, economic and political situation determines how income and assets are
distributed between men and women, and between different socio-economic and cultural groups;
the degree to which the rights of women and girls are protected by law and custom indirectly
affects their nutritional status and that of their families. Emergencies may exacerbate gender
inequality and increase GBV. Case 1 provides an example of the gender dimensions of food
insecurity and malnutrition in Zimbabwe.
Case 1: Specific gender dimensions of malnutrition in Zimbabwe
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More boys than girls under five years of age are classified as stunted (31.2% of boys, 27.6% of
girls).
Less girls than boys are fed four or more times per day among children over 23 months (26.1%
and 34.9%, respectively).
According to the 2009 Internally Displaced Persons Assessment (preliminary data), women are
more likely to consume less food than men when there is a food shortage.
According to the same assessment, there are reports of girls being forced into early marriage as a
coping strategy when there is a food shortage.
Sex- and age-specific data on nutritional issues for children over five years of age are scarce.
Source: Adapted from Best Practices 1 – Tools from 2009 Gender Marker Pilot, 2009
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Gender and malnutrition prevalence rates
It is estimated that 60 per cent of the world’s chronically hungry are women and girls, and 20 per
cent are children under five years of age;4 20 per cent are men and boys over the age of five. This
is the result of the combined effects of increased nutritional requirements and gender inequality.
Most anthropometric measurements of nutritional status (weight/height, height/age and
weight/age) are gender-sensitive since different reference tables are used for boys and girls to
determine whether they are malnourished. The middle upper arm circumference (MUAC)
measurement, however, uses the same cut-off to determine malnutrition in boys and girls. This
method is easy and fast to apply, and is commonly used for screening in emergency settings –
children need not undress, and only a measuring tape is required. The method is accepted and
recommended for both sexes; however, it may lead to a slightly higher number of girls being
admitted to feeding programmes because of their different growth pattern than that of boys.5
There is no clear evidence of a disparity in prevalence of malnutrition between girls and boys
under five years of age at the global level. However, there have been reports of a discrepancy in
some regions between the prevalence of acute malnutrition among boys and girls measured by
anthropometric surveys and the proportion of boys and girls actually admitted to feeding
programmes. Boys in southern Africa often have a higher prevalence of wasting than girls, while
more girls are admitted in therapeutic care. This issue is not well understood and needs to be
further analysed in light of the debate on the current use of separate admission standards6 for
boys and girls. These standards are based on the 2006 World Health Organization (WHO) child
growth standards and other factors such as the mortality rate of boys and girls in the same areas
and socio-economic issues including gender discrimination. Currently, separate 2006 WHO
growth standards for boys and girls are recommended and used to determine admission for
treatment of SAM. Previously, admission was based on a unisex standard derived from the
National Center for Health Statistics (NCHS) growth charts, which led to the inclusion of
approximately the same numbers of boys and girls with the same mortality risk. With the new
standard, it has been observed that more boys than girls are admitted to receive treatment. Since
girls with the same weight as some of the admitted boys are denied treatment, some scientists
argue that these new admission standards actually discriminate against girls, and that it would be
better to use the boys’ standards as a unisex standard for the admission of both.
There is a significant relationship between child malnutrition and the mother’s socio-economic
status; many nutrition surveys have shown that low maternal literacy and education levels are
associated with a poor nutritional status of young children. Since the low status of women is
considered one of the primary determinants of malnutrition, addressing gender inequalities is key
to improving the nutritional status and the lives of mothers and their children.
Gender equality improves the outcome of humanitarian nutrition interventions
4
WFP Gender Policy 2009. See www.wfp.org/content/wfp-gender-policy.
Further information is available at EN-NET: www.en-net.org.uk/question/186.aspx
6
Based on the EN-Net contribution by M. Golden. See www.en-net.org.uk/question/40.aspx
5
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Recent reports have shown that, in practice, most humanitarian sectoral responses, including
nutrition interventions, remain gender-blind, and thus fail to consider the differences within and
among crisis-affected populations. The 2011 report IASC Gender Marker in CAPs and Pooled
Funds: Analysis of Results and Lessons Learned identified that boys are more systematically
affected by malnutrition, which has influenced the orientation of the Nutrition Cluster. The
Cluster had earlier focused only on children under five years of age without considering the
gender gap.
The Global Nutrition Cluster (GNC) and humanitarian agencies are committed to promoting
gender equality in all their actions. This is also becoming a key requirement for accessing funds
through the Consolidated Appeals Process (CAP). The Nutrition Gender Marker Tip Sheet,
which includes the ADAPT and ACT Framework, guides humanitarian nutrition workers
towards achieving this (see chapter 4 of this module).
Gender-responsive programming in humanitarian action aims at effectively reaching all
segments of the affected population. It leads to emergency nutrition interventions that better
address the different needs of women, men, girls and boys through:
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gender-responsive needs assessments;
greater participation of women, girls, boys and men;
improved understanding of the needs of different groups in a crisis;
improved targeting of those with the greatest needs;
improved use of potential of beneficiaries and natural and community resources;
equal benefits for all beneficiaries;
higher effectiveness and sustainability;
improved accountability to the beneficiaries and various beneficiary groups.
Moreover, humanitarian crises provide an entry point for changing gender roles and the power
balance between men and women. Social and traditional systems are disrupted or challenged as
women need to take up different roles in the absence of male heads of households. Men may be
cut off from their livelihood opportunities, which may undermine their traditional role as head of
the household. Such changing roles and socio-cultural norms provide a fertile ground to improve
gender equality, which not only results in better programming, but also supports long-term
development (see Case 2).
Case 2: Emergencies as an entry point for improving gender equality
In 2003, Netherlands Red Cross (NLRC) implemented a project in Primary Health Care services for
internally displaced persons (IDPs) in Kassala State, eastern Sudan. It extended the project in 2007 to
support income-generating activities for IDPs, especially women, towards their economic selfsufficiency. In Hamashkorieb, the conservative socio-cultural norms forced women to stay mostly inside
their homes and always relegated to the female area of the village. In the IDP camps, the Sudanese Red
Crescent, supported by the Netherlands Red Cross, provided skills training on leather and rubber work to
produce shoes, sowing, and beadwork for clothes and decoration for which special women’s centres were
built. The training provided an opportunity for interaction with other women and was also used as an
entry point to numeracy classes, small businesses management, and awareness raising on health, hygiene
and sanitation.
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Source: End of Project Evaluation, Kassala Livelihoods Project, Netherlands Red Cross (NLRC)/Spanish Red Cross
(SRC), 2010. Available at: http://www.alnap.org/pool/vacancies/dutch-rc-tor.pdf
Normative framework, accountability and international commitments
The Sphere Handbook provides the basis and the standards for humanitarian action and for
accountability to affected populations, donors, national governments in humanitarian action.
Although none of six Sphere Core Standards specifically focuses on gender, gender is a crosscutting issue relevant to each of them and features in their Guidance Notes (see Annex 3 for an
overview of relevant standards).
Accountability
As pointed out by the Harmonised Training Package (HTP) Module 21, Standards and
accountability in humanitarian response, accountability can be understood as a way of reducing
the power differential in the relationship between the aid provider and the affected population.
The Module also points out that the GNC and its members should increase their efforts to be
accountable to their beneficiaries against the adopted standards. The basic elements of
accountability aim towards a more equal power balance, facilitated by participation and a mutual
communication between humanitarian project staff and affected populations.
Accountability is important because humanitarian agencies must report on their progress in
ensuring that women, girls, boys and men have equal access to and equally benefit from their
nutrition assistance. Girls and women encounter specific problems when dealing with public
services that make it especially difficult for them to hold service providers or authorities
accountable. These problems concern women’s access to services, the extent to which women
are visible and esteemed, and providers’ knowledge of and conduct towards women.
In addition, gender-responsive programming requires increased participation and facilitated
communication between all the different affected groups. In emergency nutrition interventions,
this includes, for example, clear communication on entitlements of food rations, monitoring of
the adequacy of rations (food basket monitoring) and the establishment of a complaint procedure
for food and nutrition interventions. When programmes and projects become more genderresponsive, the quality of their performance and their accountability will be automatically
improved.
United Nations commitments and mandates
“Understanding gender differences, inequalities and capacities improves the effectiveness of our
humanitarian response. We must work together to promote gender equality – this is a shared
responsibility of all humanitarian actors.”
– IASC Gender Handbook in Humanitarian Action, 2006
United Nations agencies and the GNC partners have formulated their gender policies based on
the United Nations Charter, United Nations Resolutions and international human rights law, such
Module 22: Gender-responsive Nutrition in Emergencies/Part 2 Technical Notes
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as the Convention on the Elimination of All Forms of Discrimination Against Women.7 In 1997,
the United Nations adopted gender mainstreaming as a strategy to ensure integration of gender
issues and objectives in all elements of their work, programmes and projects. Box 1 shows how
gender features in and contributes to achieving the Millennium Development Goals (MDGs) that
guide many of today’s programmes.
Since 1999, the IASC has required all member organizations that provide humanitarian
assistance in emergencies to formulate specific strategies to mainstream gender issues, collect
and analyse data from a gender perspective, build capacity for gender mainstreaming, and
develop reporting and accountability mechanisms that ensure attention to gender.8 During
humanitarian crises,9 all sectors are required to take specific actions to prevent and respond to
GBV (see Annex 4). The Resource List in Part 4 of this module includes references to recent
guides and manuals related to GBV and protection.
Box 1: Gender equality and the United Nations Millennium Development Goals
The third goal of the MDGs is to “Promote gender equality and empower women”. It sets a target of
eliminating gender disparity in all levels of education by 2015. Gender equality can also help the
international community to achieve other important MDGs:
MDG1: Eradicate extreme poverty and hunger.
Increasing rural women’s agricultural production and participation in the labour force helps to reduce
poverty, stimulate economic growth and reduce malnutrition.
MDG4: Reduce child mortality.
Rural women’s lack of access to education and assets is directly linked to high rates of child and infant
malnutrition and mortality.
MDG5: Improve maternal health.
The vast majority of maternal deaths – estimated at half a million a year – could be prevented through
better access for women to reproductive health services, which includes provision of micro-nutrient
supplementation.
MDG6: Combat HIV/AIDS, malaria and other diseases.
Gender inequality is recognized as one of the driving forces behind the spread of HIV infection and AIDS
having severe implications for nutrition. Women are more at risk of anaemia, which can be exacerbated
by malaria and which poses serious risks to their children.
MDG7: Ensure environmental sustainability.
As farmers and household providers, rural women manage natural resources daily. Their participation in
programmes for the sustainable management of land, water and biodiversity is essential.
Source: Adapted from FAO, Bridging the Gap: FAO’s Programme for Gender Equality in Agriculture and Rural
Development, 2009.
7
CEDAW, 1979. See www.un.org/womenwatch/daw/cedaw/text/econvention.htm
This complies with the Economic and Social Council (ECOSOC) Resolution signed in July 1998 that mandated all
United Nations organizations to “ensure that a ensure that a gender perspective is fully integrated into humanitarian
activities and policies” (E/1998/L.15 of 16 July 1998).
9
“Gender-based violence is a violation of universal human rights protected by international human
rights conventions, including the right to security of person; the right to the highest attainable standard
of physical and mental health; the right to freedom from torture or cruel, inhuman, or degrading treatment;
and the right to life.” IASC Guidelines for Gender-based Violence Interventions in Humanitarian Settings, 2005.
8
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Gender-responsive programming
Gender-responsive programming in humanitarian action aims to effectively reach all segments of
the affected population. This section provides an overview of gender-responsive programming
and on how to integrate gender in the project cycle of nutrition emergency interventions, from
needs assessment to monitoring and evaluation.
What is a gender analysis?
Gender analysis focuses on understanding and documenting the differences in gender roles,
activities, needs, and opportunities in a given context through the disaggregation of quantitative
data by sex. It highlights the different roles and learned behaviour of women and girls, boys and
men based on gender attributes, such as access to resources, activities, control of assets and
decision-making powers, how labour is divided and valued, among others.
Gender analysis is the systematic attempt to identify key issues contributing to gender
inequalities so that they can be properly addressed, thus providing the basis for gender
mainstreaming. It is a tool for understanding social processes and responding with informed and
equitable options.
In emergencies, gender analysis makes it possible to understand who is affected among the
population by the crisis – where they are, what they need, and what they can do for themselves
using their abilities or capacities. It enables nutrition practitioners to identify the prevailing
gender dimensions of malnutrition in the nutrition emergency by applying a gender lens to the
UNICEF conceptual framework for malnutrition.
The gender needs identified in the gender analysis will inform all aspects and phases of the
response. Gender needs can be categorized into practical and strategic needs (see Case 3).
Practical needs concern who needs which kind of assistance. Practical gender needs do not
challenge women’s position in a particular culture, but rather, respond to immediate necessities.,
If in a household, for example, it is the usual role of the woman to fetch water, then providing a
well close to the village is a gender-based activity even though the whole community benefits.
Strategic gender needs refer to the needs related to the promotion of the equal and meaningful
participation of boys, girls, men, and women in their family and community. As women and girls
are usually in a subordinate position when compared to men and boys in their societies,
addressing strategic needs often entails working towards the empowerment of women and girls.
Strategic needs vary according to the particular social, economic and political context in which
they are formulated. Clearly, addressing these needs will require specific actions, often outside
the nutrition and food security domain.
Where possible, humanitarian nutrition action that addresses practical needs should also support
and integrate actions that address strategic gender needs. Some of these strategic needs can be
incorporated in staff or volunteer training of emergency nutrition interventions, or in
information, education and communication (IEC)/social and behaviour change communication
(SBCC).
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Case 3: Integrating strategic needs in communication: involving men in child care
A study in Mexico published in Salubritas (1982) showed that when both men and women
appeared in printed materials that promote sanitation and oral rehydration, none of those surveyed
thought that it was unusual or silly for men to be involved in the associated activities; however,
when the printed materials showed only women, 63 per cent of the surveyed mothers and 70 per
cent of the surveyed fathers thought that only mothers should be involved in these activities. The
exposure of individuals to different gender roles facilitates their acceptance and may eventually
contribute to a more equal balance of tasks and duties between women and men, boys and girls.
Source: Adapted from UNICEF, Promoting Gender Equality through UNICEF-Supported Programming in
Young Child Survival and Development: Operational Guidance, 2011
IASC’s ADAPT and ACT Framework
This framework presents nine key elements that guide nutrition professionals in how to
mainstream gender in nutrition emergencies throughout the project cycle (see Annex 5).
Inter-cluster linkages are important to systematically address GBV. Nutrition staff should
participate in multi-sectoral working groups on GBV prevention and protection to support the
development of codes of conduct and disciplinary measures for any violations. Nutrition
interventions should also integrate Protection from Sexual Exploitation and Abuse (PSEA), and
how to refer and report cases in staff training, and complaint procedures should be established.
Coordination of GBV and child protection issues in emergencies fall under the Protection
Cluster. (Case 4 provides an example of sexual exploitation in food distribution in Burundi.)
Case 4: Sexual exploitation and food distribution
In light of various irregularities uncovered in beneficiary lists by field teams, CARE conducted a study
between October 2004 and June 2005 in Burundi to document whether sexual favours were demanded as
a means to access food aid, and if so, to identify the underlying reasons and mechanisms, and develop
strategies to reduce the risk to beneficiaries. In focus group discussions and semi-structured interviews,
both victims and perpetrators confirmed that sexual harassment and exploitation occurred in the food aid
process. Sexual exploitation occurred secretly and was never discussed openly, certainly not during the
public validation of beneficiary lists when irregularities were to be identified. Widows and other single
women, either without husbands or without adult sons, were found to be particularly vulnerable, because
they had no adult males in the household to protect their reputation and no money to bribe the village
heads to include them on the beneficiary lists. The main factor that led women to submit to requests for
sexual favours was fear that they would be excluded from the lists. Perpetrators were generally those who
established the lists.
Source: Zicherman N., ‘It is difficult to escape what is linked to survival’: Sexual exploitation and food
distribution in Burundi, Humanitarian Exchange, No. 35, 2006.
What is gender mainstreaming?
United Nations Economic and Social Council formally defined the concept:
Mainstreaming a gender perspective is the process of assessing the implications for
women and men of any planned action, including legislation, policies or programmes,
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in all areas and at all levels. It is a strategy for making women's as well as men's
concerns and experiences an integral dimension of the design, implementation,
monitoring and evaluation of policies and programmes in all political, economic and
societal spheres so that women and men benefit equally and inequality is not
perpetuated. The ultimate goal is to achieve gender equality.
Gender mainstreaming takes into consideration the needs, abilities and opportunities, as well as
the impact of all policies and programmes on women, girls, boys and men at every stage of the
programme cycle – from planning to implementation and evaluation, as advocated in the
ADAPT and ACT Framework.
What is targeted action?
In order to achieve gender equality, women and girls may need different treatment so that they
can benefit from equal opportunities; consequently, some interventions exclusively target them.
For example, school feeding programmes encourage girls’ enrolment and attendance in schools
in order to alleviate gender inequalities found in many developing countries. However, not every
intervention that targets only women or girls contributes to gender equality: breastfeeding
promotion activities or iron supplementation for women and girls, for example, do not aim to
overcome gender imbalances or obstacles to gender equality.10
A good gender analysis should help stakeholders identify who the most vulnerable and
disadvantaged groups is because of their gender and gender roles Specific interventions may also
target men and boys where they are found to be discriminated against because of their gender or
negatively disadvantaged because of their gender roles. For example, in some nomadic
communities, it is expected that boys spend their days in the fields tending and herding cattle.
This activity means that boys and men may be away from the home for long periods of time
without food or water. Hence, a nutritional program in that community may need to have some
targeted interventions to address boys and men’s nutritional needs.
Targeted actions usually focus on women and girls; however, in order to improve gender
equality, boys and men must also be engaged because failing to involve them carries risks and
reduces effectiveness. Critical issues relating to survival and health can be marginalized and
relegated as being “women’s issues”, such as child feeding and the treatment of acute
malnutrition where only mothers are targeted. Threats or risks facing men may not be adequately
understood or addressed. Men may lose some of their status and authority because emergencies
destroy traditional family and clan structures. They may resent the interference of women in the
male domains of providing security to the family, bringing food to the household or engaging in
economic activity. It is important to obtain their support for women’s involvement in nutrition
interventions. It is important to obtain their support for women’s involvement in nutrition
interventions.
IASC Gender Handbook in Humanitarian Action: Women, Girls, Boys and Men – Different Needs, Equal
Opportunities, 2006.
10
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Practical guidance on gender-responsive nutrition needs assessment,
targeting, communication and monitoring
The section above provided an overview of gender-responsive programming throughout the
project cycle, from emergency nutrition needs assessments to monitoring and evaluation based
on the ADAPT and ACT Framework. Some aspects require more attention here, particularly the
gender-responsive needs assessment, which is of key importance to effective humanitarian
nutrition response. This section provides more in-depth, detailed practical guidance. First, it
explains how to assess the prevailing gender dimensions of malnutrition. It then elaborates on
how to consider the identified issues in targeting, communication and monitoring.
Minimum gender requirements in emergency nutrition assessments
All nutrition interventions are based on a needs assessment, be it an Initial Rapid Assessment or
a more comprehensive nutrition assessment. Most anthropometric tools used to measure
nutritional status are gender-sensitive.
Assessments and analyses are key to the development of effective interventions. The following
actions should be taken to fulfill minimum gender requirements within humanitarian nutrition
needs assessments:
Preparation:
 Review secondary data while taking into account gender roles, responsibilities and
vulnerabilities.
 Interview representatives of the health, food security and water sanitation and hygiene
sectors to assess gender sensitivities and gaps in the way services had functioned
prior to the disaster.
 Select assessment teams, which should, as far as possible, be composed of both
women and men, generalists and specialists, including those with skills in the
collection of gender-sensitive data and communicating with children. Teams should
include people familiar with the language(s) and area who are able to communicate in
culturally acceptable ways. Also, translators, if needed, should be composed of both
of women and men.
 Brief the team and translators on gender sensitivities in single- and mixed-sex
discussion groups.
During assessment



Collect all nutrition, morbidity and mortality data per age group and by sex.
When a detailed breakdown by sex/age may not be possible in the very initial stages
of an emergency, immediately differentiate the needs of adults/children and
men/women.
At the earliest opportunity, further disaggregate the data by sex and age: 0 to less than
six months of age (male/female), six to less than 12 months of age (male/female), 12
to less than 24 months of age (male/female), 2-5 years of age (male/female), 6-12
years of age (male/female), 13-17 years of age (male/female); and then in 10-year
brackets and by sex, specifying numbers of pregnant and lactating women.
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



Hold key informant interviews, for example, with local authority representatives
(male and female), government staff, various relevant health facility staff, operational
agencies, traders, male and female community representatives (religious leaders,
teachers, etc.) and/or community organizations.
Ensure an adequate involvement of representatives of the whole community in the
assessment process, especially women and other marginalized and possibly less
visible groups, particularly ethnic groups and chronically ill, disabled and older
people.
To determine their needs and potential, create separate men/women focus groups.
Here, particular attention should be paid to coping strategies. When time is available,
specific focus groups can be joined with other groups, such as youth, and disabled
and older people.
Integrate HIV-related issues into all sectoral initial rapid assessments and the data
should be disaggregated by age and sex.
Analyses
 Ensure that there are mixed teams to analyse and report on assessments.
 With the community, analyse the impact of the crisis on women, girls, boys and men
in order to identify nutrition-related needs and ensure equal access to health, water,
food and nutrition services.
In-depth needs assessments: include a gender analysis
By integrating the minimum gender requirements presented above in nutrition assessments, will
allow to determine the nutritional needs of different vulnerable groups and contribute to the
identification and design of nutrition interventions. When there is sufficient time, it is strongly
recommended to incorporate additional qualitative methods to obtain sufficient information for a
gender analysis. Applying a gender lens to the UNICEF conceptual framework for malnutrition
of the humanitarian crisis will lead to a more in-depth understanding of the gender dimensions of
food security and nutrition; this would lead to more gender-responsive and therefore more
effective humanitarian nutrition interventions.
How to integrate a gender analysis in the nutrition assessment?
In order to integrate gender analysis in the nutrition assessment, the gender roles of women and
men, and boys and girls need to be examined. Focus should be placed on their abilities and skills
related to nutrition, their access to and control of food, productive resources and appropriate
technology, and their respective gender constraints, including their nutritional vulnerabilities.
The analysis should proceed as follows:
 Ask women and men about their major issues and concerns.
 Determine the norms and practices that discriminate against sex and age.
 Adapt qualitative nutrition assessment tools to determine the gender disparities
between women, girls, boys and men in terms of food security and nutrition, and access
to food and services.
 Perform a participatory assessment with women, girls, boys and men together and
separately, and consider different socio-economic or cultural groups.
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
Analyse the above information and use it to implement programmes.
As discussed above, in addition to applying the minimum gender requirements to the assessment,
more qualitative data should be collected to enable a gender analysis and to answer the following
sets of questions:11


What are the gender dimensions of food security,health and nutrition?
What are the gender disparities in nutrition outcomes?
What are the gender dimensions of food security and nutrition?

Are there socio-cultural practices, social norms, cultural beliefs and/or caring practices
that affect the nutritional status of women, girls, boys and men in different ways? Are
there any differences in feeding and care practices for young girls or boys? How do men
and women view feeding and care of young children and maternal nutrition? Who is
responsible for the young children – what is needed, and what should or should not be
done for them or given to them? Who decides what, and who controls and who influences
the children? How has this changed as a result of the crisis?

How does the socio-economic status of women differ within a country and how does this
influence the nutritional status of children? How has this changed as a result of the crisis?

Is there a correlation between maternal education and child nutritional status?

Are there differences for women, girls, boys and men in terms of access to food? How is
food distributed within the household? Are men traditionally given priority in food
allocation because of their heavier workloads, or simply due to their gender?

Who in the household controls the resources, and does this have a different impact on
access to food or the feeding habits of women, girls, boys and men? If women are heads
of the households and/or family groups, do they have access to sufficient food, especially
when pregnant or lactating?

What are the differences between women’s and men’s roles and responsibilities with
regard to nutrition?

What is the gender division of labour, tasks and duties? Who does what and when?

Is there a change in work patterns (e.g. due to migration, displacement or armed conflict)
resulting in a change of roles and responsibilities in the household, and inhibiting or
preventing certain women or men from accessing food?
11
Questions and considerations have been adapted from UNICEF HTP Module 8, Operational guidance for gender
in young child survival and development and the IASC Gender Handbook for Humanitarian Action, 2009.
Module 22: Gender-responsive Nutrition in Emergencies/Part 2 Technical Notes
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
How does the gender division of labour and decision-making patterns in the household
affect the nutrition of women, girls, boys and men within the household?

In crises and in situations of widespread and severe poverty where food security is poor,
do women and girls reduce their food intake as a coping strategy in favour of other
household members?

What other coping strategies are used by women, girls, boys and men?

Are there any adverse changes in caring practices, such as having less time for child care
due to the need to forage for wild foods and difficulties in finding drinking water and fuel
wood?

If boys and men are separated from families, can they prepare and cook food for
themselves? Are there any support structures for orphans, and for men who lack child
feeding and caregiving skills?
How do older women and men access food, and does the food basket meet their specific
needs?


How do women, girls, boys and men with disabilities access food, and does the food
basket meet their specific needs?

Is the environmental health situation affected, including hygiene, sanitation and access to
clean water? Liaise with the responsible clusters such as camp coordination and camp
management, health, as well as the global water, sanitation and hygiene (WASH).

Are prevention and protection measures in place, or are women and girls at risk of
violence when obtaining food, water and fuel? Liaise with the responsible clusters.
What are the gender disparities in nutrition outcomes?
 Do any of the available disaggregated data indicate that women and girls, boys and men,
or older people are disproportionately affected? If so, why?

What are the characteristics of populations with a poor nutritional status who are not
provided with nutrition services or inadequate food? Is there a gender issue? Determine
which groups are hard to reach (physical and social access) and/or marginalized, and the
barriers that prevent access.
What are the gender disparities in health and nutrition services? (Team up with the Health
Cluster to determine this.)
 What nutrition interventions were in place before the current emergency? How were they
organized and did they affect women, girls, boys and men differently?

Did women, girls, boys and men have equal access to these services and were these
services used by all?
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
Map the location and indicate the capacity and functional status of health facilities and
nutrition and public health programmes, including gender-specific, essential services for
women and men (e.g. reproductive health services).

Are there any gender sensitivities with respect to the health provider?

Identify trained health professionals in the community (keeping in mind they may not be
working due to family responsibilities) and enable them to return to work through the
provision of transport, security, child care and flexible work schedules, as needed.

Compile an inventory of local groups and key stakeholders in the health sector, including
gender theme groups (traditional healers, women’s organizations) in order to discover
what is being done – where, by whom and for whom.

Conduct qualitative assessments to determine perceptions about health and nutrition
services provided to the community and identify recommendations to address the
community’s concerns.
The following considerations should be taken into account:
 Childcare support needs to be provided in order to enable women and men, especially
those from single parent-headed households, to participate in meetings.

Women and girls are often at increased risk of violence and may be unable to access
assistance and/or make their needs known. They may be insufficiently included in
community consultation and decision-making processes, and thus their health needs may
not be met. Men may have to suffer other disadvantages due to gender differentiation, e.g.
their role as protectors may result in risk-taking during and after an emergency.

GBV, mental health and psychosocial issues will also impact on the nutritional status of
infants, young children and PLW, and should be assessed.
Tools for gender analysis: Participatory tools, such as focus group discussions and in-depth
interviews, are especially useful in assessing gender dimensions of nutrition in emergencies.
Activity calendars and clocks are useful to assess gender roles, duties and tasks, and can be
included in focus group discussions which then should comprise women and men in separate
groups. Annex 6 presents an overview of participatory tools that can be used to answer the above
sets of questions.
Gender-responsive and community (or participatory) targeting
Effective targeting is crucial to the success of any nutrition intervention. There are various ways
of targeting, for example, in gender-responsive humanitarian assistance programmes, utmost care
should be taken to ensure that the vulnerable, disadvantaged and less mobile members of
communities are also targeted and will benefit from the assistance. Although it should be
Module 22: Gender-responsive Nutrition in Emergencies/Part 2 Technical Notes
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recognized that community leaders may not always be the best representatives for the poor in
their communities, participatory or community targeting has many advantages (see Box 2). It is
important that an effective system for monitoring of targeting effectiveness be established to
detect and correct possible discrimination and inappropriateness. Ensure that community
leaders/representatives, both men and women, should be engaged in participatory processes.
Box 2: Advantages and disadvantages of community (or participatory) targeting
In community (or participatory) targeting, decisions are made by community members or their
representatives, including the potential beneficiaries, and criteria selection is based on their subjective
judgment of need or vulnerability. This targeting method relies on the knowledge and understanding of
one’s neighbours’ situation. It is also a low-cost procedure and overcomes difficulties in data collection
while exploiting the deeper knowledge on the community’s vulnerability. Women are a good asset in this
process. Coverage of all households, or at best, based on household size, may result from applying this
targeting mechanism. Alternatively, given customary systems of exchange and loans, assistance might be
shared beyond targeted beneficiaries, regardless of the assessment performed by outside agencies.
Gender-related advantages: People can become familiar with democratic decision-making processes
and reinforce the community’s responsibility towards its vulnerable members. Also, the participation of
communities who often know best their most vulnerable members is promoted. Kinship-support systems
are less prone to be undermined. This targeting also contributes to developing grassroots initiatives and
encouraging gender-balanced representation, which is often imposed on from outsiders. Moreover, more
refined targeting is possible (wealth, family size, family members, workloads, etc.). Finally, it usually
ensures an improved complaint system.
Gender-related disadvantages: Community leaders are not always the best representatives for the poor
in their society. In addition, the lack external supervision might reinforce the community gender
imbalance. If the targeting is biased, it may have negative effects on the community.
Source: Adapted from Socio-Economic and Gender Analysis (SEAGA) in Emergency and Rehabilitation
Programmes, FAO/WFP, 2007.
Gender-related targeting issues are most applicable to GFD and the livelihoods interventions
discussed below, because other emergency nutrition interventions select their target groups based
on age and biological vulnerability (children under five years of age, or PLW) or based on the
gender-neutral basis of their nutritional status, which determines admission to therapeutic care
and supplementary feeding programmes (SFPs).
Social and Behaviour Change Communication (SBCC)
Telling people what to do is not an effective approach for communication. SBCC was developed
as a more effective strategy, which is based on community engagement. Most nutrition
interventions use this strategy, allowing the population to voice their issues and take ownership.
Behaviour change is not a “luxury in an emergency. It is a necessary component of efforts to
Module 22: Gender-responsive Nutrition in Emergencies/Part 2 Technical Notes
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ensure the survival, health, development, protection and psychological recovery of an affected
population.”12 Nutrition SBCC can be widely used and is helpful in:



promoting good behaviour and discouraging poor practices;
familiarizing communities with the use of new products or services;
raising awareness in the community and investigating barriers to service uptake.
In the past, many programmes were gender-blind or failed to target men for communication on
nutrition, and were therefore less effective. While women are usually responsible for taking care
of young children and providing food for families, it is often the men who have more power and
take the decisions. For example, they usually determine how to distribute the food, especially the
more expensive protein-rich foods, and also have a say in when to start and to stop breastfeeding.
It is recommended to set up a central Health Education and Communication Coordination Unit
soon after the onset of an emergency so that all agencies will use the same messages and
materials. In particular, effective gender-responsive SBCC is important for infant and young
child feeding in emergencies (IYCF-E). The first step is to determine the major barriers and
beliefs related to infant feeding and other aspects of nutrition (see Module 17).
Barrier analysis is a rapid assessment tool that can help to identify why recommended healthy
behaviours are reluctantly adopted or not adopted at all.13 Food for the Hungry, a Swiss NGO,
developed this approach to identify and overcome barriers to healthy behaviour. There are seven
steps in the analysis. After tabulating or organizing the data from the analysis, decisions should
be taken on what changes are needed in programme design and in the behaviour change
messages used, and which groups to target. Changes in the determinants should be monitored
during the life of the project. Although this tool is not designed specifically for gender, it can be
used effectively to assess and address gender barriers. By working with communities, messages
are more likely to be heard.
UNICEF has produced a toolkit on SBCC specifically for use in emergencies,14 which together
with HTP Module 19, Working with communities in emergencies, provide more information on
how to develop effective evidenced-based, gender-responsive communication in emergencies.
When the content for the SBCC strategy has been developed and target groups defined, a rapid
and gender-responsive analysis of the most suitable channels for communications needs to
be undertaken. SBCC can include oral channels, such as radio and interpersonal communication
through community networks, community workers and religious channels. Innovative means of
communication include the press and mobile phone text messages. For example, during the Haiti
earthquake response in 2010, radio messages, plays performed by local theatre groups, and an
‘advertising’ car with loud speakers were used to communicate key IYCF messages in Haitian
Creole.
12
United Nations Children’s Fund, Behaviour Change Communication in Emergencies: A Toolkit, New York,
2005.
13
Barrier analysis is a tool for BCC in child survival and community development programmes developed by Food
for the Hungry. See http://barrieranalysis.fhi.net/
14
Behaviour Change Communication in Emergencies: A Toolkit. UNICEF, 2006.
http://www.influenzaresources.org/files/BCC_in_Emerg_chap1to8_2006.pdf
Module 22: Gender-responsive Nutrition in Emergencies/Part 2 Technical Notes
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When developing SBCC messages and choosing the type of communication channels (e.g. oral,
leaflets, posters), it is important that they reach and appeal to the target group. Rapid field
testing is needed in emergencies. Since in many emergency situations, children take care of their
younger siblings, SBCC on health and nutrition promotion should include them as a target group.
When messages and or communication materials are developed, they should be clear and simple
enough for them to understand. There may also be more male caregivers of young children who
should therefore be targeted; messages that address mothers will not appeal to them and vice
versa. In order to address children, a different tone and illustrations than those used for adults
should be used.
If gender-related barriers to optimal nutrition practices and to the use of services are identified,
they should be included in the communication strategy as appropriate. Moreover, SBCC also
provides a potential entry point to addressing strategic gender needs. For example, messages
involving boys and men performing domestic chores or taking care of young children together
with women and girls will eventually contribute to changing gender roles and a more even
distribution of tasks and chores among the sexes. (See Box 3 for a summary of the rationale
behind SBCC in humanitarian response.)
Box 3: Social and Behavior Change Communication (SBCC) in humanitarian response
Preparing and responding successfully to emergencies require that evidence-based social and behaviour
change communication (SBCC) strategies become an integral part of emergency preparedness plans and
training. Communication efforts will result in improved health, hygiene, protective and caring practices. It
will also lead to positive collective action and informed demand among affected communities for emergency
assistance, supplies and services. All of these actions are crucial in protecting and promoting the
well-being of children, women and their families when a disaster strikes.
Experience has shown that affected members of communities can become effective agents of behaviour
change and mobilizers for disaster preparedness and response. The participation of adults, children and young
people in recovery, relief and rehabilitation is integral to any strategic communication action plan.
Participation has proven to promote psychosocial healing and cohesion among affected community members
during times of crises. It is a truism that affected communities are too shocked or helpless to assume
responsibilities for their own survival and recovery; on the contrary, many affected people, especially
children, find strength and are able to return to normal life faster when they help others during and after an
emergency.
Source: Adapted from UNICEF, Behaviour Change Communication in Emergencies: A Toolkit’, Foreword, 2006. See
http://www.unicef.org/ceecis/BCC_full_pdf.pdf
Gender-responsive monitoring and evaluation
Monitoring the different needs of women, girls, boys and men, and vulnerable groups in the target
population, and monitoring whether and to what extent interventions are addressing these needs can
improve the quality and impact of nutrition in emergencies if this information is used appropriately.
It will also improve accountability, especially when monitoring and evaluation results are shared
with the beneficiaries, allowing for a two-way communication.
Module 22: Gender-responsive Nutrition in Emergencies/Part 2 Technical Notes
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Monitoring and evaluation systems should avoid the use of too many indicators, complex indicators
that are not understood by the staff, and indicators that do not contribute to measuring effectiveness
of interventions.
Minimum gender-sensitive indicators
At a minimum, the indicators listed in the ADAPT and ACT Framework and checklists in the IASC
Gender Handbook should be used for monitoring and evaluation in nutrition in emergencies.


Collect sex- and age-disaggregated data on nutrition programme coverage, including:
- percentage of girls and boys aged 6-59 months treated for acute malnutrition (SAM
and MAM cases presented separately;
- percentage of girls and boys under five, PLW in the target group covered by
supplementary feeding programmes and treatment for moderate acute malnutrition;
- percentage of boys and girls under five covered by nutrition surveillance;
- percentage of women, girls, boys and men who are still unable to meet nutritional
requirements in spite of ongoing programming;
- exclusive breastfeeding rates and other relevant Infant Young Child Feeding in
Emergency (IYCF-E) indicators for girls and boys.
- percentage of men and women benefitting from nutritional behaviour change
interventions
Implement plans to address inequalities and ensure access and safety for the entire target
population.
Participatory monitoring
In participatory monitoring, beneficiaries are involved in measuring, recording, collecting,
processing and communicating information to assist both operation management staff and the
beneficiary group members in decision making. Participatory monitoring is recommended (Box 4) to
improve gender equality because it places beneficiaries at the heart of the response, allows their
views to be taken into account and increases accountability towards them. Staff and beneficiaries
involved in setting up monitoring systems and in evaluation teams should ideally comprise women
and men from the various socio-economic groups and, if possible, gender equality experts.
Box 4: Participatory monitoring
Adapting a more participatory approach in monitoring and evaluation requires greater involvement of
community members, women, girls, boys and men at all steps of the project cycle. Community members
can become involved in the initial design of the intervention by collecting and analysing data through
more qualitative approaches and by ensuring that the findings are shared. Qualitative approaches to
monitoring and evaluation are of particular value, allowing voices to be heard and community members to
tell their story in a culturally appropriate and non-threatening way. Including project participants in the
impact assessment process can create an opportunity to develop a learning partnership involving the
donor, the implementing partner and the participating communities.
Source: Adapted from HTP Module 20; and Participatory Impact Assessment: A Guide for Practitioners, 2008,
Tufts University/Feinstein International Centre.
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An additional advantage of using a participatory approach in monitoring and evaluation while using
gender-sensitive indicators is that it contributes to awareness and better understanding of gender
equality among the beneficiary community. During interventions, a useful method for generating
participatory information and redefining policies and objectives is to organize participatory
workshops with all stakeholders, with an adequate and balanced representation of the beneficiaries.
Gender should be included in the workshop agenda by asking such questions as: Does gender affect
the use of services? Is the targeting gender-responsive? Which practical and strategic gender needs
should still be addressed?
Disaggregation of data by age, gender and/or diversity provides more visibility to vulnerable
groups. If vulnerable groups are visible at the data collection stage, then it is more likely that their
specific needs will be incorporated into programme planning and implementation. Disaggregating
data by age and sex can reveal biases and aspects that might not have surfaced otherwise, as
presented in Case 5 on the Democratic Republic of the Congo.
Case 5: Incorporating gender considerations into nutrition programming: Democratic Republic of the
Congo
Experience shows that when sex- and age-disaggregated data (SADD) data are available, they can
improve overall programme quality and effectiveness. For example, previous national demographic and
health surveys conducted in the Democratic Republic of the Congo showed that a larger proportion of
boys than girls were classified with moderate or severe acute malnutrition. Selective feeding programme
data, however, indicated that more girls were admitted than boys. Failure to consider boys’ increased
vulnerability resulted in a lack of understanding of the causes of this situation as well as the necessary
actions to reverse it. The Nutrition Cluster is now trying to address this gap by analysing the social
dynamics that impact boys’ nutritional wellbeing. The results of this gender analysis will eventually
inform programming.
The Nutrition Cluster also developed minimum commitments on gender in emergency nutrition. The
commitments were the product of a dialogue with cluster members at provincial and national levels, who
committed to:
 analysing the particular nutritional vulnerabilities of boys and, on that basis, take the adequate
corrective measures;
 ensuring that fathers and mothers are equally targeted by food education activities;
 engaging fathers in taking care of malnutrition cases would be encouraged;
 systematically consulting women in order to identify the opening hours and days that are most
convenient for them;
 ensuring a balanced representation of sex in care teams and community mediators;
 disaggregating by sex the number of aid beneficiaries, recruited community mediators and
care personnel targeted for training.

Source: Adapted from Delphine Brun, GenCap Inter-Agency Advisor to Global Clusters, 2011
By integrating a gender dimension into monitoring and evaluation, it is possible to capture
information leading to a better understanding of the different risks facing women, girls, boys and
men in a given context and how to best address them in programming. It will also help measure to
Module 22: Gender-responsive Nutrition in Emergencies/Part 2 Technical Notes
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what extent a project has addressed the different needs of men and women and has made an impact
on their overall lives. Taking GFD as an illustrative example, 15 some specific questions or gendersensitive programme performance indicators can be used to identify whether there is gender
disparity in the way the intervention is implemented, as follows:






Is food aid targeted to women and child-headed households?
Is a household registered in the women’s name to ensure women have greater control over
how food is used in the home and to encourage greater household food consumption?
Is the provided food basket adequate to meet the nutrition needs of women and girls, boys
and men, and the micronutrient needs of children and adolescent girls?
Are pregnant and lactating women being targeted with food aid and supplements to meet
their specific physiological requirements?
To what extent are women participating in:
o the assessment and targeting process, especially the identification of the most
vulnerable;
o the composition of the food baskets;
o decision making on the timing and location of food distribution points on the size
of the food basket and the frequency of distribution;
o the assessment of cooking needs and the collection of firewood and water;
o the assessment of their security at, and travelling between the distribution points
and their homes;
o food distribution committees – do they have an equal number of men and women?
To what extent is equal access to services achieved?
Interpreting Sex- and Age-Disaggregated Data
Although SADD is now widely applied, the collected data are not always sufficiently used.
Disparities in SADD in nutrition needs assessments require an analysis and sometimes an
additional survey. For example, there may be need to assess why there are different exclusive
breastfeeding rates for male and female babies, why there are different percentages of women,
girls, boys and men who are malnourished in some of the age groups, or why older people suffer
disproportionally. The causes may be related to any of the gender dimensions described in the
rationale. Disparities observed during a humanitarian crisis may also be the result of gender bias
or gender blindness in programme performance.
Gender-sensitive programme performance indicators also include the ratio between male and
female service providers and volunteers because this can influence enrolment and attendance of
services. (See Box 5 for a useful gender-sensitive reporting system checklist.)
In conclusion, the aim of collecting SADD is to use this information in order to develop and
implement plans to address any inequalities and ensure access and safety for all of the target
population.
15
This example was taken from HTP Module 20, Monitoring and evaluation.
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Box 5: Reporting system checklist
Determine whether the current reporting system generates information separately for men and women
concerning:
•
project staff at various levels;
•
committees at each level;
•
implementing agency staff;
•
registration committees;
•
numbers of entitled persons;
•
distribution committees;
•
category (internally displaced person, refugee, returnee);
•
participants in reconstruction work;
•
total persons receiving aid;
•
heads of households.
Was the operation designed properly to focus on the differential effect of the disaster on women and girls,
boys and men? Has their situation improved?
Did we use the available resources efficiently, measuring the outputs in relation to the inputs?
Did we achieve the expected results effectively?
How can we adjust assistance to the specific needs of women and girls, boys and men?
Was the type of aid provided truly tailored to the real and different needs of the affected women and men,
girls and boys?
Could the needs of women and girls, boys and men have been met more efficiently following a different
approach?
Does the reporting system incorporate a participatory approach among project staff at different levels to
assess the progress?
Does the monitoring and evaluation system incorporate participatory feedback from women and girls,
boys and men?
Source: Adapted from Module 10, Monitoring and evaluation, SEAGA for Emergency and Rehabilitation
Programmes, FAO/WFP, 2007.
Focusing on older people, the disabled and people living with HIV/AIDS
The monitoring and evaluation of nutrition interventions should include an analysis of the
situation of older people to better understand their specific needs, track their ability to access
basic services and assess the appropriateness of food rations to meet their needs. Relevant
questions to monitor and evaluate the interventions include:
 Are older men and women involved and consulted during the assessment phase?
 Is blended food provided as part of their ration?
 Is physical access to the general food ration sufficient (e.g. through decentralization of
distribution sites and more frequent distributions in order to reduce the weight of the food
rations)?
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 Do older people have sufficient access to fuel and water for cooking? And are there any
gender differences between older men and older women with regard to access?
 Are there any programmes assisting them? What are they and are they adequate?
One of the challenges in monitoring the nutrition situation of older people is the difficulty in
assessing them anthropometrically.16 MUAC is mainly used to determine their nutritional status
because an accurate measurement of height may be problematic due to a disability or the
inability to stand up straight. Older people are the focus of HTP Module 23, Nutrition of older
people in emergencies.
Similarly, the nutritional status of people with disabilities should be regularly monitored to
ensure that needs are being met. Depending on the nature of the disability, this may be
challenging due to difficulties in taking anthropometric measurements. It is also important to
monitor the rate at which people with disabilities are receiving food rations and other supplies,
and to take disability-appropriate measures to improve access to services where necessary.
In addition, monitoring the needs of PLWHA and how they are met by the response requires the
necessary attention, as discussed in HTP Module 18.
Gender-responsive programming for specific humanitarian nutrition
interventions
This section emphasizes gender considerations to factor in when planning and implementing
specific humanitarian interventions to prevent and treat malnutrition. Please refer to the relevant
sections in this module for guidance on gender-responsive needs assessment, targeting, design,
training, SBCC and monitoring and evaluation in nutrition emergency response.
General Food Distribution
GFD now falls under the Food Security Cluster. Because the GNC’s role in GFD is to support
adequate nutrition needs assessment and monitoring of GFD implementation (including food
basket monitoring) and subsequent advocacy, it is important to present here some of the many
gender-sensitive aspects related to GFD. Understanding these issues also facilitates the intercluster coordination between the nutrition and food security clusters, and an improved outcome
for beneficiaries.
Targeting food distribution
The section above on targeting is especially relevant to GFD since this is the largest nutrition
intervention both in terms of numbers of beneficiaries and budget, and much of its effectiveness
depends on adequate targeting. Food aid will normally be distributed to women, because this is a
World Food Programme (WFP) requirement for food assistance programmes. Targeting female-
Young and Jaspers, ‘The meaning and measurement of acute malnutrition in emergencies’, HPN Network Paper,
No. 56, 2006.
16
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headed households on the basis that they are most vulnerable to food insecurity is another
strategy often used by agencies.
For gender-responsive targeting:









ensure that each household ration card for free food distributions is issued in a
woman’s name;
register households receiving food aid to facilitate equal distribution;
ensure that female- and adolescent-headed households, polygamous households
and vulnerable groups are included in food distribution lists;
if polygamy is widely practised, ensure that women are recipients of food aid for
themselves and their children;
facilitate priority access to GFD for women and older people, and provide support
for transport of the rations;
consider, to the extent possible, direct/easily accessible distribution to the most
vulnerable groups and/or provision of means of transportation to communities or
groups of beneficiaries (e.g. community-owned wheelbarrows);
ensure that children under five years of age, ill or malnourished individuals,
pregnant and lactating women, and other vulnerable groups are given priority for
feeding and food aid programmes;
ensure available, appropriate foods for PLW, children and older people that will
meet their nutrition requirements;
ensure that the type of ration does not require much preparation work.
Effective targeting depends on an adequate gender-responsive needs assessment. In addition,
SBCC, monitoring and evaluation, and prevention of GBV are important since women and girls
are easy victims of theft. For example, during the Haiti emergency, women collecting food were
attacked and their food stolen after leaving distribution sites. In Sudan, during the Bahr El
Ghazal crisis in 1998, WFP Food Monitors distributed food to the female headed households but
the local authorities captured the food at a central location away from the WFP distribution site
and then redistribute to the entire population after taking 25 percent of the food for the Sudan
people’s Liberation Army (SPLA).
Communication and accountability around food distribution
Targeting criteria should be transparent and beneficiaries have the right to know their
entitlements and the date or period when the next distribution will take place (see Case 6).
Case 6: Transparency and Communication on General Food Distribution
In order to avoid tension, communities – host communities, refugees and internally displaced persons
(IDPs), etc. – must be informed about who qualifies for food aid, the selection criteria, the targeting and
distribution arrangements (timing, composition and size of food rations) and entitlements per person or
per household, among others, so that the intervention does not increase risks and insecurity. Consultations
with various sectors of the population can help identify potential sources of risk and entry points to
resolve tensions early on. During a focus group discussion in Colombia, for example, women reported
Module 22: Gender-responsive Nutrition in Emergencies/Part 2 Technical Notes
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tensions between people receiving food aid and other members of the community not receiving food aid
who questioned their exclusion from food aid activities.
Source: Adapted from IASC Handbook on Gender, Women, Girls, Boys and Men: Different Needs – Equal
Opportunities, 2006
Management and coordination of food distribution is the task of the Food Security Cluster; every
effort should be made to include women in decision making and implementation of GFD. While
it may be relatively easy to ensure that women have a presence in village or camp distribution
committees and are the recipients of food aid, it is more difficult to ensure they actively
participate in decision making and that their opinions and suggestions are given equal weight to
those of men. Establishing quotas for women in leadership positions as well as using voting as a
basis for decision making may mitigate gender imbalance. Guidance on GFD implementation is
provided in HTP Module 11, General food distribution, and the IASC Gender Handbook.
Monitoring and Evaluation of General Food Distribution
The GNC partners will be involved in food basket monitoring to assess the adequacy of the
provided food rations. Module 11 provides more information on nutrient requirements for GFD.
For calculating and planning appropriate rations, certain gender-related elements apply:
 population structure in terms of sex and age to estimate energy requirements. A
population composed exclusively of women and children will require approximately
6 per cent less energy than a standard population. Where boys and men constitute the
total population, the average daily energy requirements would be increased by 6 per
cent;
 micronutrient requirements for children, pregnant and lactating women, and
adolescent girls;
 the need to provide ready to use foods and blended food including ready-to-use
therapeutic foods (RUTFs)17 for children, PLW, and ill and older people (see Module
11).
If the women designated to receive food aid are not present at the time of distribution, the
reasons for this should be investigated. Women should be interviewed specifically regarding
their views on: the distribution system; how food is used at the household level; and how their
involvement in the collection of food affects their ability to care for children and perform their
other domestic responsibilities. (See also the GFD-related example of monitoring and evaluation
questions above.)
In addition, the impact of the food aid programme on women, men, girls and boys (needs, access
and control over physical and human resources) should be assessed in light of their current and
future well-being and livelihoods. This can be assessed through focus group discussions with
open questions and in-depth interviews with key informants of both sexes and all ages.
Consultations should be held with women and men separately to anticipate and address any
negative impact that food aid interventions may have on women and girls, boys and men.
17
Newly developed blended foods include corn soy blend plus (CSB +/++), which is a reformulation of the original
CSB to meet the additional energy density and micronutrient needs of some population subgroups. In the field, CSB
and super cereal are used for 6-59 months and in development context, they are used for the 6-24 months
specifically.
Module 22: Gender-responsive Nutrition in Emergencies/Part 2 Technical Notes
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Cash transfers and food vouchers
When food aid is replaced with cash transfers or food vouchers, additional gender aspects should
be considered, such as the need to minimize the risk of theft and/or GBV, as well as the risk of
male dominance over decisions on expenditures. Where cash has been specifically targeted at
women, it has contributed to their decision-making power within the household.
In all cases, cash transfer and food voucher programmes need to be sensitive to underlying
gender inequalities. When food vouchers are provided, there are nutritional benefits and incomegenerating opportunities for the whole family. There is evidence that cash can be as effective as
food aid in meeting nutritional needs of women and girls. Cash can also have a positive influence
on caring practices. In Ethiopia, Save the Children found that in households receiving cash
transfers, mothers fed their children more frequently, giving them a wider variety of grains and
pulses and an increased amount of livestock products, oil and vegetables. Furthermore, mothers
spent less time collecting firewood or dung as an income source, thus enabling them to spend
more time at home caring for their children.18
Infant and Young Child Feeding in Emergencies
Gender programming guidance is relevant and should be applied to IYCF-E.19 In particular, the
gender-responsive needs assessment presented above is paramount for identifying gender-related
and other barriers to optimal infant and young child nutrition, health, feeding and care.
For optimal IYCF-E, mothers and caregivers of infants up to six months of age need to
immediately and exclusively breastfeed, and therefore require:
- access to good maternal nutrition including safe drinking water;
- access to adequate information and skilled support;
- access to mental health and psychosocial interventions, as needed;
- decision-making power;
- privacy, especially in some cultures;
- time to breastfeed feed and care for infants and themselves;
- support by partner and wider community;
- gender-responsive and evidence-based SBCC developed with the target group.
For optimal IYCF-E, mothers and caregivers of infants from six months to two years of age
need to breastfeed and provide complementary feeding (in addition to the above), and therefore
require:
- access to micronutrient rich foods for complementary feeding;
- kitchen equipment and eating utensils;
- soap and safe drinking water for hygienic preparation;
- safe and culturally appropriate water and sanitation facilities;
- time to prepare food and to feed and care for infants and young children;
18
Save the Children UK, Impact of a cash for relief programme on child caring practices in Meket Woreda, 2005.
Infant and Young Child Feeding in Emergencies: Operational Guidance for Emergency Relief Staff and
Programme Managers. ENN/IFE Core Group, 2007. See www.ennonline.net/pool/files/ife/ops-guidance-2-1english-010307-with-addendum.pdf; and UNICEF IYCF Programming Guide. See
http://www.unicef.org/videoaudio/PDFs/IYCF_programming_guide_May_26_2011.pdf
19
Module 22: Gender-responsive Nutrition in Emergencies/Part 2 Technical Notes
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-
support by partner and wider community;
access to mental health and psychosocial interventions, as needed;
gender-responsive and evidence-based SBCC developed with the target group.
Availability and access to these factors should be the focus of the assessment and response.
Assessment teams should include at least one person who has received basic orientation on
IYCF-E and on gender. Gender inequality can undermine the mother’s choice or ability to
breastfeed, e.g. by pressure or lack of support from her husband and extended family, lack of
time due to the unequal distribution of tasks. These broader influences should be investigated to
develop effective gender-responsive SBCC that empowers mothers, fathers, and the communities
to make informed decisions. This will increase the possibility for better outcomes. For example,
in Haiti, mothers and their partners/husbands believed that the shock of the earthquake had made
their milk turn bad, and their partners insisted that the mothers feed the babies breast milk
substitutes. This possible barrier to breastfeeding could be overcome through SBCC. Identified
barriers to adequate IYCF-E practices need to be addressed in programme design and in
corresponding SBCC in order to prevent acute malnutrition and improve access and uptake of
treatment for acute malnutrition.
Time constraints for mothers often compromise caring practices during emergencies. They can
negatively affect both breastfeeding and complementary feeding, such as hygiene and the quality
of prepared complementary food, as well as reduce the frequency and duration of feeding. These
time constraints can be reduced through a variety of strategies, including the provision of mills,
fuel-saving strategies, the provision of water points in the vicinity, and community child care
services. In addition, changing gender roles with respect to household chores and child care will
achieve a more even balance of work and leisure time between women, girls, boys and men.
Social and economic factors may also critically influence IYCF practices in general and
especially in emergencies, for example, if a mother needs to go out to work to earn money, this
affects her capacity to breastfeed her infant. In addition, privacy is needed for breastfeeding in
some cultures. Community awareness and socio-cultural factors also play an important role, as
Case 7 shows.
Case 7: Socio-cultural practices that influence infant and young child feeding practices in Yemen
During gender workshops in December 2010 with a Nutrition Cluster in Aden, Yemen, Cluster members
noted that mothers-in-law and other older women in the family have control over a woman’s
breastfeeding practices. They reported that, in some cases, older women stop mothers from breastfeeding
and advise them to give secondary feed, believing that their milk will cause harm to the child.
Furthermore, among affected community, some lactating women were advised by older women to stop
breastfeeding because they believed that since the mother was not getting nutritious food, her milk had no
value. This was considered one of the reasons for acute malnutrition among children under three months
of age.
During another gender workshop with the Nutrition Cluster in Sa’ana, Yemen in March 2011, Cluster
members partly attributed high rates of malnutrition of children under five years of age to socio-cultural
practices. One Cluster member described a case in which a father did not support his child’s admission to
a Stabilization Centre because the child’s mother would have to spend the night outside the home. Given
the cultural norm that women should not appear in public, this was clearly not an option. Other Cluster
members noted that women in this region generally have no control over family income, which influences
Module 22: Gender-responsive Nutrition in Emergencies/Part 2 Technical Notes
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their and their children’s nutritional status, because less is spent on buying nutritious food. Moreover,
they reported that while women prepare the food, it is the men who distribute it, meat in particular, and
women may be forbidden from eating certain types of food including protein-rich meats due to cultural
norms.
Source: UNICEF Yemen, Mission Report, 2011
Saving lives through breastfeeding
Enabling women to breastfeed during emergencies is a life-saving measure that needs skilled
breastfeeding support (breastfeeding counselling20) and psychological support in addition to
support from the community and adequate food intake. During emergencies, in particular,
mothers lack the confidence to breastfeed, and myths about the inability to breastfeed due to
stress and shock need to be counterbalanced through gender-sensitive communication (see
Module 17, Annex).
The father, the husband or the relative of a mother who is breastfeeding or who has breastfed and
has stopped during this crisis should encourage her to continue or restart. She should be
reassured of how well she is equipped to nourish and protect her baby.
Breastfeeding is particularly critical among the most vulnerable infants – newborns, prematurely
born babies, twins, ill or malnourished infants, and infants whose mothers who face physical,
emotional or nutritional challenges. In particular, during antenatal care, the importance of
exclusive breastfeeding as a life-saving measure should be addressed together with practical
advice for early initiation of breastfeeding within one hour after birth.
This is even more crucial in populations where artificial feeding is widespread. In such
populations, health and nutrition staff may need refresher training on the importance of breast
feeding, especially in emergencies. Good results were achieved after the Haiti earthquake when
over 100 baby-friendly tents were set up by different NGOs. Mothers and caregivers with
children up to two years of age came to the tents to receive infant and young child feeding
counselling.21 In Indonesia, following the earthquake, breastfeeding counselling helped to reduce
the negative stigma in using donated infant formula by households with infants and young
children. Breastfeeding support actually improved early initiation and exclusive breastfeeding
rates to greater than pre-emergency levels.22
Clearly, it is essential that training on breastfeeding and IYCF, an important part of
emergency preparedness, be developed and integrated in all levels of nutrition programming and
healthcare. (Annex 7 describes the ten steps to successful breastfeeding that should be
implemented by all facilities providing maternity services and care for newborns and infants,
including services providing malnutrition treatment.)
20
Breastfeeding counsellors may be health professionals, community health workers or peer counsellors (e.g.
mothers and grandmothers) who have undertaken relevant training. Assistance can be provided at health facilities, in
safe breastfeeding corners and tents, and in mother-to-mother support or breastfeeding support peer groups in the
community.
21
See HTP Module 17, Case 5: Skilled Support at a Baby-Friendly Tent in Haiti.
22
See HTP Module 17, Case study 1: Indonesia.
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Services should be established to provide nutrition and care for orphans and unaccompanied
infants and young children. Additional guidance can be found in Module 17, Infant and young
child feeding, which also presents guidelines on breastfeeding and breast milk replacements in
the context of HIV/AIDS.
Gender-responsive Management of Acute Malnutrition
In the HTP modules on supplementary feeding programmes (Module 12, Management of
moderate acute malnutrition) and on outpatient and inpatient therapeutic care (Module 13,
Management of severe acute malnutrition), relatively little attention is paid to gender. Gender
considerations that are specifically related to malnutrition treatment interventions will be
presented here. The preceding IYCF-E section should also be consulted.
Supplementary feeding programmes
SFPs are usually established for the management of moderate acute malnutrition (MAM) and to
prevent deterioration into SAM. These targeted SFPs use anthropometric admission criteria for
children under five years of age and sometimes also for PLW.
Blanket supplementary feeding is generally used as a preventive measure among a specific target
group for a specific period of time in order to prevent MAM in the population. Targets groups
should be based on nutritional vulnerability and usually include children under five years of age
and pregnant and breastfeeding women as priority target groups, but could also include ill and
disabled individuals, older people and orphans.
Women leaders and mothers in particular should be involved in decision making on the design of
both types of SFPs, the locations where they will be held and the opening hours. The gender
barriers identified in the needs assessment or barrier analysis should be taken into account. For
example, Module 12 states that one of the advantages of dry take-home rations is that it is less
time-consuming for mothers and caregivers to attend weekly or every fortnight instead of daily.
This leads to better coverage and lower default rates. SFPs may face a lower attendance rate in
the rainy season or during the labour-intensive peaks in the agricultural cycle. Possible solutions
include the distribution of double rations, decentralization of distribution sites, and mobile
distribution teams that deliver care closer to homes. Other possible barriers to overcome are
related to privacy in the areas where children are weighed and measured, and the gender of the
service provider.
Therapeutic care
SAM is now mainly treated in outpatient therapeutic care as part of community-based
management of acute malnutrition (CMAM) for which children have to present themselves
weekly to receive RUTF as a take-home ration, and to have their health and nutritional status
monitored. As in SFPs, it is important that women be involved in its design and implementation.
Only children who present complications (e.g. general oedema and/or lack of appetite) will need
to be admitted to inpatient therapeutic care, and usually for only a few days or 1-2 weeks. This is
a major improvement over the therapeutic feeding centres (TFCs) that would admit all SAM
children for long periods and had a lower cure rate. Long-term admission in TFCs disrupted
family life because mothers were admitted with their children. Nevertheless, mothers or other
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caregivers need to accompany the now-reduced number of children that need to be admitted to
the inpatient therapeutic care facility; this can be a barrier that may prevent the child’s admission
and treatment (see Case 7).
Another related concern is that when a child is admitted with his or her mother in the inpatient
therapeutic care, the rest of the family depends on support from neighbours or other family
members, or on the father’s cooking and caregiving skills. To prevent a deterioration of the
nutritional status of the family members who remain behind, consultations can be held with the
caregiver and the family to identify serious problems and refer to community support services if
needed and available. A guest facility next to the hospital ward where the mothers can cook for
themselves and their families should be established (See Modules 11, 12 and 13).
It is important that therapeutic care programmes are able to provide skilled breastfeeding
assistance to support the caregivers of malnourished infants and young children, as discussed in
more detail in Module 18, HIV & AIDS nutrition, and under IYCF-E above.
Treatment of infants under six months of age
Malnourished infants under six months of age have increasingly been the focus of new
developments in IYCF-E for the treatment of MAM and SAM. The main strategy is to establish
or re-establish breastfeeding by mothers or caregivers (wet nurses) (see Module 12).
Sex-disaggregated data management
According to HTP Module 20, Monitoring and evaluation, “Where possible, indicators should be
disaggregated to reflect differences according to gender, age or other relevant factors.” However,
tracking sex-disaggregated data from admission in – to discharge from – SFPs (or default,
referral or non-response) and outpatient therapeutic care effectively doubles the reporting work.
Researchers of the Minimum Reporting Project23 acknowledge this as well as the fact that sexdisaggregated data in these interventions are seldom analysed and if so, rarely show any
significant differences. In order to address this lack, monitoring and registration of SADD are
recommended. Any substantial gender discrepancies at admission could be the result of gender
discrimination, unequal access or differences in prevalence rates between boys and girls, and
should be further investigated and addressed. Current recommendations in Module 12 on SFPs
therefore recommend only reporting sex-disaggregated data for new admissions, which will
identify gender-related differences in access and/or vulnerability (see also section Interpreting
SADD above).
Emergency School Feeding
Both in development and in humanitarian assistance, school feeding programmes are seen as
opportunities to meet the food needs of vulnerable children. These intervention should be jointly
prepared with the Food Security and Education Clusters.
Girls are usually the first to drop out of schools in emergencies. In many cases, school feeding
programmes aim to reduce gender disparities by encouraging families to send girls to school,
23
Emergency Nutrition Network (ENN) website for more information on the Minimum Reporting Project (MRP).
See www.ennonline.net/research/sfp.
Module 22: Gender-responsive Nutrition in Emergencies/Part 2 Technical Notes
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providing a school meal or take-home ration as an incentive. Where only girls or boys (based on
the situational context) receive the meal or ration, this is an example of a targeted gender
intervention.
In other school feeding programmes, both boys and girls will receive food to address low
enrolment and attendance in schools in certain geographical areas or where schools are located at
long distances from the households. When food is provided as school meals, it will contribute to
attendance, concentration and scholastic performance. If home rations are provided, they may be
shared with other family members. In both cases, school feeding programmes contribute to
reducing short-term hunger and nutritional deficiencies.
Micronutrient Interventions
Micronutrient deficiencies can easily develop during an emergency or exacerbated. This occurs
because livelihoods and food crops are lost; food supplies are interrupted; diarrhoeal diseases
break out, resulting in malabsorption and nutrient losses; and infectious diseases suppress the
appetite while increasing the need for micronutrients to help fight illness. For these reasons, it is
essential to ensure that the micronutrient needs of people affected by a disaster are adequately
met. To achieve this, it is critical that general food-aid rations are adequate and well-balanced to
meet nutrient needs, and that they are distributed regularly and in sufficient quantities.
Micronutrient deficiencies in populations affected by an emergency can be prevented and
controlled through multiple vitamin and mineral supplements for PLW and for children aged 6 to
59 months. (HTP Module 12 presents sex- and age-specific micronutrient requirements. Some
micro-nutrient interventions focus on pregnant women and girls only, such as supplementation of
folic acid and iron.)
Livelihood Interventions
Guidance on gender-responsive programming should be applied to livelihoods interventions.
While livelihood interventions may not be the primary concern of the Nutrition Cluster, they do
have nutrition and gender implications; they aim to address some of the underlying causes of
malnutrition, usually during the rehabilitation phase. Additional information can be obtained in
GFSC website.24 The HTP Module 16, Livelihood interventions, which presents a variety of
interventions:









Cash for work
Cash grants
Microfinance
Commodity vouchers
Cash vouchers
Monetization and subsidized sales
Market infrastructure
Destocking
Agriculture, livestock and fishing support.
24
See http://foodsecuritycluster.net; http://www.unicef.org/nutritioncluster/index_links.html
http://foodsecuritycluster.net/sites/default/files/FSC%20Handbook%20draft%203%20final%20for%20web.pdf
Module 22: Gender-responsive Nutrition in Emergencies/Part 2 Technical Notes
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Food-for-Work programmes are another type of livelihood support, which is described in
Module 11. Various income-generating activities, which often include skills training and
provision of inputs to start up a small business, also aim to strengthen livelihoods.
In both emergency and development settings, it is important to ensure that women as well as men
are targeted for livelihood support interventions. At the same time, programme designers and
implementing agencies need to realize that women’s involvement in cash- or food-for-work
activities will reduce their time for taking care of children and other vulnerable family members.
Female-headed households, therefore, cannot always be expected to participate in such schemes
or other activities that aim to replace GFD. Therefore, blanket SFP or other parallel support
programmes targeting female and child-headed households will be required in emergency
settings where there is no GFD.
Women are often encouraged to return to subsistence farming in the aftermath of an emergency
with the provision of seeds and tools. However, there are gender implications if only women are
targeted. It is equally important to obtain the full participation of women, girls, boys and men in
all subsequent steps such as project design, implementation, and monitoring and evaluation. It
has been argued that by focusing on women’s livelihoods to meet a food security agenda, there is
a risk of ignoring potentially more successful opportunities for livelihood development outside
agriculture.
Gender-responsive needs assessments for livelihoods interventions during rehabilitation must
focus in greater detail on productive roles and access to productive assets – i.e. focus on who
owns, uses and controls these assets, on how roles are divided, and on who makes the decisions.
During crises, women very often assist with or completely take over activities that are normally
performed by men. Special attention should therefore be given to allow women access to
services such as credit, extension, training on appropriate technologies, supply sources, transport
and mobility because, in many cases, these may have been targeted to men. Women’s access to
land is not only a legal matter or a customary issue, but also, a question of power. In some cases,
emergency interventions may negatively affect women’s control of crop production and land
cultivation. For example, when new techniques are introduced and revenues increase, men might
be attracted and take responsibility for the introduced activity.
Here, caution should be used regarding the potential negative impact of only targeting women
for livelihood projects because this increases the burden on women to be the sole provider for
their families and alleviates men of their responsibilities for their families. Opportunities for
engagement in livelihood projects should also, therefore, consider the involvement of men.
Time- and energy-saving technologies should be specifically considered and designed for
women who often carry the burden of major workloads, because this extra time will benefit care
and nutrition of families. The FAO/WFP Socio-Economic and Gender Analysis Programme
(SEAGA) materials,25 among others, provide guidance including practical steps on how to use
specific participatory rural appraisal (PRA) tools to identify needs and opportunities to improve
livelihoods of women, girls, boys and men during recovery and rehabilitation. Daily Activity
25
SEAGA for Emergency and Rehabilitation Programmes, FAO/WFP 2007.
Module 22: Gender-responsive Nutrition in Emergencies/Part 2 Technical Notes
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Clocks and Gender-disaggregated Seasonal Calendars are extremely useful in this context (see
Annex 6 for a description and user guide) .
Nutrition Surveillance
Nutrition surveillance is the continuous collection and analysis of nutritional status data in order
to give warning of an impending crisis or to make policy and programmatic decisions that will
lead to improvement in the nutrition situation of the population.
For nutrition surveillance and food security early warning systems that forecast and monitor food
and nutrition insecurity, refer to Modules 9 and 10. Case 8 illustrates how gender is
mainstreamed in the FAO/Food Security and Nutrition Analysis Unit (FSNAU).
Case 8. Gender-responsive nutrition surveillance
Since 2011, the Food Security and Nutrition Analysis Unit (FAO/FSNAU) in Somalia has been working
closely with the United Nations Office for the Coordination of Humanitarian Affairs (OCHA) Gender
Adviser and its Gender Analyst to integrate gender in nutrition analysis. Their publications provide
nutrition data disaggregated by sex, and where possible, on maternal nutritional status. This information is
available for Somali regional programming and is therefore imbedded in each relevant chapter of FSNAU
publications. Inclusion of sex-disaggregated data in the Consolidated Appeal for Somalia is now
mandatory; hence, the sex-disaggregated information provided by FSNAU is being linked to programme
design of the Consolidated Appeal. OCHA works with the response agencies to ensure that gender is
embedded in their programmes.
Source: Ahono Busili, Nutrition Manager, FAO/FSNAU, 2011
Challenges, Coordination and Support
Gender-responsive programming is growing and becoming increasingly common in
humanitarian assistance policies and strategies. Some examples include the WFP Gender Policy
and Strategy 2009 as one of the priorities in the programme Promoting Positive Gender
Relations and Supporting Sustainable Livelihoods through Food for Work and Food for
Training,26 and the central strategy of United Nations High Commissioner for Refugees’
(UNHCR) Age, Gender and Diversity Mainstreaming, which is having a positive impact on
accountability within the Organization.27 However, despite the gender-sensitive wording in
policies and strategies, much more should be done in practice to achieve gender-responsive
programming in humanitarian nutrition interventions. Some of the remaining challenges are the
effective use of common gender-responsive programming measures, and time and funding
constraints.
26
WFP Gender Policy 2009: Promoting Gender Equality and the Empowerment of Women in Addressing Food and
Nutrition Challenges. See www.wfp.org/content/wfp-gender-policy, 33, p. 12.
27
Thomas and Beck, Changing the Way UNHCR Does Business? An evaluation of the Age, Gender and Diversity
Mainstreaming Strategy 2004-2009, 2010. See http://www.alnap.org/resource/5852.aspx?tag=328.
Module 22: Gender-responsive Nutrition in Emergencies/Part 2 Technical Notes
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Effective use of gender-responsive programming measures
While many programmes and projects currently apply the widely agreed measures to improve
gender equality to a certain extent, there is a risk that they miss their goal. Collection and
analysis of SADD data are crucial to inform humanitarian nutrition programming. However,
there is no use in collecting SADD data if they are not used to design or to adjust interventions.
Pursuing a gender balance in the participation of women, from staff recruitment to management
positions and beneficiary committees is a common goal today in humanitarian response.
However, it should be realized that this is not a guarantee for equality in decision making.
Increasing the representation of women in food-related programmes and in project design does
not automatically result in equal participation in decision making. In many traditional cultures, in
particular, male dominance in the public domain prevents women from giving their opinions in
mixed forums. Additional measures are required, such as voting to take decisions instead of
listening to the loudest voice, and quotas for women to be elected in leadership positions.
Time, funding and capacity constraints in emergencies
Time constraints in emergencies may prevent conducting a gender analysis within the first rapid
needs assessment. This should be corrected after the first needs have been addressed in order to
ensure that the response is adequate in meeting the needs of women, girls, boys and men, and
that it does not perpetuate or even exacerbate gender inequality.
In a WFP survey in 2007, the gender focal points identified inadequate funding and capacity,
and limited practical tools for gender mainstreaming as challenges for implementing the
gender policy.28
Coordinating efforts and supporting gender equality in emergencies
This can be promoted through the establishment of a Gender Support Network (GenNet). The
IASC recommends that GenNets be established both at the local and national level in which
government representatives, civil society, United Nations agencies and NGOs would collaborate
to increase gender equality in society and in emergency response. Participation of the nutrition
sector in GenNets is important for coordinating activities and sharing information. In all
emergencies, nutrition staff should work with the United Nations Development Programme
(UNDP) and/or the Office for the Coordination of Humanitarian Affairs (OCHA) Gender Focal
Point and with other sectors/clusters. This is needed also to ensure gender-sensitive humanitarian
programming mechanisms for GBV prevention and response (see Annex 4).
Technical support
The IASC Gender Task Force now continues as a Sub-Working Group and supports the strategy
for integrating gender as a crosscutting issue into the Cluster Approach and into other elements
of the humanitarian reform. At the same time, the IASC Gender Standby Capacity (GenCap)
project seeks to build capacity of humanitarian actors at the country level to mainstream Genderresponsive programming, including prevention and response to GBV in all sectors of
28
WFP Gender Policy 2009: Promoting Gender Equality and the Empowerment of Women in Addressing Food and
Nutrition Challenges. See www.wfp.org/content/wfp-gender-policy
Module 22: Gender-responsive Nutrition in Emergencies/Part 2 Technical Notes
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humanitarian response. Its standby GenCap roster can provide support to humanitarian country
teams through its pool of gender advisers.29
The IASC offers the online course, Different needs, equal opportunities; increasing effectiveness
of humanitarian action for women, girls, boys and men,30 which is based on the highly useful
Gender Handbook referenced throughout this module. To address poor performance on gender
and to ensure that projects and programmes are gender-responsive, the IASC developed the
“Gender Marker” (see Box 6).
Box 6. The IASC Gender Marker
The IASC Gender Marker is a tool that codes, on a 0‐2 scale, whether or not a humanitarian project is
designed well enough to ensure that women, girls, boys and men will benefit equally from it or that it will
advance gender equality in another way. If the project has the potential to contribute to gender equality,
the marker predicts whether the results are likely to be limited or significant.
Source: The IASC Gender Marker.
See www.globalprotectioncluster.org/en/areas-of-responsibility/age-gender-diversity/gender/the-iasc-gendermarker.html
The inclusion of sex-disaggregated data and a gender-responsive approach in project proposals is
currently mandatory for obtaining funding through CAP. This forces project designers to
formulate gender-responsive projects that lead to more effective humanitarian outcomes; the
Gender Marker Tip Sheet for nutrition,31 which includes the ADAPT and ACT
Framework/checklist, assists agencies to achieve this. It also provides donors with a detailed
assessment of the gender-responsiveness of projects that seek funding. The Resource List, Part 4
of this module, includes additional guidelines and manuals to assist humanitarian nutrition
professionals in gender-responsive programming.
29
See http://oneresponse.info/crosscutting/gender/Pages/Gender.aspx information on GenCap.
The online course is available at: www.iasc-elearning.org/home.
31
Gender Marker Tip Sheet. See
https://docs.unocha.org/sites/dms/CAP/NutritionGenderMarkerTipsheetJuly2011.pdf
30
Module 22: Gender-responsive Nutrition in Emergencies/Part 2 Technical Notes
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Annex 1: Key definitions
Gender refers to the social attributes and constraints associated with being male and female,
and the relationships between women and men and girls and boys, as well as the relations
between women and those between men. Gender determines what is expected, allowed and
valued in a women or a man in a given context.
Gender analysis is a systematic way of looking at the different impacts of development,
policies, programmes and legislation on women and men that entails, first and foremost,
collecting sex-disaggregated data and gender-sensitive information about the population
concerned. Gender analysis can also include the examination of the multiple ways in which
women and men, as social actors, engage in strategies to transform existing roles, relationships,
and processes in their own interest and in the interest of others.
Gender balance means the equal participation of men and women in decision-making bodies,
including those managing community facilities, infrastructure and programmes such as food
distribution. Achieving a gender balance in staff recruitment improves the overall effectiveness
of policies and programmes, and the capacity to better serve the beneficiaries.
Gender-based violence (GBV) is an umbrella term for any harmful act that is perpetrated
against a person’s will that is based on socially ascribed gender differences. Some examples are:
sexual violence, including sexual exploitation/abuse and forced prostitution; domestic violence;
trafficking; forced/early marriage; harmful traditional practices such as female genital mutilation;
honour killings; and widow inheritance.
Gender equality, or equality between women and men, refers to the equal enjoyment by
women, girls, boys and men of rights, opportunities, resources and rewards. Equality does not
mean that women and men are the same, but rather, that their enjoyment of rights, opportunities
and life chances are not governed or limited by whether they were born female or male.
Gender mainstreaming is a strategy, an approach, and a means to achieve the goal of gender
equality. It involves ensuring that gender perspectives and attention to the goal of gender
equality are central to all activities – policy development, research, advocacy/ dialogue,
legislation, resource allocation, and planning, implementation and monitoring of programmes
and projects.
Source: Adapted from IASC Gender Handbook in Humanitarian Action, Women, Girls, Boys and Men: Different
Needs, Equal Opportunities, 2006;
UN Women website, see http://www.un.org/womenwatch/osagi/gendermainstreaming.htm;
FAO website, see http://www.fao.org/gender/gender-home/gender-why/en/;
IGWG, A Practical Guide for Conducting and Managing
Gender Assessments in the Health Sector, see http://www.igwg.org/igwg_media/gender-assessment-guide-2012.pdf
Module 22: Gender-responsive Nutrition in Emergencies/Part 2 Technical Notes
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Annex 2: The role of culture, social norms and behaviour
Culture shapes how things are done in a society and provides explanations as to why they are
done that way.32 Culture can seem natural and immutable because it conditions not just what
people do, but also how they think about and understand what they do. At the same time, a
culture is not fixed, but is continually changing; what is culturally acceptable or even desirable
today may be unacceptable tomorrow. A culture is also not monolithic; many of its aspects are
highly contested within the culture itself. For example, some segments of society may be keen to
change a cultural practice, while others – particularly those who benefit from it – may fight hard
to maintain it. It is, therefore, unwise to assume the existence of a true cultural consensus. Men
traditionally enjoy a privileged position over women, with greater power and voice. As a result,
they are frequently able to ensure that their cultural preferences and values prevail. Similarly,
socially elite groups have more power than marginalized groups to define and maintain
prevailing cultural values.
Development practitioners are sometimes reluctant to take actions that they fear may be
perceived as interfering with another culture. For ethical reasons, they may feel reluctant to
impose ideas about women’s rights that may be perceived as Western, or they might wish to
avoid being accused of cultural insensitivity. However, it is advisable to assess social norms and
practices with regard to universal human rights.
It is critical for development and emergency response practitioners to approach others’ practices
and beliefs in a spirit of openness and respect, with a view to understanding the fundamental,
underlying values that motivate such practices and beliefs; this is not the same thing, however, as
uncritically accepting them. For instance, understanding that parents who supported female
genital mutilation were concerned that, without such actions, their daughters would be
unmarriageable and thus face a lifetime of severe economic insecurity was vital to the
development of an effective approach to ending the practice. This approach consisted of a
community-wide mass abandonment of the practice that lead to all girls (and thus all potential
wives) being uncut, putting them on equal footing in the marriage market. Understanding that
parents were motivated by concern for their daughters’ long-term futures rather than by an
irrational adherence to a harmful practice was the first step in finding a lasting solution.
To understand culture and promote gender equality, the following is important:
• Listen to how people understand and talk about discrimination in the society: Is it a
taboo topic or is it readily discussed? This gives a sense of the degree to which social
change is taking place.
•
Keep in mind that the dominant group does not speak for everyone. If men are speaking
for women, or elites for the marginalized, it is necessary to help create forums in which
people can speak for themselves;
32
UNICEF, Promoting Gender Equality: An Equity-Focused Approach to Programming: Operational Guidance
Overview, 2011. See www.unicef.org/gender/files/Overarching_Layout_Web.pdf
Module 22: Gender-responsive Nutrition in Emergencies/Part 2 Technical Notes
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•
Refer to national commitments on gender equality, as set out in instruments such as the
Beijing Platform for Action and the Convention on the Elimination of All Forms of
Discrimination Against Women, and to organizations and individuals within a country
who are working for a gender-equal society;
•
Learn about the ways in which girls, women and socially marginalized or minority
groups understand and work to shape and change their culture;
•
Understand the values that underlie harmful practices rooted in cultural tradition in order
to better support alternative practices;
•
Use science and evidence to convey the benefits that gender equality brings to health and
development outcomes;
•
When an act of sex discrimination is justified as being rooted in culture, ask if this
discrimination would be acceptable if it were applied to a member of a racial or ethnic
minority group.
Module 22: Gender-responsive Nutrition in Emergencies/Part 2 Technical Notes
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Annex 3: Overview of relevant Sphere Standards for Gender
and Nutrition in Emergencies
Source: ‘Humanitarian Charter and Minimum Standards in Humanitarian Response; Chapter 3: Minimum Standards
in Food Security and Nutrition’, Geneva: The Sphere Project, 2011.
The Sphere standards specify the minimum acceptable levels to be attained in a humanitarian
response. The Food Security and Nutrition Standards cover assessment, infant and young child
feeding, management of acute malnutrition and food security (food transfers, cash transfers and
livelihoods). There are six Sphere Core Standards that are relevant to all sectors: (a) Peoplecentred humanitarian response; (b) Coordination and collaboration; (c) Assessment; (d) Design
and response; (e) Performance, transparency; and (f) Aid worker performance. Although none of
the Sphere Core Standards focus on gender as such, gender as a cross-cutting issue is relevant to
each of the six core standards and features in their Guidance Notes:
Six Core Standards
1. People-centered humanitarian response
2. Coordination and collaboration
3. Assessment
4. Design and response
5. Performance, transparency and learning
6. Aid worker performance.
The relevant Sphere Minimum Standards are:
1. Minimum Standards in Water Supply, Sanitation and Hygiene Promotion
2. Minimum Standards in Food Security and Nutrition
3. Minimum Standards in Shelter, Settlement and Non-Food Items
4. Minimum Standards in Health Action.
The first, second and fourth minimum standards include important gender implications that need
to be taken into account for successful gender-responsive programming.
Moreover, there are four basic Protection Principles that should be applied by all humanitarian
action to support gender-responsive programming:
1. Avoid exposing people to further harm as a result of your actions.
2. Ensure people’s access to impartial assistance in proportion to need and without
discrimination.
3. Protect people from physical and psychological harm arising from violence and coercion.
4. Assist people in claiming their rights, accessing available remedies, and recovering from
the effects of abuse.
Module 22: Gender-responsive Nutrition in Emergencies/Part 2 Technical Notes
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Sphere standards relevant to nutrition in emergencies
Food security and nutrition assessment standard 1: Food security
Where people are at increased risk of food insecurity, assessments are conducted using accepted
methods to understand the type, degree and extent of food insecurity, to identify those most affected
and to define the most appropriate response.
Food security and nutrition assessment standard 2: Nutrition
Where people are at increased risk of undernutrition, assessments are conducted using internationally
accepted methods to understand the type, degree and extent of undernutrition, and identify those most
affected, those most at risk and the appropriate response.
Infant and young child feeding standard 1: Policy guidance and coordination
Safe and appropriate infant and young child feeding for the population is protected through
implementation of key policy guidance and strong coordination.
Infant and young child feeding standard 2: Basic and skilled support
Mothers and caregivers of infants and young children have access to timely and appropriate feeding
support that minimizes risks and optimizes nutrition, health and survival outcomes.
Management of acute malnutrition and micronutrient deficiencies standard 1: Moderate acute
malnutrition
Moderate acute malnutrition is addressed.
Management of acute malnutrition and micronutrient deficiencies standard 2: Severe acute
malnutrition
Severe acute malnutrition is addressed.
Management of acute malnutrition and micronutrient deficiencies standard 3: Micronutrient
deficiencies
Micronutrient interventions accompany public health and other nutrition interventions to reduce
common diseases associated with emergencies and address micronutrient deficiencies.
Food security standard 1: General food security
People have a right to humanitarian food assistance that ensures their survival and upholds their
dignity, and as far as possible prevents the erosion of their assets and builds resilience.
Food security – food transfers standard 1: General nutrition requirements
Ensure the nutritional needs of the disaster-affected population, including those most at risk, are met.
Food security – food transfers standard 2: Appropriateness and acceptability
The food items provided are appropriate and acceptable to recipients so that they can be used
efficiently and effectively at the household level.
Food security – food transfers standard 3: Food quality and safety
Food distributed is fit for human consumption and of appropriate quality.
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Food security – food transfers standard 4: Supply chain management (SCM)
Commodities and associated costs are well managed using impartial, transparent and responsive
systems.
Food security – food transfers standard 5: Targeting and distribution
The method of targeted food distribution is responsive, timely, transparent and safe, supports dignity
and is appropriate to local conditions.
Food security – food transfers standard 6: Food use
Food is stored, prepared and consumed in a safe and appropriate manner at both household and
community levels.
Food security – cash and voucher transfers standard 1: Access to available goods and services
Cash and vouchers are considered as ways to address basic needs and to protect and re-establish
livelihoods.
Food security – livelihoods standard 1: Primary production
Primary production mechanisms are protected and supported.
Food security – livelihoods standard 2: Income and employment
Where income generation and employment are feasible livelihood strategies, women and men have
equal access to appropriate income-earning opportunities.
Food security – livelihoods standard 3: Access to markets
The disaster-affected population’s safe access to market goods and services as producers, consumers
and traders is protected and promoted.
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Annex 4: Guidelines for Gender-based Violence Interventions in
Humanitarian Settings
Source: Adapted from IASC Guidelines for Gender-based Violence Interventions in
Humanitarian Settings, Action Sheet 6.1: Implement safe food security and nutrition
programmes, 2005.33
Background
Women and girls often face a different set of risks from men and boys during an emergency,
such as food insecurity. Effective food security and nutrition strategies require an understanding
of the gender dimensions of crises in order to identify and assess gender-specific relief needs
(See Action Sheet 2.1, Conduct coordinated rapid situation analysis). The participation of
women in decisions on how to best implement food security and nutrition programmes is critical
to reducing the risks that women and girls face in emergency situations. Gender-based violence
(GBV) prevention requires the application of the following principles in planning and conducting
food distributions:
• The community is entitled to specific food aid benefits.
• There must be active participation of the community.
• All actions must be transparent, open and clear to all.
• All actors must facilitate access to food aid.
• All actors must ensure safety from violence and abuse.
Key actions
The following actions apply to the food security and nutrition sector; i.e organizations
implementing food distribution and nutrition programmes. The food security and nutrition sector
identifies a focal point who participates regularly in the GBV Working Group and reports on the
sector’s achievement of the key actions. The food security and nutrition sector focal point(s)
participate in cross-cutting functions led by the GBV coordinating agencies and working groups,
as described in Action Sheets for Coordination, Assessment and Monitoring, Human Resources,
and Information Education Communication.
33
Available at:
http://www.google.it/url?sa=t&rct=j&q=&esrc=s&frm=1&source=web&cd=3&ved=0CEMQFjAC&url=http%3A%
2F%2Fwww.humanitarianinfo.org%2Fiasc%2Fdocuments%2Fsubsidi%2Ftf_gender%2FGBV%2FGBV%2520Guid
elines%2520AS6%2520Food.pdf&ei=pHpMUe31O8HG7Abe4HwCw&usg=AFQjCNHtOSoZTGny02_4eQi8uMAg5s0XbA&bvm=bv.44158598,d.ZWU
Module 22: Gender-responsive Nutrition in Emergencies/Part 2 Technical Notes
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1. Collect sex-disaggregated data for planning and
evaluation of food security and nutrition
strategies.
2. Incorporate strategies to prevent sexual
violence in food and nutrition programmes at all
stages of the project cycle (including design,
implementation, monitoring, and follow-up),
giving special attention to groups in the
community that are more vulnerable
to sexual violence.
• Target food aid to women- and child-headed
households. Women and children who are the
sole providers of the household are often at
greater risk of discrimination and violence. In
times of food shortage, they are often at
heightened risk of food insecurity and
malnutrition. Registering household ration
cards in the names of women rather than men
can help to ensure that women have greater
control over food and that it is actually consumed.
• Give special attention to pregnant and
lactating women, addressing their increased
nutritional needs.
• For polygamous families, issue separate ration
cards for each wife and her dependents. Often,
the husband will be considered a member of
one of the wives’ households. Traditionally,
many polygamous men and their wives believe
that the husband is entitled to meals from
each wife. Carefully consider how to
assign the husband’s food ration and give clear
information to all members of the family (i.e.
all wives).
3. Involve women in the entire process of
implementing food security and nutrition
strategies. Establish frequent and consistent
communication with women in order to
understand the issues that need to be addressed
and resolved. Women should participate in:
• the assessment and targeting process, especially
in the identification of the most vulnerable;
• discussions on the desirability and
appropriateness of potential food baskets;
• decisions on the location and timing of
food distributions, including both general
ration distributions and supplementary feeding;
• the assessment of cooking requirements and
additional tools, their availability within the
community, and the strategies in securing
access to non-food-items. Special attention
should be given to this point since women
could be exposed to sexual violence in the
Module 22: Gender/ Part 2 Technical Notes
process of collection of these items (e.g. the
collection of firewood can put them in a vulnerable position if they have to travel very far
away or outside the camp).
4. Enhance women’s control of food in food
distributions by making them the household food
entitlement holder.
• Issue the household ration card in the woman’s
name.
• Encourage women to collect the food at the
distribution point.
• Give women the right to designate someone to
collect the rations on their behalf.
• Encourage women to form collectives to collect
food.
• Conduct distributions at least twice per month
to reduce the amount of food that needs to be
carried from distribution points.
• Introduce funds in project budgets to provide
transport support for community members
unable to carry rations from distribution
points.
5. Include women in the process of selecting the
location of the distribution point. Consideration
should be given to the following aspects:
• The distance from the distribution point to the
households should not be greater than the
distance from the nearest water or wood source
to the household.
• The roads to and from the distribution point
should be clearly marked, accessible and
frequently used by other members of the
community.
• Locations with nearby presence of large
numbers of men should be avoided, particularly
those where there is liberal access to alcohol
or where armed persons are in the vicinity.
6. Establish gender-balanced food distribution
committees that allow for the meaningful and
equal participation of women. Attention should be
given to the following aspects:
• Ensure that food is distributed by a genderbalanced team. Provide packaging that facilitates
handling and can be re-used for other domestic
activities.
• Select the time of distribution according to
women’s activities and needs in order to permit
the organization of groups that can travel together
to and from the distribution point.
• Distribute food during the day. Leave enough
time for women to return to their homes during
daylight hours.
Page 51
7. Provide enough information about distributions
using a variety of methods to ensure
communication to everyone, especially women
and girls. Inform the community about:
• the size and composition of the household
food rations;
• beneficiary selection criteria;
• distribution place and time;
• the fact that they do not have to provide services
or favours in exchange for receiving
rations;
• the proper channels available to them for
reporting cases of abuse linked to food
distribution.
8. Reduce security risks at food distributions.
Create ‘safe spaces’ for women at distribution
points.
• Appeal to men in the beneficiary community
to protect women and ensure safe passage of
women from distribution sites to their homes.
• Ensure that there is a sex balance in the food
distribution teams.
• If necessary, segregate men and women
receiving rations, either by having distributions for
men and women at different times, or by
establishing a physical barrier between them
during the distribution.
• Assure that food distribution teams and all
Module 22: Gender/ Part 2 Technical Notes
staff of implementing agencies have been
informed about appropriate conduct, prevention
of sexual abuse and exploitation, and
mandatory reporting.
• Create ‘safe passage’ schedules for child
household heads.
• Begin and end food distribution during daylight
hours.
• Consider placing two women guardians (with
vests and whistles) to oversee off-loading,
registration, distribution and post-distribution of
food. These women can signal to the security
focal point if there are problems.
9. Monitor security and instances of abuse in the
distribution point as well as on departure roads.
• Ensure that there are women staff from the
implementing agency present during food
distributions.
• Establish a community-based security plan for
food distribution sites and departure roads
in collaboration with the community.
• Establish a security focal point at each of the
distribution sites.
• Monitor security on departure roads and
ensure that women are not at an increased risk
of violence by carrying the food commodity.
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Annex 5: IASC Gender Handbook in Humanitarian Action;
ADAPT and ACT Framework for Gender Equality Programming
in Humanitarian Action
Analyse gender differences
• Use participatory assessments to gather information
about nutritional needs and cooking skills of women,
girls, boys and men, and on the resources that they
control.
• Analyse the reasons for inequalities in malnutrition
rates between women, girls, boys and men, and then
address them through programming.
• Collect information on cultural, practical and securityrelated obstacles faced by women, girls, boys and men
in accessing nutritional assistance and take measures to
overcome them.
• Reflect the gender analysis in planning documents
and situation reports.
Design services to meet needs of all
• Design nutritional support programmes according to
food culture and nutritional needs of women (including
pregnant or lactating women), girls, boys and men in
the target population.
• Employ an equal number of women and men in
nutrition programmes.
Address gender-based violence
• Include both women and men in the process of
selecting safe distribution points.
• Ensure that a gender-balanced team distributes the
food.
• Create ‘safe spaces’ at distribution points and ‘safe
passage’ schedules for women and children heads of
households.
• Make special arrangements to safeguard women to
and from the distribution point (e.g. by providing an
armed escort if necessary).
• Monitor security and instances of abuse.
Collect, analyse and report programme
Monitoring data
• Involve women and men equally and meaningfully in
decision-making and programme design,
implementation and monitoring.
• Collect and repot sex- and age-disaggregated data on
nutrition programme coverage, including:
 percentage of girls and boys under five, pregnant
and lactating women in the target group covered
by supplementary feeding programmes and
treatment for moderate to acute malnutrition;
 percentage of boys and girls under five covered by
 nutrition surveillance;
 percentage of women, girls, boys and men who are
still unable to meet nutritional requirements in
spite of ongoing programming; and
 exclusive breastfeeding rates for girls and boys.
• Implement plans to address inequalities and ensure
access and safety for all of the target population.
Train all equally
Target actions based on analysis
• Offer training on nutrition and gender issues for
women, girls, boys and men.
• Train an equal number of women and men from the
community on nutrition programming.
• Address unequal food distribution and nutrition rates
within the household through nutritional support.
• Ensure that programmes address the underlying
reasons for discrimination.
• Empower those discriminated against.
Ensure
Access for all
• Routinely monitor access to services by women, girls,
boys and men through spot checks and discussions with
communities, and promptly address obstacles to equal
access.
Ensure equal
Participation
Collectively coordinate actions
• Ensure that actors in nutrition liaise with actors in
other areas to coordinate on gender issues, including
participating in regular meetings of the gender
network.
Module 22: Gender/ Part 2 Technical Notes
Page 53
• Ensure that the nutrition area of work has a gender
action plan and routinely measures project-specific
indicators based on the checklist provided in the InterAgency Standing Committee (IASC) Gender Handbook.
Module 22: Gender/ Part 2 Technical Notes
• Work with other sectors/clusters to ensure gendersensitive humanitarian programming.
Page 54
Annex 6: Participatory tools for gender analysis
Participatory tools for gender analysis includes focus group discussions and key informant
interviews. Guidelines for these tools are provided in the form of handouts in the last two
exercises of the Trainer’s Guide in Module 19, Working with communities in emergencies.
This annex gives an overview of the following tools that are presented in the 2008 FAO/WFP
Socio-Economic and Gender Analysis (SEAGA) for emergency and rehabilitation programmes34
and in other SEAGA publications:


the Livelihoods Analysis tools, which address the flow of activities and resources
through which different people make their living;
the Context Analysis tools, which address economic, environmental, social and
institution patterns that pose support or constraints to development.
Livelihoods Analysis tools
The following is a full description of two of the livelihood analysis tools presented by SEAGA,
which are very effective in gender analysis:


Daily Activity Clocks
Gender-disaggregated Seasonal Calendars.
Daily Activity Clocks
Purpose: Daily Activity Clocks illustrate all the different kinds of activities carried out in one
day. They are particularly useful for looking at relative workloads between different groups of
people in the community, e.g. women, men, the rich, the poor, children and older people.
Comparisons between Daily Activity Clocks show who works the longest hours, who
concentrates on a small number of activities, who must divide their time among a variety of
activities, and who has the most leisure time and sleep. They can also illustrate seasonal
variations. This exercise will help you better plan your programme and services according to the
schedule of the busy beneficiary, especially women.
Process: Organize separate focus groups of women and men. Make sure that each group
includes people from the different socio-economic groups. Explain that you would like to learn
about what they do in a typical day. Ask the groups of women and men to each produce their
own clocks. They should first focus on the activities of the previous day. An outline of all the
activities carried out at different times and how long they took should be drafted. Plot each
activity on a circular pie chart (to look like a clock). Activities carried out simultaneously should
be noted, such as child care and gardening.
34
http://www.fao.org/docrep/008/y5702e/y5702e00.htm for a full description of each of the listed tools.
Module 22: Gender-responsive nutrition in emergencies/ Part 3 Trainer’s Guide
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When the clocks are completed, ask questions about the activities shown. Ask whether yesterday
was typical for the time of year. Note the present season, e.g. the wet season, and then ask the
same participants to produce new clocks to represent a typical day in the other season, e.g. the
dry season.
Compare: One of the best and often most entertaining ways to introduce the Daily Activity
Clock tool is to start by showing what your own day looks like. Draw a big circle on paper and
indicate what time you wake up, what time you go to work, and when you care for your children,
and so forth. There is no need to go into great detail, but it is important to include all activities,
such as agricultural work, wage labour, child care, cooking and sleeping.
Gender-disaggregated Seasonal Calendars
Purpose: Seasonal calendars are tools that help to explore changes in livelihood systems taking
place over the period of a year. They can be useful in counteracting time biases because they are
used to determine what occurs in each seasons; otherwise, there is a tendency to discuss only
what occurs during the time of the rapid appraisal (RA). This exercise will help you better plan
your programme and services according to the schedule of the busy beneficiary, especially
women.
Calendars can be used for many purposes, such as to learn about people’s workload at different
times of the year, or how their incomes change in different periods. It can also be used to show
the seasonality of other important aspects of livelihoods such as food and water availability.
Process: Work with one group of women and one group of men that produced the Daily Activity
Clocks. Explain that, this time, you want to learn about what people do in a year. Find a large
open space for each group. Calendars can be drawn on a large paper or can be traced in the sand
or on a dirt floor using stones or leaves for quantification. Draw a line all the way across the top
of the cleared space (or paper). Explain that the line represents a year and ask how people divide
the year, i.e. months, seasons, etc. The scale to use is the one that makes the most sense to the
participants. Ask the participants to mark the seasonal divisions along the top of the line. It is
usually easiest to start the calendar by asking about rainfall patterns. Ask them to put stones
under each month (or other division) of the calendar to represent relative amounts of rainfall
(more stones equal more rain). Once the rainfall calendar is finished, you can draw another line
under it and ask participants to make another calendar, this time showing their labour for
agriculture (putting more stones over the periods of high labour intensity). Make sure that the
labour calendar and subsequent calendars are perfectly aligned with the rainfall calendar.
Different colours or different lines can be used to differentiate the tasks by men and women.
This process is repeated, one calendar below another, until all the seasonal issues of interest are
covered. Be sure to include calendars for food availability, water availability, income sources
and expenditures. Ask the participants to put a symbol or sign next to each calendar to indicate
the topic. As much as possible, ask them also to describe the sources of food and income, and
relevant details. Other issues may be added according to the needs and interests of the
participants, such as animal diseases, fodder collection, fishing seasons, marketing opportunities
and health problems, some of which must be divided by gender.
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SEAGA Matrix: Livelihoods Analysis Tools35
Livelihood Analysis focuses on how individuals, households and groups of households make their living
and their access to resources to do so. It reveals the activities people undertake to meet basic needs and
to generate income. Gender and socio-economic group differences are shown with respect to labour and
decision-making patterns. Key questions include:





How do people make their living? How do the livelihood systems of women and men compare?
Of different socio-economic groups?
Are there households or individuals unable to meet their basic needs?
How diversified are people’s livelihood activities? Do certain groups have livelihoods vulnerable to
problems revealed in the development context?
What are the patterns for use and control of key resources? By gender? By socio-economic
group?
What are the most important sources of income? Expenditures?
Resources Mapping – Farming Systems Diagram: for learning about household members’ on-farm,
off-farm and non-farm activities and resources.
Benefits Analysis Flow Chart: for learning about benefits use and distribution by gender.
Daily Activity Clocks: for learning about the division of labour and labour intensity by gender and
socioeconomic group.
Seasonal Calendars: for learning about the seasonality of women’s and men’s labour, and seasonality of
food and water availability and income and expenditure patterns, and other seasonal issues of
importance to the community.
Resources Access and Control Matrix: for learning about use and control of resources by gender and
socio-economic group, often applied using proportional piling and picture cards.
Income and Expenditures Matrices: for learning about sources of income, sources of expenditures and
the crisis coping strategies of different socio-economic groups.
Wealth Ranking: for determining the proportion of the population that is vulnerable. Proportional piling
techniques can be used to determine proportions, e.g. of people that are poor.
35
See ftp://ftp.fao.org/docrep/fao/008/y5702e/y5702e00.pdf
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SEAGA Matrix: Context Analysis Tools36
In any particular community, there are a number of socio-economic patterns that influence how people
make a living and their options for development. Looking at the context helps us to understand these
patterns. Key questions include:




What are the important agro-environmental, economic, institutional and social patterns in the
village?
What are the links between the field-level patterns and those at the intermediate- and macrolevels?
What is getting better? What is getting worse?
What are the supports for intervention? The constraints?
Trend lines: for learning about the impact of disasters (without and with
the vulnerability of people in affected areas.




the project) and
Environmental (deforestation, water supply)
Economic (jobs, wages, cost of living)
Population (birth rates, out-migration, in-migration)
Other issues that are important to the community (crop production: good, bad and normal years
over the past 5-10 years. Area planted – year 1, year 2, year 3, year 4, year 5. Crop
harvested bags [units]: year 1, etc. Food self-sufficiency (months): year 1, etc. Households food
insecure (%): year 1, etc. Prices of main staple per bag (units): year 1, etc. Terms of exchange:
e.g. exchange of 1 adult male sheep would bring how many kg of grain over year 1, year 2, etc..
Village Resources Map: for learning about the environmental, economic and social resources in the
community.
Transects: for learning about the community’s natural resource base, land forms, and land use, location
and size of farms or homesteads, and location and availability of infrastructure and services, and
economic activities.
Village Social Map: for learning about the community’s population, local poverty indicators, and number
and location of households by type (ethnicity, caste, female-headed, wealthy, poor, etc.).
Venn Diagrams: for learning about local groups and institutions, and their linkages with outside
organizations and agencies.
36
See ftp://ftp.fao.org/docrep/fao/008/y5702e/y5702e00.pdf
Module 22: Gender-responsive nutrition in emergencies/ Part 3 Trainer’s Guide
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Annex 7: Ten steps to successful breastfeeding
The ten steps for health facilities to take towards ensuring successful breastfeeding are as
follows:37
1. Create and adapt a written breastfeeding policy that is routinely communicated to all
health care staff.
2. Train all health care staff in the skills necessary to implement this policy.
3. Inform all pregnant women on the benefits and management of breastfeeding.
4. Help mothers initiate breastfeeding within half an hour of birth.
5. Show mothers how to breastfeed and how to maintain lactation even if they should be
separated from their infants.
6. Give newborn infants no food or drink other than breast milk unless medically indicated.
7. Practise "rooming in" – allowing mothers and infants to remain together – 24 hours a day.
8. Encourage breastfeeding on demand whenever the baby is hungry.
9. Give no artificial teats or pacifiers (also called “dummies” or “soothers”) to breastfeeding
infants.
10. Foster the establishment of breastfeeding support groups and refer mothers to them on
discharge from the hospital or clinic.
The role of a father has been shown to be a powerful influence on a mother’s decision to
breastfeed. To support and increase breastfeeding initiation and continuation, the father’s
opinion, attitude and knowledge about breastfeeding and his relationship to his baby and the
baby’s mother must be considered. Strong approval and support of breastfeeding by the father is
associated with a high incidence of the decision to breastfeed. Mothers who perceive their
partners to prefer formula or be ambivalent about the feeding method are significantly more
likely to discontinue breastfeeding before discharge compared with those who perceive their
partners as being supportive. Even if the mother thinks that the father has a negative attitude
toward breastfeeding, she is more likely to bottle-feed, even if that perception was incorrect.
Much of the focus on breastfeeding support is on the maternal-infant. This focus may lead some
fathers to feel excluded and resentful of breastfeeding. Fathers’ negative perceptions of
breastfeeding’s effects on such things as interference with sex or having a damaging effect on
breast appearance can also lead the mother to bottle-feed.
37
WHO/UNICEF, Evidence for the Ten Steps to Successful Breastfeeding. 1998, Geneva.
Module 22: Gender-responsive nutrition in emergencies/ Part 3 Trainer’s Guide
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PART 3: TRAINER’S GUIDE
The Trainer’s Guide is the third of four parts contained in this module. It is not a training course;
rather, it provides guidance on how to design a training course by giving tips and examples of
tools that the trainer can use and adapt to meet training needs. The Trainer’s Guide should only
be used by experienced trainers to help develop a training course that meets the needs of a
specific audience. It is linked to the technical information found in Part 2 of this module.
Module 22 focuses on gender-responsive nutrition in emergencies. The technical notes explain
gender equality in the context of food security and nutrition in emergencies. They present the
normative context and relevant commitments that contribute to equality and accountability of
humanitarian nutrition interventions. The module explains why and how gender-responsive
programming and gender-responsive programming improve the effectiveness of the work of the
Nutrition Clusters including the Global Nutrition Cluster (GNC) and cluster partners.
Navigating your way around the Guide
The Trainer’s Guide is divided into six sections:
1. Tips for trainers – provides pointers on how to prepare for and organize a training course.
2. Learning objectives – sets out examples of learning objectives for this module that can be
adapted for a particular participant group.
3. Testing knowledge – contains an example of a questionnaire that can be used to test
participants’ knowledge of gender-responsive programming in nutrition emergencies, either
at the start or at the end of a training course.
4. Classroom exercises – provides examples of practical exercises that can be carried out in a
classroom context by participants individually or in groups.
5. Case studies – contains examples of case studies from different parts of the world that can be
used to get participants to think by using real-life scenarios.
6. Field-based exercises – outlines ideas for field visits that may be conducted during a longer
training course.
Module 22: Gender-responsive nutrition in emergencies/ Part 3 Trainer’s Guide
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Contents
1. Tips for trainers
2. Learning objectives
3. Testing knowledge
Exercise 1: What do you know about gender-responsive programming in nutrition emergencies?
Handout 1a: What do you know about gender-responsive programming in nutrition emergencies?
(Questionnaire)
Handout 1b: What do you know about gender-responsive programming in nutrition emergencies?
(Questionnaire answers)
4. Classroom exercises
Exercise 2: Gender dimensions of malnutrition
Handout 2a: What are the gender aspects related to each of the underlying causes of malnutrition:
household food insecurity, lack of health and care in your working area?
Handout 2b: A list of gender aspects related to household food insecurity and lack of health and care
Exercise 3: Practicing key informant interviews /analysing gender dimensions of malnutrition in your
place of work (in pairs)
Handout 3a: Facilitator’s notes on key informant interviews
Exercise 4: Understanding different aspects of gender-responsive programming (Part 1)
Handout 4a: Women’s contributions to reducing micronutrient deficiencies
5.Case studies
Exercise 5: Understanding different aspects of gender-responsive programming (Part 2)
Handout 5 a: Case study 1: A gender analysis of issues relating to community outreach work in North
Darfur
Handout 5 b: Trainers’ notes: Answers
Exercise 6: How to protect against and prevent gender-based violence
Handout 6a: Case study 2: Gender-based violence and the use of theatre in Burundi
6b Trainer’s notes: Answers
Handout 6c: IASC Gender-based Violence Guidelines Action Sheet (also included as an annex in
Module 22)
Module 22: Gender-responsive nutrition in emergencies/ Part 3 Trainer’s Guide
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6. Field-based exercises
Exercise 7: Finding out about Daily Activity Clocks
Handout 7a: Facilitator’s notes on how to develop a Daily Activity Clock
Exercise 8: Learning about gender-disaggregated Seasonal Calendars
Handout 8a: Facilitator’s notes on how to develop a gender-disaggregated Seasonal Calendar
Module 22: Gender-responsive nutrition in emergencies/ Part 3 Trainer’s Guide
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1. Tips for trainers
Step 1: Do the reading!




Read Parts 1 and 2 of this module.
Instructors should take into consideration the gender and cultural issues with respect to the
participants.
Familiarize yourself with the technical terms from the glossary.
Read through the following key documents (see references in Part 4 of this module):
 The Sphere Project. (2011). Sphere Handbook, Minimum Standards in Food Security and
Nutrition. Geneva.
 International Committee of the Red Cross (2008), Nutrition Manual for Humanitarian Action.
Geneva.
 World Food Programme. (2005). Food and Nutrition Handbook. Rome.
Step 2: Know your audience!

Find out about your participants in advance of the training:
 How many participants will there be?
 Do any of the participants already have gender experience in nutrition emergencies?
 Could you involve them in the sessions by having them prepare a case study or describe their
practical experiences?
Step 3: Design the training!

Decide on the duration of the training and what activities can be covered within the available time. In
general, the following guide can be used:
 A 90-minute classroom-based training can provide a basic overview of gender-responsive
programming in humanitarian nutrition interventions.
 A half-day classroom-based training can provide the basic overview and include some practical
exercises.
 A one-day classroom-based training can provide a more in-depth understanding of genderresponsive programming in humanitarian nutrition interventions and include a number of case
studies.
 A one-day classroom plus field-based training can provide theoretical and practical experience.

Identify appropriate learning objectives. This will depend on your participants, their level of
understanding and experience, how they wish to use the training in their future work, and the aim and
length of the training.
Decide exactly which points to cover based on the learning objectives that you have identified.
Divide the training into manageable sections. One session should generally not last longer than an
hour.
Ensure that the training provides a good combination of activities, e.g. combine PowerPoint
presentations in plenary with more active participation through classroom-based exercises and mix
individual work with group work. Also, do not underestimate the usefulness the ‘old’ method of flip
charts, especially when they are colourful and well-framed.



Module 22: Gender-responsive nutrition in emergencies/ Part 3 Trainer’s Guide
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Step 4: Get prepared!



Prepare PowerPoint presentations with notes in advance and do a trial run. Time yourself!
Prepare exercises and case studies. These can be based on the examples given in this Trainer’s Guide
but should be adapted to the particular training context. You may choose to audio-record case studies
instead of writing them out. Sphere and IRIN may also have video clips that could be useful.
Prepare a kit of materials for each participant to be given out at the start of the training, which should
include:
 a timetable showing the break times (coffee and lunch) and individual sessions;
 Parts 1 and 2 of this module;
 Pens and paper.
2. Learning objectives
Below are examples of learning objectives for a session on gender-responsive programming in
humanitarian nutrition interventions. Trainers may wish to develop alternative learning objectives that are
appropriate to their particular participant group. The number of learning objectives should be limited; up
to five per day of training is appropriate. Each exercise should be related to at least one of the learning
objectives.
Examples of learning objectives
At the end of the training, participants will:






be aware of the gender dimensions of malnutrition and the different needs of women, girls, boys and
men;
understand the importance of including a gender analysis in emergency nutrition response;
be aware of the importance of the participation of women, girls, boys and men – from the needs
assessment to monitoring and evaluation;
know the different measures that contribute to the prevention of – and protection from – GBV in the
context of nutrition in emergency response;
know how to use some effective participatory tools to assess gender inequality in emergency
nutrition;
be aware of how gender-responsive programming makes humanitarian nutrition interventions more
effective.
3. Testing knowledge
This section contains one exercise, i.e. an example of a questionnaire that can be used to test participants’
knowledge about why gender-responsive programming is essential in emergency response, either at the
start or at the end of a training session. The questionnaire can be adapted by the trainer to include
questions relevant to the specific participant group and training session. It may also be helpful to consider
using the questionnaire prior to the training in order to gather insight into the trainee group (see Step 2
above) and to give you time to fine-tune the training to their particular needs.
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Exercise 1: What do you know about gender-responsive programming in
humanitarian nutrition interventions?
What is the learning objective?


To test participants’ knowledge about gender.
To test participants knowledge about gender-responsive programming in humanitarian
nutrition interventions.
When should this exercise be done?

Before or at the start of a training session to establish the level of knowledge and/or at the
end to assess what participants have learned and the impact of the training on their
knowledge on gender.
How long should the exercise take?

20 minutes
What materials are needed?


Handout 1a: What do you know about gender-responsive programming in humanitarian
nutrition intervention? Questionnaire
Handout 1b: What do you know about gender-responsive programming in humanitarian
nutrition interventions? Questionnaire answers
What does the trainer need to prepare?
 Familiarize yourself with the questionnaire questions and answers.
 Add your own questions and answers based on your knowledge of the participants
and their knowledge base.
Instructions
Step 1: Start the session by asking the participants individually why gender is important
in emergencies and why gender-responsive programming is important in nutrition
emergencies.
Step 2: Note their responses on a blackboard or flip chart, return to them at the end of
the training session, and add to the points they have raised.
Step 3: Give each participant a copy of Handout 1a.
Step 4: Give participants 10 minutes to complete the questionnaire working alone.
Step 5: Give the correct answers as shown in Handout 1b and allow 5 minutes for
discussion.
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Handout 1a: What do you know about gender-responsive programming in
humanitarian nutrition interventions? Questionnaire
Time for completion:
10 minutes
Circle the correct answers. There may be more than one correct answer to a question.
1. Which of the answers below describes the meaning of gender?
a. Gender is about women.
b. Gender is a strategy to empower women.
c. Gender refers to the social differences between females and males.
2. Why is gender important during emergencies?
a. Because women are more vulnerable to malnutrition.
b. Because women and men face different risks.
c. Because women and men have different opportunities.
d. Because men are often the decision makers in the household.
3. Why are women and girls more exposed to gender-based violence (GBV) during emergencies
than in normal circumstances?
a. Because normal social structures are disrupted.
b. Because of increased frustration and anger in the population.
c. Because they need to go outside the community boundaries in search of fuel, water and
food.
d. Because of the lack of security measures.
4. What can be done to prevent this exposure to GBV?
a. Design interventions with participation of women.
b. Increase the presence of security and project staff.
c. Plan activities away from the community or camp.
d. Select a good time for services, e.g. general food distribution (GFD) in the morning.
5. What does SADD stand for?
6. Do the Sphere standards address gender?
7. Is there a Sphere core standard on gender?
Are the following statements true or false?
8. The gender marker is a participatory tool used in gender analysis.
9. Targeted action in gender programming only targets women.
Module 22: Gender-responsive nutrition in emergencies/ Part 3 Trainer’s Guide
True
True
False
False
Page 66
10. Cultural factors can influence breastfeeding patterns.
11. To assess gender inequality, mixed focus groups with
an equal number of men and women are recommended.
True
False
True
False
12. Name three reasons for which a gender-responsive approach increases the effectiveness of
nutrition interventions.
Module 22: Gender-responsive nutrition in emergencies/ Part 3 Trainer’s Guide
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Handout 1b: What do you know about gender-responsive programming in
humanitarian nutrition interventions? Answers
1. c
2. all
3. all
4. a, b, d
5. Sex- and age-disaggregated data
6. Yes (in the Guidance Notes and in the Humanitarian Charter)
7. No
8. False
9. False
10. True
11. False
12. Any of the following:
o
o
o
o
o
o
o
Better targeting
Identification of different needs of women, girls, boys and men
Identification of vulnerable groups (socio-economic/cultural/age groups and ill/disabled
individuals)
Better understanding of issues leading to a better response
Gender-balanced or gender-sensitive selection of staff/volunteers
Gender-sensitive social and behaviour change communication (SBCC)
Improved monitoring.
4. Classroom exercises
This section provides examples of practical exercises that can be carried out in a classroom context by
participants individually or in groups. They are useful between plenary sessions where the trainer mostly
lectures, since they provide an opportunity for participants to engage actively in the session. The choice
of exercises will depend on the learning objectives and the time available. Trainers should adapt the
exercises presented in this section to make them appropriate to the particular participant group. Ideally,
trainers should use cases with which they are familiar.
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Exercise 2: Gender dimensions of malnutrition, including culture
What is the learning objective?

To understand how gender plays a role in each of the underlying causes of malnutrition and
how culture affects gender aspects.
When should this exercise be done?

Early on in the training session.
How long should the exercise take?
50 to 55 minutes.
Materials:
Handout 2a: What are the gender aspects related to each of the underlying causes of
malnutrition: inadequate household food security, inadequate care and inadequate services
and unhealthy environment in your working area?
Pen and paper, flipchart and markers
Instructions
Step 1: Give the participants 5 minutes to reflect on and list the gender-related factors for
each underlying cause in their work area.
Step 2: Divide the participants in groups of mixed different geographical areas, provide
10 minutes to brainstorm, and identify the main gender aspects for each underlying cause.
Step 3: Ask one member of each working group to provide feedback to the whole group
on the most important and most interesting aspects, and to write these up as headings on a
flipchart or blackboard. Allow 10 minutes for feedback for each group.
Step 4: Spend 10 minutes reviewing the gender dimensions of malnutrition section in
Module 22 Chapter 2, while relating it to the results.
If time allows:
Step 5: Open a 10-minute discussion on how these gender aspects vary for the different
regions and cultures represented in the group work.
Step 6: Open a 5- to 10-minute discussion on how culture affects the identified key points
per underlying cause.
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Handout 2a: What are the gender aspects related to each of the underlying causes of malnutrition:
inadequate household food security, inadequate care and inadequate services and an unhealthy
environment in your working area?
The UNICEF Conceptual Framework
Classroom exercise question: describe the gender-related factors for each underlying cause in
your work area.
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Exercise 3: Practising key informant interviews while analysing the gender
dimensions of malnutrition in your place of work (in pairs)
What is the learning objective?

To understand how gender affects malnutrition in your area (consider the underlying causes
discussed in Exercise 2 and obtain hands-on experience practising key informant interviews.
When should this exercise be done?
Early on in the training session, after exercise 2.
How long should the exercise take?
60-65 minutes
Materials:
Handout 3a: Facilitator’s notes on key informant interviews
Pen and paper
Instructions
If exercise 2 has not been completed, the trainer can introduce the gender dimensions of
malnutrition in approximately 10 minutes, before starting the exercise (Module 22).
Step 1: Give the participants 10 minutes to read the hand-out and list the questions for the
interview.
Step 2: Divide the participants in pairs.
Step 3: Ask one participant from each pair to play the role of interviewer, while the other,
in the role of respondent, provides answers based on his or her knowledge of the situation
in the working area (or their own country) (15 minutes).
Step 4: Allow the pairs to reflect for a few minutes on the performance of the interviewer
and switch roles (20 minutes).
Step 5: Ask one interviewer of each pair to present his/her findings (10 minutes).
Step 6: Allow 5–10 minutes for feedback from all groups.
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Handout 3a: Facilitator’s notes on key informant interviews
How to conduct a key informant interview38
Step 1: Choose the interviewer.
The interviewer must remain neutral and refrain from asking biased or leading questions during
the interview. An effective interviewer understands the topic and does not impose judgments.
Ideally, the interviewer should:



Listen carefully.
Be friendly and comfortably establish a rapport with the informant(s).
Know and understand the local customs, behaviour and beliefs.
Step 2: Identify suitable key informants.
Choose suitable key informants according to the purpose of the interview. A key informant can
be any person who has a good understanding of the issue that you wish to explore. The informant
can be a community member, teacher, religious or secular leader, indigenous healer, traditional
birth attendant, local service provider, a child, a youth, or any other member of the affected
community. Interviews can take place formally or informally, and preferably in a setting familiar
to the informant.
Step 3: Conduct the interview.
The aim of the key informant interview is to find out from local influential leaders about the
gender-related causes of malnutrition in the area. Examples of questions are:











38
What are the leader’s beliefs and knowledge about malnutrition?
Does the leader know why nutrition is important in child and maternal health?
From whom did the leader hear the information and was it well explained?
How does the leader judge his or her community’s understanding of malnutrition?
Do both men and women have the same understanding of the nutrition and care needs
of infants and young children?
What does the leader think is the main reason for malnutrition?
Does the leader think that child care, child health and family food are the
responsibility of the family or only of mothers?
Has the leader observed sufficient support from fathers for breastfeeding of and
caring for infants and young children?
Who makes the decisions on breastfeeding and child nutrition?
What problems do fathers, mothers and other caregivers face when trying to provide
adequate child care, infant feeding and family meals?
What problems do women, girls, boys and men face when seeking health care?
Adapted from Module 19, Part 3, Handout 8a.
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Try to obtain the relevant gender aspects while further probing each of the questions! Try
to find out if there are any gender-related barriers to nutrition by using the above
questions as a starting point for an in-depth interview.









Conduct the interview in a place where respondents are at ease.
Interview one informant at a time.
Take into account culture-specific gender sensitivities; for example, women cannot be
interviewed by men in some cultures; in other cultures, women may be more open towards
female interviewers. The same gender sensitivities may apply for interpreters.
Establish contact first by introducing yourself.
Thank the participant for making his or her time available.
Describe the objectives of the interview.
Review the interview guide questions together with your notes.
If time allows for the use of a tape recorder, ask permission to tape the interview.
After each interview, transcribe the results of your discussion, using the guide questions in
recording the responses.
Do not forget to:






inform the respondent that his or her confidentiality will be protected;
avoid judgmental tones so as not to influence responses;
show empathy with the respondent and interest in understanding his or her views;
let the respondent do most of the talking;
be an active, attentive listener;
pace yourself according to the time you have allotted for the interview.
Step 4: Present findings and key issues.


Present your observations of the process in plenary.
Present key issues that have emerged that should be addressed in nutrition or gender
interventions.
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Exercise 4: Understanding different aspects of gender-responsive programming
(Part 1)
What is the learning objective?
To become familiar with different gender-responsive interventions that can be used in different
situations.
When should this exercise be done?
After Exercise 3 and as part of a one- or two-day training course.
How long should this exercise take?
1 hour.
What materials are needed?
Pen and paper
Module 22, Part 2
Handout 4a: Women’s Contributions to Reducing Micronutrient Deficiencies
Instructions
Step 1: Prepare and give a 10-minute presentation using Module 22, chapter 4.
Step 2: Divide the participants into groups of a maximum of five people.
Step 3: Give handouts to each group covering the main areas.
Step 4: Give the groups 30 minutes to read the case study, answer the questions and prepare a
presentation of their answers.
Step 5: Give each group 5 minutes for feedback in plenary.
Step 6: Close the session by trying to reach a consensus on gender inventions to be used in these
case studies.
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Handout 4a: Women’s Contributions to Reducing Micronutrient Deficiencies
Time for completion:
60 minutes
Participants are organized into groups of five. They should be given 10 minutes to read the case study
below39 and a further 15 minutes to prepare answers individually followed by 20 minutes for a group
discussion in order to agree on the answers. Groups should then use the remaining time to write down
the answers to the questions below and present back to the plenary session.
Case study
A number of agencies have adopted gender-sensitive policies that aim to strengthen the role of
women in controlling intervention resources in emergencies. The rationale for such policies is
that the empowerment of women will contribute towards improving the impact of interventions.
The findings of a recent study in non-emergency situations lend some support to this approach.
The International Centre for Research on Women (ICRW), with partners in Ethiopia, Kenya,
United Republic of Tanzania, Peru and Thailand, implemented an intervention research
programme to find ways to strengthen women's contributions to reducing micronutrient
deficiencies. The pilot interventions focused on:

enhancing women's skills in and knowledge on food production, processing and
preparation methods and feeding practices in order to improve vitamin A intake in
Ethiopia;

promoting the adoption of new varieties of beta-carotene-rich sweet potatoes by women
farmers in Kenya and encouraging their consumption to improve vitamin A intake;

increasing women's access to and use of a modified solar-drying technology to increase
year-round availability of vitamin A-rich foods in the United Republic of Tanzania;

strengthening women's skills in decision making, problem solving and management in
order to improve the quality of services in Peruvian community kitchens and improve the
iron intake of members and other consumers;

strengthening women's problem-solving and leadership skills to organize communitybased interventions and thus reduce vitamin A, iron and iodine deficiencies in rural
Thailand.
39
Adapted from Field Exchange, Issue 20, Nov. 2003, p. 10; and Johnson-Welch, C. Explaining nutrition outcomes
of food-based interventions through an analysis of women's decision-making power. Ecology of Food and Nutrition,
41:21-34, 2002.
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All five country interventions achieved significant nutrition outcomes and succeeded in reaching
their nutrition objectives in less than 18 months, particularly in two specific ways: in terms of
entry point and in terms of decision-makers. The interventions from Ethiopia, Kenya and the
United Republic of Tanzania began by addressing women's practical resource needs as they
related to food production, care and feeding practices. The intervention research programmes in
Thailand and Peru began by building women's capabilities as problem solvers, decision makers
and community leaders, followed by developing nutrition-specific interventions that addressed
women's practical resource needs.
The Thailand and Peru studies took a total of 9 and 16 months respectively, while the other
studies took between 9 and 18 months. Even more remarkable was the time needed for the
nutrition-specific intervention in Peru, taking a mere four months to implement and demonstrate
equivalently significant results. The authors suggest that the relative efficiency and effectiveness
of the Peru and Thailand studies probably reflects who made the decisions. In the Peru and
Thailand cases, women applied their enhanced skills to make decisions about which problems
they needed to address and how to solve them, including the types of resources they needed and
means to access them. The development professionals served as facilitators and technical
resources, not as the primary decision-makers. In contrast, the decision-makers in the other
studies were the research team. While community members, including women, provided
information to the technical specialists and participated in the intervention trials, their decisions
were limited to the choice of whether or not to adopt a technology or modify a practice.
Investing in women's decision-making power and expanding their freedom of choice was an
efficient and effective way to achieve results.
Group Questions
1. In which countries were strategic gender needs addressed through the described
interventions? Which needs?
2. In which countries were targeted gender interventions implemented?
3. In which countries was there a high level of participation?
4. Was gender mainstreaming used in any of the countries?
5. Does the programme in which you work(ed) include targeted interventions? Do they
contribute to strategic or practical gender needs?
6. Which approach can be used or adapted for improving nutrition during a humanitarian
crisis?
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5. Case studies
Case studies presented in this section offer different real-life situations that differ in character. They
allow participants to think through real-life scenarios, and provide an opportunity for them to work in a
group and develop their analytical and decision-making skills.
Exercise 5: Understanding different aspects of gender-responsive programming
(Part 2)
What is the learning objective?
To practise conducting a gender analysis.
When should this exercise be done?
After Exercise 4 and as part of a one- or two-day training course.
How long should the exercise take?
1 hour and 15 minutes.
What materials are needed?
 Pen and paper
 Module 22, Chapter 5 (gender analysis)
 Handout 5a: Case study 1: A gender analysis of issues relating to community outreach work
in North Darfur
Instructions
Step 1: Prepare and give a 10-minute presentation using Module 22, Chapter 5 (gender
analysis).
Step 2: Divide the participants into groups of a maximum of five people.
Step 3: Give handouts to each group.
Step 4: Allow the groups 15 minutes to read the case study and 30 minutes to discuss the
answers to the questions, and prepare a presentation of their answers.
Step 5: Allow each group 15 minutes for feedback in plenary.
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Handout 5a: A gender analysis of issues related to community outreach work in
North Darfur
Time for completion: 60 minutes
Participants should be organized into groups of five and given 15 minutes to read the case study and a
further 45 minutes to discuss and prepare answers. Groups should then answer the questions below
and present back to plenary.
Background
A review of the community outreach work associated with community-based management of
acute malnutrition (CMAM) programmes was conducted in North Darfur in August 2009.40
Three sites were included ─ Abushok Internally Displaced Persons (IDP) camp, Zam Zam IDP
camp and the Shahid Health Centre, each in a different context. Abushok IDP camp was initially
set up by an international NGO, but handed over to the Government and is currently managed by
State Ministry of Health and the host population; Zam Zam IDP camp was run by an
international NGO; and Shahid Health Centre was managed by the Sudanese Ministry of Health
(SMOH).
It is common in the area for traditional healers to ‘treat’ undernutrition. In some areas, it is
believed that oedema is air under the skin and the swelling is burned to release the air. Other
practices include applying herbs and the use of Quranic verses. The use of traditional practices
delays referral to the health facilities and often only after complications occur, which require
admission to a stabilization centre.
Findings
CMAM outreach services at the three sites were reviewed using qualitative methods such as
discussions and interviews with a range of key personnel and beneficiaries. This was supported
by direct observation of the sites.
Abushok IDP camp: The CMAM services were set up some years ago by Action Contre la
Faim (ACF), but are now run by the SMOH. The community outreach worker (CW) and the CW
supervisor are employed on a full-time basis and are highly educated and well trained. Staff have
become demotivated and unhappy with changes in their employment conditions since the
takeover by the SMOH.
Zam Zam IDP camp: This IDP camp has two parts: Old Zam Zam, which has had CMAM
services since 2006, and New Zam Zam, in which CMAM was set up in 2009. They provide very
good models and are both managed by Relief International. The CW and the CW supervisor are
employed on a full-time basis. The community leaders are active and knowledgeable in
undernutrition.
40
FANTA II. Community Outreach for Community-Based Management of Acute Malnutrition in Sudan: A Review
of Experiences and the Development of a Strategy, 2010
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Shahid Health Centre: This government facility is managed by the SMOH and has offered
CMAM services since 2008. It is well staffed, and outreach is conducted once a week by a
trained team, but coverage is low. Resources for community outreach are limited with no
nutrition or health educational materials, limited stationery and poor record keeping. The Centre
reports that 25 per cent of admissions are from outside their catchment area.
Table 1: Outline of community outreach in the three sites
Abushok IDP camp
Zam Zam IDP camp
Shahid Health Centre
6 CWs – 1 male, part-time (PT)
1 nutrition educator, FT
3 midwives, FT
1 medical assistant, FT
Teams work together to cover
their operational area every 7
months. They carry out
outreach activities one day a
week.
No.of
commun-ity
outreach
workers
(CWs) and
scope of work
12 CWs and 1 supervisor,
full-time (FT)
They conduct outreach from
six sites across the camp. It
takes 45 days to cover their
area. The entire population is
not covered by the six sites.
Services
provided
In the past: home visits with
health and nutrition
education, and follow-up of
defaulters and nonresponders; assistance was
also provided in the clinic.
Currently: screening of
children attending health
clinics using middle upper
arm circumference (MUAC)
or weight for height.
Home visits: screening and
referral for community-based
management of acute
malnutrition (CMAM), medical
care and vaccinations, health
and nutrition education, followup of defaulters and nonresponders; weekly visits for all
in CMAM; occasional
community talks.
Home visits: screening and
referral for CMAM, medical
care and vaccinations, health
and nutrition education, followup of defaulters and nonresponders.
Referral
process
Printed referral.
Printed referral.
Hand-written referral addressed
to the health centre.
Data usage
Data available but no
analysis.
Data available but no analysis.
Data available but no analysis.
Records
Numbers referred each week
are recorded, but without any
feedback from supervisor.
Numbers referred each week are
recorded, with supervisor’s
feedback.
No data available. Staff report
that 25% of beneficiaries come
from outside the catchment
area.
Commu-nity
leader’s role
Active in the early stages in
awareness raising and
sensitization. No current
involvement.
16 CWs and 1 supervisor, FT.
CWs work in pairs to visit each
house in their area once or twice
each month.
Active in early stages of
program for awareness-raising
and sensitization
on CMAM services generally
and facilitation of home visits;
ongoing
involvement to meet with
COWs monthly; community
leader name
(sheik) added on referral form
so the leader can be contacted if
problem occurs.
Active in the early stages of
awareness-raising and
sensitization activities. No
current involvement.
Adapted from FANTA II. Community outreach for Community-based Management of Acute Malnutrition in Sudan;
A Review of Experiences and the Development of a Strategy, 2010.
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Answer the questions:
1. If you would be asked to conduct a gender analysis to further shed light on the issues relating
to community outreach in this case study, which methods would you use and how would you
prepare the gender analysis?
2. Which information gaps in the text provided need to be filled through the gender analysis?
Discussion point
There is no one single answer. Please refer to the ADAPT and ACT
Framework.
Exercise 6: Case study 2: How to protect against and prevent gender-based
violence
What is the learning objective?

To be aware of the main measures to protect against, and prevent gender-based violence
(GBV).
When should this exercise be done?
 Towards the end of the course.
How long should the exercise take?
 50 minutes.
What materials are needed?



Handout 6a: Case study 2: Gender-based Violence and the Use of Theatre in Burundi
6b Trainer’s notes: Answers
Handout 6c: IASC Guidelines on Gender-based Violence (Action Sheet)
Instructions
Step 1: Divide the participants into groups of five, and ask them to read Handout 6a and reflect
on the answers individually (10 minutes).
Step 2: Ask each group to discuss and formulate their response to the case study questions.
There are various possible answers. The purpose of this exercise is to raise awareness among
the participants on the different measures that can be used against GBV while learning about
innovative means of communication (e.g. theatre) (15 minutes).
Step 3: Hand out the IASC GBV Action Sheet and allow for another 10 minutes for the group to
complete their answers.
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Step 4: Ask each group to briefly provide feedback (10 minutes in total).
Step 5: Present the recommendations made in the real situation and the follow-up (See SEAGA
Matrix on Livelihood Analysis Tools).
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Handout 6a: Case study 2: Gender-based Violence and the Use of Theatre in
Burundi
Source: Zicherman. N., ‘It is difficult to escape what is linked to survival’: Sexual exploitation and food distribution
in Burundi, Humanitarian Exchange, No. 35, Nov. 2006.
Time for completion: 35 minutes plus plenary presentation
Participants should be organized into groups of five and given 10 minutes to read and reflect
individually on the case study below, and a further 15 minutes to prepare answers in the group.
Groups should then receive the Handout 6c, IASC Guidelines for Gender-based Violence Interventions
in Humanitarian Settings, complete the answers to the questions below (10 minutes) and present the
results to plenary.
Case study
CARE International has been a key partner of the World Food Programme (WFP) in Burundi since the
outbreak of the civil war in 1993, distributing emergency food aid to refugees, returnees, internally
displaced persons (IDPs) and others.41 As the security situation in the country has improved, the
programme has moved from a generalized emergency feeding to semi-regular targeted distributions.
Implementing partners and local government officials were responsible for identifying households that
met pre-established vulnerability criteria, and thus included in the beneficiary lists.
In light of various irregularities uncovered by field teams, CARE conducted a study between October
2004 and June 2005 to document whether sexual relations were being used as a means to access food aid,
and if so, to identify the reasons and mechanisms behind such abuse, as well as to develop strategies to
reduce the risk to beneficiaries.
Partnering with a local theatre group called Tubiyage (‘Let’s talk about it’), which has extensive
experience in facilitating community discussions on ethnic conflict, sexual violence, HIV/AIDS and other
sensitive subjects, the research team used interactive theatre techniques to introduce the subject in focus
groups and public fora, and to elicit testimonials from community members.
In the focus group discussions and semi-structured interviews, both victims and perpetrators confirmed
that sexual harassment and exploitation occurred in the food aid process. Exploitation occurred in secret
and was never discussed openly, certainly not during the public validation of beneficiary lists when
irregularities were to be identified.
Widows and other single women, either without husbands or without adult sons, were found to be
particularly vulnerable, because they had no adult males in the household to protect their reputation, and
no money to bribe the village heads to include them on the lists. Fear that they would be excluded from
the lists was the main factor that led women to submit to requests for sexual favours. The perpetrators
were generally those who established the beneficiary lists.
The participants in the theatre presentations and focus groups also unanimously confirmed the presence of
bribes and other forms of corruption. Participants in the study suggested procedures to reduce the
incidence of sexual harassment and exploitation of food aid beneficiaries.
41
Adapted from Module 19, Part 3, Handout 4a.
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Answer the following questions:
1. Was the use of drama an appropriate method for understanding the problems identified?
2. What recommendations should have been made by the participants to improve transparency
of the beneficiary list and avoid corruption and GBV?(Do not use Handout 6c,
IASC
Guidelines on Gender-based Violence Interventions in Humanitarian Settings
Action Sheet.)
3. This time using Handout 6a as a resource, identify other actions that should be carried out
in this case.
6b. Trainer’s notes: Answers
Recommendations:
•
•
•
•
Have an employee of WFP or CARE present during the creation of lists to ensure transparency.
Elect mixed gender committees of beneficiaries to monitor the creation of the list and food aid
distribution.
Ensure objectivity of the local administration in the creation of lists.
Ensuring that the list is validated publicly in every village with the active participation of women
and young people.
The study has proved to be a powerful tool for advocacy with WFP. Since sharing its findings, CARE has
been allowed to devote more human resources to monitoring the development and public validation of
lists, and has been experimenting with new approaches. These include separate validations with men
and women, and involving local partners, such as the Burundian Red Cross and the Catholic Church
Diocese Committees, who are helping CARE agents to monitor the targeting and the development of the
beneficiary list at the village level.
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Handout 6c: IASC Guidelines for Gender-based Violence Interventions in Humanitarian
Settings: Action Sheet
Source: www.humanitarianinfo.org/iasc/pageloader.aspx?page=content-subsidi-tf_gender-gbv
Background
Women and girls often face a different set of risks from men and boys during an emergency; one such
risk is food insecurity. Effective food security and nutrition strategies require an understanding of the
gender dimensions of crises in order to identify and assess gender-specific relief needs. The participation
of women in decisions about how to best implement food security and nutrition programmes is critical to
reducing the risks that women and girls face in emergency situations. Preventing gender-based violence
requires the application of the following principles in planning and conducting food distributions:
• The community is entitled to specific food aid benefits.
• There must be active participation of the community.
• All actions must be transparent, open and clear to all.
• All actors must facilitate access to food aid.
• All actors must ensure safety from violence and abuse.
Key actions
The following actions apply to the food security and nutrition sector; i.e. organizations implementing
food distribution and nutrition programmes. The food security and nutrition sector identifies a focal point
who participates regularly in the GBV working group and reports on the sector’s achievement of the key
actions. The focal point(s) of the food security and nutrition sector participates in cross-cutting functions
led by the GBV coordinating agencies and working groups, as described in Action Sheets for
Coordination, Assessment and Monitoring, Human Resources, and Information Education
Communication.
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1. Collect sex-disaggregated data for planning and
evaluation of food security and nutrition
strategies.
2. Incorporate strategies to prevent gender-based
violence in food and nutrition programmes at all
stages of the project cycle (including design,
implementation, monitoring and follow-up),
giving special attention to groups in the
community which are more vulnerable
to sexual violence.
• Target food aid to women- and child-headed
households. Women and children who are the
sole providers of the household are often at
greater risk of discrimination and violence. In
times of food shortage, women and children
are often at heightened risk of food insecurity
and malnutrition. Registering household ration
cards in the names of women rather than men
can help to ensure that women have greater
control over food and that it is actually consumed.
• Give special attention to pregnant and
lactating women, addressing their increased
nutritional needs.
• For polygamous families, issue separate ration
cards for each wife and her dependents. Often,
the husband will be considered a member of
one of the wives’ households. Traditionally,
many polygamous men and their wives believe
that the husband is entitled to meals from
each/any wife. Carefully consider how to
assign the husband’s food ration and give clear
information to all members of the family (i.e.
all wives).
3. Involve women in the entire process of
implementing food security and nutrition
strategies. Establish frequent and consistent
communication with them in order to understand
the issues that need to be addressed and resolved.
Women should participate in:
• the assessment and targeting process, especially
in the identification of the most vulnerable;
• discussions on the desirability and
appropriateness of potential food baskets;
• decisions on the location and timing of
food distributions, including both general
ration distributions and supplementary feeding;
• the assessment of cooking requirements and
additional tools, their availability within the
community, and the strategies in securing
access to those non-food-items. Special attention
should be given to this point since women
could be exposed to sexual violence in the
process of collection of these items (e.g. the
collection of firewood can put them in a vulnerable position if they have to travel very far
away or outside the camp).
4. Enhance women’s control of food in food
distributions by making them the household food
entitlement holder.
• Issue the household ration card in a woman’s
name.
• Encourage women to collect the food at the
distribution point.
• Give women the right to designate someone to
collect the rations on their behalf.
• Encourage women to form collectives to collect
food.
• Conduct distributions at least twice per month
to reduce the amount of food that needs to be
carried from distribution points.
• Introduce funds in project budgets to provide
transport support for community members
unable to carry rations from distribution
points.
5. Include women in the process of selecting the
location of the distribution point. Consideration
should be given to the following aspects:
• The distance from the distribution point to the
households should not be greater than the
distance from the nearest water or wood source
to the household.
• The roads to and from the distribution point
should be clearly marked, accessible, and
frequently used by other members of the
community.
• Locations with the heavy presence of men
should be avoided, particularly
those where there is liberal access to alcohol,
or where armed persons are in the vicinity.
6. Establish gender-balanced food distribution
committees that allow for the meaningful and
equal participation of women. Attention should be
given to the following aspects:
• Make sure food is distributed by a genderbalanced team. Provide packaging that facilitates
handling and can be re-used for other domestic
activities.
• Select the time of distribution according to
women’s activities and needs in order to permit
the organization of groups that can travel together
to and from the distribution point.
• Distribute food during the day. Leave enough
time for women to return to their homes during
daylight.
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7. Provide sufficient information on distributions
using a variety of methods to ensure
communication to everyone, especially women
and girls. Inform the community about:
• the size and composition of the household
food rations;
• beneficiary selection criteria;
• distribution place and time;
• the fact that they do not have to provide services
or favours in exchange for receiving the
rations;
• the proper channels available to them for
reporting cases of abuse linked to food
distribution.
8. Reduce security risks at food distributions.
Create “safe spaces” for women at distribution
points.
• Appeal to men in the beneficiary community
to protect women and ensure safe passage of
women from distribution sites to their homes.
• Ensure a balance in the sexes of those carrying
out the distribution.
• If necessary, segregate men and women
receiving rations, either by having distributions for
men and women at different times, or by
establishing a physical barrier between them
during the distribution.
• Assure that food distribution teams and all
staff of implementing agencies have been
informed about appropriate conduct, avoidance
of sexual abuse and exploitation, and
mandatory reporting. (See Action Sheet 4.3,
Implement confidential complaints mechanisms.)
• Create “safe passage” schedules for child
household heads.
• Begin and end food distribution during daylight
hours.
• Consider placing two women guardians (with
vests and whistles) to oversee off-loading,
registration, distribution, and post-distribution of
food. These women can signal to the security
focal point if there are problems.
9. Monitor security and instances of abuse in the
distribution point as well as on departure roads.
• Ensure that there are women staff from the
implementing agency present during food
distributions.
• Establish a community-based security plan for
food distribution sites and departure roads in
collaboration with the community.
• Establish a security focal point at each of the
distribution sites.
• Monitor security on departure roads and
ensure that women are not at an increased risk
of violence by carrying the food commodity.
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6. Field-based exercises
This section outlines ideas for exercises that can be carried out as part of a field visit. Field visits require
a great deal of preparation. An organization that is actively involved in community development
programming must be identified to host the visit – this could be a government agency, an international
non-governmental organization (NGO) or a United Nations agency. The agency needs to identify an area
that can be easily and safely visited by participants. Permission has to be sought from all the relevant
authorities and communities, and care taken not to disrupt or take time away from programming
activities. Despite these caveats, field-based learning is probably the best way of providing information
and teaching new skills that participants will remember.
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Exercise 7: Learning about Daily Activity Clocks
What is the learning objective?
To obtain practical experience of how to develop Daily Activity Clocks with separate groups of
men and women.
When should this exercise be done?
As part of an in-depth course.
How long should the exercise take?
0.5 day (excluding travel).
What materials are needed?
Pens, paper, clip board or flat sandy area and stones
Handout 7a: Trainer’s notes on how to develop Daily Activity Clocks
What does the trainer need to prepare?
Organize the field work for pairs who will create a Daily Activity Clock. This can be carried out in
refugee/IDP camps or in the community.
Work with the participants the day before the field work to develop key questions and practise
their communication skills.
Read Handout 6a and prepare a short presentation.
Instructions
Step 1: Give each participant a copy of Handout 7a and introduce the tool.
Step 2: Divide participants into pairs to carry out the field work. Be gender-sensitive. (In
traditional cultures, it may be preferred that women work with the women, and men with
the men.)
Step 3: Spend no more than 1-1.5 hours on the exercise.
Step 4: Allow the participants 1-1.5 hours to analyse their findings. Participants should
give each other feedback on their conduct during the group discussion (peer review).
Step 5: Bring all the participants together for 1- to 2-hour plenary feedback.
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Handout 7a: Facilitator’s notes on how to develop Daily Activity Clocks
Daily Activity Clocks42
Purpose: Daily Activity Clocks illustrate all the different kinds of activities carried out in one
day. They are particularly useful for looking at relative workloads between different groups of
people in the community, e.g. women and men, the rich and poor, the young and old.
Comparisons between Daily Activity Clocks show who works the longest hours, who
concentrates on a small number of activities, who must divide their time to carry out a variety of
activities, and who has the most time for leisure and sleeps. They can also illustrate seasonal
variations.
Process: Organize separate focus groups of women and men. Ensure that each group includes
people from different socio-economic groups. Explain that you would like to learn about what
they do in a typical day. Ask the groups of women and men to each produce their own clocks.
They should first focus on the activities of the previous day. They should draft an outline of all
the activities carried out at different times, and their duration. Plot each activity on a circular pie
chart to represent a clock. Activities that were carried out simultaneously should be noted, such
as child care and gardening.
When the clocks are completed, ask questions about the activities shown. Ask whether yesterday
was typical for the time of year. Note the present season, e.g. the wet season, and then ask the
same participants to produce new clocks to represent a typical day in the other season, e.g. the
dry season.
Compare: One of the best (and often entertaining) ways to introduce the Daily Activity Clock is
to start by showing what your own day looks like. Draw a big circle on paper and indicate what
time you wake up, what time you go to work, when you care for your children, and so forth.
There is no need to go into great detail, but it is important to illustrate that all kinds of activities
are included, such as agriculture work, wage labour, child care, cooking and sleep.
42
FAO/WFP Socio-Economic and Gender Analysis (SEAGA) for Emergency and Rehabilitation Programmes, 2005
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Exercise 8: Learning about gender-disaggregated Seasonal Calendars
What is the learning objective?
To obtain practical experience of how to develop gender-disaggregated Seasonal Calendars.
When should this exercise be done?
As part of an in-depth course, after exercise 7.
How long should the exercise take?
0.5 day (excluding travel).
What materials are needed?
Pens, a long roll of paper (e.g. wall paper), a clip board, or a flat sandy area and stones.
Handout 8a: Trainer’s notes on how to develop gender-disaggregated Seasonal Calendars
What does the trainer need to prepare?
 Organize the field work for pairs working on one calendar with a group of men or women.
This can be carried out in a refugee/IDP camp or in the community.
 Work with the course participants the day before the field work to develop key questions
and practise their communication skills.
 Read Handout 8a and prepare a short presentation.
Instructions
Step 1: Give each participant a copy of Handout 8a and introduce the tool.
Step 2: Divide participants into groups of two to carry out the field work. (Be gendersensitive: in traditional cultures, it may be preferred that women work with the women,
and men with the men.)
Step 3: Dedicate no more than 1.5–2 hours to the exercise.
Step 4: Allow the participants one hour to analyse their findings. Participants should
share feedback on how they conducted the exercise (peer review).
Step 5: Bring all the participants together for 1- to 2-hour plenary feedback.
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Handout 8a: Trainer’s notes on how to develop gender-disaggregated Seasonal
Calendars
Gender-disaggregated Seasonal Calendars
See Annex 6, Participatory tools for gender analysis43
Purpose: Seasonal Calendars are tools that help to explore changes in livelihood systems
taking place over the period of a year. They can be useful in exploring how to strengthen
livelihoods following emergencies and avoids time biases because they show what occurs in
different seasons; otherwise, there is a tendency to discuss only what has occurred during the
rapid assessment.
Seasonal Calendars can be used for many purposes: to learn about people’s workload at different
times of the year and how their incomes change in different periods as well as to show the
seasonality of other important aspects of livelihoods such as food and water availability.
Process: Work with a group of women and a group of men that produced the Daily Activity
Clocks. Explain that, this time, you want to learn about what people do in a year. Find a large
open space for each group. Calendars can be drawn on a large paper or can be traced in the sand
or on a dirt floor using stones or leaves for quantification. Draw a line all the way across the top
of the cleared space (or paper). Explain that the line represents a year and ask how people divide
the year, i.e. months and seasons. The scale to use is the one that makes the most sense to the
participants. Ask the participants to mark the seasonal divisions along the top of the line. It is
usually easiest to start the calendar by asking about rainfall patterns.
Ask them to put stones under each month (or other division) of the calendar to represent relative
amounts of rainfall (more stones equal more rain). Once the rainfall calendar is finished, you can
draw another line under it and ask participants to make another calendar, this time showing their
labour in agriculture (placing more stones over the periods of high labour intensity). Make sure
that the labour calendar and subsequent calendars are perfectly aligned with the rainfall calendar.
Different colours or different lines can be used to differentiate the tasks by men and women. This
process is repeated, one calendar below another, until all the seasonal issues of interest are
covered. Be sure to include calendars for food availability, water availability, income sources
and expenditures.
Ask the participants to put a symbol or sign next to each calendar to indicate the topic. As much
as possible, ask them also to describe the sources of food and income, and relevant details. Other
issues may be added according to the needs and interests of the participants, such as animal
diseases, fodder collection, fishing seasons, marketing opportunities and health problems, some
of which must be divided by gender.
43
FAO/WFP Socio-Economic and Gender Analysis (SEAGA) for Emergency and Rehabilitation Programmes,
2005.
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Field exercises
1. Facilitate the creation of the calendar by the community group, while paying attention to the
different gender roles (e.g. tasks carried out by men and women, who controls the resources).
2. Analyse the situation based on the calendars:
 What are the lean periods?
 What are the idle periods?
 Which foods are abundant and when?
 What are the available opportunities to improve food security of the community
concerned looking at food surpluses and other community resources and time
availability?
 Should men or women be assisted to develop food security activities?
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MODULE 22
Gender-Responsive Nutrition in Emergencies
PART 4: TRAINING RESOURCE LIST
The training resource list is the last of four parts contained in this module. It provides a
comprehensive list of reference material relevant to this module, including guidelines, training
courses and reference manuals. Part 4 provides background documents for training material.
What can you expect to find here?

an inventory of available guidelines and manuals listed alphabetically by agency name
with details about their availability;

an inventory of some of the most useful research and publications pertinent to the module
topic;

a list of known training resources listed alphabetically by agency name with details
about:
 overall content;
 intended use;
 target audience;
 expected duration of the course.
Guidelines and manuals
1. FAO (2005). Protecting and promoting good nutrition in crisis and recovery. Rome.
These guidelines were designed to further the development of a more strategic focus that
strengthens programme planners’ capacity to protect and promote good nutrition in crisis
situations.
Availability: Printed and pdf version, in English
Contact: http://www.fao.org/
2. HELP AGE and UNHCR (2007). Older People in Disasters and Humanitarian Crises:
Guidelines for best practice. London.
These guidelines describe best practices to meet the special needs of older people in
emergencies.
Availability: Printed and pdf version, in English
Contact: www.helpage.org/
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3. IASC (2003). Guidelines for HIV/AIDS Interventions in Emergency Settings. Geneva:
IASC.
These guidelines help individuals and organizations to address the special needs of HIVaffected people living in emergency situations.
Availability: Printed and pdf version, in English
Contact: http://www.unaids.org
4. ICRC (2008). Nutrition Manual for Humanitarian Action. Geneva.
This manual provides a comprehensive description of nutrition in emergencies for ICRC
staff.
Availability: Printed and pdf version, in English and French
Contact: www.icrc.org
5. ICRC and International Federation of Red Cross and Red Crescent Societies (2007).
Guidelines for cash transfer programming. Geneva.
These guidelines describe how to use cash and vouchers in multi-sectorial integrated
programming, planning and disaster response. They provide practical, step-by-step support
to the design and implementation of cash programmes.
Availability: Printed and pdf version, in English
Contact: www.ifrc.org
6. Médecins Sans Frontières (1995). Nutrition Guidelines.
These guidelines facilitate the application of fundamental concepts and principles necessary
for the assessment of nutritional problems and the implementation of nutritional programmes
in emergency situations. They are aimed at field workers and are presented in three parts.
Available: Printed format, in English, French and Spanish
Contact: www.msf.org
7. The Sphere Project (2011). Humanitarian Charter and Minimum Standards in
Humanitarian Response. Geneva.
The new edition of the Sphere Handbook takes into account recent developments in
humanitarian practice in water and sanitation, food, shelter and health, together with
feedback from practitioners in the field, research institutes and cross-cutting experts in
protection, gender, children, older people, disabled people, HIV/AIDS and the environment.
It is the product of an extensive collaborative effort that reflects the collective will and
shared experience of the humanitarian community, and its determination to improve on
current knowledge in humanitarian assistance programmes.
Availability: In English, French, Spanish, Arabic in hard copy; CD-ROM and electronically
via the Sphere website (below)
Contact: www.sphereproject.org
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8. UNHCR (1997). Commodity Distribution: A Practical Guide for Field Staff. Geneva.
This guide outlines procedures to assist UNHCR field staff and operational partners in the
design and implementation of systems for commodity distribution, needs assessment, the
planning of rations and the management of the logistics chain.
Availability: Printed version and pdf version from website, in English
Contact: http://www.unhcr.org
9. UNHCR (2003). Handbook for Registration. Geneva.
This Handbook provides guidelines on registration, documentation and population data
management in various operational contexts. It defines new standards and processes for
registration for managers and practitioners in a camp setting.
Availability: Printed version and pdf version from website, in English
Contact: http://www.unhcr.org
10. UNHCR (2007). Handbook for Emergencies, 3rd ed. Geneva.
This reference tool serves to strengthen a common understanding among the main key actors
in emergency situations.
Availability: Printed version and pdf version from website, in English
Contact: http://www.unhcr.org
11. UNHCR, UNICEF, WFP & WHO (2003). Food and Nutrition in Emergencies. Geneva.
This manual aims to strengthen the understanding of managers and practitioners to ensure
that the food and nutrition needs of affected populations are addressed appropriately.
Availability: Printed version and pdf version from website, in English
Contact: www.who.int/
12. UNHCR &WFP (2004). Integration of HIV/AIDS activities with food and nutrition
support in refugee settings: Specific programme strategies. Geneva.
This report provides practical guidance on integrating support activities for people with
HIV/AIDS among refugees and host populations into food and nutrition programmes. While
the guidelines focus mainly on refugees, internally displaced populations and asylumseekers, they are also applicable to host communities and other emergency-affected
populations.
Availability: Printed version and pdf version from website, in English
Contact: http://www.unhcr.org
13. WFP (2002). Emergency Field Operations Pocketbook. Rome.
This is quick-reference resource for all WFP staff engaged in the provision of humanitarian
assistance in the field. The Pocketbook provides: a brief aide-mémoire on relevant WFP
policies, guidelines and procedures; check-lists and data that may be useful for assessment,
planning, monitoring and problem-solving field visits; and cross-references to more detailed
guidance.
Availability: pdf version from website, in English
Contact: www.wfp.org
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14. WFP (2005). Food and Nutrition Handbook. Rome.
This manual is designed to enable staff to assess and analyse the nutrition situation in their
country or region. It aims to help manage the design, implementation, monitoring and
evaluation of interventions. It is designed as a stand-alone document, but can be used with
the WFP basic training course Nutrition in Emergencies. The manual provides a
comprehensive overview for planning, implementing and monitoring a food distribution.
Availability: pdf version from website, in English.
Contact: www.wfp.org
15. WFP (2006). Food Distribution Guidelines. Rome.
These are guiding principles of food distributions, including general food distribution, foodfor-work and vulnerable feeding.
Availability: Printed version and pdf version from website, in English
Contact: www.wfp.org
16. WFP (2008). Food Assistance in the Context of HIV: Ration Design Guide. Rome.
This guide has been prepared primarily for WFP programme officers in the field who are
responsible for designing rations for HIV programmes. It may also be helpful to other
agencies, including WFP cooperating partners, to help them understand the rationale behind
different WFP rations and to strengthen partnership.
Availability: pdf version from website, in English
Contact: www.wfp.org
17. WFP (2009). Cash and Vouchers Manual. Rome.
This manual defines processes, procedures, safeguards and standards to guide the use of cash
and vouchers in WFP.
Availability: pdf version from website, in English
Contact: www.wfp.org
18. WFP & UNHCR. Nutval. Rome: WFP.
Nutval is a spreadsheet application developed by WFP, UNHCR, University College London
and the IASC Global Nutrition Cluster for planning, calculation and monitoring of
nutritional value of general food rations. Nutval aims to ensure a nutritionally adequate
ration to minimize public health problems such as micronutrient deficiencies.
Availability: Excel spreadsheet, in English
Contact: www.nutval.net
19. WFP /UNHCR (1997). Guidelines for estimating: Food and nutritional needs in
emergencies. Rome: WFP.
These guidelines describe the rationale for increasing the ration from 1900 kcal to
2100 kcal, and describes the factors to consider when planning a ration.
Availability: Printed version and pdf version from website, in English
Contact: www.wfp.org
20. WHO & FAO (2002). Living well with HIV/AIDS: A manual on nutritional care and
support for people living with HIV/AIDS. Geneva.
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This manual provides practical recommendations for a healthy and balanced diet for people
living with HIV/AIDS (PLWHA) in countries with a low resource base.
Availability: Printed version and pdf version from website, in English
Contact: http://www.fao.org
21. WHO, UNHCR, IFRC & WFP (2000). The management of nutrition in major
emergencies. Geneva.
This manual aims to assist those involved in the management of major emergencies with a
nutritional component. It serves as a practical guide to measures needed to ensure that the
food and nutrition needs of disaster-stricken populations are adequately met.
Availability: Printed version
Contact: http://www.who.int/
22. WHO, WFP & UNICEF (2006). Preventing and controlling micronutrient deficiencies
in populations affected by an emergency: Multiple vitamin and mineral supplements
for pregnant and lactating women and for children aged 6 to 59 months. Geneva.
This is a joint statement, which provides practical suggestions to minimize the risk
of
micronutrient deficient disease (MDD).
Availability: Printed version and pdf version from website, in English
Contact: http://www.who.int/
23. World Vision International (WVI) (2008). Food Resource Manual: 2nd ed.
The core purpose of this manual is to equip those involved in the delivery and distribution of
food to better serve the poor and improve management and accounting for the food aid
resources, and to show good stewardship of the food aid resources entrusted to World
Vision.
Availability: Printed version and pdf version from website, in English, French and Spanish
Contact: http://www.wvifood.org/
Relevant Publications
1. ENN (2007). Review of the published literature of the impact and cost-effectiveness of
six nutrition related interventions. Oxford: ENN
This is a review of the published evidence for the impact and cost-effectiveness of six key
humanitarian interventions commonly implemented in emergencies, including general ration
distribution. It identifies gaps in the literature and suggests methodologies for filling them.
Availability: Pdf version, in English
Contact: http://www.ennonline.net/
2. ENN & Oxfam (2007). From food crisis to fair trade; livelihood analysis, protection and
support in emergencies. Oxford.
This technical paper collates and analyses recent experiences of livelihoods programming in
emergencies. Chapter 4 examines situations where food aid is not necessarily the right
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response to address food insecurity or impact of disasters on livelihoods.
Availability: Pdf version, in English
Contact: http://www.ennonline.net/
3. ENN and SCUK (2004). Targeting Food Aid in Emergencies. ENN special supplement.
Oxford.
This technical paper provides guidance on the design of food targeting systems in
emergencies including rapid and slow onset emergencies and responses aimed at emergency
preparedness, in acute and protracted settings.
Availability: Pdf version, in English
Contact: http://www.ennonline.net/
4. FANTA (2002). Use of Compact Foods in Emergencies: Technical Note 3. Washington
DC, USA.
This is a brief overview of the growth of compact foods in emergencies, which highlights the
key issues and considerations in the use of compact foods and identifies gaps. The focus of
this note is on compact foods used for the whole population in the initial stages of an
emergency.
Availability: Pdf version, in English
Contact: http://www.fantaproject.org/
5. HELP AGE & African Regional Development Centre (2001). Addressing the
Nutritional Needs of Older People in Emergency Situations in Africa: Ideas for Action.
London.
This technical paper brings together key issues affecting the nutrition of older people in
emergencies and suggests ways in which their rights and needs can be more effectively
addressed.
Availability: Printed and pdf version, in English
Contact: http://www.helpage.org/
6. Jaspars, S. (2000). Solidarity and soup kitchens: A review of principles and practice for
food distribution in conflict. HPG Report 7. London: ODI.
This technical paper discusses current principles and practice for food distribution in
conflict. It aims to assist humanitarian agencies in developing a more principled approach to
food distribution.
Availability: Printed and pdf version, in English
Contact: http://www.odi.org.uk/
7. ODI Core Team (1996). The international response to conflict and genocide: lessons
from the Rwandan experience, Study 3, Humanitarian Aid and Effects. Journal of
Humanitarian Assistance.
Of particular relevance is Chapter 5, which reviews the food distribution systems and draws
out important lessons learned and recommendations.
Availability: Printed and pdf version, in English
Contact: http://www.reliefweb.int
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8. ODI Humanitarian Policy Group (2010). Food aid and food assistance in emergency
and transitional contexts: A review of current thinking. London.
This report presents the findings of a review of changes in food aid and food assistance
policies and strategies within the international aid system; discusses the shift from food aid
to food assistance by key donors, United Nations agencies and non-governmental
organizations (NGOs); details changes in the context in which food assistance is provided;
and reviews changes in the international architecture and the delivery of food assistance.
Availability: Printed and pdf version, in English
Contact: www.odi.org.uk/work/programmes/humanitarian-policy-group
9. ODI Relief and Rehabilitation Network (1995). General Food Distribution in
Emergencies: from Nutrition Needs to Political Priorities: Good Practice Review 3.
London.
This review is chiefly concerned with assessing the need for food assistance, targeting,
planning and determining food rations, and the management and organization of the delivery
of general food rations.
Availability: Pdf version, in English
Contact: http://www.alnap.org/
10. WFP (2006) Targeting in Emergencies. Rome.
This policy document that reviews the definitions of targeting and WFP policies related to
targeting in emergencies discusses the process of targeting and targeting errors, and offers
recommendations for good targeting practice.
Availability: Pdf version from website, in English
Contact: http://www.wfp.org
11. WFP (2010a) Revolution: From Food Aid to Food Assistance. Rome.
This paper documents a compilation of state-of-the-art food assistance innovations by WFP.
It lays out both new tools and traditional responses that provide life-saving relief, improve
nutrition, enhance human capital and strengthen food markets, while supporting countryled food security strategies.
Availability: Pdf version from website, in English
Contact:http://www.wfp.org/
12. WFP (2007). Enhanced commitments to women to ensure food security. Rome.
This is a comprehensive study based on research in 48 countries showing how WFP has
implemented its 2003-2007 gender policy for managers planning a food aid intervention
targeting women.
Availability: Printed version and pdf version from website in English
Contact: http://www.wfp.org/
13. WFP (2010b) Nutrition Improvement Approach. Rome.
The Nutrition Improvement Approach was built on the 2004 WFP Nutrition Policy Papers
and 2008-2013 Strategic Plan to help WFP offices translate policy into reality.
Availability: Pdf version from website in English
Contact: http://www.wfp.org/
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14. WFP/IFPRI (2004). Rethinking food aid to fight AIDS. Rome.
This document reviews food aid strategies using an HIV/AIDS lens in order to reduce the
risk and mitigate the impact of the pandemic for managers planning an intervention to assist
HIV/AIDS affected people.
Availability: Printed version and pdf version from website, in English
Contact: http://www.wfp.org/
15. WFP/IFPRI (2005). Assessing the effectiveness of community based targeting of
emergency food aid in Bangladesh, Ethiopia and Malawi. Rome.
This study provides an overview of effectiveness of three community-based targeting food
distribution systems for managers planning community-based targeting systems.
Availability: Printed version and pdf version from website, in English
Contact: http://www.wfp.org/
Training courses
1. FANTA (2004). A Training Manual. Washington, USA.
A three- to five-day course is designed to enable African institutions to integrate issues on
nutrition and HIV and AIDS into their training programmes. The manual provides technical
content, presentations and handout materials, and can be used together with a set of
PowerPoint training modules.
Availability: Printed version and pdf version from website, in English
Contact: http://www.fantaproject.org/
2. FAO (1999). Field programme management: Food, Nutrition and Development. Rome.
The training package provides technical information, case studies and exercises to assist
field workers in carrying out the daily tasks, and aims to improve skills in solving
community nutrition problems. Participants learn to assist communities in identifying their
problems and planning, implementing and monitoring activities. All of the key elements
required to conduct a five-day course are provided in one package. It includes some good
examples for field workers involved in establishing community-based targeting food
distribution systems.
Availability: Printed version, in English.
Contact: http://www.fao.org/
3. FAO. Improving Nutrition Programmes: an Assessment Tool for Action (AT). Rome.
The most useful modules are on participatory monitoring, including methods for collecting
information and basic analysis and interpretation.
Availability: Printed and pdf version, in English
Contact: http://www.fao.org/
4. FAO & University of Western Cape (2004). User’s Training Manual: Improving
Nutrition Programmes - An Assessment Tool for Action. Rome.
This training manual was developed to enhance the capacity of the assessment team
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members to conduct nutrition programme assessments. It was founded on a common
understanding of concepts underpinning effective and sustainable community-based nutrition
programmes. The manual is divided into six topics to be covered over three to five days. It
can be adapted to the level of the learners involved and the amount of time available. A field
visit is recommended. Each topic consists of key issues, case studies, ideas for discussion
related to conducting an assessment, trainer’s notes and a set of handouts for learners. A
series of overhead transparencies have also been prepared to assist learners based on the
lessons learned from the assessment team’s experiences.
Availability: Printed and pdf version, in English
Contact: http://www.fao.org/
5. Nutrition Works & Feinstein International Famine Center, Tufts University (2007).
Sphere Training on Nutrition Module: Contents. Geneva: The Sphere Project.
These training modules aim to improve the technical capacity for humanitarian response in
nutrition. It is targeted for staff responsible for designing or monitoring nutrition-related
projects and to ensure an understanding of the scope and content of Standards in the Food
Security, Nutrition and Food Aid chapter of the Sphere Handbook, the key indicators and the
scientific and/or practical rationale behind these standards. The training modules include a
lesson plan, handouts and visual materials for each of the eight sessions. The general
nutrition support session assumes a working knowledge of the Sphere Handbook. A case
study, based on south Sudan in 1988, synthesizes information provided in the health and
nutrition sections of the Handbook, and can be used over an additional half-day to
consolidate learning. This course is designed to build technical capacity among mid-level
technical specialists.
Availability: Printed version and pdf version from website in English, French, Spanish and
Arabic
Contact: http://www.sphereproject.org/
6. UNHCR and ICH (2003). Micronutrient malnutrition-detection, measurement and
Intervention – training pack for field staff. Geneva: UNHCR.
This training course on micronutrient malnutrition consists of PowerPoint presentations,
handouts and photo cards aimed at raising awareness of micronutrient deficiencies. Useful
for managers planning food aid rations and must consider the risk of MDD.
Availability: Printed version and pdf version from website in English
Contact: http://www.unhcr.org
7. University of Nairobi, FSAU & FAO (2005). Training Package of Materials for the
Course Food and Nutrition Surveillance and Emergency. Rome: FAO.
This training course provides an understanding of the nutritional outcomes of emergencies
(malnutrition, mortality and morbidity) and also the causes of malnutrition and mortality in
emergencies (the process and dynamics of an emergency). The course has an operational
focus and incorporates relevant applied research. The course is divided into three parts.
Availability: Unknown
Contact: http://www.fsausomali.org/
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8. WFP (2000). Gender-sensitive Food Aid programme. Rome.
This is a training manual for WFP gender trainers.
Availability: Printed version
Contact: http://www.wfp.org/
9. WHO & FAO (2002). Nutritional care and support for people living with HIV/AIDS: A
training course. Geneva.
This is a training course for caregivers of PLWHA and their families, which focuses on
practical nutrition care and communication skills.
Availability: Printed version
Contact: http://www.who.int/
10. WFP & Feinstein International Famine Centre (2001). WFP Food and Nutrition
Training Toolbox. Rome: WFP.
This basic five-day training course on food and nutrition is aimed at providing participants
with a greater understanding of food and nutrition in relation to WFP’s work, and will
provide opportunities for participants to practise related basic skills. The course includes 13
sessions, two guides and training material: Trainer’s Guide, Workshop Organizer’s Guide
and Training Materials for Participants. It provides a comprehensive overview of issues
related to food aid.
Availability: Cannot be downloaded
Contact: http://www.wfp.org/
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