Elizabeth Whelan is a nutritionist managing the Leveraging Essential Nutrition Actions to Reduce Malnutrition (LEARN) Project, which is a consortium of Save the Children International, Action Contre La Faim and Helen Keller International to strengthen and develop more nutrition-sensitive food security interventions in Myanmar. Before joining Save the Children in November of last year, over the past ten years she has worked for Catholic Relief Services, Partners in Health, Tufts University, the Congressional Hunger Center and Action Contre La Faim in the Democratic Republic of Congo, Ghana, Kenya, Haiti and the United States.
The reason I work on the Leveraging Essential Nutrition Actions to Reduce Malnutrition (LEARN) project, which supports LIFT implementing partners in carrying out nutrition-sensitive programming, is because I believe in nutrition’s impact on wellbeing. My interest in nutrition started off, quite simply, with my love for food and my realization at a young age that not everyone gets to enjoy it. When I was a child my family lived in Zambia for five years, and for part of this time the country experienced a famine. By birth luck I was not hungry, but it was impossible not to notice those who were. So, as an elementary student I learned a basic lesson: we can’t take for granted that everyone has the quantity of food they need to be healthy, and if they don’t consume enough calories they will become malnourished. It seemed easy enough to understand, and straightforward enough to solve.
Some years later I graduated from college eager to do something productive in the world, so I decided to volunteer in rural Haiti. There, where the road ended in an economically impoverished village, was a small but bustling clinic where I worked on a therapeutic feeding program for children with severe acute malnutrition. During these two years, the straightforward view I had of the causes of malnutrition became far less so.
Most of the women who walked through the hospital doors looked exhausted. There was a vacant look in many of their eyes. Many had thin, wiry bodies while others were swelling with pregnancy and almost always had multiple children orbiting around them. They paid for the services with brown wrinkled bills when they could afford it and always, always, always had work waiting for them at home. The sick children they brought with them were often under five years old and many came with parasites, tuberculosis and acute respiratory infections. Many of the children were malnourished. Whether the illness (on top of poor diet) caused the malnutrition, or whether being hungry compromised their immune system, resulting in illness, was unclear. What was evident, though, were the tell-tale clinical signs of protein, energy and vitamin A deficiency. Their compromised immune systems, and often diarrhea, prevented them from absorbing what little nourishment they were probably getting.
The longer I spent doing nutrition work the more factors I learned contributed to under nutrition. For women, taking care of sick children meant time away from domestic chores, the field or paid work. Work meant time away from infants, which often meant they weren’t being exclusively breastfed, but families needed either the income or the food from the field so women had no choice. Undernourished mothers worked at a slower pace and in all likelihood were less productive in their fields. Families may have had to borrow money at the beginning of the planting season to buy seeds and sometimes were so hungry that by the time the corn was hard and green they were harvesting it for the family afternoon meal. The man, typically the head of the household, was served first and the most.
Sometimes there was a short time gap between pregnancies and as iron and protein rich foods tended to be expensive, women often couldn’t eat enough of them to stave off iron-deficiency anemia. The babies they gave birth to were born small and grew more slowly than they should have—and years down the line, those children too would likely be less productive, earn less money, and eventually their own children would be smaller. The little food families were able to save was not always properly stored, which meant it got moldy or infested with insects, but probably had to be eaten anyway even if the body ended up rejecting it. What little families did sell didn’t go for much because access to markets was limited. When households did have access to credit, the interest rates were high; in order to pay back loans they would sell valuables and productive assets, such as animals. If food was in short supply at home, so also was money for schooling—particularly for girls— or for medical care. The water used to clean the pots and plates for family meals was dirty and soap was rarely used. As a result, diarrhea and illness frequented their homes, particularly among the youngest family members. Back to square one.
Despite the fact that the narrative I describe above is from the other side of the world, the themes probably sound familiar to you. Where malnutrition rates are high, such as Myanmar, we often run into a similar web of immediate, basic and underlying causes of under nutrition. Yes, there are nutrition specific interventions that have proven to be extremely cost effective. However, not everyone is running nutrition specific programs and if they did, quite frankly, we’d be missing out on so many opportunities to prevent malnutrition rather than suffer its consequences. Nutrition sensitive interventions, which do not specifically address food intake or disease (the immediate causes of undernutrition) but address the diverse underlying and basic causes of malnutrition, can be just as valuable.
It is precisely for this reason that LIFT has raised the profile of nutrition by including it in its very purpose and identifying improved nutrition of rural women, men and children as one of the four main outcomes to achieve through LIFT partner programming. The 2014 – 2018 LIFT strategy states that in Myanmar:
Food poverty and malnutrition rates are high. Over 35% of children are stunted and poor households spend over 70% of their income on food, with one-third of rural households borrowing at some point during the year in order to buy food. This severely constrains their capacity to invest in productive livelihoods now and impacts on their future economic opportunities; stunting is highly correlated with poor educational performance and reduced income earning capacity later in life.
The key to LIFT’s success in this is finding out how program activities can best contribute to achieving one or more positive nutrition outcomes. When field agents are working with a group of mainly male farmers, can the field agents be educated to provide a five minute education session to those fathers (and future fathers) on why it’s important for pregnant and lactating women to eat diverse foods? In aquaculture activities, is it possible to promote varieties of small fish which are more likely to be consumed by women and children rather than sold along with other fish varieties? When doing a cash for work program are there actions that can be taken that allow new mothers to participate without jeopardizing their ability to exclusively breastfeed? When targeting beneficiary households, can the program target those with pregnant and lactating women and children under 2 (in the critical 1000 day window)? When distributing, promoting or subsidizing seeds, can the nutrient density of those foods be factored into seed selection? Is it possible to provide hygiene training related to livestock rearing to prevent the spread of zoonotic diseases to humans? The list goes on.
The LEARN Project, a consortium of Save the Children International, Action Contre La Faim and Helen Keller International, exists to build the capacity of LIFT implementing partners in carrying out nutrition-sensitive programs. We are available to work with you in multiple ways. Our team can provide training sessions for your staff on how to make projects more nutrition sensitive. We can support integrated food security & nutrition assessments; carry out project site visits and provide feedback on upcoming proposals; and share IEC and guidance material related to nutrition‐sensitive programming. To request training or support for your LIFT funded project, please contact me at elizabeth.whelan@savethechildren.org or Saw Eden, Deputy Program Manager at saw.eden@savethechildren.org.
