Download LIFT's policy note on nutrition in English here. In Myanmar here.
Background
Myanmar is one of the world’s 36 high-burden countries for chronic malnutrition, with up to 45 per cent of the poorest quintile of the population experiencing stunting. Malnutrition is particularly dangerous in a child’s first 1,000 days of life and limits future growth and development. Good nutrition is also essential for children to learn at school and for adults to perform at work, and it enables all individuals to cope better with shocks and setbacks.
One of the biggest challenges to achieving good nutrition is mobilising resources and political support for nutrition programmes and policies. At Union level Myanmar has embraced nutrition as a policy priority: in 2014, Myanmar joined the Scaling Up Nutrition (SUN) movement. In March this year, the President set up a Working Committee on Food and Nutrition Security (WCFNS), and a National Committee on Food and Nutrition Security (NCFNS) to plan and implement such commitments respectively.
LIFT's Approach
In 2015, LIFT, along with UN agencies, NGOs, government and other stakeholders, made substantial progress in stressing the need to invest in nutrition, particularly among women and children.
Improved nutrition was also formally prioritised in the new LIFT strategy (2014) as one of LIFT’s four major desired outcomes. The programmes LIFT developed in 2015 were designed to reduce stunting through multiple approaches. The number of implementing partners including nutrition in their projects has risen dramatically. Twelve LIFT grants awarded in 2015 are nutrition-specific or sensitive. Twelve organisations (World Vision, WHH-GRET, World Fish, Mercy Corps, Save the Children, International Organization for Migration, the UN Food and Agriculture Organisation, HelpAge, International Fertilizer Development Centre, Social Policy and Poverty Research Group, UN-HABITAT) include nutrition objectives in their projects. Ten new projects (International Organization for Migration, Mercy Corps, WHH-GRET, World Vision, Save the Children, HelpAge, International Fertilizer Development Centre, Social Policy and Poverty Research Group, UN-HABITAT) include nutrition promotion or education activities.
In 2015, new nutrition indicators were also integrated into the LIFT logical framework. Indicators include moderate stunting among children under five, children under five with diarrhea, households reached with nutrition-sensitive information, children 6-23 months with acceptable dietary diversity, exclusive breastfeeding, and utilisation of improved sanitation facilities and improved water sources. These nutrition-sensitive and specific indicators will allow LIFT to comprehensively measure nutrition achievements.
Although global evidence of the impact of nutrition on society continues to grow, data for Myanmar is limited. Globally, research shows that improving nutrition during a child’s first 1,000 days (conception until its second birthday) can boost gross national product by 11 per cent, increase wages by 5 to 50 per cent, reduce poverty, empower women, improve school achievement, and significantly reduce child mortality. Globally, for every USD 1 invested in nutrition, at least USD 16 will be returned through increased productivity and reduced health care costs. There are significant opportunities for synergy between nutrition-sensitive and nutrition-specific activities, and LIFT is well-placed to gather important evidence.
Maternal and child cash transfers: One of LIFT’s most significant nutrition interventions is the introduction of maternal and child cash transfers in Rakhine, the Delta and the Dry Zone. Starting in Rakhine in 2014, mothers were given a monthly stipend of MMK 13,000 (about USD 11) to buy nutritious food and access health services over the course of the first thousand days of a child’s life. In addition to cash, pregnant women and mothers learned about the importance of a varied and nutritious diet. Fifteen ‘control’ villages offered women education about nutrition and healthcare. Fifteen other villages provided the MMK 13,000 payment along with health-related behaviour change communication. Early qualitative results are impressive. Mothers receiving the transfers and behaviour change communications had heavier babies than mothers in the control group. In addition, exclusive breastfeeding amongst mothers in the intervention group doubled and stunting rates decreased by five per cent.
Based on the success of the pilot, similar projects are being introduced in the Delta and the Dry Zone. In total, maternal and child cash transfer projects of USD 14.5 million are being implemented by LIFT with over 54,000 mothers and children enrolled. Randomised control trials have been designed to measure the impact of the projects with the objective of determining the most cost-effective way to deliver the transfers and accompanying nutrition and health messages.
Download the maternal and child cash transfer policy note in English here. In Myanmar here.
Improving the evidence base: In 2015, the LIFT-funded LEARN consortium conducted a review of all data sources related to food and nutrition security in Myanmar over the past five years in order to better understand the linkages between food security, livelihoods and nutrition in the country as a whole, as well as in LIFT’s geographic focus areas. The links between child nutritional status and independent variables of programmatic importance to LIFT (such as income, livelihoods, food security, and water, sanitation and hygiene) were explored through a secondary analysis of nutrition-related data from the 2013 LIFT Household Survey. The report highlighted that while the rate of undernutrition in all LIFT areas is high, there are some key differences by zone. For example, the Uplands is characterised by very high rates of stunting and low levels of wasting, and diarrhoea is also more common in the Uplands than elsewhere. The report also found that diets of infants in Rakhine and the Delta are extremely poor, where almost no infants have an adequately diverse diet.
Improving access to micronutrients via staple foods: PATH is introducing and commercialising fortified rice. In collaboration with the National Nutrition Centre, the project is promoting direct purchase of fortified rice by consumers as well as distribution to existing food and nutrition programmes supported by the government and NGOs. Rice fortification (adding iron, zinc, niacin, vitamin B6, vitamin B1, vitamin A, folic acid and vitamin B12) is done in a hot extrusion process during milling, and is currently blended with local rice by six millers. (For more details see Annex 6).
Increasing positive nutrition practices: In addition to activities described in the relevant geographic sections (Chapter 3), the following national level activities were implemented in 2015:
LIFT funds a dedicated project, the Leveraging Actions to Reduce Malnutrition (LEARN) that advises LIFT partners how to improve the nutrition components in their projects. LEARN provides partners with nutrition-sensitive training, technical support and input for project design, as well as awareness raising activities to promote a comprehensive approach to the three food security pillars: food availability, access and utilisation.
LIFT and LEARN, in partnership with the National Nutrition Centre, held a media event in June for the local version that they produced of the Scaling Up Nutrition’s 1000 Days video. This resulted in the video being used as an advertisement on MRTV, MITV and MRTV 4, with the message translated into eleven ethnic languages for broadcasting. The audio is also regularly broadcast on Padamyar FM radio and City FM radio (listen here). The video was broadcast after the national anthem in cinemas in Yangon, Mandalay and Nay Pyi Taw.
LEARN worked with Padamyar FM to carry out nutrition programming on national radio, including live radio shows and short nutrition dramas from August to October.
In order to prevent the decline of high breastfeeding rates in Myanmar, in 2015 LEARN collaborated with stakeholders, including UNICEF and the Scaling Up Nutrition movement, to reinforce the government’s monitoring system for violations of the Order of Marketing of Breast Milk Substitutes.
By the end of 2015, LIFT projects had assisted nearly 196,000 households to gain better nutrition through the increase and/or diversification their food consumption.
Ending Malnutrition in the First 1,000 Days - In this short video, Roger Thurow of the Chicago Council on Global Affairs as senior fellow on global food and agriculture, chronicles four mothers and babies in Uganda, India, Guatemala, and USA to explain the importance of the 1,000 Days initiative to end early childhood malnutrition.
