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| Photo Credit: Wikipedia/Scanned from 1000 Fragen an die Natur, via The Metropolitan Museum of Art, Rogers Fund, 1948. |
In Pakistan, 44 per cent of children under the age of five are stunted while 15 per cent are wasted and 32 per cent are underweight (NNS, 2011). These statistics indicate that malnutrition is a serious problem in Pakistan - according to World Health Organisation classifications Pakistan falls in the ‘very high’ range for severity of malnutrition for all three figures. The occurrence of micronutrient deficiency is also alarmingly high with half of the population of children under 5 suffering from anaemia and vitamin A deficiency, while 39 per cent are deficient in zinc (NNS, 2011).
Despite the high proportion of the population that is involved in agriculture (45 per cent of the workforce) many rely on the market to purchase their food. Seventy-seven per cent of households are net buyers of wheat, the main food staple in the country. Good nutrition, however, is not just about having enough bread to fill your belly. It is about having a varied and nutritious diet with adequate levels of protein and micronutrients. And for nutritious foods the reliance on markets is even greater than it is for the main staples, in urban and rural areas alike. Understanding how markets can work better to deliver nutritious foods to the poor and undernourished, therefore, can help to improve diets and in turn nutrition.
Value chains as an approach
The value chain is a useful tool to study market based approaches to improve nutrition through food. It builds on the more familiar concept of a supply chain which is used to improve efficiency in business processes. The value chain, according Hawes and Ruel (2011) is “a supply chain in which value is added to the product as it moves through the chain. It is described by the series of activities and actors along the supply chain, and what and where value is added in the chain for and by these activities and actors.” So the focus of the value chain concept is on value addition by various activities and actors, and the concept has been used widely in development to enhance the achievement of particular policy goals, such as improving incomes of poor producers, or reducing the price of an essential good. In Pakistan, value chain interventions in agriculture have focused primarily on improving the livelihoods of small farmers. There is scope, however, of applying this same approach to reducing undernutrition by ensuring consumers are having nutrient-rich foods.
Prioritising infants and young children
The value chain approach provides a framework to study the channels through which food moves from the farm to markets and on to households. Within the household, with regards to nutrition, there is a need for a special focus on children under the age of two years. Nutritionist tell us that the first 1,000 days of a child’s life, beginning at conception, are the most critical in determining their nutrition outcomes throughout their lifetime, therefore ensuring that children up to the age of two have nutrient rich diets is an important objective. It is thought, for example, that stunting (or growth below potential) in this age is not reversible.
We are also told that the first six months after birth infants are to be exclusively breastfed. Therefore feeding children between the ages of 6 to 24 months, also known as Infant and Young Child Feeding (IYCF), is regarded a critical period for the introduction of nutrient-rich foods into the diet. By ensuring that children of this age group are consuming nutrient-rich food value chains have the potential to make an important contribution to improving nutrition outcomes.
We already know something about infant and young child feeding in Pakistan. According to the latest Demographic and Health Survey (DHS), most of them continue to be breastfed, as prescribed by health professionals, through to the age of two years. Complementary foods are dominated by food made from grain. Milk (other than mother’s milk) is the only nutrient-rich food that is present in the diet of any significant number of children. Few of them are fed other nutrient-rich foods such as fortified baby foods, Vitamin A-rich fruits and vegetables, eggs, and meat-based preparations.
A better understanding of value chains in grains, milk and fortified baby foods can help to identify the types of interventions and policies which can lead to improvements in the consumption of nutrient-dense foods by those that most need it. Grains, because these dominate complementary foods, and there are existing and proposed programmes for enhancing their nutrient density. Milk because it is the main nutrient-dense food in infant and young children diets, and fortified baby foods because there are well-established value in the private sector, and potential lessons there for public policy. Using value chains as an analytical tool not only helps uncover how market based approaches to delivering food can be strengthened but may also highlight where subsidies and social protection programmes are required.
Research exploring some of these concepts is currently underway (forthcoming LANSA Working Paper). We hope to share further insights and learnings as we proceed.
The value chain is a useful tool to study market based approaches to improve nutrition through food. It builds on the more familiar concept of a supply chain which is used to improve efficiency in business processes. The value chain, according Hawes and Ruel (2011) is “a supply chain in which value is added to the product as it moves through the chain. It is described by the series of activities and actors along the supply chain, and what and where value is added in the chain for and by these activities and actors.” So the focus of the value chain concept is on value addition by various activities and actors, and the concept has been used widely in development to enhance the achievement of particular policy goals, such as improving incomes of poor producers, or reducing the price of an essential good. In Pakistan, value chain interventions in agriculture have focused primarily on improving the livelihoods of small farmers. There is scope, however, of applying this same approach to reducing undernutrition by ensuring consumers are having nutrient-rich foods.
Prioritising infants and young children
The value chain approach provides a framework to study the channels through which food moves from the farm to markets and on to households. Within the household, with regards to nutrition, there is a need for a special focus on children under the age of two years. Nutritionist tell us that the first 1,000 days of a child’s life, beginning at conception, are the most critical in determining their nutrition outcomes throughout their lifetime, therefore ensuring that children up to the age of two have nutrient rich diets is an important objective. It is thought, for example, that stunting (or growth below potential) in this age is not reversible.
We are also told that the first six months after birth infants are to be exclusively breastfed. Therefore feeding children between the ages of 6 to 24 months, also known as Infant and Young Child Feeding (IYCF), is regarded a critical period for the introduction of nutrient-rich foods into the diet. By ensuring that children of this age group are consuming nutrient-rich food value chains have the potential to make an important contribution to improving nutrition outcomes.
We already know something about infant and young child feeding in Pakistan. According to the latest Demographic and Health Survey (DHS), most of them continue to be breastfed, as prescribed by health professionals, through to the age of two years. Complementary foods are dominated by food made from grain. Milk (other than mother’s milk) is the only nutrient-rich food that is present in the diet of any significant number of children. Few of them are fed other nutrient-rich foods such as fortified baby foods, Vitamin A-rich fruits and vegetables, eggs, and meat-based preparations.
A better understanding of value chains in grains, milk and fortified baby foods can help to identify the types of interventions and policies which can lead to improvements in the consumption of nutrient-dense foods by those that most need it. Grains, because these dominate complementary foods, and there are existing and proposed programmes for enhancing their nutrient density. Milk because it is the main nutrient-dense food in infant and young children diets, and fortified baby foods because there are well-established value in the private sector, and potential lessons there for public policy. Using value chains as an analytical tool not only helps uncover how market based approaches to delivering food can be strengthened but may also highlight where subsidies and social protection programmes are required.
Research exploring some of these concepts is currently underway (forthcoming LANSA Working Paper). We hope to share further insights and learnings as we proceed.
