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Poverty Reduction Poverty Reduction Cooperation Fund Projects Improving Nutrition of Poor Women and Children in Asia
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Improving Nutrition of Poor Women and Children in Asia
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Champion: Dr. Joseph M. Hunt, ADB's Advisor on Health, Nutrition, and Early Childhood Development, RSAN / RSDD
Team work in ADB: Project will be monitored by the Social Sector Division, SARD; and the Health, Nutrition, Population/Early Childhood Committee
Development Partners: International Rice Research Institute, International Food Policy Research Institute, International Center for Wheat and Maize Research (CIMMYT), International Center for Agricultural Research for Dryland Areas (ICARDA), National Agricultural Research Systems (Bangladesh, India, Indonesia, Pakistan, Uzbekistan, Philippines, Viet Nam), DANIDA, USAID, Micronutrient Initiative, Institute of Child Health (University of London), Waite Agricultural Research Institute, University of Adelaide (Australia), Pennsylvania State University
August 2002-December 2002
| Fact-finding | Concept Paper to RSDD | Appraisal Mission | DFID approval | ADB approval | Letter of Agreement signing | Implementation |
|---|---|---|---|---|---|---|
| July 2002 | 22 August 2002 | - | Expected in September 2002 | Expected in November 2002 | - | December 2002 - October 2003 |
Poverty situation: One of the striking characteristics of poverty in Asia is the high prevalence of micronutrient deficiencies among women and poor children that endanger life and health, and reduce life expectancy, cognitive potential of children, and wages of the labor force. The leading deficiencies are iron, zinc, and Vitamin A. Three quarters of the micronutrient-deficient persons are living in Asia, and the highest concentration live in South Asia. Micronutrient deficiencies affect well over a billion Asians who suffer from premature death, diminished mental development and chronic illnesses arising from poor health and nutrition. Many Asian countries, carrying a high burden of micronutrient malnutrition, have much reduced potential for both human and economic development. These nutrition problems are causes of poverty because they depress schooling achievement, wages, household incomes, and GDP. Despite many years of effort to solve these problems through public health programs, they persist at alarming levels. Eliminating these deficiencies through enrichment of staple foods is one of the most cost-effective and sustainable methods of raising human capital and thereby reducing poverty.
Anemia and Entrenched Poverty: It is estimated that 2.1 billion people globally are iron?deficient and that this problem is severe enough to cause anemia in 1.2 billion people. The problem for women and children is more severe because of their greater physiological need for iron. Of the approximately 500,000 maternal deaths that occur each year due to childbirth, mostly in developing countries, anemia is the major contributor or sole cause in 20 percent of such deaths. Iron deficiencies during childhood and adolescence impair physical growth, mental development, and learning capacity. In adults, iron deficiency reduces the capacity to do physical labor and earn income. In Asia, 60 percent of all pregnant women, half the women of reproductive age, and 40 percent of preschool children have iron-deficiency anemia. At the private level, iron deficiency anemia extracts an enormous toll. It contributes significantly to maternal mortality, cognitive impairment, decreased physical activity, and reduced immunity. All these factors inhibit income generation, and hence contribute to increased poverty. At the public level, the economic costs are also high. A recent study funded under the Asian Development Bank (ADB) TA 5671 derives conservative estimates of the forgone gross domestic product (GDP) as a result of iron deficiency anemia in childhood. For Bangladesh the economic cost of iron deficiency in children alone is nearly 2 percent of GDP. Yet, no effective and sustainable solution has been found to this enormous public health problem. Supplementation with iron tablets is expensive in terms of recurrent costs, and compliance is difficult due to the need to take the tablets at least once a week and due to consumer acceptability problems. The fortification of commonly consumed foods also requires further technological innovation to ensure good storage and cooking properties of fortified iron products. Diet diversity into iron-dense food sources such as dairy and livestock products will require large increases in incomes, increases that at current rates of poverty reduction will require 30 to 50 years to achieve.
Linkage to ADB Portfolio: The proposed activities under the PRF project complement other projects addressing nutrition of the poor in the ADB portfolio. The early childhood development project in Philippines has a key component on eliminating micronutrient deficiencies through fortification of staple foods that children consume; the Women's Health Project in Pakistan provides micronutrients to reduce maternal risks. The JFPR Project to "Improve Nutrition of Poor Women and Children" is fortifying iodized salt and iron-premix based wheat flour by providing production equipment, and capacity strengthening in food technology, regulatory and trade reform for the Central Asian Republics, Mongolia and Azerbaijan. And relevant to the PRF project, ADB is leading an effort to raise the nutritional content of rice germplasm, as described below. The PRF Project will enable Asian policy makers to make fully informed decisions, at the end of 2003, regarding the appropriateness of releasing micronutrient-enriched rice varieties through seed multiplication and distribution networks. The project also complements pilot investments and public- private-NGO partnerships for nutrition of poor children and mothers in Central Asia, financed under a Japan Fund for Poverty Reduction (JFPR) project ($6.85 million) with ADB.
Objectives: The broad objective of the plant breeding project (referred to as the "biofortification" strategy) is to develop high-yielding, high-profit, iron-dense rice germplasm adapted to growing environments in four Asian countries (Bangladesh, Indonesia, Philippines, and Vietnam) and to organize the institutions and financing necessary for generating a permanent flow of nutrient-improved rice technologies to Asian farmers in the future. The collaborating institutions are IFPRI, IRRI, the University of Adelaide, and the NARs of Bangladesh, Indonesia, Philippines, and Vietnam. The specific objectives are to (i) carry out agronomic research and human nutrition efficacy trials to increase the iron content of seed and iron bioavailability in rice diets; (ii) develop capacity at selected NARS (Bangladesh, Indonesia, Philippines, Viet Nam) for adapting iron-dense varieties to local growing conditions for eventual dissemination to farmers; and (iii) support economic research to demonstrate feasibility and cost-effectiveness of the plant breeding strategy, and prepare a regional investment plan for rapid dissemination of the seed technology into national production systems.
Targeting the Poor: The project targets the poor and reduces poverty in several ways. First, the agronomic advantages accruing to genotypes which are more efficient in taking up trace minerals from the soil and which load these trace minerals into the seeds, are realized primarily on trace mineral deficient soils -- that is, the less productive soils of less productive farmers. Second, and more importantly, it is women and children from the poorest households who suffer most from poor dietary quality. It is the poorest households who can least afford animal and fish products, which are the richest source of bioavailable minerals and vitamins in the diet. Treating anemia in women and children in these poor households lowers the risk of maternal mortality during pregnancy and childbirth, increases their capacity to perform strenuous chores, and improves the cognitive abilities and health of children. These outcomes all serve to improve individual welfare and to increase incomes of the poorest households in both the short-run and long-run. Poor women are benefited in particular because of the elevated requirements of women for iron during their reproductive years.
Sustainable Poverty Reduction and Development Impact: The combined benefits for human nutrition and agricultural productivity resulting from breeding staple food crops that are more efficient in the uptake of trace minerals from the soil and which load more trace minerals into their seeds, result in extremely high ex ante estimates of benefit/cost ratios for investments in agricultural research in this area. This finding derives from the combination of several complementary factors: (i) rates of micronutrient malnutrition are high in developing countries, as are the consequent costs to human welfare and economic productivity; (ii) high trace mineral density in seeds produces more viable and vigorous seedlings in the next generation, and efficiency in the uptake of trace minerals improves disease resistance and agronomic characteristics, which improve plant nutrition and productivity in trace mineral-deficient soils; (iii) a significant percentage of the soils in which staple foods are grown are deficient in these trace minerals, which has kept crop yields low; in general, these soils contain high amounts of trace minerals, but because of chemical binding with other compounds, the trace minerals are unavailable to the staple crop varieties presently used; (iv) farmer adoption and spread of nutritionally improved varieties can rely on profit incentives, either because of agronomic advantages on trace mineral-deficient soils or incorporation of nutritional improvements in the most profitable varieties being released; (v) because staple foods are eaten in large quantities every day by the malnourished poor, delivery of enriched staple foods (fortified by the plants themselves during growth) can rely on existing consumer behavior; (vi) benefits to relatively small investments in agricultural research can be disseminated widely, potentially accruing to hundreds of millions of people and millions of hectares of croplands; and (vii) breeding advances are derived from initial, fixed costs, with low recurring costs, and thus tend to be highly sustainable as long as an effective agricultural research infrastructure is maintained.
Convent Feeding Trial To Test Efficacy of Improvement in Iron Status: Intensive preparations have been undertaken by collaborators at the University of the Philippines at Los Banos, the International Rice Research Institute, the University of Adelaide, Pennsylvania State University, and Cornell University. 12 convents will participate, including 300 participants who, on a randomized basis, will be fed high-iron and low-iron rice varieties. Female field staff have been trained and are residing in each of the convents. Deworming has been completed. All subjects are presently consuming the low-iron rice. Baseline blood draws were initiated the first week of July and feeding of the high-iron rice began in mid July 2002.
The DFID-financed PRF will complete the policy framework for ADB's regional project on rice biofortification (loading micronutrients into rice seed) and initiate the next great challenge for the Asian region: Wheat Biofortification. This PRF Project will develop micronutrient-enriched rice and wheat for direct consumption by the poor. The Project directly addresses the Millennium Development Goals for reducing maternal and child mortality and reaching universal primary school enrollment and completion. The project is compatible with ADB's and DFID's strategic objectives for reducing severe poverty and hunger, which are interrelated.
The proposal has four components:
Inclusion of Vitamin A in the Rice Bio-fortification Project to include varieties that are rich in vitamin A in the program to enrich nutrition for poor children in Asia. Because of the importance of nutrient interactions, adding beta carotene to rice may do much to reduce iron-deficiency anemia. And it may be possible to breed beta carotene into rice using conventional breeding methodologies.(Vitamin A, iron and zinc mutually promote each other's absorption so the nutritional impact would be increased); Screening of 1200 rice varieties with beta carotene will raise the nutrition potential of the rice breeding project greatly because it will help eliminate Vitamin A deficiency responsible for child and mother deaths, and help the body absorb iron much better. The project's scientific advisor on germless screening, the Waite Agricultural Institute, Adelaide University, Australia, will carry out this activity. Appendix 1 briefly describes the component to screen IRRI germplasm banks for rices that contain beta-carotene naturally in the endosperm.
Infant Feeding Trial in Bangladesh using iron-enriched complementary food for infants from the Rice Biofortification Project to provide evidence that rice based food would reduce infant anemia and maternal mortality and raise infants' psycho-motor skills, enhance children's language (children 3-6) and reading abilities (children 6-8) substantially. Anemia is responsible for a large proportion of primary school drop-outs (1/3 of school entrants in many Asian countries). The trial will be community-based, with a matched set of control and experimental sites, and will use a semi-solid biofortified rice-based complementary food for infants 6-24 months. A nine-month trial is planned. The interventions will combine both feeding and early psychosocial stimulation and care as independent and integrated approaches to improving nutrition and pre-literate cognition in infancy. This will be the first trial of its kind in Asia. The project thus will address the Millennium Development Goal for Primary School completion. The Principal Investigator will be the Institute of Child Health, University of London (with established experience is testing methods to reduce anemia and benefits to cognition of young children), in association with the International Centre for Diarrheal Diseases Research, Dhaka, Bangladesh, and Department of Nutrition, Pennsylvania State University (co-P.I. for the adult women's feeding trial described above). A full proposal is being prepared for submission once this concept note is cleared. ICH (U.L. ) and ICDDRB, Bangladesh have already collaborated on field research in Bangladesh and are prepared to work on this project based on a successful experience.
Screening of Complete Wheat Germplasm Accession Banks for varieties with high micronutrient density, especially for iron. This will cover South and Central Asia, assisted by CIMMYT and ICARDA (2002-2003). Wheat is also major staple consumed in India, Pakistan, Afghanistan and Central Asia. It is important to diversify research activities into additional staple crops as well, both to reach malnourished populations reached by rice and to exploit synergies in lessons learned from research on two (or more) crops. Screening of wheat germplasm is justified on the same basis that rice has proceeded, i.e. wide range of micronutrients in wheat and no confounding gene-environment interactions so that good results in one ecological setting is probably replicable elsewhere. Initial activities are modeled after the experience already gained with rice. The proposal is further described in Appendix 2. Based on the results of this wheat screening, ADB and DFID may wish to partner in leading a three year Wheat Biofortification Project along the lines of rice, staring in 2004.
Policy Development to link the agricultural research to national food policy formulation that will prioritize dissemination of the rice and wheat biofortification strategies to all major rice and wheat producing nations, with a public-private partnership linking research to the seed industry's investment decisions. An investors' roundtable for rice biofortification is planned IV 2003, and DFID will co-sponsor this event and help lead the resource mobilization effort.
The Project Framework is in Appendix 3.
The rice and wheat germplasm components will be carried out by the national agricultural research systems in the selected Asian countries, in collaboration with IRRI (for rice) and CIMMYT/ICARDA (for wheat). The Waite ARI, Australia, consistent with the existing arrangement under the Rice Biofortification Project, will do the analysis. Three research partners, led by the Institute of Child Health, University of London, will execute the infant feeding trial. The Principal Investigator will be Dr. Sally Grantham-McGregor, the leading expert on infant nutrition and pre-literate cognition in developing countries. The co-investigators will be the ICDDR,B (Bangladesh) and the Pennsylvania State University. Established protocols of agreement will be employed as well as common protocols for ethical review of investigative research involving human subjects. ICDDR,B research staff will provide managerial support for the design, pretesting, and implementation of the field surveys. One possible site is the Matlab Thana, where intensive demographic and health survey research over a quarter century offers unparalleled opportunities to situate the study within a comprehensive household database. The Chair International Union of Nutrition Scientists, is also the Chair of the ICDDR,B Board, and has agreed to head a peer review panel to evaluate the project regarding likely benefits to infant and young child nutrition, including learning achievement.
The total project costs are estimated at $3.89 million, of which ADB proposes for financing under PRF 0.905 million, and the remaining coming from local and domestic research institutes and partners, and ADB. A detailed cost estimate for the 4 components is in the attached input-outcome matrix (Appendix 4). In case DFID has resources constraints to finance the whole fortification package in 2002, it is proposed to finance components 1+2 this year ($694,000) and the remaining component 3 and 4 ($210,000) in 2003.
DFID support is being sought for two reasons: (i) DFID's strategic paper on reducing hunger globally calls for innovative approaches that link agriculture and industry in a common objective, reducing hunger and poverty simultaneously - the biofortification research study is designed to do precisely that; and (ii) the project has identified additional activities that will link to the Millennium Development Goals for mothers and children (virtual elimination of mortality, universal enrollment and completion of primary schooling, and halving of global hunger and severe poverty). These activities cover both rice and wheat biofortification.
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