Webex title: Integrating Nutrition Specific with Nutrition Sensitive: the case for agriculture, gender and WASH
WebEx date: December 4, 2013
Presenters: Bethann Cottrell, Lenette Golding, & Mary Lung'aho

Power Point Presentations




Click the link below to play the recorded audio from the Webex

https://care.webex.com/care/lsr.php?AT=pb&SP=MC&rID=75788392&rKey=f6eb9f64b5837e71

Q & A from the Webex


Gender-related questions and answers

1. I agree that culturally, most taboos are based on animals and the respective animal protein is restricted to the individual woman/women and/or children. In my country we also have totems that are mainly animal based and it is taboo to eat meat from your totem animal. I think with education on different animal sources, people will have a choice. For example if its taboo to eat chicken one can select from other sources like fish, pork, goat, sheep, rabbits, beef, turkey etc…the list is long for one to choose. Taboos are there but I think they can be overcome by providing choices from different animal sources
This is really interesting and promoting what is already feasible and acceptable sounds like a great place to start. We’ve come across all kinds of taboos that restrict the foods pregnant women, lactating women and young children are able to eat according to what is socially acceptable. In our nutrition work and certainly with Nutrition at the Center, we aim to address taboos that restrict eating certain healthy foods while also working to encourage a healthy diet based on foods that are already acceptable.

2. Some women seek health services at will but before leaving their households, they inform those they stay with so that their whereabouts are known. These women will not be asking for permission to go for health services but is just courtesy to let other family members know where they are. Can we safely say these women are empowered? There are some who inform family members so that they are assisted with user fees for health services...in which category do these women fall?
Measuring empowerment is tricky in general, and so it can be hard to comment on women’s empowerment by any simple question. However, this is where a mix of methods may be useful. We encourage COs or teams to try to understand what empowerment means for women themselves, by asking them at the start of projects, examined against broader analysis of the context, gender relations of a particular place. Some ideas on ways to approach understanding empowerment are on the Gender Toolkit.

Mobility as a construct of women’s empowerment seems to be one of the trickier categories. There can be confusion about where mobility autonomy overlaps with decision-making autonomy. Additionally, other factors such as safety concerns can impact how a woman responds to questions related to her mobility (if unsafe, a woman may choose not to travel alone, even if it is acceptable to do so).

Qualitative measurements can be used to build a rich picture of the situation of women and men in terms of spaces. Social mapping can be a useful exercise for this, mobility analysis exercises, or exercises to increase understanding of what access women have to different social networks and services to advance their rights and interests.

Additionally, Nutrition at the Center (N@C) incorporated quantitative measures into its baseline survey that aim to assess women’s mobility. N@C used a modified version of the WE MEASR tool, a quantitative tool developed by CARE to assess women’s empowerment in health programs. The mobility section includes a series of questions, phrased in terms of ‘can you go...’ For example, ‘Can you go to the market to buy or sell things on your own, only if someone accompanies you, or not at all?’

This set of questions aims to assess the extent to which a woman has the freedom to move as she desires. Therefore if a woman is alerting her family of her whereabouts or informing her family and seeking financial assistance for payment, as long as she has the freedom to move as she wants, she would be considered empowered in terms of mobility autonomy. This touches on other areas of empowerment such as the ability to access and use financial resources and exercise decision-making power to seek health services when needed.

Food Security-related questions and answers

1. Speaking of micro-rich varieties, I'd be interested to hear the group's opinion on genetically modified crops, such as "Golden Rice".

2. I would also be interested to hear something about specific model adjustments in an urban setting.

3. Lancet said a major gap in nutrition sensitive work is lack of intentional, well planned M&E. Can you talk to that point? What to monitor, and how?

4. Do you have any specific suggestions on M&E?

5. How to integrate nutrition in the implementation of a community project?

6. Have someone who implemented nutrition activities in a cocoa producing communities ? if yes share strategy of implementation with me, please


WASH-related questions-related questions and answers

1. My concern is on the protected play spaces. In the African rural setting, there are animal droppings everywhere and on household yards that are generally swept on daily basis (usually once a day in the morning ). Animal droppings (cow dung; goat, chicken, rabbit droppings) are used as manure for backyard gardens and in fields. How best can the children have protected play spaces?
Yes, in areas where livestock are not penned or contained, animal feces is often present in households and yards despite daily or regular sweeping. Cornell University has conducted research in various settings suggesting that, because letting animals roam is often an economic decision, creating an enclosed, and protected space for children to play is a more feasible action for ensuring their separation from fecal exposure. A ‘protected play space’ is an area that is enclosed in such a way as to prevent animals from entering and defecating, or bringing in feces from the surrounding environment - thus isolating infants from animal feces. An ideal protected play space is one that has the following characteristics: 1) a blanket or flooring to protect infants from contact with a dirt or earthen floor, 2) an enclosed space into which animals cannot enter, and infants cannot exit without assistance, 3) a space that is easily kept clean from (wiped of) dirt and feces.

2. I have a donor doesn't want to prioritize WASH as part of a nutrition program, but wants to know what if any WASH elements we would naturally incorporate into an agriculture/nutrition program. So although this is not a core focus, are there specific WASH aspects we do routinely (or should do routinely) and what might they be? e.g., blending WASH messaging with a BCC strategy?
WASH is an essential element of ensuring nutrition outcomes – by enabling food production and increasing dietary diversity through household gardens and smallholder agriculture, as well as decreasing incidence of environmental enteropathy, diarrheal and other diseases that inhibit nutrient absorption via the intestines, particularly among children. In this sense, increasing access to water for productive uses and small-scale irrigation can help to ensure reliable and diversified food production at the homestead. Ensuring that households have access to, and use, a safe and clean latrine, and that children and mothers wash their hands with soap at critical times, are both essential to decreasing fecal exposure among children at the household level. At the macro level, nutrition outcomes have been shown to be tightly correlated with access to household sanitation.

In general, there is a need to better incorporate and leverage WASH activities in nutrition programs, though how nutrition programs can feasibly tackle all the important elements of WASH is a tough question. BCC strategies intended to increase hand-washing behaviors is a WASH program element that is commonly, cheaply, and often very successfully, incorporated into both nutrition and food security/agriculture programs. In Bangladesh for example, CARE’s SHOUHARDO program, USAID’s SPRING program (HKI and Save the Children), and the BMGF-funded Alive and Thrive program all emphasize hygiene elements such as, 1) educating mothers and farmers on the importance of good hygiene practice, 2) incorporating WASH and hand-washing BCC messaging into nutrition messaging and agricultural best practices, and 3) encouraging households to build and sustain simple hand-washing stations (tippy-taps) and place them in key areas within the house. Though directly impacting household sanitation uptake may not be feasible, conducting joint advocacy in concert with other health and WASH stakeholders, towards increasing public attention to and investment in household sanitation may be an area of strategic programmatic overlap. Similarly, broader environmental sanitation is an area commonly neglected by both the WASH and health sectors, and BCC materials and activities that encourage the identification and removal of human and animal feces from the home and yard is an area where nutrition programs can fill a clear programmatic gap.

3. How to ensure that sanitation issues are in place where water is seems as a big problem?
This is a really tough question. Ideally, all households should have access to a safe, clean, private latrine, and enough water for household-use to ensure good hand-washing and hygiene practices in the home. Latrines should be designed and constructed carefully so as not to contaminate groundwater in areas where the water table is high. In reality however, access to water and to appropriate sanitation don’t always go hand in hand; some households have access to water without sanitation, or vice versa, while some households have access to neither. Since both access to sanitation and to water (largely to encourage good hygiene habits) are important to nutritional outcomes, facilitating the work of WASH sector stakeholders, and ensuring that households invest in both water and sanitation access is an important element of the nutritional impact of programs.