86387 South Asia Gender Initiative Issue 5 – April 2014 Applying a gender lens to the Bank’s work in South Asia GENDER Matters for Undernutrition in South Asia T hough South Asia has experienced high economic Inclusive Nutrition Activities in South Asia: Volume II: Lessons growth during the last decade, it has the world’s highest From Global Experiences, surveys programs worldwide and com- rates of undernourished children – a gap known as the piles more than 30 case studies to identify short and long-term “South Asian Enigma.” Forty-two percent of all South Asian chil- intervention strategies that could be used to achieve the above dren under age five are underweight, compared with 23 percent four objectives shown in the figure on the next page. in West and Central Africa, the second worst region for malnu- trition (UNICEF 2012). Generally, the study finds that the most innovative, promising interventions are more comprehensive than traditional maternal Evidence suggests that gender, particularly women’s status, is an and child health programs. They include outreach to influential important factor in nutrition in South Asia, where women’s low members of the household through men and grandmothers and position and high levels of malnutrition exacerbate children’s nu- the community through its leaders. There have been a growing trition problems. Researchers have asserted that child malnutri- number of programs that incorporate behavioral change com- tion would drop 13 percent if gender equity were attained there munication strategies to do this, targeting messages toward spe- (Smith et al. 2003). cific actors in the community who will then use their training to enact change within their households. Conditional cash transfers The World Bank South Asia Region (SAR) is undertaking a (CCTs) have met with marked success in changing household number of research initiatives to improve gender-inclusive nutri- and community behaviors especially in Latin America. Mass me- tion interventions in the region. dia using radio and television continues to be an effective means In 2012, the Bank published Gender-Inclusive Nutrition Activi- to change community norms, and long term programs to keep ties in South Asia: Mapping Report, the first of a series that ex- adolescent girls in school and those to support women to earn an plores how gender can be more comprehensively incorporated income remain powerful means to improve nutrition outcomes. into nutrition interventions in the region in order to improve Having identified an array of strategies, the path ahead is to ex- the effectiveness these programs. The report finds that nutrition periment with these strategies to gather evidence on what works interventions rarely target adolescent girls, fathers, or elderly women. The report stresses that gender inclusive nutrition pro- and in what context. This work is already underway in Nepal grams would ideally increase (1) women’s household autonomy; where a gender aware behavior change communications (BCC) (2) household support for the woman and her own and her chil- is being designed for incorporation into two ongoing projects. dren’s nutrition; (3) community support for the woman and her The Nepal Community Action for Nutrition (Thousand Days) own and her children’s nutrition; and include (4) help for ado- Project and the Nepal Agriculture and Food Security Project lescent girls. both pilot the gender sensitive BCC program aimed at improv- ing infant care and feeding practices. This cross unit collabora- The second report in the series published in April 2013, Gender- tive exercise will rigorously evaluate the pilot implementation. 1 Autonomy Adolescents Households Community Intensive, participatory Use influential Help women earn Incentive for Parents Nutrition Education community members an income and to Keep Daughters (BCC) Targeted to all as nutrition promoters control it in School Household Members Provide Services to Use CCTS to Use mass media to Draw Adolescents: incentive disseminate nutrition Skills, Income HH Members messages Generating Activities (Caution) World Bank assistance: §§ $200 million for the Second Health Sector Development Project (SHSDP) to further enhance the quality of the health sector services in Sri Lanka. §§ $106 million for the Integrated Child Development Services Systems Strengthening and Nutrition Improvement Pro- gram (ISSNIP) to help combat persistently high rates of malnutrition in India. §§ $100 million to support the implementation of the Punjab Health Sector Reform Project (PHSRP) to improve repro- ductive health and nutrition in Pakistan. §§ $100 million grant for the System Enhancement for Health Action in Transition Project (SEHAT) to expand the scope, quality and coverage of basic health and essential hospital services in both rural and urban areas in 22 of the country’s 34 provinces in Afghanistan. §§ $46.6 million for the Nepal Agriculture and Food Security Project (NAFSP) to target the poorest and most vulnerable population groups in the mid- and far-western regions of Nepal with a view to improve food and nutrition security as well as livelihood opportunities. §§ $40 million for the Nepal Community Action for Nutrition Project (Sunaula Hazar Din) to improve attitudes and prac- tices known to improve nutritional outcomes of women of reproductive age and children under the age of two. For more information and to become involved in SAGE activities, please contact: Social Development Unit: Jennifer Solotaroff, Maria Correia, Indira M. Edwards, Dustin Smith Country Teams: Sector and Service Units: Afghanistan: Asta Olesen and Rebecca Haines PREM: John Lincoln Newman Bangladesh: Jessica Leino, Sabah Moyeen HD: Jessica Leino, Nkosi Mbuya, Yoko Nagashima Bhutan: Stefania Abakerli Finance/PSD: Martin Maxwell Norman, Sarah Iqbal India: Sangeeta Kumari SD: Parmesh Shah, Bernice Van Bronkorst, Luis Andres, Maldives: Parthapriya Ghosh Nishtha Mehta Nepal: Bandita Sijapati SARSQ: Zia Al Jalaly Pakistan: Mehreen Muqaddissa SAREX: Alison Reeves Sri Lanka: M. Razaak Ghani 2