a review of food security and human nutrition issues in nepal
DESCRIPTION
Report by Gerald Shively.Nepal faces multiple development challenges, including chronic andwidespread food insecurity and adult and child malnutrition. Due to population growth, agricultural stagnation and a range of institutional failures, the threat of a serious food crisis in Nepal is substantial. The recent scaling back of WFP assistance means that food security conditions in some parts of Nepal will undoubtedly worsen in the near future. This paper presents a brief review oftopics and available evidence regarding food security, malnutrition and related subjects in Nepal. It is intended to document important source material and provide an overview of topics for non‐specialists or those moving into new areas of concern.TRANSCRIPT
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AReviewofFoodSecurityandHumanNutritionIssuesinNepal
GeraldShively,JaredGarsandCelesteSununtnasukDepartmentofAgriculturalEconomics
PurdueUniversityWestLafayette,IN47907
September28,2011
ABSTRACT.Nepalfacesmultipledevelopmentchallenges,includingchronicandwidespreadfood insecurityandadultandchildmalnutrition.Duetopopulationgrowth,agriculturalstagnationandarangeofinstitutionalfailures,thethreatofa serious food crisis in Nepal is substantial. The recent scaling back of WFPassistance means that food security conditions in some parts of Nepal willundoubtedlyworsen in thenear future. This paperpresents abrief reviewoftopicsandavailableevidence regarding foodsecurity,malnutritionand relatedsubjects in Nepal. It is intended to document important sourcematerial andprovideanoverviewoftopicsfornonspecialistsorthosemovingintonewareasofconcern.
Thisworkwasmadepossible through supportprovidedby theBureauofEconomicGrowth,AgricultureandTrade,U.S.AgencyforInternationalDevelopmentthroughtheGlobalNutritionCollaborative Research Support Program. The opinions expressed herein are those of theauthorsanddonotnecessarilyreflecttheviewsofthesponsoringagency. PatrickWebbandShibani Ghosh provided helpful suggestions and input on an earlier draft. Please directcorrespondencetoshivelyg@purdue.edu.ThisisPurdueUniversityDepartmentofAgriculturalEconomicsStaffPaper1105.
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1.Introduction
Nepalfacesmultipledevelopmentchallenges,includingchronicandwidespreadfoodinsecurity
andadultandchildmalnutrition.Asaresultofrapidpopulationgrowth,agriculturalstagnation
andarangeofinstitutionalfailures,thethreatofaseriousfoodcrisisinNepalissubstantial.1
Nepalsmostrecent(2010)GlobalHungerIndex(GHI)scoreis20,whichplacesit27thoutof84
rankedcountries;westernregionsofthecountryscorefarlower(HollemaandBishokarma,
2009).Governmentexpenditureonagricultureiscurrentlythelowestithasbeenindecades,
andthecountryhasrecentlyexperiencedsubstantialfoodgraindeficitsof225,000mtin2007
and133,00mtin2009(Hobbs,2009).TheWorldHealthOrganization(WHO)placesthecurrent
malnutritionrateatcrisislevel,andarecentWorldFoodProgram(WFP)reportnotesthat
thecountrysuffersfromtheworstmalnutritioninAsia,onparwiththeDemocraticRepublicof
theCongo,Sudan,Uganda,andSomalia(Hobbs,2009).Withmorethan3.5millionpeople
moderatelytoseverelyfoodinsecure,manyoftheminregionsgeographicallyremoteand
difficulttoreach,foodaidhasplayedaprominentandgrowingroleinmeetingfoodneedsin
recentdecades(Frankenbergeretal.,2010).However,accordingtorecentmediareports,
reducedfundingresultingfromtheglobalfinancialcrisishasforcedcutsinmanyfood
assistanceprojects.ThescalingbackofWFPassistance,includingthehaltofhelicopterandair
operationsusedtoflyaidintoremoteregions,isprojectedtodecreasethenumberofthose
1ThemajorityofdistrictsinNepalwereestimatedtobefoodinsecurein2007,andthirteendistrictsreportedannualpercapitacerealproductionbelow150kg/person.IndecreasingorderofdeficitthesedistrictsareKathmandu,Humla,Lalitpur,Bajura,Achham,Dolakha,Bhaktapur,Mahottari,Kalikot,Baitadi,Bajhang,DolpaandRautahat.Inaddition,fourteenotherdistrictshadpercapitacerealproductionbetween150kg/personand180kg/person,significantlybelowthenationalaverageandbelowthelevelconsideredtheminimumrequirementforsufficiency(FAO/WFP,2007).
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receivingfoodaidfromonemilliontoapproximately100,000,2suggestingthatfoodsecurity
conditionsinsomepartsofNepalwillundoubtedlyworseninthenearfuture.
Thispaperpresentsabriefreviewoftopicsandavailableevidenceregardingfood
security,malnutritionandrelatedsubjectsinNepal.Itisbynomeanscomprehensiveinits
scopeorcoverage,butisintendedtodocumentimportantsourcematerialandprovidean
overviewoftopicsfornonspecialistsorthosemovingintonewareasofconcern.Thematerial
isorganizedunderaseriesofbroadthematicheadings,althoughitisimportanttorecognize
thatmostofissuescoveredinthepaperareinterconnectedbothintheircausesandtheir
impacts.Throughoutthepaper,referenceismadetodataderivedfromtheNepal
DemographicandHealthSurvey(NDHS).DHSsurveydataforNepalareavailablefor2001and
2006.Bothsurveysarenationallyrepresentative,georeferencedandpubliclyavailable(see
theAppendixfordetails).Acurrentroundofthesurveyisbeingcollectedatthetimeof
writing,andwilllikelybemadepublicinthenext1218months(byearly2013).TheDHSdata
providethemostcomprehensiveassessmentofnutritionoutcomesavailableforNepal.
2.Malnutrition,FoodInsecurityandHealth
Nepalisoneoftheleastwellnourishedcountriesintheworld.Accordingtodatafromthemost
recentNepalDemographicandHealthSurvey(NDHS,2006),halfofallNepalesechildrenunder
theageoffivehavealowheightforageorsufferfromstuntingasaconsequenceofchronic
2SeereportsbyABCandBBCathttp://www.abc.net.au/pm/content/2011/s3220545.htmandhttp://www.bbc.co.uk/news/worldsouthasia13422384.TheWFPprograminNepalisdescribedathttp://www.wfp.org/countries/Nepal/Operations.
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malnourishment.Approximately40percentareunderweight.Thehighestratesofhungerare
foundintheFarandMidWesternHillandMountainregions.AccordingtoHollemaand
Bishokarma(2009)HungerIndexscoresintheseareasofNepalareclosetoorabove30,andno
subregionfallsintoeitherthemoderatehungerorlowhungercategories.Evenso,anddespite
ahighlyunstablepoliticalenvironment,Nepalhasmadestepstowardsachievingimproved
healthindicatortargetsasidentifiedinthecountrys10thfiveyearplanningperiod.These
includereducingchildandmaternalmortalities(WorldBank,2010).AsFAOdatapresentedin
Figure1indicate,boththenumberandtheproportionofundernourishedpeopleinNepal
peakedin1998.Nevertheless,about15%ofthepopulationremainedundernourishedasof
2005.RecentdataprovidedbytheNDHS(seeFigure2)showasignificantdeclineinthe
percentofchildrenwithstuntedgrowthandamodestdeclineinthepercentofchildrenthat
areunderweight.Despitethesegains,theMillenniumDevelopmentGoaltoreducethe
proportionofunderweightchildrenby50percentbefore2015remainselusive.ArecentUnited
NationsChildrensFund(UNICEF)reportshowsthat69percentofNepalesechildrenare
severelydeprivedofoneormoreofthesevenbasicnecessitiesincludedintheBristolindex
(sanitation,information,water,shelter,food,education,health)and38percentareseverely
deprivedoftwoormoreoftheseindicators,whichisconsideredamarkerofabsolutepoverty
(UNICEF,2010).Ofparticularconcernaretheindicatorsofmalnutritionandsanitation.More
thanhalfofallchildrenbetween0and17monthsofagelackaccesstoanykindoftoiletand
sufferfromthecombinedeffectsofinsufficientnutritionandpoorhygiene(UNICEF,2010;
Kohleretal.,2009).
UndernutritionisanationwideprobleminNepal,butdisparitiesacrosssocioeconomic
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groupsandecologicalregionsaremaskedwhenlookingatnationalaggregates.Asanexample,
54percentofchildrenunderagefivewerefoundtobeunderweightinthelowestincome
quintile,comparedwith24percentinthehighestquintile(MOHP,2007).Intermsofregions,
53percentofchildrenfromtheMidWesternregionwerefoundtobeunderweight,in
comparisonto37percentofchildrenfromtheEasternregion.Lookingatthesubregional
level,childmortalityrangesfromalowof4percentintheCentralHillsubregionto18percent
intheWestern,MidWesternandFarWesternMountainsubregions(Hollemaand
Bishokarma,2009).From1996to2004,poverty(asmeasuredbyaconsumptionindex)declined
from42percentto31percentinNepal,largelyduetoariseinremittanceflows,highernon
agriculturalincomes,increasedurbanization,andfertilitydeclines.However,largeincome
disparitiespersistacrossecologicalzones,urbanandrurallocations,andalonggender,
ethnicityandcastelines.Althoughthedeclineinconsumptionpovertyhasbeenaccompanied
bysubstantialreductionsinchildpovertyoverthesameperiod(from44percentto36
percent),11percentofchildrenfallmorethanthreestandarddeviationsbelowthe
internationalreferencepopulationforweightforage,whichisanindicatorofsevere
malnutrition.Childreninruralareasaredisproportionatelyaffectedbymalnutritionrelativeto
theirurbancohorts,with51percentvs.36percentstunted,and41percentvs.23percent
underweight(Hobbs,2009).
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Figure1:TrendsinundernutritioninNepal(Source:FAO,2007)
Usinglivelihoodasamarker,Romer(2004)identifiesover9millionNepaleseas
vulnerabletofoodinsecurity.Ofthese,themajorityaremarginalfarmhouseholdslocatedin
theHillsandTerai,followedbyruralcastes,agriculturallaborersintheTerai,marginalfarmers
intheMountains,porters,andpoorurbanhouseholds.However,thosemostvulnerabletofood
insecurityaresubpopulationswithinthosegroups,namelywomen,children,indigenous
people,andthoseinthelowestcastes.Lowdietarydiversityalsoisaconcern.Accordingto
NDHSdata,accesstofoodsrichinvitaminAisseverelylimited.NDHSdatafrom2001and2006
showthat,intheweekleadinguptothesurvey,fewerthanonethirdofchildrenbelowage
threehadconsumedvegetablesandfruitsrichinvitaminA.Urbanruraldisparitiesarealso
evidentintheavailabilityoffruitsandvegetablesrichinvitaminA.Forexample,37percentof
urbanchildrenconsumethesefoodscomparedtojust28percentofruralchildren.VitaminA
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supplementationiswidespreadinruralandurbanareasofNepal,althoughasomewhatlarger
proportionofchildreninruralareasreceivedirectvitaminAsupplementationthaninurban
areas(80percentvs.75percent)(Pradhan,2005).
Figure2:Childnutritionalstatus(Source:NDHSdata;figurefromWorldBank)
Inanenvironmentwhereoneofeverytwochildrenisalreadymalnourished,the
incidenceandeffectsofdiseasescanbelifethreatening.Withserioushealthimplications,the
mostwidespreadseveredeprivationfacedbychildreninNepalislackofsanitation,whichisa
directcontributortothediseaseburden.Nearly6.4millionofNepalschildren(morethanhalf)
defecateintheopen.Thislackofsanitationhasimportantramificationsforthespreadof
disease.Ruralchildrenarethreetimesworseoffthantheirurbancounterparts(UNICEF,2010).
ThoselivingintheWesternMountains,theMidwesternHills,andtheCentralTeraisuffer
disproportionately.Over70percentofchildrenintheseareasdefecateinopenspaces.In
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additiontopoorsanitation,11.4percentor1.3millionchildreninNepallackaccesstoasafe
andadequatesupplyofwater.Theresultsofpoorsanitationanduncleanwaterincludeworm
infestations(affectingnearlyallchildren),typhoid(affecting200,000childrenin2004),anda
rangeofvectorborneillnessesincludingJapaneseencephalitisandMalaria(UNICEF,2010).
Rai,etal.(2002)provideacomprehensiveoverviewofinfectiousdiseasesinNepaland
theirlinkstomalnutrition.NumerousinfectiousdiseasesarewidespreadinNepaland
accordingtotheNationalPlanningCommission(NPC)infectiousdiseaseisimplicatedinnearly
threequartersofallillnessesanddeaths(NPC,1998).IntestinalparasitosisisoneofNepals
mostimportantpublichealthproblems.Itisestimatedthat60percentofthepopulationis
infectedwithoneormorespeciesofparasite(Ishiyama,OnoandRai,2001),withinfection
ratesashighas90percentinsomeruralareas(Estevez,LevineandWarren,1983;Raiand
Gurung,1986;Raietal.,2000a).Choleraoutbreaksandinfectionsofthesmallintestinespeak
duringtherainyseason(Iseetal.,1996).
Soiltransmittedhelminthes,alsoknownasintestinalworms,arethemostcommon
intestinalinfectioninNepal(Adhikarietal.,1986;Raietal.,1994;2000a).Thewormsareso
widespreadthatRaietal.(2000b)reportthateventhesoilinKathmanduiscontaminatedwith
eggs.Additionally,ithasbeenestimatedthatnearly50percentofotherwisehealthyNepalese
(Rai,1999)andmostlivestock(Raietal.,1996)areinfectedwithToxoplasmagondii,anormally
minorinfectionthatcanbefatalforfetusesandnewborns.ThroughouttheTeraiandinvillages
alongrivers,vectorbornediseasesincludingmalaria,leishmaniasisandJapaneseencephalitis
areendemic(Raietal.,2001).
FewstudiesreportcomprehensivedataregardingmicronutrientnutritioninNepal.The
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mostrecentnationalmicronutrientstatussurveydatesto1998(WorldBank,2010).That
surveyfoundlowprevalenceofnightblindness(0.24percent)andBitotsspots(0.33percent),
andlowserumretinollevelsamongpreschoolchildren(32.3percent).3Thesemeasurements
indicatechroniclackofvitaminAconsumption.Additionally,Iodinedeficiencydisorderssuchas
goiterwerepresentamong40percentofthetotalpopulation,andamong32percentoftested
preschoolers.TheNDHS2006surveyrevealedhighprevalenceofanemiaamongwomenand
children:48percentofchildrenages659monthswerereportedasanemic(WorldBank,2010).
AkeycontributortochronicundernutritioninNepalislowweightatthetimeofbirth.
MorethanathirdofNepalesechildrensufferfromlowbirthweight(LBW),whichoriginates
withpoormaternalnutrition.AroundaquarterofNepalesewomenhaveabodymassindex
(BMI)belownormalandabout36percentofpregnantwomenareanemic.Anotherbarrierto
reducingtheprevalenceofunderweightchildrenissuboptimalinfantandyoungchildfeeding
(IYCF)practices.ContrarytoWHOsbreastfeedingrecommendations,whichcallforexclusive
breastfeedingupto6months,only53percentofNepalesechildrenunder6monthsare
exclusivelybreastfed.RecommendedIYCFpracticescallformilkormilkproductsandfoods
fromspecificallyrecommendedfoodgroupsandaskthatinfantsarefedatleastthe
recommendedminimumnumberoftimes(WorldBank,2010).AlmostallNepalesechildren
aged623monthsarebreastfedorgivenmilkproducts,butonly57percentofchildrenare
providedwiththerecommendednumberoffoodsitems(foodfromthreeormoregroupsfor
breastfedchildren),and18percentarefedlessoftenthanisrecommended.Anotherfactor
3WHOusesa0.5%prevalencerateforBitotsspotsanda1.0%prevalenceratefornightblindnessasthelowerthresholdsfordeterminingapublichealthconcern.
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thatgreatlycontributestochildhoodundernutritioninNepalispooraccesstosafedrinking
waterandadequatesanitation(WorldBank,2010).
In2007,theGovernmentofNepalundertookstepsthroughtheDepartmentofChild
HealthDevelopment(CHD)toendproblemsofchildmalnutritionthroughthedraftingofthe
NationalNutritionActionPlan(NNAP),whichadvocatesforacomprehensive,integratedand
intersectoralstrategyforaddressingtheproblemofmalnutritioninNepal.However,whileit
wasanimportanteffortfromthegovernment,thedocumenthasnotbeenfinalized.The
GovernmentofNepal(GON)hasmadeseveraleffortsandinterventionswithdifferentdegrees
ofsuccesstoaddresstheproblemofundernutrition,includingtheestablishmentofa
nationwideprogramformiddaymeals.Althoughthemiddaymealprogramhasbeenjudged
asquitevaluableforpromotingeducationandschoolattendance,itsrecordasanutrition
interventionprogramislesswellestablished(WorldBank,2010).Nepalhasimplementeda
NationalVitaminAProgramme(NVAP),aNationalIodineDeficiencyDisordersControl
Programme(NIDDCP),andanumberofprogramsaimedatsupplementingironandfolatefor
pregnantandlactatingwomen.TheNationalNutritionPolicyandStrategy,whichis
administeredbytheChildHealthDivisionoftheDepartmentofHealthServices,strivesto
improvehealthandimplementbasicnutritionalaidssuchasvitaminAsupplementation.The
distributionofvitaminAandothernutritionalsupplementsismainlydoneviaFemale
CommunityHealthVolunteers(FCHV)andVillageHealthWorkers(VHW).Amongother
responsibilities,thesegroupsalsomobilizecommunitiestohelpwithfamilyplanning,maternal
careandchildhealth.OtherministriesinNepalhavebeeninvolvedinnutritionrelatedplans
withinspecificsectors.TheseincludetheMinistryofAgriculture,theMinistryofEducation,and
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theMinistryofWomen,Children&SocialWelfare(WorldBank,2010).
DetailedmalnutritionmapsweredevelopedandpublishedjointlybytheNepalCentral
BureauofStatistics,theWorldFoodProgramandtheWorldBankinSeptember2006.4These
mapsillustrateahighdegreeofoverlapamongwastingandunderweightindicators;in
contrast,stuntingisfarmoreprevalentinMountainsubregions.Themapsunderscorethe
considerablegeographicdiversityamongnutritionindicatorsinNepal.Thehighestincidences
ofstuntingandunderweightoccurintheMountainandHillareasoftheFarandMidWestern
developmentregions.Intheseareas,60percentofchildrenshowsignsofstuntingand50
percentregisterasunderweight.Theseoutcomescanbeattributedlargelytothelimited
availabilityoffoodandhighunderlyingratesofpovertyintheseareas.
IntheTerai,onaverage,17percentofchildrensufferfromwasting,althoughratesas
highas21percentarereportedintheCentralTerai.BothUNICEFandActionContreLaFaim
(ACF)haveconductednutritionsurveysindroughtaffectedNepalesedistricts.TheUNICEF
reportshowsthat72percentofchildrenarestuntedinBajuradistrictand70percentare
underweight.InJumla,ratesofmalnutritionareevenmorestriking,withindicationsthat82
percentofchildrenarestuntedand77percentareunderweight(FAO/WFP,2007).Wasting
levelsrecordedinthesedistrictsarealsoextremelyhigh.Aseparatesurveyconductedin
January2007byACFinthedistrictofBajhangplacedthechronicmalnutritionrateat59
percent(FAO/WFP,2007).
AseparateWFPsurvey,alsoconductedin2007indroughtaffectedareas,used
4Threemaps(oneeachforprevalenceofstunting,wastingandunderweight)areavailableat:http://www.un.org.np/sites/default/files/maps/tid_113/MalnutritionMap.pdf
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measurementsofmidupperarmcircumference(MUAC)togaugemalnutritionlevels.Results
showmalnutritionratesinexcessof50percentintheseareas,withanadditional24percentof
childrenatrisk(FAO/WFP,2007).Thesamestudyinvestigatedfoodconsumptionpatternsand
concludedthatpeopleindroughtproneareasdonotgenerallyconsumedietsrichinproteins,
vitaminsandminerals.Accordingtothesurvey,householdsconsumedfish,meat,eggsand
freshfruitveryrarely.Furthermore,consumptionpatternsinareasaffectedbydrought
deterioratesharplysurroundingsevereweatherevents.Asanexample,despitetheirroleas
basicingredientsintheNepalidiet,lentilsandpulseswerenotconsumedbymorethanhalfof
householdsindroughtaffectedareas.Ontheotherhand,onlyabout12percentofhouseholds
fromnondroughtareashadnotconsumedlentilsandpulses.Similarly,thesurveyshoweda
reductionintheintakeofgreenvegetablesamonghouseholdsindroughtaffectedareas
(FAO/WFP,2007).Overall,householdsinthesemostvulnerableareashavefewviablecoping
strategies;marketstendtofunctionpoorly,alternativesourcesofincomeandlivelihoodare
rareandtemporaryorpermanentmigrationisdifficult.Themessage,therefore,isthat
householdsinareaspronetodroughtandotherexogenousshocksmustconsequently
internalizeasignificantproportionoftheseshocksthroughreducedconsumptionand
subsequentdegradationofnutritionandhealth.
3.AgriculturalProduction,LivelihoodsandFoodSecurity
Incomefromfarmingremainsadominantsourceofincomeforalargemajorityoftherural
populationinNepal,especiallythoselocatedintheMountainregionsandmanyareasofthe
HillsandTerai.Datafromthe2004NepalLivingStandardsSurveyshowthatnearlyhalfof
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householdincomecomesfromagriculturalproduction.Thesecondlargestincomesourceis
nonfarmwages(28percent),followedbyremittances(11percent).Thecontributionof
agriculturetooverallincomeisloweratthenationallevelthanfortheMountainregions,
where60percentofhouseholdincomeisderivedfromfarmingactivities,withnonfarm
incomejust19percentandremittanceincome9percent.Thepooresthouseholdsrely
disproportionatelyonfarmincome.Thepoorestandsecondpoorestquintiles(basedon
consumption)derive62percentand58percentoftheirincome,onaverage,fromfarming
activities,andreceivelowerthanaverageremittances(8and9percent,respectively)(Floydet
al.,2003).
ThemostrelevantongoingproblemintheHillsandMountainsoftheFarandMid
Westernregionsissimplelackoffood.Thisproblemisexacerbatedbyverylowpurchasing
powerandextremelyhighmarketpricesintheseremotelocations.Whentheseareasfacefood
deficitstheyrarelyseeaninfluxofprivatesupplies(FAO/WFP,2007).Moreover,deficitstend
nottobefilledbynationalorinternationalagenciesbecauseofextremelyhightransportation
costs.Thesehighcostsprohibitthenecessaryquantitiesoffoodfrombeingtransportedto
thesedeficitareas.Ontheotherhand,problemswithfoodinsecurityintheTeraiandLower
Hills,whichtendtobefoodsurplusareas,arerelatedtodistribution,accessandpurchasing
power.TheselatterareasarecharacterizedbylowerratesofpovertythanarefoundintheHills
andMountainsoftheFarandMidWest;however,theconcentrationofpoverty(asmeasured
bythenumberofpoorpeoplepersquarekilometer)isquitehigh(FAO/WFP,2007).
MostNepalesehaveextremelylimitedpurchasingpower.AccordingtotheWorldFood
Programsmissionobservations,incomeinequalitytendstobehigherintheTeraithaninthe
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HillsandMountains,andgroupsthattendtobeespeciallyvulnerable(suchasDalits,Adivasi
JanajatisandKamayas)oftenstruggletoaccessfoodinsufficientquantities.Asaresult,the
Terairegionischaracterizedbyveryhighwastinglevels,oftenaboveemergencylevels.Dueto
theheterogeneityofNepalslandscape,analysisofaggregateddataismisleading.
Unfortunately,disaggregateddataarerarelyavailabletoprovidebetterinsightonfoodsecurity
withinmarginalizedgroups(especiallywithintheTerai).Thesegroupsoftensuffernotjust
economically,butsocially.Theyhavelimitedknowledgeregardingnutritionandappropriate
hygieneandcaringpractices,andtheirviewsregardinggenderdivisionswithinthehousehold
tendtoplacewomenindisadvantagedpositionsvisvismen(FAO/WFP,2007).
Fromtheperspectiveoffoodproduction,overallperformanceinNepalisdisappointing
andagriculturalproductivityremainslowbySouthAsianstandards.A2004reportbythe
MinistryofAgriculture(MOA)indicatedthatthemainstaplefoodcropsinNepal(wheat,maize,
rice,andpotato)wereproducedatonly50percentofthemaximumattainableyield;cereal
yieldsareestimatedtoberoughly2tonsperhectare.Theprimaryreasonsputforwardforlow
productivityareaheavilyrelianceonrainfedproduction(roughlytwothirdsofagricultural
productionisrainfed)andsubsistenceorientation.Populationgrowthcompoundsthese
problemsbyreducingfarmsizesovertime.5TheMOAreportedthatthesourcesoflowyields
werelowinvestmentinirrigation,infrastructure,fertilizers,ruralcreditandruralpower,aswell
asalackofresearchintoimprovingagricultureandverylittlecoordinationamonggovernment
departments(Shresthaetal.,2008).Asaresultofthesefailures,theannualgrowthrateof
5Nepalspopulationgrowthratepeakedat2.5%in1996.Asof2009,thepopulationgrowthratewas1.8%andtotalpopulationstoodat29.3million.
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agricultureremainsquitelow(below3%).Notsurprisingly,observershavepointedto
increasingagriculturalproduction,marketingandtradeaspathwaystoreducemalnutritionin
Nepal,withaspecificfocusonboostingagriculturalactivityintheremoteareasoftheHilland
Mountainregions.Althoughtheeconomyincludesservices,smallscalemanufacturingand
tourisminadditiontoagriculture,thelargestshareofnationalincomebyfarisderivedfrom
agriculture,whichprovideslivelihoodformorethan80percentofthepopulationandaccounts
forapproximately40percentofGrossDomesticProduct(FAO/WFP,2007).Furthermore,much
ofthecountrysindustrialactivityisdirectlyorindirectlyrelatedtoagricultureandthe
processingofagroindustrialproducts.Theseproductsincludejute,sugarcane,tobaccoand
grains.GiventhecurrentstructureofNepalseconomy,economicdevelopmenteffortsmust
emphasizetheagriculturalsector.
SeasonalfoodshortagesarequitecommoninmanypartsofNepal,apatternthatis
drivenbysharpmonsoonalinfluencesinproduction,poorpostharveststorageandhandling,
andweaktransportinfrastructureandmarketintegration(Sonogo,2008).Acropcalendarfor
NepalsmaincerealcropsispresentedinTable1.Thisindicatesstrongtemporalcorrelationsof
harvestswithinagroecologicalzones,butsubstantialnegativecovarianceofproductionacross
agroecologicalzones.Thislatterfeatureprovidessomeunderlyingopportunitiesforspatialand
temporalgapfillingthroughinternaltrade,apotentialthathasnotyetbeenrealized.Panter
Brick(1993)demonstratesthatthestrongseasonalpatternofsubsistenceagricultural
productioninNepalhasimportantramificationsforwomensactivityandenergydemands,
especiallyduringpregnancyandlactation.Levine(1988)reviewsaseriesofcasestudiesthat
provideinsightsintotherelativeworkburdensandtimeallocationofwomeninmountainous
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areasofNepal,concludingthat,atalllevelsofincome,womentendtoplacegreateremphasis
onproductiveactivitiesthanchildcare,andtendtoorganizethelatteraroundtheformer.Asa
result,seasonalpeaksinagriculturallabordemandtranslatedirectlyintotimeconstraintsfor
womenandincreasedvulnerabilityforchildren.
InmuchofNepal,pricesforstaplefoodsarestronglylinkedtocorrespondingpricesin
Indianmarkets,asthecerealmarketsinmuchoftheHillandTeraiareasareintegratedinto
thoseofNepalssouthernneighbor.ThemarketsoftheMountainregionaremuchmore
isolated,however,whichleadstorelativelyhigherricepricesthere.From2004to2007,prices
forriceintheMountainregionwereonaverage177percenthigherthanforthemarketsinthe
Terairegionandwere123percenthigherthanintheEasternregion(FAO/WFP,2007).
Additionally,householdslocatedintheMountainregionsspentasmuchas65percentoftheir
incomeonfood,comparedwithanationalaverageof37percent(FAO/WFP,2007).When
undernourishmentismeasuredintermsofinsufficientcaloricintake(usingtheCBSminimum
of2,124kcalsperday)thepercentageofpeoplethatareundernourishedatthenationallevelis
approximately41percent.Asonemightexpect,theWesternregionshaveamuchlower
averagecaloricintakethantherestofthecountry(2,310and2,250kcal/dayvs.2,405kcal/day
forthecountryasawhole).Thesamebasicgeographicpatternholdsforthoseconsideredtobe
severelyundernourished(FAO/WFP,2007).
SuchregionalpatternsleadShresthaetal.(2008)todescribepovertyinNepalasa
predominantlyruralphenomenonrelatedtoalackofdecentralizationofprogramplanningand
misallocationofresourcesinruralareas.Asinmanypoorruralareas,individualsinruralNepal
sufferfrominadequatecalorieintake,widespreadnutritionaldeficiencies,lowratesofliteracy
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(especiallyamongwomen),pooremploymentopportunities,lowprovisionofhealthservices
(includinglowlevelsofprenatalcare),andlimitedaccesstosafedrinkingwater.Asaresult,
manyyoungpeopleattempttomigrateoutofruralareasinsearchofemploymentinthetowns
andcitiesofNepal,inIndia,oroverseas.Aspartofthistransitioninvolvinghumancapital
movingoutofruralareas,thenatureofagriculturalproductionhasbeenchangingandpresents
opportunitiesandchallengesforagriculturaldevelopment.
Table1:CropCalendarforMainCerealCropsCultivatedinNepal(Source:FAO,2007)
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Isaresponsetoongoingagriculturalchallenges,avarietyofprogramshavebeen
implementedacrossNepalinrecentdecadesaimedatincreasingagriculturalproduction,
especiallyforsmallholders.TheNepalAgriculturalResearchCouncil(NARC)wascreatedin1991
asanautonomousresearchbodymeanttoinformpolicymaking,andtocoordinateand
implementresearchonagricultureinNepal.TheNARCcurrentlyimplementsmorethan400
projectsannually.Italsopartnerswithregionalandinternationalorganizationstodevelop
technologiesandsystemsaimedatincreasingfoodsecurityandreducingpoverty.Many
projectsfocusoninformationdiffusion,infrastructuredevelopment,anddispersionof
technology,irrigation,andvillagesavingsfunds.However,progresshasbeenimpededby
institutionaldeficienciesinoversightandinnovation(Shresthaetal.,2008).
In2007,theFAOandWorldFoodProgramengagedinanationwideassessmentto
betterunderstandthecausesofchronicandtransitoryfoodinsecurityinNepal.Themetrics
usedinthatassessmentincludedharvestindicatorsforyear2007wintercerealcrops,a
measureoffoodavailability,marketaccessassessments,andnational,subnationaland
householdlevelindicatorsoffoodutilization.6Thereporthighlightstheimportanceof
agriculturalmodernizationinreducingfoodinsecurity.Asdiscussedabove,irrigationavailability
isoftenaprimarydeterminantofcropchoice,thetimingofcropplantingandultimatefarming
success.IntheTerai,wherereliableirrigationexists,threeannualricecropscanbegrownand
harvested.IrrigationintheHillsallowsfortwocropsofrice(summerandspring).IntheTerai,
maizecanbeharvesteduptothreetimesperyear;intheHills,twomaizecropscanbeplanted.
6TheremainderofthissectiondrawsfromthatFAOreportandothersources.Thefullreportisavailableathttp://documents.wfp.org/stellent/groups/public/documents/ena/wfp135449.pdf.
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SomeearlymaturingmaizevarietiescanbeusedintheHills.Theseallowformoreflexibilityin
croprotationandgreatercroppingintensity.Inadditiontomaize,wheatandbarleycanbe
plantedbetweenthemonthsofOctoberandDecember.Milletisplantedprimarilyasasummer
cropintheMountainsandasarelaycropintheHills,mostoftenfollowingamaizeharvest.In
theHills,areasthatarelocatedclosetoriversandonlowerslopesbenefitfromirrigationdue
totheirproximitytorivers.Thisallowsfarmerstogrowriceastheirmajorcropinthesummer
andwheatastheirwintercrop.WhereirrigationisavailableintheHills,plantingpatternsare
similartothosefoundintheTerai.However,areasintheHillsthatmustrelyonrainwaterasa
sourceofirrigationlargelythoseathigherelevationsgrowprimarilymaize.Inshort,
croppingpatternsandagriculturalsuccessintheHillslargelyreflecttheavailabilityofwaterand
irrigationresources.
LowproductivityandlackofagriculturalcompetitivenessservetomagnifyNepals
povertyandfoodinsecurity.RiceyieldsinNepalhavegraduallyincreasedsincetheearly1990s,
althoughtherealizedgrowthratehasbeenmuchlowerthanthoseofneighboringcountries.
Between1990and2005,Nepalsriceyieldincreasedby13percent.Thiscompareswithgrowth
overthesameperiodof20percentinIndia,37percentinPakistanand47percentin
Bangladesh.Basedonaverageyieldsovertheperiod2001to2005,Nepalsriceyieldswere7
percentbelowPakistans,8percentbelowIndias,and22percentbelowBangladeshs.Yields
arehighestintheTerai,makingthisthedominantriceproducingregionofNepal.Nevertheless,
averagericeyieldintheTeraisubstantiallylagsthoseofNepalsneighbors.Inthecaseofmaize,
acomprehensivestudyconductedbyCIMMYTconcludedthat,asof2001,therehadbeenvery
fewimprovementsinyieldsovertheprevious30years.Theauthorsattributethistothe
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expansionofmaizeintolesssuitableagroecologicalzones,decliningsoilfertilityandslow
adoptionofimprovedmanagementpractices(Paudyaletal.,2001).Thesameauthorsalso
underscoretheproblemsofseasonalandinterannualvariabilityinyields.
ManyfactorscontributetoNepalslowagriculturalproductivity,includingtheuseof
cropsandlivestockwithinherentlypoorgeneticcharacteristics,inadequateandoften
inappropriateallocationofinputsinproduction,aheavyrelianceonlabor,traditionbound
socialandeconomicconditions,andpoormarketsandmarketingsystems.Inanattemptto
addressNepalsproblemoflowagriculturalproductivity,anumberofimprovedcerealcrop
varietieshavebeenreleasedinrecentyears.Theseofferhigheryieldpotential,arebetter
suitedtolocalgrowingconditions,andareinsomecasesmorehighlyresistanttoeconomically
importantdiseasesandpests.Improvingriceyieldshasbeenaparticularlyimportantobjective,
sincericeistheprimarystapleinNepal,andmorethan15millionhectaresareallocatedtorice.
TheNARCreportsthat38ricevarietiesformainseasoncultivationand11varietiesforearly
seasonplantinghadbeenreleasedasof2007.Secondtoriceasastaplefoodismaize,ofwhich
therewere19differentvarietiesbeinggrownatthetimeofwriting(NARC2007).Amongthese
varieties,onemaizehybridhadbeenreleasedforcultivationinseveralagroecologicalzones.
ThethirdmostimportantstaplecropinNepaliswheat,ofwhich28varietieshadbeenreleased
by2007(mostlymatchedtodifferentagroecologicalregions).Maizehasbeengainingin
popularityasamajorcrop,asevidencedbyannualincreasesinplantedarea,productionand
productivity.Nevertheless,maizeyieldsremainlowbymoststandards,withanationwide
averageyieldofjustover2mt/ha.
Anotherdragonproductionistherelativescarcityofarableland.The1992National
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SampleCensusofAgriculture(NSCA)reportedanationalaveragefarmsizeof0.9hectares.
Furthermore,landownershipisextremelyskewedinNepal.Forexamplemarginalfarmers
constitute43percentoffarmhouseholdsbutcultivatejust11percentoftotalagriculturalland.
Pyakuryaletal.(2005)arguethatwithsuchsmallandskewedlandholdings,prospectsfor
productivitygrowthinagriculturearebleak.Investmentsinagricultureandlandimprovements
areestimatedatjust3percentofhouseholdincomeandcurrentoverallproductivitygrowthin
agricultureisjust0.4percentperyear.
Nepalreportslowratesofuseofmoderninputs,inparticularfertilizer.Measuredin
termsofavailablenutrient,ratesoffertilizeruseinNepalareapproximately60kg/ha
comparedwithapproximately90kg/hainIndia.Thegovernmentsubsidizedfertilizerpurchases
formanyyears,butsubsidieswereeliminatedin1999.Anumberofobservershaveargued,
however,thattheprimaryconstrainttogreateruseoffertilizerinNepalhasnotbeenlackof
affordability,butlimitedsupplies.Becausethecountrydoesnotproducefertilizers,all
commercialfertilizerusedinagriculturemustbeimported.Theremovaloffertilizersubsidies
hadtwopronouncedeffects.First,andnotsurprisingly,fertilizerpricesincreased.Thisincrease
wasseenasinevitablefollowingtheremovalofsubsidies.However,asecondandlesseasily
predictedoutcomewasthattheoverallsupplyoffertilizerincreased.Althoughformalimports
offertilizerhavefallen,informalimportsfromIndiahaveincreasedbymorethanenoughto
offsetthedecline(UN,2010).
Despitetheuptickinfertilizeruseinrecentyears,anumberofissueshavearisenin
responsetothesubsidyremoval.Perhapsthemostimportantistheunreliabilityoftheinformal
sectorasafertilizersource.Thisperceivedunreliabilityarisesduetoexportrestrictions
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imposedbyIndia,whichpartlyhavetheirrootsinNepalssubsidyprogram.Additionally,many
blameinformalimportsfordrivingdownprices,therebyunderminingtheviabilityand
developmentofNepalsprivatesector.Anotherargumentregardsthefertilizerprovidedbythe
informalsectortobeoflowerordubiousqualitycomparedwithformalchannelimports.
Adulterationisthetypicalargument.Nevertheless,evenwithrelativelyabundantsuppliesof
fertilizerviainformalchannels,aroutinecomplaintisthattherisingcostoffertilizerreduces
Nepalsagriculturalcompetitiveness,especiallyvisvisIndia(Karkee,2008).Basedonthe
GlobalCompetitivenessReportof20062007,Nepalranks110outof125countriesin
competitiveness,afactthatunderscorestherangeofdifficultiesfacingallsectorsofthe
Nepaleseeconomy,notjustagriculture(Pyakuryal,2008).
Ashighlightedearlier,irrigationisakeyagriculturalinputthatremainsunderutilizedin
Nepal.Irrigationisespeciallyimportantfordroughtmanagement,andtheuseofshallowtube
wellirrigationcaninmanycasesallowfarmerstobeginplantinghighervaluecropssuchas
vegetables.ManyexpertswithinNepalarguethatshallowtubewellswillbeessentialfor
increasingproductionandenhancingfoodsecurity.Onebenefitofshallowtubewellsisthat
theyarerelativelyinexpensiveandthereforewithinthereachofpoorfarmers.Formerly,tube
wellsweresubsidizedbytheGovernmentofNepal.In2000,however,irrigationsubsidieswere
eliminatedaspartofNepalsStructuralAdjustmentProgram(aroundthesametimeasthe
fertilizersubsidieswerephasedout).IntheTerai,shallowtubewellsholdmuchpromise
becausetheareaisdrybutcontainssubstantialgroundwaterthatcanbeaccessedbythe
shallowtubewells.Onerecommendationhasbeentoconnectgroupsoftubewellstorural
electricitygridstoimproveuptakeandreduceenergycosts.
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WhilefertilizersupplyandavailabilityhaveimprovedinrecentyearsinNepal,theseed
sectorremainspoorlydeveloped.Themainissueappearstobetheactualqualityofseeds,
ratherthanavailability.Governmentsourcesandvariousstudiessuggestthatasizeable
proportionofcultivatedareainNepaliscoveredbyimprovedseeds(estimatesrangebetween
80and90percentforcerealsandvegetables)(GON,2006).However,becauseofpoorseed
quality,performanceremainsdisappointing.Mostfarmersuseseedsfromtheirownprevious
harvest,orthatofaneighbor.Eveniftheseseedscomefromimprovedstrains,theyrarely
performwellafterafewgenerations.Themainconcernistoswitchtheoldimprovedseeds
thatfarmerscurrentlyhavewithnewimprovedseeds.Itwouldbedesirabletoreplace
improvedseedsatarateof25percent,oreveryfouryears.Doingsowouldremoveseedsfrom
usebeforetheydegeneratebeyondtheirvalue.Theactualreplacementrateisnotknown
becauseoflackofstatisticsinseedreplacement,butisthoughttobeabout5percentforwheat
andevenlowerforriceandmaize.Someobserversareoptimisticaboutchangesthatcanbe
broughtaboutbysimplyupgradingthequalityofseedsusedbyfarmers,claimingthatcereal
productioncouldberaisedby20percentthroughsuchmethodsalone(GON,2006).Atwoyear
projectundertheEUFoodFacilityoftheEuropeanCommissionsoughttoprovidevulnerable
farmerswithhighqualityseedsandotherqualityinputssuchasfertilizertoincreasefood
productioninJuneof2009.Ofthe92,000targetedhouseholds,themajoritywereinthemid
hillsandTerairegion.Inassessingsuccessesandimpactsofvariousprogramsrelatedto
nutritioninNepal,Adhikari(2011)recognizedtheprospectofscalinguptheprograminfood
deficitareas,incollaborationwithactivitiescurrentlyundertakenbytheWFP,FAO,andMoAC.
Unfortunately,theinstitutionalinfrastructureneededtosupportagricultureinNepalis
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weak.WhiletherearemanyruralfinancialinstitutionsinNepal,andthebasicinstitutional
structurenecessarytosupporttheexpansionofagriculturalcredit,formalsectorruralcreditis
severelyconstrained.Theformalsector(thoseentitiesregisteredwiththeCentralBankof
Nepal)consistsofanetworkofcommercialbanks(withmorethan300ruralbranches),the
AgriculturalDevelopmentBank(with450branches),andarangeofvariousdevelopmentbanks,
savingsandcreditcooperatives,andmicrofinanceNGOs.Inadditiontoformallending,alarge
numberofruralcreditprograms,savingsandcreditcooperatives,andNGOshaverurallending
asoneaspectoftheiroperation.SomeNGOsremainoutsideofthesupervisionoftheCentral
Bank;otherinformallendersincludecommunityorganizations,tradersandmoneylenders.
Theforgoingdiscussionsuggestsseveralpointsofentryforpublicpolicytopromote
agriculturalproductionandfoodsecurityinNepal.Howpotentiallyvaluablemightbepublic
expendituresinagricultureorinagriculturalareas?Therehavebeenmodestattemptsto
quantifythehouseholdwelfareimpactsofpublicexpendituresonagricultureinNepal.For
example,Dillonetal.(2011)usehedonicestimatesofplotvaluetomeasurethebenefitsof
ruralinfrastructureinvestments.Theirmetricsofinvestmentincludetraveltimetotheclosest
market,accesstoirrigation,andvisitsfromextensionservices.TheyemployNepalLiving
StandardsSurvey(NLSS)datafrom1996and2004andcontrolforarangeoffixedeffects,
includingdistrictlevelinitialpublicinvestmentandagroecologicalzones.Asanalternative
methodology,theyalsousepaneldatamethodsappliedtothesamedatasettomeasurethe
impactofpublicinvestmentonconsumptiongrowth,agriculturalincomes,andpovertystatus.
Resultsshowthatimprovingaccesstoroadsiswelfareimproving,leadingtoimprovementsin
landvalues,incomegrowth,consumptiongrowthandpovertyreduction.Theyreportmixed,
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butgenerallypositiveeffectsofirrigationonlandvalues,butfindnomeasurablehousehold
welfareeffectfromextensionservices,regardlessofthemethodtheyemploy.Thislatterpoint
emphasizescurrentweaknessesinNepalsagriculturalextensionservice,aswellasthe
challengingenvironmentinwhichitmustoperate.
AnadditionalagriculturalchallengeofemergingimportanceinNepalisthe
contaminationoffoodandfeedwithmycotoxins.Mycotoxinsaretoxicsecondaryfungal
metabolitesthathavesignificantbiologicaleffectsonhumansandanimalswhencontaminated
cropsareconsumed.Ofthemainclassesofmycotoxins,AspergillusflavusandAspergillus
paraciticusaretheprominentproducersofaflatoxins(Farombi,2006).AflatoxinB1isanatural
carcinogenandthemosttoxicandabundantofaflatoxins(Koiralaetal.2005).Theoccurrence
ofthechemicalisheavilyinfluencedbyconditionsfavorabletomoldgrowthduringpreand
postharvestingprocessesandstorage.Theseconditionsincludehightemperature(36to38C)
andhumidity(above85%)levels(Hell&Mutegi,2011).Dietarystaplessuchascorn,peanuts,
cassava,andricearesomeofthemorecommonagriculturalcommoditiescontaminatedwith
thetoxins,andpoorprocessingandstorageleavedevelopingcountriesmorevulnerableto
contamination(Farombi,2006).
ThefirstexaminationofmycotoxinlevelsinNepalbeganin1978aspartoftheRegional
MonitoringofFoodContaminantsProjectunderneaththeFAOandUnitedNations
EnvironmentalProgramme(UNEP).Foodsamplesweretakenfromfourcountries(Nepal,India,
Pakistan,andSriLanka)andtestedforaflatoxinbetween1980and1987(Karki&Sinha,1989).
Resultsshowedthatcornandpeanutswerethetwocommoditiesmostpronetoaflatoxin
contamination,andtheplainsoftheTeraiprovidedthemostfavorableenvironmentforthe
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growthofA.flavusgiventheregionshightemperaturesandhumidity.KarkiandSinha(1989)
notedthattheprocessbywhichcornwasharvested(athighmoisturecontent[1821%]and
thendriedandstoredwithoutbeingshelledforsixmonths)providedampleopportunityforthe
growthofmolds.ThetransportofgrainsfromtheTerairegiontofooddeficitareasintheHills
andMountainsfurtherprovidedanopportunityforaflatoxincontamination.Another832
sampleswererandomlycollectedbetween1995and2003from16districtsineasternNepalto
testforaflatoxinbyKoiralaetal.(2005).Highlevels(greaterthan30ppb)weredetectedin
peanuts,cornflakes,peanutbutter,andvegetableoil.Onethirdofallsamples(32.8%)were
contaminatedwithaflatoxinB1orB2.
Whilecornandpeanutsaretwoofthemostcommonlyreportedfoodcommoditiesfor
contaminationofaflatoxin,ricerepresentsanequallyimportantNepalesestaplefoodatriskfor
growingaflatoxinproducingfungi.Lackofproperstoragefacilities,particularlyinthestorageof
ricegrainsthatmustbedriedinthesunduringthewetseason,mayresultinhighermoisture
contentmakingthegrainsmorepronetofungiandbacteria.AstudyconductedbyReddy,
Reddy,andMuralidharan(2008)detectedlevelsofAspergillusspeciesinnearlyall1,200rice
samplescollectedacrosstwentystatesinIndia.ThemostfrequenttoxindetectedwasA.flavus,
theproducerofaflatoxin.Degreesofcontaminationwereheavilyinfluencedbystorage
conditionsandenvironmentalfactorsineachstate,withlevelsofaflatoxinB1mostprominent
wherestorageconditionsofricewereopenandexposedtorain.ThisfindingfromIndia
suggestsaflotoxinproblemsinricelikelyextendtoNepal,althoughspecificevidenceislacking.
Economicconsequencesofcontaminationincludecroplosses,reducedfertilityandfeed
efficiencyandutilizationinanimals,andthecostsofmonitoring,testing,anddecontamination
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ofthetoxin(Bryden,2007).Thehealthandnutritionalconsequences,particularlyindeveloping
countries,areofevengreatersignificance.InadditiontostrongevidencethataflatoxinB1
contributestohighincidencesoflivercancer(particularlyinindividualswithHepatitisBorC),
exposuretoaflatoxininchildrenagesninemonthstofiveyearshasbeenassociatedwith
stuntingandbeingunderweight(Bryden,2007;Gongetal.,2002).
Preharveststrategiestoreducemycotoxinlevelsincludetheuseoffungicidesand
insecticides,irrigationtopreventmoisturestresswhenwaterislimited,andpropertimingof
harvesting.Toprotectcommoditiesfromthegrowthoffungusorproductionoftoxinsbefore
orduringstorage,grainsmustbedriedquicklyafterharvestandaeratedproperly,damage
causedbyinsectsmustbeminimized,andmoisturecontentandtemperatureduringstorage
shouldberegularlymeasured.Sodiumbisulfite,ozone,andammoniaarechemicaltreatments
thatmaybeusedtodetoxifycontaminatedgrain,andhydratedsodiumcalciumaluminosilicate
(HSCAS)hasbeenidentifiedasadietaryadditivethatcanpreventthetoxinsabsorptionwhen
ingested(Bryden,2007).
AfinalfeatureoftheagriculturallandscapeinNepalthatdirectlybearsonfoodsecurity
isanongoingproblemoflanddegradation,which,inthefaceofstagnantproductivitygrowth,
hasbecomeincreasinglyworrisomeasaresultofhighpopulationdensityrelativetolandmass
(Hobbs,2009).Onefindslargedifferencesacrossregionsduetodifferencesintopology,
population,geology,andexistingandhistoricallandusepatterns.Desertificationand
deforestationhavebeenidentifiedasthetwomostpressingconcerns.IntheMountainsub
regions,landslidesanddeforestationhavebeenmajorsourcesofcroploss,whileonethirdof
thetotalareahasnovegetationgrowthandisthereforecharacterizedasacolddesert.Over
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twothirdsofthelandareainNepalisconsideredgeologicallyfragile,andwithhighratesofsoil
erosiontheman/landratiocontinuestorise.Officialreportsindicatethatinordertomaintaina
subsistenceliving,afamilyrequiressomewhatmorethanonehectareoflandintheMountain
districtsandhalfofahectareintheHillsandTerai;currently,overhalfthepopulationoccupies
lessthanhalfahectare(Paudeletal.,2009).Beyondgeologicalconsiderations,athirdofthe
districtsinNepalhavepoortoverypoorwatershedconditions.Sedimentationiscontributingto
ariseinriverbedswhichresultsinincreasedflooding(Paudeletal.,2009).Deforestationalso
increasestimerequiredforcollectionoffuelwood,whichcompeteswithotheractivities,
especiallyamongwomenandchildrenforwhomfuelwoodcollectionisatraditionalchore.
4.Vulnerability,WeatherShocksandCopingStrategies
WardandShively(2011)useEMDATcountryleveldataovertheperiod19802007to
investigatetheextenttowhicheconomicdevelopmentreducesbothacountry'sdisasterrisk
anditssocialvulnerabilitytoclimaterelateddisasters.TheiranalysisindicatesthatNepalranks
amongthetop10countriesfordisasterrisk,andthatNepalspredicteddisasterimpact(in
termsofdeathsper1,000people)ismuchhigherthanaverageforthecountrysunderlying
levelofdisasterrisk.IndividualslivingindroughtproneareasofNepalareespeciallyvulnerable
tonutritionaldeficiencies.Duetoisolation,thishasbeenalongstandingprobleminsome
locations,althoughPyakuryaletal.(2005)arguesthattheproblemhasintensifiedinrecent
decades.Beginninginthe1990s,shockstofoodproduction(includingflooding,drought,and
varioussevereweatherconditions)ledtoannualfooddeficitsatthenationallevel.A2006
winterdroughtresultedinnearly900,000householdsexperiencingacutefoodandlivelihood
-
crises.Asimilarwinterdroughtin2009ledtoacuteandseverefoodinsecurityamong700,000
people(aboveandbeyondthe2.7millionNepalesethatwerealreadychronicallyfood
insecure).Historically,floodsandlandslidesarethemostcommonnaturaldisastersinNepal,
althoughtheincidenceoffiresanddroughtshasincreased.Between2006and2009,extreme
weatherdetrimentallyaffectedfoodproductioninNepal.Theeventsin2009reducedwinter
cropharvestsintheMountain,Hill,andTerairegionsby40percent,25percent,and10
percent,respectively.Despiteoneofthelargestsummercropsonrecord,aggregateproduction
ofwheatandbarleydecreasedby15and17percent,respectively,in2008/09,resultingina
cerealdeficitof133,000mt.Giventhatstocklevelswerealreadylowfrompreviousseasons,
theisolatedsubregionsintheWesternHillsandMountainswereseverelyaffected.
WhileisolatedareasinNepalhavealwaysbeensubjecttoseverehunger,theproblem
seemstohavebecomemorewidespreadinrecentyears.Todealwiththeadverseweather
disasterslistedabove,andperiodicallyhighfoodprices,manyNepalesemustresorttoarange
ofcopingmechanismstosurvive.Forexample,inthe42districtssurveyedbytheWFP,one
thirdofhouseholdssoldagriculturalassetsin2008,incontrasttoonlyonetenthin2006;the
proportionthatconsumedseedstockdoubledfrom19to38percent.Oneinthreerural
familiesreportedremovingachildfromschoolwhilealmost80percentofhouseholdsreported
borrowingmoneyorbuyingfoodoncredit.Halfofthehouseholdssurveyedreportedeating
less(Hobbs,2009).
Tobetterunderstandtheimpactofextremeweatherandotherexogenousshockson
localfoodsecurityinruralNepal,theWFPundertookasurveyfocusedonthisissuein2007.
ThesurveyresultspointoutthefragilityofthefoodsecuritysituationinmuchofruralNepal;
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94percentofthehouseholdssurveyedreportedthatadverseshocks(drought,lackof
employment,illness,death,etc.)resultedinsomedegreeofimmediatefoodshortage.Inthe
areasthatweredirectlyaffectedbydroughtin20062007,morethan85percentofhouseholds
reportedthatfoodshortagesweremoreseverethaninthepreviousyear;themajorityhad
depletedtheirstocksoffoodasaresponsetothedrought.TheWFPfoundthathouseholdfood
grainstockswouldbedepletedin90daysinareasthatwerenotaffectedbythedrought,while
thecorrespondingfigurewas15daysindroughtaffectedareas(FAO/WFP,2007).Overall,a
householdsabilitytoprotectitselffromadverseshocksappearstobelargelydependentonits
socioeconomicstatus.Poorandexcludedgroupsfounditdifficulttomaintainconsumption
relativetobetterpositionedandwealthierhouseholds.Regionaldifferencesincopingalso
werereported.HouseholdsintheFarandMidWestregionsweremorelikelytoresortto
irreversibleandharmfulcopingstrategies,suchassellingproductiveassets(FAO/WFP,2007).
Thefindingssuggestthatpracticallyallhouseholdsaffectedbydroughtshiftedtheir
consumptiontowardslessexpensiveandlesspreferredfoods.Inaddition,morethan75
percentofhouseholdswereforcedtoborrowmoneytosupplementconsumptionandjust
underthisproportionreducedoverallfoodconsumption(FAO/WFP,2007).Amoredramatic
impactofthedroughtwasthatnearly37percentofhouseholdsresortedtowildfoodsources
andalmost50percentdidnoteatforatleastoneday.Nearlyhalfofallhouseholdssenta
familymemberinsearchofwork,and20percentsoldland(FAO/WFP,2007).
Followingthe20062007drought,thelargestfooddeficitswerereportedintheCentral
regions(281,000tonsintheCentralHillsand113,000tonsintheCentralTerai).Inpartthis
reflectshighratesofurbanizationinthesepartsofthecountry(whichincludestheKathmandu
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Valley).However,whenexaminedinpercapitaterms,thefoodgraindeficitsweremostsevere
intheFarWesternHills(142kg/person),theFarWestMountains(143kg/person),theMid
WesternMountains(158kg/person),andtheWesternMountains(165kg/person)(FAO/WFP,
2007).Theonlyfoodstuffsimportedintotheseregionsweresubsidizedriceprovidedthrough
theNepalFoodCorporation(NFC),smallamountsofinternationalfoodaid,andgrainbrought
inbymigrantworkersreturninghome.Duetothelimitedcapacitytobringinfood,localfood
productionisconsideredakeyfactorinprovidingfoodsecurityintheseregions.Localizedcrop
failureshavethecapacitytodramaticallyimpactfoodavailability,whichcouldleadtoacute
foodcrisesinthefuture(FAO/WFP,2007).
5.CivilUnrestandPriceVolatility
Pricevolatilityisknowntohavenegativeconsequencesforgrainproductionandthecaloric
intakeofruralhouseholds.Whileweatherdisastersrepresentthelargeststochasticthreatto
foodsecurityinNepal,civilunrestthatismanifestedinblockadesandgeneralstrikes(locally
knownasbandhs)disruptfoodsuppliesandmarketoperation,therebyresultinginfood
shortagesandgenerallyhigherfoodprices.AnApril2009strikethatoccurredintheTeraileft
almost40percentofthemarketsintheMountainsandHillswithinsufficientsuppliesofmajor
commodities.Thefirstsixmonthsof2009sawjust12dayswithoutlargescalebandhs(Hobbs,
2009).SosevereandubiquitousarestrikesinNepalthattheUnitedNationsmaintainsa
workingmonthlyupdateofthedistributionofbandhsacrossthecountry.7
Bandhshavebeencitedby20percentoftradersasthemostimportantfactor
7ThelistcanbefoundontheUNwebsiteforNepal,www.un.org.np.
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influencingrisingpricesforimportedcommodities.Thegoodsthatareaffectedbybandhsare
notlimitedtofoodandincludehumanitarianaidonaweeklyordailybasis.Hobbs(2009)
reportsthat,foraperiodoftendaysinApril2009,theWFPcouldnotdistribute3,000mtof
foodintheTerai;thisaffected325,000highlyfoodinsecurehouseholds.Whilebandhstypically
beginintheTerai,theycanquicklyproducefarreachingeffectsonpricesandquantities
throughoutthecountry.
WorkingundertheassumptionthatruralhouseholdsinNepalmakeproductionand
consumptiondecisionsrecursively,Panetal.(2009)findthatthepresenceofpriceuncertainty
inproductionreducesthecropincomeofruralhouseholdsatharvesttimeandthatthislower
incomeleadstoareductioninthecaloricintakeofruralhouseholds(duetothepositive
incomeelasticityofdemandforcalories).Whendemandforcaloriesishighlypriceinelastic,
caloricintakedecisionsarenotstronglyaffectedbychangesinthepricesofstaplefoods.From
thisitcanbearguedthatthecaloricintakeofruralhouseholdsinNepalisdeterminedlargely
byincomenotprices.Inpartthisreflectsthesubsistenceorientationofmanyruralfarm
households.Ifmuchofstaplecropconsumptioncomesfromownproduction,responsetoprice
signalswillbeweak.Inaddition,thosefarmersthatparticipateinthemarkettendtoselltheir
outputatharvest,ratherthanstorethecropforlatersale(atpresumablyhigherprices).This
patternreflectshighonfarmstoragelosses,indebtedness,andcashneedstomeetfamilyand
socialobligations.Thesefactorsallcontributetoexplainingthestylizedempiricalfactthatrural
farmhouseholdsinNepalarenotveryresponsivetopricechanges(Panetal.,2009).
Withthisinmind,Pyakuryaletal.(2005)arguethatmediumrundevelopmentpolicyin
Nepalshouldfocusonthestorageandmarketingofcropsbyprivateenterprises.Plausible
-
incentivestofacilitatethisincludedevelopmentoftransportationandstoragefacilities.Alarge
proportionofgovernmentsubsidieshasbeendirectedtowardsplantinggrainsduetothe
adversegeographyofthecountry.Thisincludesairtransportforshippinggrains.Pyakuryalet
al.(2005)arguethatatransitiontogroundtransportationwillimprovefoodsecurity.Longrun
goalsmightthereforeincludeintegratingmarketsthroughroadnetworks,infrastructureand
marketing.
6.Society,GenderandNutrition
InoneofmultiplestudiesoffactorscorrelatedwithmalnutritioninNepal,Pant(2008)argues
thatmalnutritiondoesnotnecessarilyresultfromalackoffoodproduction,butratheris
causedbyarangeofsocialproblemsandtheinherentlylowstatusofwomeninNepalese
society.Inmanyinstances,theeffectsofsocialindicatorscanactuallybeattributedtogroup
normsbecauseethnicgroupsinNepalhavestronginfluenceonlaborsupply,familyplanning
decisionsandthetimingofbirths(Thapa,1989).Usingdatafromthe1996NepalLiving
StandardsSurvey,Nyyssla(2007)findsarelationshipbetweenmothersstatusandher
childrensfoodsecurity,showingthatanincreaseinchildbearingageandmotherseducation
leadtohigherzscoresamongchildren.
Motherseducationisakeydeterminantofnutritionaloutcomesatthehouseholdlevel,
sinceaprimarycauseofmalnutritionissimplyalackofknowledgeregardingthefactorsthat
contributetoimprovedhealthandnutrition(Marmot,2007).NDHSdatafrom2006showthat
childrenofuneducatedmothersaremorelikelytobeunderweightthantheircohorts,andthat
thispatternholdsacrosswealthquintiles(UNICEF,2010).Thissuggestsnutritioneducation
-
interventionsmaybenecessaryatalllevelsofwealth,notjustforthepoorestfamilies.
Moreover,acorrelationbetweenmotherseducationandnutritionalstatusexistsformultiple
deprivationoutcomes.Thelargestmarginalimpactsofimprovementsineducationarelikelyto
befoundintheMountainregions,wheremalnutritionratesareonethirdlowerforwomen
withprimaryeducationthanforthosewithnoeducation.TheNDHSdataindicatethatfewer
thanhalfofallNepalesewomenareliterate,whichcreatesalargeimpedimenttoimproving
childhealthandnutritionoutcomes(UNICEF,2010).InNepal,manyparentsarereluctantto
investineducationfortheirdaughtersbeyondfifthgrade,sincethisrequiresafamilytooffera
largerdowrytoattractahusbandofsimilarorhighereducationalstature(Sah,2005).
AgricultureinNepalisincreasinglyanactivityoffemalemembersofthehouseholdas
moremenmigrateandenterthenonfarmsector.Thischangehasbeenaccompaniedbya
changeinthestructureofincomesforruralfamilies,inwhichfarmincomehasdeclinedasa
resultoflowerproductivityandnonfarmsourceshaveincreasedinimportance.Theseforces
haveledtoarelativedeclineinwomensincomescomparedtomens.Becausefemaleliteracy
islessthan35percentandgirlstendtodropoutofschoolbeforeboys,theyhavelower
productivityandhaveheavierworkloads,highriskofpregnancy,poornutrition,andworse
health.Mengenerallyhaveauthorityoverfamilyplanningandfinancialissues,andeveninthe
casewherewomenhaveautonomyinthehousehold,theyareconstrainedinmanycasesby
communityconsiderations(Sah,2005).
InastudyofthedeterminantsofchildnutritionintheTerai,Sah(2005)foundthatsocial
factorsweresignificantinexplainingobservedlevelsofunderweightandstuntinginchildren.
DataweredrawnfromapostinterventionevaluationofachildnutritionprograminDhanusha
-
in2003.Theoutcomesofinterestwerestunting,measuredasheightforage,andunderweight,
measuredasweightforheight.Bivariatecorrelationsrevealedastrongrelationshipbetween
thenutritionalstatusofchildrenunder36monthsofageandthreefactors:mothers
education,theuseofricescum,andage.Theuseofcolostromwasastrongpredictorof
underweightbutwasnotcorrelatedwithheightforageatstatisticallysignificantlevels.
However,indicatorsofhouseholdssanitarybehaviorswerepositivelycorrelatedwith
nutritionalindicators.
Sahusedregressionanalysistodemonstratedifferencesinnutritionalstatusacrossage
groups,whereolderchildrenweremorelikelytobeunderweightthanchildrenunder6months
ofage.Amongchildrensixmonthsofageoryounger,onlyasmallproportionwerefoundtobe
underweight,buttheproportionincreasedmarkedlyatagegroupsof712monthsandbeyond.
Amonghouseholdsocioeconomicindicators,beingamemberofaminoritygroupincreasedthe
probabilityofachildbeingbothstuntedandunderweight.Themostpronounceddifferences
wererelatedtotheliteracyofthemother,ratherthaneconomicwellbeing.Sahdidnotfind
genderdifferencesinchildoutcomes.
Amongtheattributesassociatedwithfeedingpracticesandhealth,theintakeof
colostrumhasbeenfoundtohaveameasuredeffectonunderweight.Also,householdsthat
reportedutilizingricescumhadareducedpropensityofbothunderweightandstunting.Finally,
washinghandspriortofeedingreducedstunting.Inlinewithotherstudies,Sahsresearch
suggeststhatbeginningsupplementaryfeedingsixmonthsafterbirthisbeneficialtoachilds
nutritionalstatus,becausemothersmilkprovidesinsufficientnutritionbeyondthisage.For
SahssampleofchildrenintheTerai,lateinitiationofsupplementaryfeedingwascorrelated
-
withincreasedprobabilityofachildbeingunderweight.Saharguesthattheresultsreflect
socialtaboosoftwoformsthosethatprohibitwomenfromconsumingnutritiousfoods
duringpregnancyandchildbirth,andthosethatpreventthemfromreceivingpropermedical
attentionduringpregnancyandchildbirth.Hismainconclusionisthatsupplementaryfeeding
atappropriateagescombinedwithattentiontomaternalcarearethepathwayswithgreatest
potentialtoreducechildmalnutrition.
Gittelsohnetal.(1997)useddietaryjournals,comprisedofbothfoodintakerecalland
directobservationofmeals,toshowthatdespitevariationintheapplicationofculturalnorms
relatedtofoodconsumption,dietaryprescriptionsdohaveadirectimpactonfood
consumptionbehavior.Theyfoundapositiverelationshipbetweentheamountofcalories
consumedandtheintakeofvariousmicronutrientsforthewholepopulation,butnorobust
patternacrossparticularsubpopulations,includingadultwomenandadolescentgirls.These
groupsareatriskfordietdeficienciesinvitaminsAandC,especiallyinruralareasinNepal.The
authorsfoundthatfoodbeliefsandpracticesresultedinsubgroupsbeingatriskfornutritional
deficiencies,whichmayexplainthelowcorrelationbetweenmicronutrientintakeandenergy
intake.Genderdifferencesinaccesstoparticularfoodswerefoundtobeassociatedwith
specificfoodbeliefsandpractices,resultinginthereductionofwomensconsumptionoffoods
richwithmicronutrients.Practicesincludedietaryrestrictionsduringmenstruation,pregnancy,
andlactation.Compoundingtheseparticularpracticesisageneraldiscriminationinfavorof
menforintrahouseholdallocationoffood.Theauthorsarguethatstaplefoods,suchasrice,
lentils,bread,andsoup,arefairlyevenlydistributedacrossgenderlines,butthatsidedishes
richinmicronutrients,suchasvegetables,yogurt,ghee,andmeat,areallocatedpreferentially
-
tosmallchildrenandadultmales.
UsingdatafromtheNepalDemographicandHealthSurvey(2006),Dancerand
Rammohan(2009)showthatmotherseducationhasalargepositiveinfluenceonthenutrition
ofallchildren,particularlygirls.Theyfindthatprimaryeducationhasverylittleimpactonthe
heightforagemeasureofmalechildren;however,therearesubstantialimprovementsonthe
heightforagezscoresacrossthewholesamplewhenthemotherreceivesasecondary
education(comparedtonoschooling).Childrenwithmotherswhohadreceivededucation
throughprimaryschoolwerefoundtobelessstunted.Theeffectsofsecondaryschoolingon
stuntingweredramaticforbothsexes,buttheeffectwaslargestforfemalechildren:those
withamotherwhohadasecondaryeducationwerehalfaslikelytobestuntedasthosewith
uneducatedmothers.Formales,thecorrespondingoddsofnotbeingstuntedwere1.45times
greater.Whilethemotherseducationhadanimpactonchilddevelopment,afathers
educationdidnotcorrelatewithstunting.Whenawomanhadmoreautonomyindecision
making,thereweremuchhigheroddsofherchildnotbeingstunted.
Pokhreletal.(2005),using1999NLSSdata,reportsevidenceofgenderbiasinthe
reportingofillness,andthatthebiasgrowsfollowingtheinitialdecisiontoseekmedicalcare.A
culturalexplanationisputforth,basedontheobservationthatmanypeopleinNepalhavea
strongsonpreference.Consideringhealthcareasaninvestment,somefamiliesmaynot
capturetherewardsofaninvestmentinagirlifshesubsequentlymarriesandleavesthefamily.
However,themagnitudeofthisgapinthepredictedprobabilityofreportinganillnessis
relativelyconstantacrossincome,suggestingthatgenderdiscriminationdoesnotresultwholly
fromeconomichardship.
-
Anadditionalfindingisthatchildgendernotonlyinfluenceswhetherafamilyutilizes
healthcare,butalsoimpactsmultipledecisionsregardinghealthactions.Inadditionto
influencingthedecisiontoreportanillnessandthentosubsequentlyseekcare,childgender
hasalsobeenfoundtoinfluencewhetheronechoosesapublichealthcareprovider,compared
withseekingnocareorusinginformalsources.Asmightbeexpectedgiventheprevious
finding,expendituresonprivatecarefavormalechildren,afindingthathasalsobeenobserved
inKeralastateinIndia,wheregenderwasnotassociatedwithwhetherthechildwastreated
butdidplayaroleintheselectionintoallopathictreatmentversusalternativetreatments.
Inanefforttodeterminewhethersmallincreasesinfemaleincomehaveasignificant
effectonfamilywelfare,health,andnutrition,Katzetal.(2001)conductedanonrandomized
controlledexperimenttomeasuretheimpactofsmallamountsofincome(deliveredtofemale
membersofahousehold)onfoodexpendituresandthenutritionalstatusofwomen.Women
inthestudywereparttimeworkersinahealthproject.Becausetheywerescreenedfor
employment,thosethatwerehiredtendedtobeyoungerandbettereducatedthanwomen
notemployed,butsimilarinotherrespects.Baselinecomparisonsbetweenthegroupsshowed
thatthewomenweresimilarincaste,householdsize,ownershipofanimalsandhousehold
durables.Additionally,themidupperarmcircumference(MUAC)acrossthegroupshada
differenceofjust.2cm,andfoodconsumptionexpendituresaftercontrollingforbaseline
characteristicswerealsocomparable.Followupsurveystakenaftertwoyearsshowedno
differencesinMUACbetweenthetwogroups.However,womenintheemployedcategory
consumedghee,meat,eggs,fish,andvegetablesathigherrates.Overthesurveyperiod,
consumptionofhighervaluedproductsdecreasedacrossbothgroups,buthouseholdswith
-
employedwomenmaintainedrelativelyhigherlevelsofconsumptionoftheseproducts.
Finally,inanotheranalysisofhouseholdfoodsecurityinruralNepal,Gittelsohnetal.
(1998)usedaprincipalfactormethodtooperationalizetheconstructionofhouseholdfood
security.Householdfoodsecuritywasconceivedofasbeingmadeupofthreecomponents:
pastfoodstability,currentfoodsupply,andfutureproductivity.Theresultsoftheanalysis
indicatedthathighcasteandsocioeconomicstatushadpositivecorrelationswiththe
consumptionofgreenvegetables,tubers,anddairyproducts.Currentfoodstocks,aswellasa
measureoffutureagriculturalproductivity,werefoundtobeusefulpredictorsofdietary
varietyandconsumptionofdairyandmeats.Theresultssuggestthathouseholdfoodsecurity
inthesamplehadnosignificantrelationshipwithconsumptionofgrainandbeans,astheyare
consideredstaplefoods.However,themeasuresdidseemtoimpactdietarydiversity,inthe
formofleafyvegetables,dairy,andmeats.Householdcasteandsocioeconomicstatushad
similarimpacts.Generally,thestudyrepresentsanattempttocreateaformalframeworkfor
analyzingfoodsecurityatthehouseholdlevelbytakingintoaccountmultipledimensionsof
foodsecurityacrosstime.
7.ImpactAssessmentofNutritionInterventions
AgrowingbodyofresearchseekstoreportontheefficacyofnutritioninterventionsinNepal.
Pantetal.(1996)reportresultsfromarandomizedcontrolledexperimentthatwasundertaken
insevendistrictsoftheTeraiandMidHillareasofNepal.Theyevaluatedtheperformanceof
twoprogramsdesignedtoimprovevitaminAstatus.Thetwoprogramsfocusedon
supplementationandeducation.Theeducationcomponentincludedhorticulturalandpublic
-
healthactivities.Theauthorsarguethatalthoughnutritioneducationhasbeenpromotedas
oneofthebestwaystoimprovethenutritionalstatusofatriskindividualsandpopulations,
educationprogramscanbedifficulttoimplement.Theirargumentisthatnutritioneducation
programstoaddressvitaminAdeficiencywillhaveverysmallimpactsunlesseducationis
combinedwithpersonnel,finances,andequipment.
TheprogramimplementedbyPantetal.(1996)usedtwocriteriatocompareoutomes:
(1)thecostfortheoverallproject(whichwasextrapolatedtoassessdifferentlevelsofprogram
intensity),and(2)theprojectsimpactonindividualhealthstatus(primarilyxerophthalmiaand
wasting).Tomeasureoutcomesoftheinterventions,theyalsoincludedasametricof
performancetotalcoverage,asawaytojudgeanypotentialspillovereffectthatmayariseina
traditionalsupplementationprogram.Twosamplepopulationswerestudiedtomeasurethe
impactofthetwoprograms.Cohortswerefollowedfor24monthsafterprogram
implementationinordertocaptureshortrun,mediumterm,andlongerruneffectsonvitamin
Adeficiencystatus.Resultsrevealedaconsistentpatterninwhichsocioeconomicand
ecologicalproblemsexplainedalargeamountofthevariationinvitaminAlevels,vitaminA
deficiencyrisk,wasting,andexcessivemortality.Bothnutritioneducationandsupplementation
werefoundtobeeffectiveinreducingrisksamongchildren;however,neitherprogramhada
significantinfluenceoverwhetherthecommunitycouldbeconsideredahighriskclustersite.
Theyconcludethatimprovingeconomicopportunities,sanitaryconditions,andagricultural
productivityareessentialtominimizingtheimpactsofvitaminAdeficiency.However,the
authorsalsoconcludethatdistributingmegadosecapsulesonasemiannualbasis,boosting
vegetableconsumption,andimprovingaccesstoprimaryhealthcareservicesshouldbepolicy
-
initiativesintheshortterm.Whenconsideringtheimplementationofasupplementation
programinNepal,theiranalysispointsoutthatdecisionsregardingprogramchoicemaybe
influencedmorebytherelativecostsoftheprogramthanbydifferencesinprogramoutcomes.
Theirresultsshowthateducationandsupplementationhadcomparableeffects,althoughthe
overallcoveragerateofthesupplementationprogramexceededthatoftheeducation
program.TheprimarybenefittheyobserveincontrollingvitaminAdeficiencyisareductionin
mortality.Mortalityriskwasreducedbyasomewhatgreateramountamongthe
supplementationcohorts,althoughspecificaspectsoftheirnutritioneducationandmaternal
literacyprogramsweremoreeffectiveinreducingmortalitythansupplementationalone.
Overall,resultsofPantetal.sstudysuggestthatnutritioneducationinNepalcanbe
justaseffectiveasdirectsupplementation.However,wherematernalliteracyratesarelowand
pathwaysforcommunicatingpublichealthandnutritionmessagesareweakornonexistent,
achievingthesamelevelofeffectmaybemorecostlyforeducationthanforcapsulebased
supplementation.TheyobservethatpolicymakersinNepalhavebeenreluctanttouse
nutritioneducationprogramstoaddressvitaminAdeficiencybecauseeducationhasbeen
viewedaslesseffectivethansupplementation.Theirfindingsshowthatnutritioneducation
maybelesscosteffectivethansupplementationnotbecauseitislesseffective,butbecauseit
tendstobemorecostly.
AdifferentrandomizedcontroltrialwasundertakenbyChristianetal.(2003)tostudy
theeffectsofdifferentcombinationsofmicronutrientsonbirthsizeandriskoflowbirth
weight.Theyfoundthatprovidingmotherswithsupplementalfolicacid(alone)didnot
influencechildsizeatbirth.However,combiningthefolicacidsupplementwithironincreased
-
meanbirthweightby37g(the95%confidenceintervalwas16gto90g).Thiscombination
alsoreducedthepercentageoflowbirthweightbabies(thosebelow
-
disabilityadjustedlifeyearsavedshouldbeconsidered.Thisprogramsatisfiesthis
requirement.Furthermore,beyondtheprogrambenefitsquantifiedinthestudy,theauthors
suggesttheprogramalsoprovidedlongtermbenefitsforsubsequentpregnancies,reductions
inmorbidity,andpotentialcostsavingsinsettingupandsupervisingfutureprojects.
8.ProjectsUnderway
DuetothenumerousfoodsecuritychallengesNepalfaces,ithasbeenselectedasoneof
twentycountriestobenefitfromtheU.S.FeedtheFuture(FtF)PresidentialInitiative.Aspart
oftheprogram,16districtsoftheWesternTeraiandHillregionsofNepalhavebeenchosenas
programbeneficiaries.8TheUS$68millionprogramforNepal,whichisplannedtorunfrom
20112015,callsforamultisectorapproachtoincreaseagriculturalproductivity,raiseincome,
increasenutrition,andstemchronicfoodinsecurityinthetargetedregions.Thethreefociiof
theprogramare(1)nutritionandhygiene,(2)highvalueagriculturalproduction,and(3)
integrationofvulnerablegroups.
Withrespecttoagriculturalproductivity,theUnitedStatesAgencyforInternational
Development(USAID)planstointroduceyieldenhancinghighvaluecropsandtechnologies,
improvetechnicalsupportforfarmers,expandaccesstoirrigation,andimprovesmallscale
marketinfrastructure.Fornutritionaloutcomes,theplanfocusesonincreasingproductionof
highnutritionfoods,trainingandemployingthousandsofcommunityfacilitatorsandnutrition
hygienevolunteers,andincreasingaccesstosafedrinkingwater.Finally,toaddressinequalities
8ThesedistrictsareBaitadi,Dadeldhura,Kanchanpur,Doti,Kailali,Achham,Dailekh,Jajarkot,Rukum,Surkhet,Salyan,Rolpa,Phuthan,Banke,BardiyaandDang.
-
inaccessandeducationforparticulargroups(women,children,minorities),theplanseeksto
provideliteracy,nutritionandentrepreneurialskillstraining,toencouragefemalefriendly
farmingpractices,andtotargetallfamilymemberswitheducationintendedtoshapeand
changebehaviors.
InadditiontothemassiveFtFprogram,USAIDhasoveradozenprogramsrunning
throughoutthecountrywithafocusonhealth,nutrition,growth,education,orfoodsecurity.
USAIDisoneofthelargesthealthdonorsinNepal,withannualinvestmentsin2010ofover
US$26milliontowardsthedevelopmentofequitableandwellgovernedhealthsystemswith
thegoalofreducingmortalityamongwomenandchildrenandimprovingaccesstohealth
services.
Since1963,theWorldFoodProgramhascarriedout51projectsandprogramsforan
increasingnumberoffoodinsecurepopulationsinNepal(Frankenbergeretal.,2010).Many
foodaidoperationsaregeographicallyconcentratedinfooddeficitareasintheHillsand
MountainsoftheFarandMidWesternNepal,wherepoorinfrastructureisamajorobstruction
tothedistributionoffoodfromsurplusareastomarkets.AsnotedbyCodling(2011),many
aspectsoffoodinsecurityrelatetoaccessissuesandpoverty.Povertyisconcentratedinthe
agriculturalsectorwhichmakesup70%ofNepalsworkforce(Codling,2011).Inadequateroads
andmarketscoupledwithlowagriculturalproductivitymakeitdifficulttoproducesufficient
income.Asaresult,householdsmustdependdirectlyonproductionfortheirfood.
CurrentWFPoperationsincludeFoodandCashforAssets(F/CFA),micronutrient
supplementationinterventionsforchildren,schoolfeedingprograms,girlsincentiveprogram
(GIP),MotherandChildHealthCare(MCHC),andfoodassistanceforBhutaneserefugees.Food
-
andCashforAssetsprogramsareamongthemostwidelyimplemented,comprising38%of
totaloperationsbetween2002and2009,and1.6millionweretargetedfortheprogramin
2010(Frankenbergeretal.,2010).Throughtheseprograms,participantsworkoncommunity
infrastructureprojectssuchasbuildingandrepairingroadsandbuildingirrigationsystems.
WhileWFPassessmentsfoundthattheseprogramswereabletopositivelyimpactimmediate
incomeandfoodneeds,theprogramswerelessaffectiveatimprovinglivelihoodsinthelong
runthroughtherestorationofkeyassets(Frankenbergeretal.,2010).
DecreasesinfundingrelatedtotheglobalfinancialcrisishaveforcedtheWFPto
dramaticallyscalebackoperationsinsomeofthemostfoodinsecureareasinwesternNepal.
TheWFPhasrecognizeditslimitsinaddressinglongtermfoodsecurityincomparisonwith
shorttermneeds,andacknowledgedthatthegovernmentmuststepintoleaddevelopment
projectstoaddresschronicfoodinsecurityintheregion.Ina2009nutritionassessmentand
gapanalysisreport,Pokhareletal.(2009)suggestthattheGoNintegratepoliciesrelatedto
povertywithnutritioninterventionprogramstopreventfutureemergencycrises.Establishinga
formalandinstitutionalizedapproach,ornutritionarchitecture,toguidecoordinationacross
sectorsmayhelptoensurethatpreviousprogramfailuresarenotrepeated.
-
Appendix:DataAvailability
TwolargecountrywidedatasetsavailableforNepalaretheDemographicandHealthSurveys
(DHS)andtheNepalLivingStandardsSurveys(NLSS).DHSsurveydataareavailablefor2001
andforthemostrecentround,conductedin2006.Botharegeoreferencedandarepublicly
available.Acurrentroundofthesurveyisbeingcollectedatthetimeofwriting,andwilllikely
bemadepublicinthenext1218months(byearly2013).The2006sampleincludes10,793
womenand4,397menbetweentheagesof15and59.Characteristicsofthesampleinclude
datacoveringabortionhistory,anemiaandanemiatesting,anthropometry,birthregistration,
causeofdeath,earlychildhoodeducation,HIVknowledgeandtesting,malaria,micronutrient
intakes,reproductivecalendar,TB,tobaccouse,vitaminA,andmaternalmortality.
TheNLSSdatasetswerecollectedin1996and2003/2004andincludeapartialpanel
datacomponent.AthirdNLSSdatasetwascollectedin2010/2011andpreliminaryfindings
wereprovidedbytheCentralBureauofStatisticsofNepalinAugustofthisyear;however,afull
statisticalreporthasyettobereleased.TheNLSSincludesinformationonarangeofhousehold
welfareindicators,includingincome,consumption,housing,labormarketparticipation,
educationandhealth).Secondrounddataaresimilarincontentandcoveragetofirstround
data.TheNLSSsurveyfollowstheapproachoftheWorldBanksLivingStandards
MeasurementStudy(LSMS).Thesurveyconsistsofanintegratedhouseholdquestionnaire
supportedbyacommunityquestionnairetocollectinformationonavailablefacilities,service
delivery,pricesandgeneralconditionsfacinghouseholds.Thesurveyincludesamodule
focusedspecificallyonhealth,andincludesanumberofancillaryquestions.Thesequestions
includedistancetohealthfacilities(modeoftransportandtime)andexpendituresonhealth
-
services(duringthepastmonthandyear).Thehealthmodulecontainsinformationonchronic
illnessesandrecentillnesses,includinglengthofaffliction,amountoftreatmenttime
incapacitated,andcurrentselfreportedhealthstatus.Immunizationinformationiscollected
forchildrenunder5,alongwithmaternityinformationandfamilyplanninginformation.
Subjectivequestionsincludehowthefamilyratesthequalityoftheirhealthservices.Food
consumptiondataarebasedonvariableperiodrecall.Questionscoverwhetheraparticular
foodwasconsumedoverthepastyear,howmuchwasgrownandconsumed,howmuchwas
typicallyconsumedpermonth(byweight),foodexpendituresfortypicalmonth,andthe
amountoffoodreceivedinkind.ThelistoffoodsistypicalofanLSMSsurveyanddoesnot
varybyquality.Additionalinformationincludeshouseholdproduction,wageemployment,
education,creditandsavings,householdbusinessactivity,remittances,andothersourcesof
income.
-
References
Adhikari,J.,2011.Nutritionsensitiveinterventionsforagriculturalsector:NepalmultisectoralnutritionplanningframeworkforthereductionofchronicmalnutritioninNepal.ConsultantReport.HellenKellerInternational(HKI)andTuftsUniversity.
Adhikari,R.K.,etal.,1986.BacterialstudyofdrinkingwaterofKathmanduValley.JournaloftheInstituteofMedicine(Nepal)8,313316.
Bryden,W.L.,2007.Mycotoxinsinthefoodchain:Humanhealthimplications.AsiaPacificJournalofClinicalNutrition16,95101.
Christian,P.,etal.,2003.EffectsofalternativematernalmicronutrientsupplementsonlowbirthweightinruralNepal:Doubleblindrandomisedcommunitytrial.BMJ326(7389),571576.
Codling,K.,2011.AcceleratingprogressinreducingmaternalandchildundernutritioninNepal:AreviewofessentialinterventionsfortheNepalHealthSectorPlanIIandMultisectoralPlanfornutrition.FinalConsultingReporttotheWorldBank(June),109pp.
Dancer,D.andRammohan,A.,2009.Maternalautonomyandchildnutrition:EvidencefromruralNepal.IndianGrowthandDevelopmentReview2(1),1838.
Dillon,A.,Sharma,M.,Zhang,X.,2011.EstimatingtheimpactofruralinvestmentsinNepal.FoodPolicy36(2),250258.
Estevez,E.G.,Levine,J.A.andWarren,J.,1983.IntestinalparasitesinaremotevillageinNepal.JournalofClinicalMicrobiology17,160161.
FAO/WFP,2007.Specialreport:FAO/WFPfoodsecurityassessmentmissiontoNepal(25July2007).Rome:FoodandAgricultureOrganizationoftheUnitedNations.Accessed23August2011athttp://www.fao.org/docrep/010/ah869e/ah869e00.pdf.
Farombi,E.O.,2006.Aflatoxincontaminationoffoodsindevelopingcountries:Implicationsforhepatocellularcarcinomaandchemopreventivestrategies.AfricanJournalofBiotechnology5(1),114.
Floyd,C.,etal.,2003.HouseholdadoptionandtheassociatedimpactofmultipleagriculturaltechnologiesinthewesternhillsofNepal.AgriculturalSystems76(2),715738.
Frankenberger,T.R.,Walters,T.,Kiff,E.,&Awasthi,G.D.,2011.Nepal:AnevaluationofWFPsportfolioVol.Ifullreport.Rome:WorldFoodProgramme
Gittelsohn,J.,Mookherji,S.,Pelto,G.,1998.OperationalizinghouseholdfoodsecurityinruralNepal.FoodandNutritionBulletin19(3),210222.
Gittelsohn,J.,Thapa,M.,Landman,L.,1997.Culturalfactors,caloricintakeandmicronutrientsufficiencyinruralNepalihouseholds.SocialScience&Medicine44(11),17391749.
Gong,Y.Y.,Egal,S.,Hounsa,A.,Turner,P.C.,Hall,A.J.,Cardwell,K.F.,Wild,C.P.,2003.DeterminantsofaflatoxinexposureinyoungchildrenfromBeninandTogo,WestAfrica:Thecriticalroleofweaning.InternationalJournalofEpidemiology32,556562.
-
GovernmentofNepal,2006.Monograph:AgriculturalCensusNepal,2001/02.Kathmandu:NationalPlanningCommissionSecretariat,CentralBureauofStatistics.
Hell,K.,Mutegi,C.2011.AflatoxincontrolandpreventionstrategiesinkeycropsofSubSaharanAfrica.AfricanJournalofMicrobiologyResearch5(5),459466.
Hobbs,C.,2009.Thecostofcoping:AcollisionofcrisesandtheimpactofsustainedfoodsecuritydeteriorationinNepal.WorldFoodProgrammeNepalFoodSecurityMonitoringSystem.Kathmandu:WorldFoodProgramme.
Hollema,S.andBishokarma,M.,2009.AsubregionalhungerindexforNepal.Kathmandu:WorldFoodProgramme,NepalfoodSecurityMonitoringSystem(NeKSAP).
Ise,T.,etal.,1996.OutbreaksofCholerainKathmanduVallueinNepal.JournalofTropicalPediatrics42(5),305307.
Ishiyama,S.,Ono,K.,andRai,C.K.,2001.StudyofenteropathogenanditspredisposingfactorsinsuburbanpublicschoolchildreninKathmandu,Nepal.NepalMedicalCollegeJournal3(1),59.
Karkee,M.,2008.NepalEconomicGrowthAssessment:Agriculture.Kathmandu:UnpublishedReporttoUSAID.52pp.
Karki,T.B.,Sinha,B.P.,1989.MycotoxincontaminationoffoodsandfeedsinNepal.InR.L.Semple,A.S.Frio,P.A.Hicks,J.V.Lozare(Eds.),Mycotoxinpreventionandcontrolinfoodgrains,282287.Bangkok,Thailand:UNDP/FAORegionalNetworkInterCountryCooperationonPreharvestTechnologyandQualityControlofFoodgrains(REGNET),ASEANGrainPostharvestProgramme.
Katz,J.,etal.,2001.ImpactofprovidingasmallincomeonwomensnutritionalstatusandhouseholdfoodexpendituresinruralNepal.FoodandNutritionBulletin22(1),1318.
Kohler,G.,Cali,M.,Stirbu,M.,2009.RethinkingpovertyandsocialexclusionresponsesinpostconflictNepal:Childsensitivesocialprotection.Children,YouthandEnvironments19(2),229249.
Koirala,P.,Kumar,S.,Yadav,B.K.,Premarajan,K.C.,2005.OccuranceofaflatoxininsomeofthefoodandfeedinNepal.IndianJournalofMedicalSciences59(8),331336.
Levine,N.E.,1988.Womensworkandinfantfeeding:AcasefromruralNepal.Ethnology27(3),231251.
Manandhar,D.,etal.,2004.EffectofaparticipatoryinterventionwithwomensgroupsonbirthoutcomesinNepal:Clusterrandomisedcontrolledtrial.TheLancet364(9438),970979.
MOHP,2007.Nepaldemographicandhealthsurvey2006.MinistryofHealthandPopulation,NewERA,andMacroInternationalInc.Kathmandu:MinistryofHealthandPopulation,NewEra,andMacroInternationalInc.
Marmot,M.,2007.Achievinghealthequity:Fromrootcausestofairoutcomes.TheLancet370(9593),11531163.
NationalPlanningCommission,1998.TheNinthPlan.Kathmandu:NPC.
-
NepalAgriculturalResearchCouncil,2007.Releasedcropvarieties.Kathmandu:NepalAgriculturalResearchCouncil.AccessedonAugust29,2011atwww.narc.org.np/publicaton/pdf/varieties_released/VarietiesEng.pdf.
Nyyssla,M.,2007.WomensstatusandchildrensfoodsecurityinNepal.ResearchPaperNo.2007/84.Helsinki:UnitedNationsUniversityWorldInstituteforDevelopmentEconomicsResearch.
Ono,K.etal.,2001.SeasonaldistributionofenteropathogensdetectedfromdiarrhealstoolandwatersamplescollectedinKathmandu,Nepal.TheSoutheastAsianJournalofTropicalMedicineandPublicHealth32(3),520526.
Pan,S.,Fang,C.,Rejesus,R.,2009.FoodcalorieintakeundergrainpriceuncertaintyinruralNepal.JournalofFamilyandEconomicIssues30(2),137148.
Pant,B.R.,2008.WomenandNutritioninHimalayanRegion:ACaseStudy.ENVISBulletinonHimalayanEcology16(1),1827.
Pant,C.,etal.,1996.ImpactofnutritioneducationandmegadosevitaminAsupplementationonthehealthofchildreninNepal.Bull.oftheWorldHealthOrganization74(5),53345.
PanterBrick,C.,1993.SeasonalityofenergyexpenditureduringpregnancyandlactationforruralNepaliwomen.AmericanJournalofClinicalNutrition57(5),620628.
Paudel,P.,Devkota,B.,Kubota,T.,2009.LanddegradationinNepal:Areviewonitsstatusandconsequences.JournaloftheFacultyofAgriculture,KyushuUniversity54(2),477479.
Paudyal,K.R.,etal.,2001.MaizeinNepal:Productionsystems,constraints,andprioritiesforresearch.Kathmandu:NARCandCIMMYT.
Pokharel,R.K.,Houston,R.,Harvey,P.,Bishwakarma,R.,Adhikari,J.,Pant,K.D.,Gartoulla,R.,2009.NepalNutritionAssessmentandGapAnalysis(NAGA).FinalreportofNutritionalAssessmentTeam.Kathmandu:ChildHealthDivision/MinistryofHealthandPopulation(CHD/MOHP).
Pokhrel,S.,etal.,2005.GenderroleandchildhealthcareutilizationinNepal.Healthpolicy74(1),100109.
Pradhan,A.,2005.ChildnutritioninNepal.KathmanduUniversityMedicalJournal3(1),23.
Pyakuryal,B.,2008.ComparativeandCompetitiveAdvantagesofNepal.Kathmandu:CenterforProfessionalJournalismStudies.Accessed8/30/11athttp://cpjsnepal.org/.
Pyakuryal,B.,Thapa,Y.,Roy,D.,2005.TradeliberalizationandfoodsecurityinNepal.MTIDdiscussionpaper88.Washington,DC:InternationalFoodPolicyResearchInstitute.
Rai,S.K.,1999.Toxoplasma,toxoplasmosisanditsimplicationaspossibleopportunisticpathogeninNepal.NepalMedicalCollegeJournal1,8186.
Rai,S.K.andGurung,C.K.,1986.IntestinalparasiticinfectionsinhighschoolchildrenofBirgunjCity.JournaloftheInstituteofMedicine(Nepal)8(1),3338.
-
Rai,S.K.,etal.,1994.StatusofsoiltransmittedhelminthicinfectionsinNepal.KansenshogakuZassi68,625630.
Rai,S.K.,etal.,1996.SeroprevalenceofToxoplasmagondiiinfectionincommonmeatanimalsanditspublichealthimportanceinNepal.JournaloftheInstituteofMedicine(Nepal)18,5560.
Rai,S.K.,etal.,2000a.EffectofintestinalhelminthinfectionsonretinolandcarotenestatusamongruralNepalese.NutritionResearch20(1),1523.
Rai,S.K.,etal.,2000b.ContaminationofsoilwithhelminthparasiteeggsinNepal.SoutheastAsianJournalofTropicalMedicineandPublicHealth31,388393.
Rai,S.K.,etal.,2002.InfectiousdiseasesandmalnutritionstatusinNepal:anOverview.MalaysianJournalofNutrition8(2),191200.
Reddy,K.R.N.,Reddy,C.S.,Muralidharan,K.,2009.DetectionofAspergillusspp.andaflatoxinB1inriceinIndia.FoodMicrobiology26(1),2731.
Romer,C.,2004.FoodinsecurityandvulnerabilityinNepal:Profilesofsevenvulnerablegroups.ESAWorkingPaperNo.0410.Rome:FoodandAgricultureOrganizationoftheUnitedNations.
Sah,N.,2005.DeterminantsofchildmalnutritioninNepal:AcaseanalysisfromDhanusha,CentralTeraiofNepal.SavetheChildrenJapanNepalOffice.Kathmandu:SavetheChildrenJapanNepalOffice.
Sanogo,I.,2008.Spatialintegrationofthericemarket:EmpiricalevidencefrommidwestandfarwestNepalandtheNepaleseIndianborder.AsianJournalofAgricultureandDevelopment4(1),139156.
Shrestha,N.,etal.,2008.PovertyalleviationthroughagricultureandruraldevelopmentinNepal.ProceedingsoftheRegionalMeetingTowardsaJointRegionalAgendafortheAlleviationofPovertythroughAgricultureandSecondaryCropDevelopment,97118.Bogor:UNESCAPCAPSA.
Stoltzfus,R.J.,etal.,1998.PlausibleevidenceofeffectivenessofanironsupplementationprogrammeforpregnantandpostpartumwomeninruralBangladesh.FoodandNutritionBulletin,19(3),197204.
Thapa,S.,1989.TheEthnicFactorintheTimingofFamilyFormationinNepal.AsiaPacificPopulationJournal4(1),334.
UNICEF,2010.ChildpovertyanddisparitiesinNepal2010:Arewefailingourchildren?UNICEFGlobalStudyonChildPovertyandDisparities.Kathmandu:UNICEFandGovernmentofNepalNationalPlanningCommission.AccessedAugust2011athttp://www.unicef.org/rosa/Child_Poverty_Study_Brief.pdf.
Ward,P.andShively,G.,2011.DisasterRisk,SocialVulnerabilityandEconomicDevelopment.WestLafayette,IN:PurdueUniversityDepartmentofAgriculturalEconomics.
WorldBank,2010.Nepaloverviewofchildhoodmalnutrition.Washington,DC:TheWorldBank.