Impacts of family planning on

nutrition and food security

Reshma Naik Ellen Smith

April 14, 2015

Background USAID-funded: Health Policy Project

Collaboration between Futures Group and Population Reference Bureau

Two evidence reviews: unidirectional impact of family planning on: 1) nutrition; 2) food security

Aim to inform policy and programming

Methods Search methods: electronic databases, journal reviews, USAID resources, organization websites

Documents reviewed: peer reviewed articles, technical briefs, guidelines, statements and strategies, grey literature

Common themes identified

Context

Unmet Need Direct impacts Indirect impacts

Key nutrition outcomes ▪ Low birth weight ▪ Preterm birth ▪ Small-for-gestational age ▪ Breastfeeding* ▪ Stunting ▪ Underweight ▪ Wasting

▪ Body Mass Index ▪ Growth ▪ Micronutrient deficiency

Level of evidence varies

Weak Strongest

Guidelines recommend waiting

after having a child to

become pregnant

Illustrative evidence for infants conceived within 6 months of a previous birth: Conde-Agudelo (2006): 26% greater odds of

small-for-gestational age (vs. 18-23 months)

Rutstein (2008). 42% greater odds of low birth weight (vs. 36 – 47 months).

Wendt (2012). 41% greater odds of pre-term birth (vs. > 6 months).

Poor spacing leads to poor infant nutrition

Illustrative evidence. Compared to children conceived within an interpregnancy interval of 36-47 months: Those conceived within 6 months have nearly 40

percent greater odds of stunting and underweight

Those conceived within 12-17 months have about 25 percent greater odds of stunting and underweight

Poor spacing leads to poor child nutrition

Rutstein 2014, 45 DHS Surveys

Adolescents are vulnerable to malnutrition

15-20% height and 50% weight attained during adolescence

Require more protein, iron, micronutrients

Pregnancy adds risk

Adolescent pregnancy can halt growth and development

“Pregnancy and lactation during adolescence ceased linear growth and resulted in weight loss and depletion of fat and lean body mass of young girls.”

(Rah 2008, Bangladesh)

“Pregnant adolescents appear to adjust their resting energy needs by ceasing growth.”

(Casanueva 2006, Mexico)

“[Pregnant] adolescents ages 15 years or younger had higher risks for….anemia compared with women ages 20 to 24.” (Conde-Agudelo 2005, Latin America)

America)

Infants of young mothers are at risk for undernutrition

Finlay et al. 2011, DHS data from 55 low and middle income countries

Compared to children with mothers 27-29 years, children who have very young mothers (12-17 years) face higher risks of: Stunting Underweight Anemia

Children of mothers ages 12-14 years have a 51 percent greater risk of stunting

Children of mothers ages 15-17 have a 36 percent greater risk of anemia

Children of adolescent mothers are at risk for undernutrition

Other potential areas of linkage

Weaker Strongest

Feeding practices

Time, energy, resources for optimal feeding practices Early weaning Adolescent breastfeeding

No strong, clear conclusions

More research needed when it comes to mechanisms of action

Maternal depletion

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Pregnancy intention Inconclusive evidence about links between unintended pregnancy and:

Birth outcomes

Exclusive breastfeeding

Stunting

Indirect impacts of family planning on nutrition

Nutrition Maternal mortality &

Women’s empowerment

Reducing maternal mortality can improve infant and child nutrition

In developing countries, women face a 1 in 150 lifetime probability of dying from maternal causes Many pregnancies unintended Family planning can reduce exposure to risks of pregnancy and child birth. When mothers survive, children survive

Increasing women’s empowerment can improve nutrition

Decreases in fertility are associated with empowerment In turn, empowerment can improve nutrition

Food Security

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Four food security pillars Food availability: sufficient quantities of appropriate, necessary types of food are consistently available or are within reasonable proximity or are within their reach

Food access: individuals have adequate income or other resources to obtain levels the amounts of appropriate foods they need to maintain an adequate diet/nutrition level.

Food utilization/consumption: individuals meet the appropriate biophysical conditions to adequately use food to meet their dietary needs.

Stability: the first three pillars are consistent over time and are not lost as a consequence of sudden shocks or cyclical events.

Pillar 1: Food availability Agricultural outputs: increase by 70% by 2050

TFR of 2.1 by 2050 would reduce crop demand: Globally, by 600 trillion kcal SSA, by 25%

High fertility can decrease the ability of women to contribute to food production.

Climate change will decrease agricultural production; adaptation is easier with fewer people.

Pillar 1: Food availability

Rapidly growing populations and increased food production demands can: Stress water supplies

Force agricultural production onto marginal lands, leading to deforestation, land degradation & soil erosion

Lead to more intensive agriculture and lack of fallow time

Shrink plot size for small farmers

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Pillar 2: Food access Larger households spend

less per capita on food Poorer families spend a

larger percentage of their expenditures on food; tend to have higher unmet need

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Pillar 2: Food access Fertility can affect female labor force participation:

Fertility has “..large negative effect of the fertility rate on female labor force participation” (Bloom 2007)

Women spend 0.5 years out of the labor force for each child (Ashraft 2012)

Having fewer, well-spaced children increases female labor force participation and educational attainment (Lee-Rife 2012)

Photo by Oxfam/Aubrey Wade

Pillar 2: Food access Matlab: Women in treatment area earned more for each year of schooling, weighed more, had higher BMI than women in comparison area.

Photo by Oxfam/Aubrey Wade

Pillar 3: Food Utilization and Consumption

Pregnancy and breastfeeding require greater energy and nutrient intake

First 1000 days of life are especially vulnerable to food insecurity

Poor sanitation in high-growth, poor urban areas can affect absorption of nutrients.

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Pillar 4: Food Stability

Women are less likely than men to be resilient in the face of external changes and shocks.

Early childbearing and early departure from school can decrease ability to adapt to shocks.

Maternal mortality and morbidity can decrease food stability for entire household.

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What next?

Open up the dialogue about the role family planning can play Broaden our views on how family planning can be better leveraged Start integrating family planning into nutrition and food security programs and policies

www.healthpolicyproject.com

Thank You!

The Health Policy Project is a five-year cooperative agreement funded by the U.S. Agency for International Development under Agreement No. AID-OAA-A-10-00067, beginning September 30, 2010. The project’s HIV activities are supported by the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR). It is implemented by Futures Group, in collaboration with Plan International USA, Avenir Health (formerly Futures Institute), Partners in Population and Development, Africa Regional Office (PPD ARO), Population Reference Bureau (PRB), RTI International, and the White Ribbon Alliance for Safe Motherhood (WRA).