Life in a Time of Food Price Volatility: Evidence from Two Communities in Pakistan

This report contributes to the Life in a Time of Food Price Volatility project by examining the impact of food price volatility on poor and vulnerable households through qualitative research conducted in 2012 and 2013 at ‘listening posts’ in a rural and urban area of Pakistan. While food prices are high in relation to the purchasing power of the poor, price volatility has remained in check. This is partly due to policies for preventing shortages and price spirals which were put in place following the crisis period of 2007-09. Idiosyncratic shocks rather than price changes are conspicuous sources of food insecurity for poor households. Our study finds that the poor and vulnerable face short periods of hunger but prolonged hunger is prevented by informal mechanisms of support that operate through the ‘food economy’. While formal systems in the form of cash transfers and government employment are considered significant sources of support, the government is not considered as a guarantor of food security by the poor. We find that the ‘future farmers’ hypothesis does not hold true for Pakistan as increases in output prices have not changed attitudes of young people towards farming

Agriculture and nutrition in Pakistan: pathways and disconnects

LANSA is funded by UKAid through the Department for International Development (DFID).This paper analyses the pathways and disconnects between agriculture and nutrition in the context of Pakistan, using a framework developed by theTackling the Agriculture-Nutrition Disconnect in India (TANDI) research programme. The pathways identified are: agriculture as a source of food; agriculture as a source of income; supply and demand factors in agriculture that impact household food security; non-food expenditure of income derived from agriculture; and, role of gender through female employment in agriculture and its impact on intra-household allocations, care practices and women's own energy expenditure. The analysis highlights the importance of moving beyond understanding agriculture as a source of food for farm households, and examines the trade-off between self-consumption and the market price of food. The study shows that in Pakistan: the price of most food is not determined by local supply and demand conditions, but by global markets an increase in agricultural income from cash crops, such as cotton, does not necessarily lead to increase in consumption of own-produced food. Cash crops often leave less room for food crops some regions with the worst nutritional outcomes are those where the agricultural economy is doing relatively well. In such areas, demand for women's labour is often high, which can have both positive and negative effects on nutritional outcomes. These findings have important policy implications and the TANDI framework is a useful starting point to understand the agriculture-nutrition link in Pakistan. However, the authors establish that assessing progress along any particular pathway between agriculture and nutrition reveals that there are a wide range of intervening processes and conditions, which require further investigation: Agricultural growth may benefit those households which have access to land, but it may be the landless or land-poor that are the most nutritionally deprived. There is a clear hierarchy between farmers and labourers in terms of income, food security, nutritional outcomes. Patriarchy and unequal gender relations influence social policy and norms which adversely affects maternal health practices, women's empowerment and intra-household allocations of food. Behaviour and preferences of households and individuals over matters concerning food consumption, dietary diversity, and care practices have an influence over agriculture's ability to address undernutrition. Political priorities and organisational effectiveness. The authors conclude that a research agenda that addresses these gaps can play a strategic role in addressing agriculture-nutrition disconnects and improve nutritional outcomes. Existing programmes and policies, such as cash transfer programmes and land grant schemes, that address themes in gender relations and access to land provide opportunities for grounded empirical and policy research. [adapted from summary written by S. Zuberi, from CSSR Pakistan]UK AidDepartment for International Development (DFID

Agriculture and Nutrition in Pakistan: Pathways and Disconnects

Results of the latest nationwide nutrition survey show that the ‘South Asian paradox’ of persistently high rates of undernutrition despite respectable rates of economic growth appears to hold true for Pakistan. Although nutrition has largely been framed as a health issue in Pakistan, it is an outcome of complex processes. Amongst various economic sectors, agriculture – a sector that employs 45 per cent of the workforce in Pakistan – might have direct implications for nutrition outcomes through drivers such as the availability and diversity of food and income distribution. Using evidence from Pakistan, this article reviews trends and policymaking in agriculture and applies a framework for analysing pathways between agriculture and nutrition. It then goes on to highlight potential disconnects in the agriculture?nutrition linkage and identifies areas for future research

Synergy or Trade-Off between Agricultural Growth and Nutrition Women’s Work and Care

This paper examines the implications of women‘s work in agriculture and children‘s nutritional outcomes in Pakistan. Agricultural growth is an important element of overall economic growth and poverty reduction. It is generally presumed that growth in agriculture will also lead to better nutrition through the higher availability of nutritious foods and increased incomes for the poor. Growth, however, might also imply changes in the amount of time and effort women expend in agricultural work. This may have positive outcomes for nutrition if women have access to their own income, but might also have negative consequences if women‘s agricultural work diminishes their ability to provide nutrition-related care for themselves and their children. The cotton sector which relies very largely on women‘s labour, particularly in harvesting [Siegmann and Shaheen (2008)], can serve as a key vantage point for observing the link between women‘s agricultural work, care and nutrition outcomes in Pakistan. We first set the context for our research by discussing the problem of under nutrition in Pakistan and why agriculture can play a role in improving nutritional outcomes (Section 2). In Section 3, we introduce the concept of care as it exists in the literature the determinants of nutrition review the existing evidence on the relationship between care and women‘s agricultural work. Empirical findings from qualitative research in a cotton-growing region in Pakistan are reported in Section 4. The paper concludes in Section 5 with discussion on how growth in agriculture can be made more inclusi

Women’s Agricultural Work and Nutrition in Pakistan: Findings from Qualitative Research

Does women’s work in agriculture help or hinder nutrition in Pakistan? This question has assumed great significance due to the steady feminisation, over the last decade, of the agricultural labour force, and the absence of nutritional improvement in the same period. This exploratory paper builds upon the agriculture-nutrition pathways framework to propose an approach to individual or household-level decision-making in which the provision of care (for children and women) plays an important part in determining nutrition outcomes. If nutrition is one of the factors in work, care and consumption choices, how might the terms of any trade-off be made more favourable to nutrition? The paper examines various linkages between agricultural work and care using insights gained from qualitative research in two high productivity agricultural areas of the country. These linkages are strongly mediated through gendered norms in agricultural work as well as in care provision, and the terms of the possible choices with respect to work, care and consumption vary between socio-economic groups.UK AidDepartment for International Development (DFID

Food Prices and the Politics of Hunger: Beneath Market and State

What accounts for the persistence of hunger and undernutrition in political and administrative systems which might be otherwise sensitive to the risk of food price volatility and market failure? If pre?empting food price volatility has a political constituency why is there not a similar constituency for preventing vulnerability to hunger? The policy response to globally?driven food price volatility in Pakistan was largely successful in achieving its proximate goals, and price spirals and market shortages in 2008 were aberrations from which lessons were drawn effectively. Research for the Life in a Time of Food Price Volatility project shows that the food economy of the poorest is relatively insulated from price fluctuations, and vulnerability to hunger is mostly driven by idiosyncratic shocks. The poorest often operate beneath the market, or at the lowest rung of a highly segmented market, and their expectations with respect to rights and entitlements to food correspond with their prevailing sources of informal social support

Multi-Institutional Datasets Validate the Recursive Partitioning Analysis for Overall Survival in Patients Undergoing Spine Radiosurgery for Spine Metastasis

Purpose/Objective(s): The recently published spine radiosurgery (sSRS) recursive partitioning analysis (RPA) for overall survival (OS) separated patients into 3 distinct prognostic groups. We sought to externally validate this RPA using a multi-institutional dataset. Materials/Methods: A total of 444 patients were utilized to develop the recently published sSRS RPA predictive of OS in patients with spine metastases. The RPA identified three distinct prognostic classes. RPA Class 1 was defined as KPS \u3e70 and controlled systemic disease (n=142); RPA Class 2 was defined as KPS\u3e70 with uncontrolled systemic disease or KPS ≤70, age ≥54 and absence of visceral metastases (n=207); RPA Class 3 was defined as KPS ≤70 and age \u3c54 years or KPS≤70, age ≥54 years and presence of visceral metastases (n=95). We utilized data from large tertiary care centers to validate this RPA. A total of 749 patients were in the validation cohort and were divided based on their RPA Class. Kaplan-Meier method was used to estimate OS and log-rank test was used to compare OS between RPA classes. Results: In the validation cohort (749 patients), the median OS was 11.0 months. One-hundred-thirteen (15.1%) patients were in RPA Class 1, 432 (57.7%) patients in RPA Class 2 and 204 (27.2%) patients in RPA Class 3. The median OS in the validation cohort based on RPA Class was 27.1 months for Class 1, 13.0 months for Class 2 and 3.5 months for Class 3. Patients in RPA Class 1 had a significantly better OS compared to those in Class 2 of the validation cohort (p\u3c0.01). Similarly, patients in RPA Class 2 had a significantly better OS compared to those in Class 3 (p\u3c0.01). Conclusion: The external datasets from two large centers validated the spine SRS RPA successfully for RPA for OS for patients undergoing sSRS for spinal metastases. This is the first RPA for OS to have been externally validated using a large dataset. Based on this validation, upfront spine SRS is strongly supported for patients in RPA Class 1. Upfront SRS is also supported for RPA Class 2 patients. Patients in RPA Class 3 would benefit most from upfront conventional radiotherapy given their poor expected survival. Given successful external validation, this RPA helps guide physicians to identify those patients with spinal metastases who most benefit from sSRS

Leveraging agriculture for nutrition in South Asia and East Africa: examining the enabling environment through stakeholder perceptions

South Asia and sub-Saharan Africa are the two regions of the world with the highest concentration of undernutrition. The majority of the nutritionally vulnerable populations in both regions is dependent in some way upon agriculture as a primary source of livelihood. The agriculture sector and wider agri-food system is considered to be central to sustained progress in reducing undernutrition – and yet not enough is known about how to unleash this potential. Recent scoping assessments have also revealed a paucity of information on wider political, institutional and policy-related challenges relating to the agriculture-nutrition nexus globally. Contextualized research into policy processes and the political economy of agriculture and nutrition is needed to better characterize “enabling environments” for agriculture to benefit nutrition, and how these environments can be shaped and sustained. This study aims to contribute to filling this gap, by drawing upon evidence from a set of case studies in South Asia (India, Bangladesh and Pakistan) and eastern Africa (Ethiopia, Uganda and Kenya). In synthesizing results across countries, while recognizing important nuance and detail, we conclude by highlighting four key issues to be addressed. First, improving knowledge and perception of undernutrition and its links to agriculture, on the part of agricultural policymakers and programme managers. Second, generating system-wide incentives for decisions and actions to become more pro-nutrition. Third, developing transparent systems of accountability for nutrition-relevant action throughout the agriculture sector, through linking timely and actionable data and evidence with incentives. And fourth, cultivating and strengthening leadership and capacities at different levels, underpinned by adequate financing.UK AidDepartment for International Development (DFID

Women's agricultural work and nutrition in South Asia: From pathways to a cross-disciplinary, grounded analytical framework

Copyright © 2018 The Authors. In this systematic review, we aim to examine the impact of women’s work in agriculture on maternal and child nutrition in South Asia. Building on previous reviews supported under the Leveraging Agriculture for Nutrition in South Asia (LANSA) consortium, and recent published literature, we include findings from new LANSA research. While mapping literature onto the gender-nutrition pathways linking agriculture to nutrition (Kadiyala et al., 2014), we also point to conceptual and methodological directions for further exploration emerging from our work. Key amongst these are a focus on seasonality, poverty, and gender relations, moving beyond both an exclusive focus on women as a unified and homogenous group, and agriculture as an unchanging and common set of activities and production processes. Our analysis suggests the need for a more contextualised approach, and for a richer cross-disciplinary framework for effectively addressing the ways in which women’s work mediates agriculture’s role in improving child and maternal nutrition in South Asia.This article is part of the research generated by the Leveraging Agriculture for Nutrition in South Asia Research (LANSA) research consortium, and is funded by UK aid from the UK government

Agriculture, Food Systems, and Nutrition: Meeting the Challenge

Malnutrition is a global challenge with huge social and economic costs; nearly every country faces a public health challenge, whether from undernutrition, overweight/obesity, and/or micronutrient deficiencies. Malnutrition is a multisectoral, multi-level problem that results from the complex interplay between household and individual decision-making, agri-food, health, and environmental systems that determine access to services and resources, and related policy processes. This paper reviews the theory and recent qualitative evidence (particularly from 2010 to 2016) in the public health and nutrition literature, on the role that agriculture plays in improving nutrition, how food systems are changing rapidly due to globalization, trade liberalization, and urbanization, and the implications this has for nutrition globally. The paper ends by summarizing recommendations that emerge from this research related to (i) knowledge, evidence, and communications, (ii) politics, governance, and policy, and (iii) capacity, leadership, and financing