The Cost of Improving Nutritional Outcomes Through Food‐Assisted Maternal and Child Health and Nutrition Programmes in Burundi and Guatemala

Evidence on the cost‐effectiveness of multisectoral maternal and child health and nutrition programmes is scarce. We conducted a prospective costing study of two food‐assisted maternal and child health and nutrition programmes targeted to pregnant women and children during the first 1,000 days (pregnancy to 2 years). Each was paired with a cluster‐randomized controlled trial to evaluate impact and compare the optimal quantity and composition of food rations (Guatemala, five treatment arms) and their optimal timing and duration (Burundi, three treatment arms). We calculated the total and per beneficiary cost, conducted cost consequence analyses, and estimated the cost savings from extending the programme for 2 years. In Guatemala, the programme model with the lowest cost per percentage point reduction in stunting provided the full‐size family ration with an individual ration of corn–soy blend or micronutrient powder. Reducing family ration size lowered costs but failed to reduce stunting. In Burundi, providing food assistance for the full 1,000 days led to the lowest cost per percentage point reduction in stunting. Reducing the duration of ration eligibility reduced per beneficiary costs but was less effective. A 2‐year extension could have saved 11% per beneficiary in Guatemala and 18% in Burundi. We found that investments in multisectoral nutrition programmes do not scale linearly. Programmes providing smaller rations or rations for shorter durations, although less expensive per beneficiary, may not provide the necessary dose to improve (biological) outcomes. Lastly, delivering effective programmes for longer periods can generate cost savings by dispersing start‐up costs and lengthening peak operating capacity

Cognitive interviewing to improve women's empowerment questions in surveys: Application to the health and nutrition and intrahousehold relationships modules for the project-level Women's Empowerment in Agriculture Index

In 2015, the United Nations adopted the Sustainable Development Goals, which include fostering gender equality and women's empowerment and ending hunger and malnutrition. To monitor progress and evaluate programmes that aim to achieve these goals, survey instruments are needed that can accurately assess related indicators. The project-level Women's Empowerment in Agriculture Index (pro-WEAI) is being developed to address the need for an instrument that is sensitive to changes in empowerment over the duration of an intervention. The pro-WEAI includes new modules with previously untested survey questions, including a health and nutrition module (focused on women's agency in this area) and an intrahousehold relationships module. This study uses cognitive interviewing to identify how new survey questions might be misinterpreted and to understand what experiences women are referencing when they respond to these questions. This was undertaken with the goal of informing revision to the modules. The study was conducted in Bangladesh with women from nuclear, extended, and migrant-sending households and from two regions of the country to identify difficulties with interpretation and response formulation across these groups. Findings revealed that questions were generally understood, but participants occasionally responded to the wrong part of the question, did not understand key phrases, or were uncomfortable with questions. The findings also suggested ways to revise the modules and strengthen the pro-WEAI. The revised pro-WEAI health and nutrition and intrahousehold relationships modules will advance the ability to measure changes in these domains and their relationship with the health and nutritional status of women and their children

A process guide for the development of a mixed-methods research tool for measuring and understanding intra-household decision making

Numerous approaches have been developed by researchers for measuring intra-household decision making. Most use quantitative surveys that often rely on a standard set of questions that inquire about who contributes to key household decisions or women’s abilities to participate in these decisions. Such questions have been criticized for focusing too much on the identity of the decision maker and less on understanding why and how decisions get made within the household and on the multiple facets of women’s roles in decision-making processes1. To address the shortcomings of current approaches, we (an interdisciplinary group of applied gender and agriculture researchers) developed a transdisciplinary and mixed-methods approach that can be adapted across livelihoods and geographies to measure intra-household decision making and shed light on the “who,” “why,” and “how” of important household decisions. This guide describes the transdisciplinary process that was used to develop the mixed-methods research tool for understanding and measuring intra-household decision making. In our approach, we focus on measuring who makes which decisions, how, and why and how this influences food, nutrition, and economic security outcomes. This guide, therefore, provides a base for other researchers and development practitioners to develop a context-specific mixed-methods tool for understanding and measuring intra-household decision making

FR1.2: Is Women's Empowerment Bearing Fruit? Mapping Women's Empowerment in Agriculture Index (WEAI) results to the Gender and Food Systems Framework

This review examines the relationships between domains of women's empowerment and food system outcomes, as defined by the Gender and Food Systems Framework (Njuki et al. 2022). We reviewed papers that cited both the original WEAI and/or pro-WEAI papers, Alkire et al., (2013) and Malapit et al. (2019), between 2013 and April 2022. The literature search had the following additional inclusion criteria: published in English; published as a journal article or working paper; calculated a WEAI, A-WEAI, or pro-WEAI metric and/or indicator; and, reported significance level of a food system outcome. We found that women's empowerment is significantly associated with various outcomes, though which aspect of empowerment matters for a particular outcome varies across contexts. Many studies found significant positive associations between women's empowerment and intrahousehold gender equality with various children's dietary and nutrition outcomes; household food security; and agricultural production indicators. Several studies document significant associations between empowerment indicators and women's dietary diversity scores, but with mixed results. The findings suggest that increasing women's empowerment and closing empowerment gaps contribute to improved dietary and nutrition outcomes, but household wealth, gender norms, and country-specific institutions are also critical. Most papers identified illustrate associative relationships; future research may investigate these relationships more deeply to determine causal relationships that drive desired food system outcomes. Further, stronger commitments to address structural and institutional barriers to gender equality in policy may enhance food system outcomes

A Bitter Taste Receptor as a Novel Molecular Target on Cancer-Associated Fibroblasts in Pancreatic Ductal Adenocarcinoma

Cancer-associated fibroblasts (CAFs) execute diverse and complex functions in cancer progression. While reprogramming the crosstalk between CAFs and cancer epithelial cells is a promising avenue to evade the adverse effects of stromal depletion, drugs are limited by their suboptimal pharmacokinetics and off-target effects. Thus, there is a need to elucidate CAF-selective cell surface markers that can improve drug delivery and efficacy. Here, functional proteomic pulldown with mass spectrometry was used to identify taste receptor type 2 member 9 (TAS2R9) as a CAF target. TAS2R9 target characterization included binding assays, immunofluorescence, flow cytometry, and database mining. Liposomes conjugated to a TAS2R9-specific peptide were generated, characterized, and compared to naked liposomes in a murine pancreatic xenograft model. Proof-of-concept drug delivery experiments demonstrate that TAS2R9-targeted liposomes bind with high specificity to TAS2R9 recombinant protein and exhibit stromal colocalization in a pancreatic cancer xenograft model. Furthermore, the delivery of a CXCR2 inhibitor by TAS2R9-targeted liposomes significantly reduced cancer cell proliferation and constrained tumor growth through the inhibition of the CXCL-CXCR2 axis. Taken together, TAS2R9 is a novel cell-surface CAF-selective target that can be leveraged to facilitate small-molecule drug delivery to CAFs, paving the way for new stromal therapies

TH1.1: A mixed-methods research tool for improving measurement and understanding of intra-household decision making

A key aspect of women's empowerment is participation in important intra-household decisions. This paper describes a new mixed-methods emic-informed approach that we developed involving multiple stakeholders to explore intra-household decision making on agriculture- and expenditure-related matters. The tool was piloted in cassava-producing districts in Kagera and Kigoma Regions of Tanzania. It first comprises a qualitative guide that was used to interview 40 dyads (mostly married couples) who grow, process, and/or trade cassava. We conducted thematic content analysis of these interviews and identified seven distinct patterns that dyads used to make decisions. These included: husband shares idea, discusses with wife, then (i) husband makes the final decision; (ii) wife makes the final decision; or (iii) they make a joint final decision. Alternatively, (iv) husband shares idea with his wife before he makes the final decision; or wife shares idea, discusses with husband, then (v) husband makes the final decision; (vi) wife makes the final decision; or (vii) they make a joint final decision. These patterns informed the development of vignettes that describe intra-household decision making, along with survey questions asking respondents which decision-making vignettes they most identify with and additional questions on why and how decisions are made in their households. Finally, these new modules were included in a multi-topic survey that was administered to around 1300 couples to validate the new decision-making modules. Our approach aims to help us better measure and understand intra-household decision making and its links to household-level economic, food, and nutrition security outcomes

Women's empowerment, production choices, and crop diversity in Burkina Faso, India, Malawi, and Tanzania: a secondary analysis of cross-sectional data

BACKGROUND: Bolstering farm-level crop diversity is one strategy to strengthen food system resilience and achieve global food security. Women who live in rural areas play an essential role in food production; therefore, we aimed to assess the associations between women's empowerment and crop diversity. METHODS: In this secondary analysis of cross-sectional data, we used data from four cluster-randomised controlled trials done in Burkina Faso, India, Malawi, and Tanzania. We assessed women's empowerment using indicators from the Women's Empowerment in Agriculture Index. Farm-level crop diversity measures were the number of food crops grown, number of food groups grown, and if nutrient-dense crops were grown. We used a two-stage modelling approach. First, we analysed covariate-adjusted country-specific associations between women's empowerment and crop diversity indicators using multivariable generalised linear models. Second, we pooled country-specific associations using random-effects models. FINDINGS: The final analytic sample included 1735 women from Burkina Faso, 4450 women from India, 547 women from Malawi, and 574 women from Tanzania. Across all countries, compared with households in which women provided input into fewer productive decisions, households of women with greater input into productive decisions produced more food crops (mean difference 0·36 [95% CI 0·16-0·55]), a higher number of food groups (mean difference 0·16 [0·06-0·25]), and more nutrient-dense crops (percentage point difference 3 [95% CI 3-4]). Across all countries, each additional community group a woman actively participated in was associated with cultivating a higher number of food crops (mean difference 0·20 [0·04-0·35]) and a higher number of food groups (mean difference 0·11 [0·03-0·18]), but not more nutrient-dense crops. In pooled associations from Burkina Faso and India, asset ownership was associated with cultivating a higher number of food crops (mean difference 0·08 [0·04-0·12]) and a higher number of food groups (mean difference 0·05 [0·04-0·07]), but not more nutrient-dense crops. INTERPRETATION: Greater women's empowerment was associated with higher farm-level crop diversity among low-income agricultural households, suggesting that it could help enhance efforts to strengthen food system resilience. FUNDING: Bill & Melinda Gates Foundation