ensuring that no harm is done to the nutritional status
of people who are affected by the program). How does a
“nutrition lens” work? Take the example of agricultural
value chains. Clearly stating that improved nutrition is an
objective of a project focused on agriculture value chains
ensures that nutritional changes and outcomes are measured
all along the value chain; moreover, opportunities to reduce
the potential for harm and to create positive nutritional
outcomes can be identified.56
The difficulty is that improving maternal/child nutrition
is an objective of few, if any, projects or programs in other
sectors. Therefore, measures of nutritional impact have not
been built into the design and evaluation of projects. As a
result, it has been difficult to demonstrate improved nutrition
outcomes through nutrition-sensitive actions in other
development sectors. Two recent systematic reviews—Webb
Girard, et al. (2012)57 and Masset, et al. (2011)58—underscore
the lack of available evidence that agricultural programs
improve nutritional outcomes.59 Masset concluded, “…
agricultural interventions improve the production and
consumption of nutritious food among poor households
but could not identify a direct impact on the nutritional
status of children…. the absence of any reported statistically
significant impact of agricultural interventions on children’s
nutritional status found by this review, as well as by other
reviews that preceded this one, should not be attributed to
the inefficacy of these interventions. Rather it is the lack of
power of the studies reviewed that could have prevented the
identification of such impact, if any.”60
Costing and Investing in NutritionSensitive Development
A June 2012 IFPRI policy brief noted that SUN countries
“need more information on the cost and value-added of
incorporating a nutrition-lens (nutrition-sensitive) into
complementary sectors and development sectors.”61 A
2010 forum on agriculture and nutrition collaboration62
attempted to look at entry points along the agricultural
value chain where nutrition outcomes might be considered.
The report states, “There were certainly as many questions
raised as there were answers offered and in the end, it was
clear that there is as great a need to unify thoughts around
the subject as there is a call for specific actions.”
Lack of consensus about what constitutes nutritionsensitive development and what are its contributions
to reducing undernutrition has made it challenging
to establish the relative cost effectiveness of different
approaches. Quantifying the cost effectiveness of nutritionspecific interventions—activities that lead to direct impact
on stunting and wasting rates, specific micronutrient
deficiencies, and/or nutrition-related chronic diseases—is
www.bread.org
much easier and more straightforward than identifying and
attributing the costs of a package of indirect activities to an
impact that is the result of several actions working together.63
For this reason, the SUN movement recognizes the limited
evidence base for nutrition-sensitive development. World
Vision International64 recommends: “Based on input from
all stakeholders, the war on undernutrition must include
the costing of direct and indirect nutrition interventions
and outline the responsibilities of each sector for delivering
improved nutrition for children.”
Pathways to Improving Nutrition through
Nutrition-Sensitive Development
A 2003 World Bank Economic Review article on
child malnutrition concluded that delivery of “indirect”
(nutrition-sensitive) actions for income growth through food
security and agriculture interventions alone is not enough
to reach the Millennium Development Goal of halving
the prevalence of underweight children by 2015.65 The
SUN movement has built on the consensus that improving
maternal and child nutrition will require a multi-sectoral
approach. Q