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A large proportion of Malawian households are caught in a trap where poverty and food insecurity reinforce one another and where periods of food deficits and severe food crises are frequent occurrences. In recognition of this, the Malawian government has since 2005/06 implemented a large-scale Farm Input Subsidy Program (FISP), which supplies half of smallholder farmers with sufficient fertilizer and maize seeds to satisfy the maize consumption needs of an average-sized family. While the program boosted maize production and lowered maize prices, thus ensuring increased caloric availability at the household level, its effect on overall food consumption, dietary diversity, micronutrient deficiency, and child nutrition is less clear. This study evaluates household expenditure survey data to measure changes in nutrition outcomes between 2004/05 and 2010/11.
Malawi has made significant progress in improving nutrition outcomes in the past decades. Despite this, the rates of stunting and anaemia remain high and overweight and obesity amongst women is rising. Malawi remains one of the most committed countries to nutrition, ranking 3rd out of 45 African countries on the Hunger and Nutrition Commitment Index, but effective implementation of policies is still challenging. Progress is being inhibited by a lack of dedicated budget lines for nutrition at district level, over reliance on external donors, poor coordination and competing priorities for limited resources within sectoral budgets. The pandemic, climate change and the Ukraine war have disrupted food systems, increased prices of fuel, fertilizer, and food, and caused loss of harvest and livelihoods, threatening to reverse decades of progress. Positive and coordinated action is needed to increase financial commitment to food and nutrition security, ensure nutrition is prioritised in the nation’s economic and development agenda, and continue Malawi’s progress to reducing malnutrition.
New evidence this year corroborates the rise in world hunger observed in this report last year, sending a warning that more action is needed if we aspire to end world hunger and malnutrition in all its forms by 2030. Updated estimates show the number of people who suffer from hunger has been growing over the past three years, returning to prevailing levels from almost a decade ago. Although progress continues to be made in reducing child stunting, over 22 percent of children under five years of age are still affected. Other forms of malnutrition are also growing: adult obesity continues to increase in countries irrespective of their income levels, and many countries are coping with multiple forms of malnutrition at the same time – overweight and obesity, as well as anaemia in women, and child stunting and wasting.
Although the Malawian food supply is shaped largely by trends in smallholder food crop production, Ma­lawi’s decades-long focus on improving smallholder productivity has only moderately improved food secu­rity and nutrition outcomes. Country statistics indicate an estimated 36.7 percent of rural Malawian house­holds failed to access sufficient calories between 2010 and 2011. During the same period, 47 percent of children under the age of five years were esti­mated to be stunted in their growth. These indicators imply that some Malawian diets are lacking in terms of quantity (total calories consumed), and most are lacking in terms of quality (sufficient calories derived from nutrient-dense foods, such as meat, fish, eggs, dairy, legumes, fruits, and vegetables). Good nutrition requires both enough total calories (quantity) and enough vitamins and minerals per calorie (quality). How can Malawi better leverage its smallholder agriculture sector to improve nutrition? This report provides a series of primary and secondary data anal­yses that examine different aspects of this question.
Smallholder agriculture is the mainstay of Malawi’s economy. Its importance for livelihoods cannot be overstated. 94 percent of rural residents and 38 percent of urban residents engage in agriculture to some extent (Jones, Shrinivas, and Bezner-Kerr 2014), the vast majority as smallholder farmers with landholdings of less than one hectare. Smallholder crops are primarily maize—which accounted for nearly 80 percent of smallholder-cultivated land in 2011 —followed by cassava and other food crops (FAO 2008; IFAD 2011). These foods are grown for household consumption and for sale at local and regional markets. As such, the Malawian food supply, especially in rural areas where markets are thin with few buying or selling options, is shaped largely by trends in smallholder food-crop production
A review of evidence was conducted to understand the trends and determinants of malnutrition and identify interventions and programmes that improved maternal and child nutrition in Malawi. While children are less malnourished than two decades ago, one in three children remains stunted (37%) and 63% are anaemic. Children born from younger and less educated mothers, or from poorer rural households are more likely to be malnourished. One in ten children are born with a low birth weight (< 2.5kgs), with nearly half of them stunted by age two. The main causes of malnutrition include recurring sickness, poor infant and young child feeding and hygiene practices and low use of health and nutrition services, influenced by a wide range of factors, including food insecurity, poverty, gender inequality and food taboos. Programme evaluations and intervention trials have shown mixed results but overall highlight the need to address the multiple underlying drivers of malnutrition, rather than focus on one intervention.
Micronutrient deficiencies are common across the developing world and have major effects on the health outcomes of its population. Although this is well understood, many countries find it difficult to bring about policy change in this regard. This paper uses micronutrient policies designed and implemented in Malawi as a case study to shed light on the barriers and gaps faced by developing countries for similar programs and policies. To understand the drivers of policy change, this paper uses the kaleidoscope model to trace the policy processes of three major micronutrients—iodine, vitamin A, and iron. Using a select set of policy process tools, as well as field interviews with key informants who were part of Malawi’s micronutrient policy process, the authors test a set of hypotheses on 16 variables that drive policy change in the micronutrient policy sphere. Results indicate that much of the agenda setting for micronutrient policies and programs was triggered by external events that focused on the elimination of micronutrient deficiencies as part of the global development agenda. These events include the International Conference on Nutrition, the Millennium Development Goals, and, more recently, Scaling up Nutrition. The design of micronutrient policies and program interventions in Malawi was adopted by locally mandated ministries and institutions, in collaboration with development partners who provided both financial and technical support at the design stage. The adoption of micronutrient policies and intervention programs was driven primarily by external funding, particularly through supplementation programs related to vitamin A and iron. Adoption of fortification standards for vitamin A has been going on for more than a decade due to continuous resistance from the private sector, which faces additional costs and needs greater technical expertise. The biofortification method of micronutrient interventions for iron and vitamin A is externally driven and relatively new in Malawi. Although this method is widely accepted by policy makers, no concrete strategy has been developed for its design, adoption, and implementation. Further, supplementation and fortification programs continue to face implementation challenges due to poor physical infrastructure and monitoring systems. However, the national institutional architecture required for agenda setting, design, adoption, implementation, evaluation, and review to address micronutrient deficiencies is in place in Malawi. The system needs continued support from development partners for effective functioning at all levels. The use of various tools for the policy change part of the kaleidoscope model indicate that policy change is a dynamic process; over time, changes in the nature and composition of the members of policy and institutional architecture can result in different policy outcomes. The Malawi case study demonstrates two things. First, local leadership is crucial in keeping micronutrient deficiencies on the policy-making agenda, and second, it matters where coordinating power is placed in the policy hierarchy. This paper finds that, even with policy champions, adopted policies will face implementation challenges unless they are supported with adequate resources and are systematically followed through to final execution and delivery.
Updates for many countries have made it possible to estimate hunger in the world with greater accuracy this year. In particular, newly accessible data enabled the revision of the entire series of undernourishment estimates for China back to 2000, resulting in a substantial downward shift of the series of the number of undernourished in the world. Nevertheless, the revision confirms the trend reported in past editions: the number of people affected by hunger globally has been slowly on the rise since 2014. The report also shows that the burden of malnutrition in all its forms continues to be a challenge. There has been some progress for child stunting, low birthweight and exclusive breastfeeding, but at a pace that is still too slow. Childhood overweight is not improving and adult obesity is on the rise in all regions. The report complements the usual assessment of food security and nutrition with projections of what the world may look like in 2030, if trends of the last decade continue. Projections show that the world is not on track to achieve Zero Hunger by 2030 and, despite some progress, most indicators are also not on track to meet global nutrition targets. The food security and nutritional status of the most vulnerable population groups is likely to deteriorate further due to the health and socio economic impacts of the COVID-19 pandemic. The report puts a spotlight on diet quality as a critical link between food security and nutrition. Meeting SDG 2 targets will only be possible if people have enough food to eat and if what they are eating is nutritious and affordable. The report also introduces new analysis of the cost and affordability of healthy diets around the world, by region and in different development contexts. It presents valuations of the health and climate-change costs associated with current food consumption patterns, as well as the potential cost savings if food consumption patterns were to shift towards healthy diets that include sustainability considerations. The report then concludes with a discussion of the policies and strategies to transform food systems to ensure affordable healthy diets, as part of the required efforts to end both hunger and all forms of malnutrition.