Nutrition

Community Nutrition and Health Activity Equity Gap Analysis

The Community Nutrition and Health Activity (CNHA) conducted an equity gap analysis to investigate the existing inequities in health and nutrition outcomes within its target areas in Bangladesh. This analysis aimed to identify not only the current inequities but also the underlying reasons for these disparities. Using USAID’s Unofficial Guidance to an Equity Gap Analysis, the CNHA team defined desired outcomes, assessed differential health and nutrition outcomes among various population groups through secondary data, and conducted stakeholder consultations with marginalized groups to understand the reasons behind these inequities. The findings highlighted that individuals in the two lowest wealth quintiles face significant barriers to accessing health care services, with persons with disabilities particularly excluded. Stakeholder consultations revealed issues such as lack of respectful care from community health care providers, restrictions on women's mobility, and inadequate participation in government safety net programs.

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The First 1000 Days, Phase III in Sekong and Phongsaly Provinces

The First 1000 Days Project Phase III focuses on improving maternal and child mortality, improving health outcomes for women, adolescents, and children in the first 1,000 days of the life of children in Sekong and Phongsaly Provinces as well as to support poor and vulnerable households in remote, rural areas to facilitate access to and improve the quality of nutrition-related health services for mothers and children and improve food and nutrition security for community members. The project also integrates adolescent sexual reproductive health, women’s economic empowerment, responses to gender based violence, and stakeholder engagement in health.
This report examines the health, nutrition, and economic empowerment of women, adolescents, and children in Phongsaly and Sekong provinces of Laos. The baseline assessment aimed to understand the current situation and identify areas where interventions could have the greatest impact. Data was collected through a combination of surveys, focus group discussions, key informant interview with key stakeholders and interviews with mother of CU5, adolescent (age 15-19), men, healthcare providers, and community leaders.
The results showed that despite high antenatal care (ANC) utilization rates in both Phongsaly and Sekong, there remains room for improvement in overall healthcare delivery, particularly around childbirth. Home births remain common, highlighting the need for increased access to skilled birth attendants at health facilities and mobile outreach services. Sekong lags behind Phongsaly in skilled birth attendance rates.
Another area requiring attention is postnatal care. While attendance is satisfactory, there's potential to improve these services. Additionally, a concerning practice of some women lying over fire after childbirth needs to be addressed due to potential health risks.
Regarding family planning, awareness and usage vary significantly between the two provinces, with Phongsaly showing higher rates. Sekong especially needs increased access to family planning services, while both provinces could benefit from addressing confidentiality concerns surrounding these services, particularly in Phongsaly.
Food and nutrition security presents a significant challenge, as nutrition indicators showed poor nutritional status of children. Stunting rates among children under five are high, particularly in Sekong. Both provinces struggle with low dietary diversity, lacking adequate consumption of fruits, vegetables, legumes, and animal source proteins. While breastfeeding practices show positive trends in early initiation and colostrum feeding, there remains poor long-term rates of exclusive breastfeed. Sekong has lower rates of early initiation and exclusive breastfeeding duration compared to Phongsaly, and even in Phongsaly, many mothers wean before the recommended 6 months. Read More...

Systems-Level Change in Niger: Women and Girls Are Better Off Today Than in 1991

Few development programs have a decades-long lifespan and impact. CARE’s Mata Masu Dubara model (MMD) has been rolled out since 1991, championing women's leadership and economic empowerment in Niger. Originally conceived as savings and credit groups, the model has evolved over the years to address women’s groups demands to have better access to public health services, improve nutrition, receive technical training and participate in civic and electoral processes, among others.

In 2023, CARE initiated a ground-breaking systems evaluation of MMD groups in Niger to explore the actual influence the groups have on women’s and girl’s voice, leadership, economic autonomy and climate justice, published in a May 2023 report. A complementary mixed-methods evaluation conducted from July to December 2023 explores the influence of MMD on women and girls’ maternal health, early and forced marriage, education and nutrition, in partnership with the Government of Niger.

Using CARE’s pathways of systems-level change, combined with qualitative and quantitative data, the study explored four dimensions of change for each one of the topics mentioned above: 1. Advocacy to influence policies and programs; 2. Changes in social norms; 3. Supporting social movements; 4. Strengthening systems and social responsibility. Today, CARE Niger serves 33,795 groups with 865,000 women and girl members. In Maradi, Zinder, Dosso and Tahoua 1,378 women and men answered a survey; 314 women and men participated in focus group discussions and individual interviews.

Are women and girls of Niger better off in 2023 than they were in 1991? Yes. While the review noted progress made towards more gender equity for girls’ education, access and use of sexual and reproductive health services and more attention paid to the welfare of pregnant and breastfeeding women, early and forced marriage still persists. Leveraging the power of MMD groups and other trusted community leaders (teachers, principals, MMD female leaders, religious leaders) to design interventions to curb early marriage would yield tremendous benefits. Indeed, early marriage robs girls of 9% of their future income.

Through MMD, women of Niger have found their voice, been elected to parliament in record numbers (over 30% in 2021), and participate in local decision making processes as town councilors and local representatives. Acting both at the program, local level and the national, influencing one, CARE, its partners and networks of MMD groups will continue to create a better, safer, more prosperous environment for Nigerien girls. (86 pages) Read More...

Endline Report: Maman Lumière III Project Project / Etude Endline: Projet Maman Lumière III

In response to the major findings and to help achieve the objectives of the State's Economic and Social Development Plan (PDES°), CARE in Niger has negotiated the third phase of the "Projet Maman Lumière III" project, whose interventions aim to break the cycle of malnutrition, particularly in contexts of recurring crises. Financed in January 2020 by the Ministry of Foreign Affairs of the Kingdom of Luxembourg for a period of 48 months, the objective assigned to this project is to contribute to a substantial and sustainable reduction in malnutrition among children under 2 and women aged 15-49 in poor households in the Zinder region by December 2023. At the end of four years of project implementation, and in accordance with contractual requirements with the donor, a final evaluation is carried out to assess the performance, quality of activities carried out, results and sustainability of the project.

The methodology used for this study is based on a sample survey with two (2) sampling levels. It targets children under 5 and their mothers. In addition to quantitative data, focus groups were held to gather qualitative data from communities and groups. In all, 412 households were surveyed in 21 villages by 3 teams.
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Pour faire face à des constats majeurs et contribuer ainsi à l’atteinte des objectifs du Plan de Développement Economique et Social de l’Etat(PDES°), CARE au Niger a négocié la troisième phase du projet « Projet Maman Lumière III » dont les interventions visent à briser le cycle de la malnutrition, en particulier dans des contextes de crises récurrentes. Financé en janvier 2020 par le Ministère des Affaires Etrangères du Royaume de Luxembourg pour une durée de 48 mois, l’objectif assigné à ce projet est de contribuer à une réduction substantielle et durable de la malnutrition des enfants de moins de 2 ans et des femmes 15-49 ans des ménages pauvres de la région de Zinder d’ici décembre 2023. En effet à l’issue de quatre ans de mise en œuvre du projet et conforment aux exigences contractuelles avec le bailleur une évaluation finale est conduite pour apprécier la performance, la qualité des activités réalisées, les résultats et la durabilité du projet.

Ainsi la méthodologie utilisée pour cette étude est basée sur une enquête par sondage à deux (2) degrés d’échantillonnage. Elle cible les enfants de moins de 5 ans et leurs mères. Au-delà des données quantitatives, des focus groupes ont été animés pour recueillir de données qualitatives auprès des communautés et groupements. Au total, 412 ménages ont été enquêtés dans 21 villages par 3 équipes.
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Strengthening Productive Safety Net Program (PSNP) Institutions and Resilience II (SPIR II) Gender Analysis

Ethiopia’s current estimated population is around 123 million; out of which, approximately 50% are women, and 41% are under the age of 15 (The World Bank). Despite Government's efforts to close the gender gap, women and girls still do not have the same opportunities as men and boys. For instance, in Ethiopia girls and women aged 10 and above spend about 19.3% of their time on unpaid care and domestic work in comparison to only 6.6% spent by men (UN Women). This situation limits their ability to enter and remain in the labor force, which in turn hinders economic growth and development.

World Vision (WV), CARE Ethiopia, IFPRI, and ORDA Ethiopia are jointly implementing Strengthening Productive Safety Net Program (PSNP) Institutions and Resilience II (SPIR II) – a five- year program funded by the USAID. SPIR II's goal is aligned with the Government of Ethiopia’s Productive Safety Net Program 5 (PSNP 5), that aims to address the pervasive issues of food and nutrition insecurity in Ethiopia’s Amhara, Oromia, and Tigray regions. SPIR II targets 531,788 PSNP clients in nine, eight and fours woredas in the Amhara, Oromia and Tigray, respectively.

In March 2023, SPIR II conducted a Gender Analysis (GA) to identify gender and social inequalities that could negatively affect the achievement of SPIR II project objectives and to ensure that the design and interventions to increase women’s empowerment, equity for women, men, boys and girls, and other vulnerable groups (including the elderly, PWDs1, IDPs2) do not exacerbate existing power or abusive gender relations. SPIR II was not implementing in Tigray at that time, so the results generated are from Amhara and Oromia only. Read More...

IPC & Rapid Gender Analysis Pilot – Somalia: Gender, Food Insecurity & Drought

Acute food insecurity (AFI) in Somalia has deepened amidst a prolonged humanitarian crisis that is further amplified by the climate crisis, conflict, disease outbreaks, and the ripple effect of government instability. The interconnection between gender equality and food security on the local, national, and global level is well established; wider gaps in gender inequality in the public and private sphere heighten the likelihood of food insecurity within a country.1 Yet most global data sets on food insecurity are not disaggregated by sex. Primarily, gender-disaggregated approaches have been applied most consistently regarding indicators related to women’s reproductive role – such as anemia in women of childbearing age – and overlook key questions around women’s access to resources, safety,mobility,andparticipation. Thesespheresbroadenthelensofdatatoprovideamoreholistic understanding of the experience of food insecurity, and most importantly, can inform strategic responses that target the needs of the most vulnerable. Thus, this objective Rapid Gender Analysis (RGA) is to strengthen and operationalize mixed methodologies that integrate gender analysis into global food security measurement systems, such as the Integrated Food Security and Nutrition Phase Classification (IPC), to account for the differential vulnerabilities of men and women and provide concrete and actionable recommendations that inform both the process of data collection and the implementation of more effective humanitarian programming. This study was conducted from February 25 to March 11, 2023 and focused on four districts in Somalia, each situated within two distinct pastoralist Livelihood Zones.

The Integrated Food Security and Nutrition Phase Classification (IPC) serves as a pivotal analytical instrument, guiding decision-makers in understanding the magnitude and extent of both acute and chronic food insecurity as well as acute malnutrition.2 This assessment, which aligns with international standards, demonstrates a shortfall in the absence of consistently incorporating gender- disaggregated data and analysis, an aspect that is crucial for fostering a more inclusive approach to addressing food and nutrition insecurities globally. The IPC analytical approach comprises of data from governments, UN agencies, NGOs, and other stakeholders that have applied the most rigorous and technical methodologies aligned with the IPC Technical Manual 3.1.3 Recognizing the profound impact of gender dynamics on the escalating global acute food and nutrition crises, CARE implemented an adapted strategy that combined both quantitative and qualitative instruments and disaggregated by sex as well as individual and household level data. This pilot study engaged 1,708 respondents, encompassing both women and men, and incorporated quantitative surveys and qualitative data gathering techniques such as key informant interviews, focus group discussions, and individual stories. This synergistic fusion of methods illuminated the complex and diverse experiences of men and women, as well as the underlying themes associated with acute food insecurity in the specified two Livelihood Zones (LZs) and the subsequent four districts. The quantitative component incorporated IPC-approved indicators such as the Food Insecurity Experience Scale (FIES), the Household Hunger Scale (HHS), and the reduced Coping Strategies Index (rCSI), complemented by the WFP's adapted Gender Equality for Food Security (GE4FS) questions. Meanwhile, the qualitative analysis primarily utilized CARE's proven Rapid Gender Analysis (RGA) toolkit. Triangulation across quantitative and qualitative data sources underscores the importance of mixed method approaches and enables a more comprehensive understanding of the impacts of the prolonged drought on men and women and the development of more targeted programming that meets the needs of the most vulnerable crisis-affected populations.

Gender inequalities are both a cause of and the result of the differentiated experiences of acute food insecurity. Gender norms and dynamics impact men and women’s social, economic, and political participation, as well as their access to resources and services. When shocks hit, they can both reinforce and exacerbate existing barriers and discriminatory practices and/or create new opportunities and pathways for resilience, adaptation, and recovery. This report notes multiple shifts in gender dynamics that have occurred since the start of the drought that have shaped the capacity of men and women to participate in the drought response and recovery.

Structural inequalities in Somalia are based on the patriarchal clan-based system that is the foundation of social systems. Numerous indicators demonstrate how - from an early age - women are socially positioned to face risks and barriers that significantly reduced their agency in accessing opportunities, participating in household and community decision making and improving living conditions. Simultaneously, men’s roles towards their family defined by customary law and clan systems has been challenged due to the loss of livelihoods that has created increased vulnerability in accessing food and asserting their traditional roles.

The study explores nuanced gender disparities in acute food insecurity experiences within these LZs, highlighting the vulnerabilities exacerbated by the recent drought. The following highlight key findings:

• Gender Disparities in Acute Food Insecurity: There were distinct gender-based discrepancies, particularly in the Hawd LZ. In this LZ, the data indicated that men are facing a higher degree of acute food insecurity compared to women; the majority of women are grappling with conditions corresponding to IPC phase 3 (Crisis) or worse, whereas men are predominantly experiencing hardships consistent with indicative IPC phase 4 (Emergency). Conversely, in the Addun , both groups are contending with similar levels of acute food insecurity, at indicative IPC phase 4 (Emergency).
• Gender Analysis and Cultural Factors: Remarkably, the gender disparity observed in Hawd contradicts the traditional, cultural, and social norms that are prevalent in Somalia, which typically favor men. Thus, gender analysis of qualitative and secondary data provides critical nuance, with qualitative interviews indicating that men and women both generally perceive women as more vulnerable to acute food insecurity. Likewise, interviewees surfaced trends and cultural factors that may have influenced how men and women experienced or perceived acute food insecurity, such as customary eating habits, khat consumption, and humanitarian assistance. Further study is warranted to determine to what extent these factors are shaping IPC analysis in Somalia writ large.
• Severe Acute Food Insecurity: The findings from the study confirm a dire scenario, where over 70% of the population in the surveyed LZs are facing IPC phase 3+ (Crisis) or worse conditions, as confirmed by FIES, HHS, and rCSI outcome indicators. Disturbingly, there are households and individuals within these LZs confronting even more dire acute food insecurity circumstances consistent with IPC phase 5 (Catastrophe) levels.
• Collapse of Livelihoods Impacts Gender Roles: Drought conditions and the associated collapse of core livelihood pathways due to the loss of livestock has severely impacted traditional roles. The near total collapse of pastoralist livelihoods associated with the drought has threatened men’s traditional role of “provider” and has led some men to report strong feelings of mental health distress. Women have increasingly expanded outside of their traditional roles in the home to seek income opportunities, however, disparities remain that continue to limit their decision-making power at the household and community levels.
• Health Access: Respondents frequently drew connections between the food insecurity and malnutrition situation in their area to the lack of access to basic and life-saving health services. Health services, particularly for pregnant women, were noted by many to be dire, as was the need for better access to clean water to mitigate risks of increased diseases from contaminated sources.
• Protection: Increased tensions within the household due to growing limitations around access to resources heightens risks for gender-based violence within the household, especially as the scope of women’s roles expand around income generation and increased access to humanitarian aid. Culturally accepted practices around early and forced child marriage, as a coping method, also creates added stressors for women and families. Read More...

Evaluation finale du projet: Résilience et Cohésion Sociale des communautés transfrontalières du Liptako – Gourma (Burkina Faso, Mali, Niger)

Le projet « Résilience et Cohésion Sociale des communautés transfrontalières du Liptako-Gourma (RECOLG) au Burkina Faso, Mali et Niger », a pour objectif global « Améliorer les conditions de vie, la résilience à l’insécurité alimentaire et nutritionnelle et face aux conflits et la cohésion sociale des populations vulnérables dans 13 communes de Liptako-Gourma dont 5 au Burkina Faso, 3 au Mali et 5 au Niger. Sa mise en œuvre est assurée par un consortium composé de huit organisations nationales et internationales dont Save the Children (lead), CARE, DRC, CRUS, AREN, RBM, Tassaght et Karkara, pour une durée de 48 mois et couvre la période décembre 2019 à décembre 2023.

En fin de mise en œuvre, le dispositif de suivi-évaluation-apprentissage du projet a prévu une évaluation finale (endline), axée sur le suivi des indicateurs basée sur le cadre de mesure de performance du projet sur les quatre années d’intervention du projet afin de générer des évidences permettant de comprendre dans quelle mesure les stratégies, approches et actions mises en œuvre ont contribué ou pas à l’obtention des effets attendus et inattendus à la lumière des éléments de contexte de la zone d’intervention des trois pays.

Pour mener à bien cette évaluation finale (endline), le cabinet Ingénierie Internationale en Décentralisation et Développement local (2ID) a adopté une démarche méthodologique participative en quatre phases : (i) la phase préparatoire qui a consisté d’abord à l’élaboration du rapport de démarrage (échantillonnage, outils de collecte de données et chronogramme), ensuite à la prise en compte des feedbacks et la validation du rapport de démarrage à travers des échanges par mail. En fin une réunion de cadrage de la mission s’est tenue le 25 octobre 2023 en présentiel dans les locaux de 2ID pour repréciser les attentes du commanditaire et prendre en compte les besoins du cabinet notamment la documentation et l’établissement d’une lettre d’accréditation pour l’équipe de collecte de données sur le terrain ; (ii) la phase de collecte de données sur le terrain, faite de quatre (4) principales étapes : la mobilisation des ressources humaines, la formation des enquêteurs, la collecte des données et la supervision de la collecte des données ; (iii) la phase de traitement et analyse des données collectées et (iv) la phase de rapportage et restitution.
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Takunda Resilience Food Security Activity (RFSA) Outcome Mapping Baseline report

The main objective of Progress Marker Monitoring/Outcome Mapping is to assess, the extent to which gender transformative changes are taking place in Takunda Program areas among men, women, and youth based on age, life stage, socio-cultural norms, and religious practices. Takunda acknowledges that gender inequality is both a cause and consequence of food insecurity; hence gender equality is at the heart of the Takunda Program. To challenge gender norms that fuel food insecurity, the Program implements Social Analysis and Action (SAA), a key gender transformative approach that triggers shifts in gender norms at the individual, household, community, and policy level. This progress marker assessment specifically measured behaviors and practices at play for the different study participants before Takunda’s Social Analysis and Action (SAA) interventions and it confirmed some of the findings of the Takunda gender Analysis study held in December 2021. The progress marker assessment measured gender outcomes/behaviors as defined by the communities, whereas the gender analysis assessed program-wide challenges experienced by different groups as defined by the program. Read More...

2023 Participant Based Survey: Titukulane Project – PaBS Outcome Report

Despite decades of robust government and donor investments in livelihoods, food security, nutrition, and resilience, over 50% of the population lives below the poverty line. Previous activities have not sufficiently reduced the number of chronically food and nutrition insecure households nor effectively enhanced the capacity of local and government structures to implement resilience focused policies and actions. To address these issues, the Government of Malawi developed a National Resilience Strategy 2018-2030 (NRS) to guide investments in agriculture, reduce impacts and improve recovery from shocks, promote household resilience, strengthen the management of Malawi’s natural resources, and facilitate effective coordination between government institutions, civil society organizations and development partners. CARE and consortium partners designed the Titukulane Resilience Food Security Activity (RFSA) which means “let us work together for development” in the local Chichewa language—to support pilot implementation of NRS in Zomba and mangochi districts. The Titukulane RFSA, implemented by CARE International in Malawi (CIM), aims to achieve sustainable, equitable, and resilient food and nutrition security for ultra-poor and chronically vulnerable households. Specifically, Titukulane is designed to increase households’ abilities to deal with shocks without experiencing food insecurity following a three-purpose approach:

1. Increased diversified, sustainable, and equitable incomes for ultra-poor, chronically vulnerable households, women, and youth.
2. Improved nutritional status among children under 5 years of age, adolescent girls, and women of reproductive age.
3. Increased institutional and local capacities to reduce risk and increase resilience among poor and very poor households in alignment with the Malawi NRS.

To meet these three purposes, the Titukulane RFSA provides households with a package of interventions, including: Care Groups with Nutritional Cash Transfers (NCT), Farmer Field Business Schools and crop marketing support, Village Savings and Loan Associations, Adolescent nutrition, Irrigation farming, Youth vocational training including start-up capital and Gender dialogues. Read More...

Qualitative Monitoring Improvement Initiative Pilot for the SHOUHARDO III Program in Bangladesh

Strengthening Household Abilities to Respond to Development Opportunities (SHOUHARDO) III was a five-year multisectoral and integrated program implemented by CARE Bangladesh between 2015 and 2020 and funded by USAID and the Government of Bangladesh. The objective of the program was to improve the lives and livelihoods of 549,000 people living in poor and extreme poor communities in eight districts in the Deep Haor and Remote Char region of northern Bangladesh. The program focused on community-based asset development and women’s empowerment, building the capacity of local government and community-service organizations, increasing resilience to frequent shocks and stressors, and improving nutrition and health outcomes for mothers and children under two-years of age. SHOUHARDO III was extended for two years (2020 to 2022) and a second extension phase (SHOUHARDO III Plus) was funded for an additional two years (2022 to 2024). During this period the program will focus on engaging with and linking local service providers with the government and the private sector. Read More...

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