Malnutrition is a significant health problem for the population of Ethiopia in general, women and children in particular. Although rates of malnutrition have declined in recent years, they remain exceedingly high among children under five. According to the 2016 Demographic Health Survey, 38% of Ethiopian children were experiencing chronic malnutrition (stunting), 10% had acute malnutrition (wasting), and 24% were underweight. Malnutrition in Ethiopia is most often caused by lack of access to sufficient and nutritious food; limited knowledge of nutrition; and/or lack of basic health, water, and sanitation services.
Fortunately, we have substantial evidence on how to prevent and reverse nutrition deficits in these contexts. The Growing Nutrition for Mothers and Children in Ethiopia (GROW) project, funded by the Government of Canada, relied on this evidence base to address undernutrition among women of reproductive age and young children in two regions of Ethiopia (Oromia and Afar).
What changed?
- More families began producing their own food. GROW participants learned how to establish and maintain perma-gardens or keyhole gardens near their homes, improving their access to fresh vegetables. Over 16,000 of these gardens were established in project areas, and more than 10,000 were still functioning at the end of the fourth year of implementation. Some of the poorest female-headed households also received dairy goats which they could use for milk production and income generation when they gave birth to offspring. The number of households consuming self-produced food grew from 67% to 84% over the life of GROW.
- Infants and young children began eating more age-appropriate, nutritious meals. Experts recommend that infants consume only breastmilk until they reach six months of age if possible, at which point they should begin to try other soft and healthy foods. Exclusive breastfeeding of infants up to six months of age increased from 56% to 76% among GROW participants, and parents began integrating goat milk, fruits, and vegetables from their backyard gardens for older children. As a result, stunting (a sign of chronic undernutrition) among children age 6-59 months decreased from 44% at baseline to 33% at endline.
- The diets of women and adolescent girls became more diverse. Eating a variety of foods is the best way to ensure you are getting all the micro-nutrients your body needs to stay healthy, but poor families often struggle to access all the recommended food groups. Thanks to home gardens and the nutrition education offered through GROW, the proportion of women reporting that they had consumed five or more food groups in the past 24 hours increased significantly (from 30% at baseline to 52% at endline).
How did it happen?
- Training and equipping health and agriculture workers. Through GROW, health extension workers and agricultural development agents received training on adolescent, maternal, infant, and young child nutrition to enhance their existing knowledge and skills. Trainers took a multi-sectoral approach and highlighted the role of gender norms in child feeding practices, emphasizing the benefits of male participation in childcare and food preparation. Other government employees and community leaders were also trained to be nutrition educators.
- Educating parents and promoting access to healthy foods. Once trained, health extension workers and agricultural development agents led community education sessions for women groups and men groups respectively, teaching participants about the nutritional needs of adolescents and women of reproductive age and those who are pregnant or lactating. They also conducted cooking demonstrations using a contextualized recipe book designed by GROW and encouraged families to try new, more nutritious foods. GROW worked to increase the availability of nutritious foods by engaging participants in the production of vegetables and fruits through the introduction of home garden and perma-garden technology, distributing seeds, and providing additional livelihood support, such as goats, to increase meat and dairy consumption. The project also strengthened health referral pathways and encouraged parents to seek out maternal and child health services regularly.
- Improving water, hygiene, and sanitation. GROW also worked to facilitate access to clean drinking water and hygiene facilities through the construction or rehabilitation of water points/wells, hand-washing stations, and latrines. Community groups also learned to assess, monitor, maintain, and repair these facilities, and what hygienic behaviors are most critical to keep themselves and their families healthy.
- Promoting gender equality and shifting social norms. Women in Ethiopia are primarily responsible for the care and feeding of their families, but they generally lack control over financial resources and have limited authority to make healthcare decisions. GROW worked to transform gender norms adversely affecting the health and nutrition outcomes of women and children through Social Analysis and Action community dialogue sessions and supported service providers to ensure accountability and gender sensitivity in their work. Some men who participated in GROW activities started taking on new household responsibilities (especially when their partners were away, pregnant, or breastfeeding), creating more balance in the gendered division of labor. They also became more comfortable discussing nutrition and accompanying their children and wives to antenatal care and growth monitoring and promotion sessions, which rarely happened before the project intervention.
- Focusing on sustainability from the very beginning. The GROW project was designed to create sustainable change. To accomplish this, the project team worked within existing platforms and structures including nutrition coordination committees and other technical committees for design, implementation, and monitoring, ensuring all activities were aligned with the national government’s health and nutrition priorities. Existing health and nutrition referral pathways were strengthened as well. After the project ended, government and community stakeholders participated in discussions around lessons learned and many committed to continuing to help their friends and neighbors to adopt healthy behaviors and nutrition practices.
For more information on this project and its impact, see the final evaluation.