“Being food secure at the national level is great. But there are people who are falling through the cracks. Who are these people? The female-headed households, the people who have very little or no land, the laborers—these people are not being reached by most of the programs we have put in place.”


deficit economy, and malnutrition and infection are widespread among women and children. Improved coordination among the government, NGOs, and donors and use of evidence-based approaches could help address the high rates of malnutrition and illness.29


In Sri Lanka most


poor people are involved in agriculture, so agricultural threats are also health threats. To incorporate nutrition goals into agriculture and rural development projects, the following ac- tions should be taken: expand cash crop pro- duction, introduce hybrid varieties, create effec- tive and appropriate extension services, make agricultural credit available to male and female producers, and expand food crop production.30


East Asia Most people in East Asia depend on agriculture for their livelihoods, and most farmers cultivate small farms of less than one hectare. Fluctua- tions in food prices thus affect the incomes of small farmers, with consequences for both pro- duction and consumption. And farmers still have problems getting access to high-quality seeds, fertilizers, water, rural infrastructure, and ma- chinery for processing. Although East Asia does not suffer from as much undernutrition as some other regions, problems of malnutrition remain.


—Agnes B. Kalibata, Minister of Agriculture and Animal Resources, Rwanda For a number of countries in East Asia, agri-


culture means rice production. Impressive gains in the productivity of rice farmers in recent decades have helped raise incomes and reduce hunger. For example, after the fall of the Khmer Rouge, Cambodia attained rice self-sufficiency in 1995 and produced a rice surplus in 2009 owing to new technologies and more produc- tive farming systems. Poverty and undernutri- tion, however, are still widespread there.31


It is


important to promote more diverse diets and educate farmers in the region about the poten- tial for growing more nutritious crops, such as fruits and vegetables. Scarcity of land is also an important issue in the region. Many malnour- ished children come from households that have tiny plots of land or no land at all and are thus unable to produce their own nutritious food.


A holistic community-based approach to link- ing agriculture, nutrition, and health has worked well in some countries, including Thailand. Expe- rience there shows the importance of teaching people about nutrition at the community level, teaching agricultural skills, and making sure farmers have the land, credit, and postharvest technologies they need. Special attention to im- proving the nutrition and health of women and children is a crucial component of success.32


A Long-Running Mystery: Why Does India Remain Undernourished? For decades, rates of child undernutrition in India have remained stubbornly high. Undernutrition also affects one-third of all Indian men and women. At the same time, India is the second-fastest-growing economy in the world. Whereas economic growth in other countries has often been accompanied by reduced child malnutri- tion, this has not been the case in India. The jury is still out on the reasons for the apparent disconnect between agriculture and nutrition in India. Factors may include changes in diets away from coarse grains and pulses and toward fats, an inefficient Public Distribution System for food, other livelihood shocks and stresses, and the femi- nization of agriculture, which may have a detrimental effect on women’s ability to care for themselves and their children if not accompanied by measures to empower women. Agriculture can only do so much—other drivers of undernutrition, such as poor healthcare and sanitation, are key too. What is clear is that because of India’s sheer size, overcoming undernutrition there would actually make a large dent in poor nutrition globally.33


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