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Using Innovative tools to understand the drivers of women’s empowerment

  |   Empowering Women and Girls to Improve Nutrition, SUN in Practice

”Women are the key in improving nutrition”

Dr. Saida Umarzoda,

First Deputy Minister of Health and Social Protection of Population

With contributions from:
Dr. Sherali Rahmatulloev, Head of Maternal and Child Health Department, Ministry of Health and Social Protection; Yuki Suehiro, Chief, Health and Nutrition, UNICEF; Safina Abdulloeva, Nutrition Officer, UNICEF and Samantha Huffman, HIV/AIDS and Tuberculosis Technical Advisor/SUN Coordinator, USAID

In Tajikistan, agriculture accounts for 75 percent of total employment and 23 percent of gross domestic
product. However, as a result of Tajikistan’s mountainous topography, water shortages, and poor irrigation system, only seven percent of Tajikistan’s land surface is arable. These constraints, coupled with a history of conflict have left almost half the population living below the national poverty line, and many women and children undernourished.

Women undertake 80 percent of the farm work in Tajikistan, often because the men in the family have migrated out of Tajikistan or to a city to gain off-farm employment. These women are organising themselves with more than 4,200 self-directed women’s groups established throughout the country around community and income generating activities. The Government of Tajikistan believes that by giving women equal access to agriculture inputs and training, they can dramatically improve farm output and household nutrition.

Nutrition-specific interventions – maternal and child health and nutrition:
Maternal and child health and nutrition is one of the priorities of the Government of Tajikistan as outlined
in major strategy documents pertaining to improving the health status of the population.15 Given the critical
role women play in this area, many components of the maternal and child health and nutrition programmes in Tajikistan directly and indirectly target women. Moreover, efforts to better understand and address the gender norms that underlie malnutrition are also rising. For example, formative research is planned to explore the barriers to exclusive breastfeeding and optimal infant and young child feeding practices among young mothers who are not empowered to make their own decisions or who do not receive enough support from their husbands and other family members. Early pregnancy leading to a vicious cycle of malnutrition is another area which the Ministry of Health and Social Protection together with development partners have been addressing recently.

Nutrition-specific interventions – tackling iodine deficiency through women’s groups
While Tajikistan was among the first countries in Central Asia to adopt a national law on iodization of table salt (2002), Iodine Deficiency Disorders (IDD) remain a crucial public health problem, with high prevalence observed especially in the south and in mountainous areas. In this context, USAID, GAIN, and UNICEF, together with civil society organizations such as Mercy Corps and Save the Children, have been supporting the Government of Tajikistan to promote universal salt iodization through a combination of marketbased interventions aimed at encouraging consumers to select iodized salt, and active private sector engagement to
drive production and increase the availability of iodized salt to consumers. The extensive network of women’s groups played a major role here to keep generating community awareness on salt iodization and iodine deficiency. As the country will move forward with flour fortification, a similar approach involving women could be considered for demand creation and quality monitoring.

Understanding the drivers of disempowerment
The Women’s Empowerment in Agriculture Index (WEAI) is a tool that is used to measure the empowerment, agency, and inclusion of women in the agriculture sector. Using a scale from zero to one, a person is identified as empowered if her or his score is 0.80 or higher. In Tajikistan, a baseline assessment was conducted in January 2013 with the help of the United States Government’s Feed the Future Initiative in 12 districts of Khatlon province. The WEAI score was 0.69, meaning that women are considered disempowered in Khatlon province.

Additional analyses of the WEAI in Khatlon province have shown that women in households with moderate to severe hunger are significantly less likely to be empowered in making decisions about agricultural production, ownership of assets, and the purchase, sale, or transfer of assets compared to women in households with no hunger. A positive correlation has also been shown between women’s empowerment and both exclusive breastfeeding of children under 6 months of age, and children aged 6-23 months receiving a minimal
acceptable diet. With support from partner programmes like Feed the Future, the Government of Tajikistan is using the WEAI tool to better understand how women are disempowered and what can be done to reverse this.

Supporting governments to inform programming with evidence

Feed the Future, the U.S. Government’s global hunger and food security initiative, works from farms to markets to tables to improve incomes and nutrition. In Tajikistan, Feed the Future focuses its activities in the southwestern Khatlon Province, a key region for agricultural production that also has some of the highest rates of undernutrition in the country and the largest number of people living below the poverty line. Coordinating with the active and diverse development partner community in Tajikistan, Feed the Future is supporting the Government of Tajikistan’s efforts to implement agricultural, land and water reforms and improve food security and nutrition based on the information generated by the Women’s Empowerment in Agriculture Index (WEAI).In Tajikistan, women play a major role in farming but lack control over resources in the household and within society. Feed the Future is addressing gender issues to support broad-based growth inclusive of both men and women.
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Strengthening the fruit and vegetable value chains where women predominate helps build capacity among women to
not only improve household farming but also to generate income from their labor and increase control of their assets. Feed the Future is targeting nutritional behavior change activities toward women and men to ensure improved household nutrition and health. The initiative also considers gender roles in service delivery by identifying and training women facilitators to act as local organizers. All efforts to advance agrarian reform help ensure that women are fully represented and receive and control their share of land and water resources.

How does Feed the Future use the the WEAI?

  1. As a monitoring indicator to evaluate whether programs are having intended effect on women’s empowerment.
  2. As a diagnostic tool to help identify areas in which women and men are disempowered, so that programs and policies can be targeted to those areas.
  3. Impact evaluations, testing new indicators/assessing validity in different contexts, etc.
Habiba Tukhtaeva shows off the vegetables she grew in her family’s kitchen garden with assistance from Feed the Future

Areas of collaboration to scale up interventions empowering women and girls

Catalysed by its membership to the SUN Movement, the Government of Tajikistan is committed to the development of a common results framework and multi-sectoral plans for nutrition. The plans will be aligned with the existing policy frameworks and will build capacity for planning, costing and budgeting of both nutrition-specific and nutrition-sensitive interventions. The government is committed to ensuring that women’s empowerment issues are taken into account in the design and targeting of all food security and nutrition actions through:
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  • Safeguarding and increasing women’s access to, and control over, incomes and other resources
  • Reducing women’s time constraints
  • Enhancing women’s understanding of good nutrition
  • Increasing women’s involvement in decision making at all levels
  • Protecting women’s employment and livelihoods through guaranteed three years of maternity leave (of which six months are paid)
  • Women’s education including a special provisions to support girls in remote areas to access tertiary education (through free tuition and housing)

Key lessons learned

  • Recognize the role of women in agriculture in terms of their control over resources and decision-making, as well as their role in improving nutritional outcomes.
  • Tools such as the Women’s Empowerment in Agriculture Index allows us to understand and quantify the problem, and identify the specific domains of empowerment which are most problematic in the specific country context. This then enables an evidence-based approach in tailoring programming to the specific areas in which it is most needed and most likely to effect change.
  • The process of developing a common results framework provides an important opportunity for gender to be emphasized as one of the main components of a nutrition strategy.

Tackling gender equity, one nutrition TV spot at a time

This blog was written by Ann Jimerson, Behavior Change Specialist at Alive and Thrive and was originally featured on the Alive & Thrive LESS GUESS blog which discusses the art of using data for strategic behavior change design

As the clock ticks to mark the first hour of the baby’s life, a young mother raises her hand to contradict her mother-inlaw, who wants to give the baby honey instead of breastmilk. It’s one of my favorite TV spots from Alive & Thrive’s (A&T) program in Bangladesh. Every time I view this TV spot, I feel a surge of emotion when the young mother firmly says, “No, give her to me. I have to breastfeed.” This young mother surprised viewers by taking control of her baby’s first hour of life.

So it caught me off guard when a participant in the recent SUN Movement Global Gathering questioned the program planners’ decision to portray this young mother standing up to the authority of elders. “Why did you show the mother that way? It’s completely unrealistic. That would never happen,” the participant said.

We didn’t have much time during that session on Social and Behavior Change Communication (SBCC) to follow up
on the participant’s question, but I did take the opportunity to talk about the value of emotional messages that are “aspirational”—that is, that model an action or a situation that our audiences may wish were their reality. The discussion was enough, though, to trigger a personal response from Mona Girgis, Country Director in Lao PDR for Plan International. Mona had been asked to report to the Global Gathering on the content of the SBCC session. Mona and others in Lao PDR are deeply committed to gender equality and women’s empowerment in their work on nutrition. In its publication “Women’s empowerment for improved community nutrition,” the SUN’s Civil Society Alliance in Lao PDR points out that “there is evidence of a positive association between women’s empowerment and improved nutrition outcomes, and conversely, the disempowerment of women can result in reduced nutritional status for themselves and for their families[1].” But Mona confessed that she has at times felt discouraged at the gap between the rhetoric and the reality of women’s lives.

“We do have a problem at the moment at the global (and national) level where we have the rhetoric on women’s
empowerment, and it is clearly defined in policy, but we are struggling to translate to practice.” Mona wrote to me following the conference.

Seeing the young mother’s bold move in the TV spot—and similar depictions of empowered young women in other
nutrition materials—gave Mona a glimmer of hope.

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I went back to the TV spot from Bangladesh and recounted the ways that 40-second drama shows us what a more
gender-equal community might look like: When the mother expresses her wish, the elders hand her the baby
to breastfeed. Her husband watches the scene and lovingly affirms, “I’m lucky the mother of my baby is so intelligent.” Perhaps most importantly, the spot opens on the anxious men waiting outside the home for news of the birth. The young father beams at the joyous cry, “It’s a girl!” If Sanjeeda Islam had been with us in the Global Gathering session, she would have given a definitive response to the participant’s question about why the spot was written as it was. Sanjeeda led A&T’s creative team for the design of our TV spots, and she is clear that when she wrote the line “It’s a girl!” she wanted to break through the ageold
preference for a son. She reports that “surprisingly” there were no raised eyebrows. In fact, in our pretests of the TV spot, mothers had a highly emotional and positive response to the scene where the mother proactively asks for the baby. Mothers also liked the proud father’s praise for his wife. The groups of mothers who saw the spot scored it high for credibility—and opinion leaders did too.

A&T’s behavior change activities intentionally targeted grandmothers and other older women, along with fathers, frontline health workers, and community leaders. Our evaluation didn’t measure these groups’ attitudes, but we know that Bangladeshi women of different ages watch TV together. With the shared experience of seeing the image of that empowered young mother, the older women were likely more open to listening to the ideas of the young mothers in their community.

And the data for A&T’s Bangladesh evaluation suggest that our strategy worked to increase mothers’ self-efficacy related to breastfeeding. After three years of program implementation, mothers in A&T areas were significantly more confident than their counterparts in comparison areas that they could prevent others from feeding a child aged less than 6 months anything other than breastmilk (73% vs. 47%). In areas where the only A&T intervention was mass media, women who viewed one of our breastfeeding TV spots were 48% more likely to initiate breastfeeding within an hour of birth, compared with those who had not viewed one of the spots.

“It is possible to subtly address the wide gender gap that exists not only in Bangladesh but in many countries using different channels and mediums,” Sanjeeda wrote me recently. “Gender roles are changing, though very very slowly, but we need to keep trying to sneak in our messaging initially. We need the change to happen soon if we want to make any progress in the nutrition scenario, where success depends on gender equity.”
Let’s all take hope, then, in the power of emotive messaging that can model a better world. Our communication materials may be explicitly addressing improved child feeding practices. But these same messages and materials can subtly, almost subliminally, introduce changes in gender roles and power as we move from rhetoric to action.

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