This post by senior fellow Roger Thurow originally appeared on the Outrage and Inspire blog.
Part I - Biofortification: A New Arrow in the Quiver
Fortifying diets with minerals and vitamins is an important front in the fight against malnutrition, particularly in the critical 1,000 day period during a woman’s pregnancy through the second birthday of her child.
Micronutrient deficiency afflicts some two billion people globally; it is sometimes called “hidden hunger,” for the absence of vitamins or minerals may be imperceptible, and certainly less graphic than the bloated bellies, stick-figure limbs, and hollow eyes of full-blown famine victims. But to those taking a closer look, it is clearly undermining the health of the world; doctors, scientists, and academics estimate that one quarter of the world’s children are stunted physically or mentally (or both) because of this undernourishment. For instance, nearly 200 million children under the age of five suffer from vitamin A deficiency, which damages immune systems and turns common diseases fatal, and is the main cause of preventable blindness in children. Iron deficiency anemia leads to stunting in children and is a leading cause of maternal deaths.
Iron and vitamin supplements are important for pregnant moms around the world, and these nutrients are also vital for infants as they begin to eat solid foods at six months. Billions of dollars are spent annually in the developing world on supplementation and commercial fortification of food. But even with these efforts, the supply of the supplements is inconsistent, particularly in remote rural areas. Delivery is burdensome, budgets are always under stress. Even when the supplements are available, those in pill form must be taken with water, which is usually unclean, triggering other health problems. And follow-up care to assure adherence to a supplement regiment is sporadic at best.
What if we could get plants to do some of this nutrient supplement work for us? That was the question consuming Howarth Bouis since the 1980s. He was an economist exploring the diets of poor households in Asia, especially how nutrient intakes were influenced by food prices and household incomes. The conventional wisdom had been that lack of energy (calories) was the primary dietary factor limiting better nutritional outcomes in developing countries. Bouis was finding something different—that mineral and vitamin deficiencies, and not energy, were the leading constraints to better nutrition and, in turn, to healthy and economically productive lives. Since the poor couldn’t afford the non-staple foods (fruits, diversified vegetables, meats) that provided these micro-nutrients, Bouis wondered if they could be increased in the common grains and vegetables that were the basis of the everyday diets of the poor. This led to a crop breeding innovation called biofortification, which highlights nutrients that naturally appear in staple foods, such as wheat, millet, beans, rice, potatoes, and cassava.
Bouis leads a program known as HarvestPlus. During a trip to Uganda and fields filled with vitamin A-rich orange flesh sweet potatoes and beans with higher iron content, I discussed the progress and potential of biofortification with Bouis and Anna-Marie Ball, the HarvestPlus director in Uganda.
Part II - Biofortified Babies
At a village gathering in rural northern Uganda, Molly Ekwang walked her 15-month-old son to a spot under a shade tree where Howarth Bouis, the head of HarvestPlus, was sitting. The little boy climbed up on his lap.
Could someone take a photo?, the mother asked, so when her son is older she can tell him, “This is the man who made you smart and gave you a successful future.”
The mother is also a farmer, and she has joined a community effort to grow biofortified crops developed by HarvestPlus. Her orange flesh sweet potatoes are rich in vitamin A and her beans have a higher iron content. It is a new initiative to reduce malnourishment by increasing the nutrient value of staple crops—the foods that are consumed daily. Good nutrition, especially during the 1,000 days from the beginning of a woman’s pregnancy to the second birthday of her child, is vital for proper physical and mental development of the child.
Molly Ekwang said she became pregnant at a time when she was first eating the sweet potatoes after the initial harvest. She believed those potatoes and the high-iron beans had fueled her son’s development; she noted he was walking and talking earlier than her other children. “He’s very bright,” she told Bouis.
Part III - Moving the Needle With "Nutrition-Smart" Agriculture
Agriculture and nutrition would seem to be a natural pairing. But for so long, there was a wide gap between the two. In development jargon, they were isolated in separate “silos.”
The main task of agriculture, as viewed by the ag industry and farmers, was to grow ever more food. Increase yields, boost harvests, churn out calories. Agriculture policy resided in agriculture ministries.
Nutrition was widely considered to be a health issue. Diets, vitamins, nutritional supplements. Nutrition policy resided in health ministries.
Efforts to bridge the gap, to focus on the nutritional content of crops, were largely kept on the fringe by fears that they would interfere with yields.
Over the past several years, though, agriculture and nutrition have become allies in the push to reduce malnutrition and childhood stunting. Efforts to biofortify certain staple crops—to raise their inherent vitamin and mineral levels through conventional breeding—are being called “nutrition-sensitive” or “nutrition-smart” agriculture. This emphasis on improved health of food consumers is gaining the support of doctors, scientists, economists, and development workers, as well as nutritionists and the agriculture industry.
As Howarth Bouis, a biofortification pioneer, points out, nutrition-smart food crops are being evaluated or have been released in more than 30 countries. His own program, HarvestPlus, has released these crops in seven countries.
He recently wrote: “These crops are released as public goods so they are accessible to poor farmers. Furthermore, we are multiplying and delivering these crops to farmers, working with both private and public sector partners to educate farmers and consumers, and to build markets for these foods. Since orange sweet potato was first released about seven years ago, more than 1.5 million farming families have adopted this and other nutrition-smart crops.”
The goal is to scale-up these efforts to substantially impact public health; HarvestPlus and its partners are aiming to reach more than 100 million people by 2018. In the third part of my conversation with Bouis and Anna-Marie Ball, HarvestPlus Uganda director, the focus is on future prospects for moving the needle on malnutrition through agriculture.