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A Cost of the Diet Analysis in Pindra Block, Varanasi District, India

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A Cost of the Diet Analysis in Pindra Block, Varanasi District, India A Cost of the Diet Analysis in Pindra Block, Varanasi District, India Location: Pindra Block, India Date collected: December 2014 HEA data: November-December 2014 Lead agency: Save the Children India 23 Acknowledgments The Cost of the Diet analysis was led by Archana Choudhary (Save the Children India) and Alexandra King (The Food Economy Group), with in- country support from Fazlul Krishnan (Save the Children India) and remote technical support from Amy Deptford (Save the Children UK). This report was written by Archana Choudhary and Alexandra King, based heavily on a report format developed by Amy Deptford. The Cost of the Diet fieldwork was conducted by Nutrition Counsellors from Save the Children and SRF’s Karuna Project. The field team included Ram Prakash Yadav, Sunil Mishra, Rakesh Choubey, Sanjay Lal Srivastav, Virendra Tiwari, Vijay Kumar, Krishna Kumar Yadav and Fazlul Krishnan. The analysis was funded by the Dalai Lama Foundation under Save the Children’s Karuna Programme. Thanks are due to the Save the Children Food Security and Livelihoods team in Uttar Pradesh and to the SRF team in Varanasi District for their warm welcome and for making the practical arrangements for the analysis to take place. In particular, Sunil Kumar (Save the Children India) and Dr. Shreya Singh (SRF) helped to facilitate the exercise, Rajesh Rai (SRF) helped with area and market identification, Rajeev Kumar (SRF) helped with Hindi translations and typing. Rajeev Kr. Singh, Secretary of SRF, is sincerely thanked for allowing the use of project staff time for the study. Last but by no means least, this analysis would not have been possible without the willing help of the market traders of Pindra Block and of the women who participated in the focus group discussions. Their time, hospitality and insights are greatly appreciated. Suggested citation: Save the Children UK, (2015). A Cost of the Diet Analysis in Pindra Block, Varanasi District, India. London: Save the Children, U.K. 2 Table of contents 1. Summary ………………………………………………………. 4 2. Introduction ………………………………………………… 12 3. Methods ……………………………………………………….. 15 4. Results …………………………………………………………. 21 5. Key findings ………………………………………………..... 42 6. Recommendations and conclusions …………… 44 7. Annex ………………………………………………………….. 48 3 Summary Purpose of the assessment A Cost of the Diet analysis of Pindra Block, Varanasi (UP), has been conducted as part of an integrated study with a Household Economy Approach (HEA) assessment, funded by Dalai Lama Foundation under Save the Children’s Karuna Programme. The aim of this analysis was to assess the degree to which economic constraints might prevent households in Pindra Block from having access to a nutritious diet. The data collection and analysis set out to answer the following questions: What is the cost of a nutritionally adequate diet for typical households in Pindra Block? What nutrients have the greatest influence on the cost of a nutritious diet? What local foods are inexpensive sources of essential micronutrients and could be promoted through programme interventions? How affordable is a nutritious diet for a typical household in different wealth groups? How might nutrition, food security and social protection interventions improve access to a nutritious diet by households in the assessment area? Introduction to the study area Pindra Block is located in Varanasi District of Uttar Pradesh State. Pindra is divided into 14 Nyay Panchayats and 98 Gram Panchayats. As per the census of 2011, the population of Pindra Block is 276,000. According to the Karuna Programme baseline, 50% of children (aged 6-59 months) were stunted or too short for their age, 29.1% were wasted or too thin for their height and 46.6% were underweight. The MUAC (Mid-Upper Arm Circumference) was less than 11.5 cms for 2% of children in project block. An encouraging 78% of mothers with children in the age group of 0 to 24 months started breastfeeding within an hour of birth. 76% of mothers gave colostrum to their newborn, while only 37% exclusively breastfed their babies for the first six months. According to mothers of children aged 0-24 months, 65.2% had begun complementary feeding of their child within the age group of 6-8 months in the project. 4 Methods This Cost of the Diet analysis was done in Pindra Block, which falls in an agricultural plain livelihood zone. This block was selected because the Karuna project is active throughout the block. 144 market surveys, 32 dietary habit interviews and 4 focus group discussions were conducted in the selected zone. The market price, seasonal availability and consumption patterns of all local foods was collected, including herbs, spices and condiments. For the purpose of the assessment, retrospective price data were collected to cover a period from January – December 2014. With these data the cost of three theoretical diets were estimated using the Cost of the Diet software for a typical household of 7 individuals: a lowest cost diet that only meets recommended average energy requirements; a lowest cost diet that meets recommended intakes for energy and nutrients (nutritious diet); and a lowest cost ‘nutritious’ diet that meets recommended intakes for energy and nutrients based upon typical dietary habits of households in Pindra Block (the food habits diet). A nutritious diet for the typical family is defined as one which provides all of the following: the estimated average requirement (EAR) for energy1; the 95th percentile of an individual’s intake of protein2; between 30% and 60% of total energy intake from fat3 and the reference nutrient intake (RNI) of vitamins and minerals4 all specified by the World Health Organization and the Food and Agriculture Organization. The annual cost of the foods selected by the software were expressed as a percentage of the estimated annual cash income and expenditure from the HEA undertaken in Pindra Block, to estimate the affordability of a nutritious diet for households in each wealth group. The shortfall in income when the cost of the diets and the expenditure on essential non- food items is applied is defined as the ‘affordability gap’. 1 WHO/FAO (2001). Human energy requirements. Geneva: World Health Organization 2 WHO/FAO (2007). Protein and amino acid requirements in human nutrition. Geneva: World Health Organization 3 WHO/FAO (2008). Fats and Fatty Acids in Human Nutrition. Geneva: World Health Organization 4 WHO (2004) Vitamin and mineral requirements in human nutrition. Second edition. Geneva: World Health Organization 5 Key findings In a nutritious diet (not the food habits diet), wheat flour, buffalo milk, Bengal grams and fenugreek leaves provide the majority of essential macro and micronutrients in Pindra Block. Although the diet that the software selects is hypothetical and does not reflect local dietary habits, it does give an indication of which foods found on the local market are the least expensive and most nutritious. In this diet, wheat flour is the largest provider of energy, protein, vitamin B1, niacin and zinc (plus a significant provider of vitamin B6); buffalo milk is the largest provider of fat and vitamins B2 and B12 (plus a significant provider of energy, protein and calcium); Bengal grams are the largest provider of vitamin B6 and iron (plus a significant provider of energy, protein, folic acid, zinc and vitamin B1); fenugreek leaves are the largest provider of vitamins A and C, folic acid and calcium (plus a significant provider of vitamins B6 and B12). In a nutritious diet, recommended intakes of calcium, fat and iron are the most difficult for the software to meet. These nutrients are available in the local markets but they are in expensive foods such as buffalo milk, fenugreek leaves and Bengal grams. These nutrients are therefore expensive for the software to meet and are likely to be deficient in the current diet. These foods and nutrients should therefore be prioritised in programmes that aim to improve the quality of the diet. The availability of nutrient-rich foods is not a key barrier to typical poor households obtaining a nutritious diet. The data collection team found 110 foods on the market in Pindra Block. The foods selected by the software for the food habits diet were all available in more than half of the markets that were visited and were therefore considered to be available in Pindra Block. This finding suggests that economic constraints and cultural practices are exacerbating poor dietary diversity in the assessment area rather than availability of nutrient-rich foods. A nutritious diet is not possible when typical food habits of households in Pindra Block are imposed. The food habits diet does not meet the recommended intake of calcium. The main constraints that are imposed with the food habits diet are to force rice, mustard oil and potato into the daily diet. Rice is not very rich in micronutrients compared to other cereals. Potato is considered a vegetable in this part of India – indeed it is considered the main vegetable – but it does not have the micronutrient content of other available green vegetables. Unconstrained, the software selects buffalo milk and dried coconut as sources of fat rather than mustard oil, suggesting that they contain other required nutrients in addition to fat. 6 A diet that takes into account typical dietary habits (the food habits diet, which is deficient in calcium) is over 6 times more expensive than a diet that only meets energy requirements. The analysis indicates that a nutritious diet was over 5 times as expensive as the energy only diet, meaning that it costs over 5 times as much money to meet recommended protein, fat and micronutrient requirements compared with only meeting energy requirements. The food habits diet was 22% more expensive than the nutritious diet, which means that the constraints applied to the software to reflect typical dietary habits have required the software to add more expensive foods to meet the recommended nutrient intakes of a typical poor household (and in this case the software does not succeed in meeting the RNI for calcium).
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