J7_FTF_PBS_Baseline_Report_FINAL.pdf

Feed the Future Nepal Zone of Influence Baseline Report

December 2013

Prepared for the United States Agency of International Development, USAID Contract Number GS-23F-8144H/AID-OAA-M-12-00006, Feed the Future FEEDBACK.

Recommended Citation:

Feed the Future FEEDBACK. 2013. Feed the Future Nepal Zone of Influence Baseline Report.

Rockville, MD: Westat.

Westat Contact:

Detra Robinson, Chief of Party 1600 Research Boulevard Rockville, MD 20850 Tel: (301) 738-3653 Email: detrarobinson@westat.com mailto:detrarobinson@westat.com

Feed the Future Nepal Zone of Influence Baseline Report iii

Table of Contents List of Acronyms ............................................................................................ vii Executive Summary ....................................................................................... viii

1. Background

1.1 Feed the Future and FTF FEEDBACK Overview

1.2 Feed the Future ZOI Profile

1.2.1 Rationale for ZOI Designation

1.2.2 Strategic Objectives for Feed the Future in the

ZOI

1.2.3 Government of Nepal Strategies and

Investments

1.2.4 Feed the Future Intervention Areas Within the

ZOI

1.2.5 Demographics

1.2.6 Agriculture

1.2.7 13 Population-Based Indicators for the ZOI

(Primary and Secondary)

1.3 Purpose of this Report

2. Methodology for Obtaining Baseline Values for the PBS Indicators

2.1 Secondary Data

2.1.1 Secondary Data Sources

2.2 Primary Data Collection

2.2.1 Review of Standard Questionnaire Modules

2.2.2 Timing of Survey Work

2.2.3 Survey Sample Design

2.2.4 Limitations and Challenges

3. Descriptive Findings

3.1 Household Characteristics

3.1.1 Household Demographic Characteristics

3.1.2 Dwelling, Water, and Sanitation Characteristics

3.1.3 Housing Construction Materials and Fuel

3.2 Household Expenditures

3.2.1 Prevalence of Poverty in the ZOI

3.2.2 Daily Per Capita Expenditures

3.3 Nutrition and Household Hunger

3.3.1 Child Nutrition: Anthropometry (Stunting, Wasting and Underweight)

3.3.2 Child Nutrition: Infant and Young Child

Feeding

3.4 Women’s Empowerment

3.4.1 WEAI Overview

3.4.2 5DE

3.4.3 GPI

Feed the Future Nepal Zone of Influence Baseline Report iv

Table of Contents (continued)

4. Analysis of Findings

4.1 Analysis Requested by USAID/Nepal

4.1.1 Women’s Anemia

4.1.2 Children’s Anemia

5. Summary and Conclusions

List of Appendixes A. References

List of Annexes A. Protocol for the Napal Population Baseline Survey (PBS) in the Feed the Future Zone of Influence (ZOI) A.1 Overview A.2 Sample Size Estimates for Feed the Future

Baseline Survey A.3 Survey Design

A.3.1 Questionnaire Design A.3.2 Sample Design

A.4 Fieldwork A.5 Data Management A.6 Analysis and Reporting A.7 Institutional Review Board (IRB) Approval

Annex A – Attachments

1. Nepal Baseline FTF FEEDBACK Indicators, by

ZOI and All Districts

2. Workplan

3. Nepal PBS Questionnaire

B. National Living Standards Survey (NLSS) III Study Design

C. Nepal PBS 2013 – Survey Administration D. Nepal PBS 2013 – Sample Size Design E. NLSS III and NDHS Data References F. Nepal PBS 2013 Feed the Future Indicator Descriptions and Calculations

List of Tables Table 1. Nepal 2013 national and ZOI populations and households Table 2. Percent change in area, yield and production of crops from

2000-01 to 2010-11 Table 3. Sources of data for Nepal Feed the Future ZOI: Population-based indicators (primary and secondary) Table 4. Required sample size from baseline to endline Table 5. Districts by development region

Feed the Future Nepal Zone of Influence Baseline Report v

List of Tables (continued) Table 6. Nepal Feed the Future ZOI: Population-based indicators

(11 indicators) Table 7. Nepal Feed the Future ZOI: Household demographics indicators (i) Table 8. Nepal Feed the Future ZOI: Age, literacy and education of primary respondent, by sex Table 9. Nepal Feed the Future ZOI: Household demographic indicators (ii) Table 10. Nepal Feed the Future ZOI: Roof type Table 11. Nepal Feed the Future ZOI: Exterior wall type Table 12. Nepal Feed the Future ZOI: Floor type Table 13. Nepal Feed the Future ZOI: Fuel type Table 14. Nepal Feed the Future ZOI: Prevalence of poverty and per capita expenditures Table 15. Annual per capita expenditures of USG targeted beneficiaries

(in 2010 USD) Table 16. Nepal Feed the Future ZOI: Prevalence of stunted children under 5 years of age Table 17. Nepal Feed the Future ZOI: Prevalence of wasted children under

5 years of age Table 18. Nepal Feed the Future ZOI: Prevalence of underweight children under 5 years of age Table 19. Nepal Feed the Future ZOI: Nutritional status of children under 5 Table 20. Nepal Feed the Future ZOI: Prevalence of exclusive breastfeeding of children under 6 months of age Table 21. Nepal Feed the Future ZOI: Prevalence of children 6-23 months receiving a minimum acceptable diet Table 22. Nepal Feed the Future ZOI components of minimum acceptable diet among children 6-23 months of age Table 23. Nepal Feed the Future ZOI: Prevalence of underweight women

(BMI < 18.5)

Table 24. Nepal Feed the Future ZOI: Nutritional status of women of reproductive age Table 25. Nepal Feed the Future ZOI: Women’s dietary diversity: Mean number of food groups consumed by women of reproductive age Table 26. Nepal Feed the Future ZOI: Percent of women eating each of the nine food groups Table 27. Nepal Feed the Future ZOI: Household hunger, for all and by household type Table 28. WEAI indicators Table 29. Women’s 5DE index Table 30. Women’s 5DE score and household type

Feed the Future Nepal Zone of Influence Baseline Report vi

List of Tables (continued) Table 31. Percent of women who are not yet empowered and who have inadequate achievement (Censored Headcount) in the 5DE indicators

Table 32. GPI Table 33. Percent of men and women who are not yet empowered and have inadequate achievement (Censored Headcount) in the 10 5DE indicators

Table 34. Nepal Feed the Future ZOI: Prevalence of anemia in women of reproductive age (15-49), by select background characteristics

Table 35. Nepal Feed the Future ZOI: Prevalence of anemia in women of reproductive age (15-49), by smoking/tobacco usage and gendered household type

Table 36. Nepal Feed the Future ZOI: Prevalence of anemia in children 6-59 months, by sex and gendered household type

Table 37. Nepal Feed the Future ZOI: Prevalence of anemia in children 6-59 months, by sex and age group

Table 38. Nepal Feed the Future ZOI: Prevalence of anemia in children 6-59 months, by sex and ecological zone

Table 39. Nepal Feed the Future ZOI: Prevalence of anemia in children 6-59 months, by sex and household wealth quintiles

List of Figures Figure 1. Map of Nepal: Feed the Future ZOI and approximate geographic location of intervention areas

Feed the Future Nepal Zone of Influence Baseline Report vii

List of Acronyms 5DE Five Domains of Empowerment

ADS Agricultural Development Strategy

BMI Body Mass Index

CIP Country Investment Plan

CPC Carolina Population Center of the University of North Carolina at Chapel Hill

CPI Consumer Price Index

DHS Demographic and Health Survey

DM Data Management

FSIP Food Security Interim Plan

FTF Feed the Future

GPI Gender Parity Index

HH Household

HHS Household Hunger Scale

IFPRI International Food Policy Research Institute

MAD Minimum Acceptable Diet

MOHP Ministry of Health and Population

M&E Monitoring and Evaluation

MSNP Multi-Sector Nutrition Plan

NDHS Nepal Demographic and Health Survey

NHSP National Health Sector Plan

NLSS National Living Standards Survey

ODK Open Data Kit

PBS Population-Based Survey

PPP Purchasing Power Parity

PPS Probability Proportional to Size Sampling Method

QC Quality Control

USAID United States Agency for International Development

USG U.S. Government

VDC Village Development Committees

WEAI Women’s Empowerment in Agriculture Index

WHO World Health Organization

ZOI Zone of Influence

Feed the Future Nepal Zone of Influence Baseline Report viii

Executive Summary This document reports the findings of the baseline population-based survey (PBS) for the Feed the Future initiative in Nepal. Feed the Future is supported by 10 federal agencies and led by the U.S.

Agency for International Development (USAID), and seeks to reduce poverty and undernutrition in 19 developing countries by focusing on accelerating growth of the agriculture sector, addressing root causes of undernutrition and reducing gender inequality. The survey captures data in the geographic areas targeted by Feed the Future interventions, known as the Feed the Future Zones of Influence

(ZOI).

The PBS was conducted by the Feed the Future FEEDBACK (FTF FEEDBACK) project, which is responsible for performance monitoring and impact evaluation of the Feed the Future initiative.

FTF FEEDBACK is implemented by Westat in partnership with TANGO International, the International Food Policy Research Institute (IFPRI), and the Carolina Population Center (CPC) of the University of North Carolina at Chapel Hill. In Nepal, the PBS fieldwork was conducted by a local research organization, New ERA, with direction and oversight from Westat. The fieldwork took place from April 15 to May 28, 2013.

The ZOI in Nepal comprises 20 districts across the western, mid-western and far-western development regions. A total of 2,000 households in the ZOI were interviewed for the PBS data collection activity. These households were spread across 100 clusters in the targeted districts. The Feed the Future baseline for Nepal draws on data from both primary and secondary sources. Of the 13 Feed the Future indicators reported, three were calculated using data gathered in the Nepal Baseline PBS of 2013: (1) Women’s Empowerment in Agriculture Index (WEAI); (2) prevalence of households with moderate or severe hunger; and (3) women’s dietary diversity.1 The following eight indicators were calculated from secondary data from the Nepal Demographic and Health Survey (NDHS) of 2011:

(1) prevalence of stunted children under 5 years of age; (2) prevalence of wasted children under 5 years of age;

(3) prevalence of underweight children under 5 years of age; (4) prevalence of underweight women; (5) prevalence of children 6-23 months receiving a minimum acceptable diet; (6) prevalence of exclusive breastfeeding; (7) prevalence of anemia in children 6-59 months and (8) prevalence of anemia among women of reproductive age [15-49 years]. The Nepal Living Standards Survey (NLSS III of 2010-2011) was used to calculate the following two indicators: (1) prevalence of poverty and (2) per capita expenditures. This report documents the baseline status of indicators against which changes in the Feed the Future ZOI in Nepal will be measured over time. It should be noted that the survey was not designed to allow for conclusions about attribution or causality.

Overall, the prevalence of poverty in the ZOI, based on the $1.25/person/day threshold, is

32.5 percent. Per capita expenditure in the ZOI is $2.12/day (USD 2010). Since remittances are important in the Nepal context, USAID/Nepal has requested FTF FEEDBACK to conduct additional analyses to study the impact of remittances in the Nepal ZOI. The results will be presented separately as an addendum to this report.

1 Women’s dietary diversity score and prevalence of underweight women are measured on women of reproductive age

(15-49 years).

Feed the Future Nepal Zone of Influence Baseline Report ix

The average number of household members in the ZOI is approximately five. Households with both male and female adults (the male and female adult households) in the ZOI have significantly more members, more females, and more children in the 0-5 year age bracket than other gendered household types. There are significantly more children between ages 5 to 17 years in male and female adult households compared to adult male only households. Regarding dwelling characteristics, about 74 percent of households in the ZOI have electricity. The mean number of rooms per household in the ZOI is 2.6. The male and female adult households have more rooms compared to other gendered household types.2 Approximately 84 percent of all households use an improved drinking water source, and 57.5 percent use improved sanitation facilities. About 85 percent of the households use firewood as their main source of cooking, followed by piped or propane gas (about 12 percent).

The nutrition data show that about 45 percent of children less than 5 years of age in the ZOI are stunted. The data also show that the prevalence of wasting in children under 5 is 12 percent.

Although more boys are stunted or wasted, in comparison to girls, the differences are not statistically significant. The prevalence of exclusive breastfeeding for children under 6 months in the ZOI is about 71 percent. Slightly less than a quarter (22.7 percent) of children 6 to 23 months of age obtains a minimum acceptable diet (MAD). About one tenth of all interviewed households (10.6 percent) reported moderate or severe hunger based on the Household Hunger Scale (HHS).

Women’s dietary diversity is low, with women of reproductive age reporting an average consumption of approximately four out of nine total food groups.

The WEAI measures the empowerment, agency, and inclusion of women in the agriculture sector using two sub-indices. The Five Domains of Empowerment (5DE) subindex measures women’s empowerment in five key domains (production, resources, income, leadership and time), and the Gender Parity Index (GPI) measures the average level of equality in the empowerment of men and women in the household. The Nepal PBS data show the 5DE subindex is 0.79. Overall, about 41 percent of women have achieved empowerment (a score of 0.80 or greater). The GPI sub-index in the Nepal ZOI is 0.89. Within households with both a male and a female adult, about 47 percent of women have achieved adequate gender parity (i.e., a 5DE score equal to or higher than the man in their household). The WEAI, which is the weighted sum of the 5DE and GPI sub-indices, is 0.80.

Additional analysis conducted at the request of USAID/Nepal showed that there are no significant differences in women’s and children’s anemia across categories of household type, nor is there a clear pattern by household wealth quintile. However, for both women and children, anemia prevalence is significantly greater in Terai areas than in hill areas. Additionally, girls are significantly

2 As mentioned in USAID 2012. “Feed the Future household (HH) level indicators are disaggregated by “gendered household types” – that is: (1) HH with male and female adults (18+ years), (2) HH with at least one male adult and no female adult, (3) HH with at least one female adult and no male adults, and (4) HH with children and no adults. This categorization is somewhat different that the standard “male-headed vs. female-headed” households, and the distinction and change is very meaningful. The concept of “head of household” is highly loaded, presumes certain characteristics that may or may not be present in household gender dynamics, and often reflects the bias of the researcher or respondent. In addition, the head of household concept may perpetuate existing social inequalities and prioritization of household responsibilities that may be detrimental to women.” Note: Some of the background data presented in this report were analyzed by household head rather than gendered HH type in the cited reports, and in these cases, the household headship disaggregation is used.

Feed the Future Nepal Zone of Influence Baseline Report x more likely than boys to be anemic, as are younger children (6-23 months) compared to older children (24-59 months), suggesting that the most vulnerable categories with respect to anemia are very young (6-23 months) female children living in Terai areas.

Feed the Future Nepal Zone of Influence Baseline Report 1

1. Background

1.1 Feed the Future and FTF FEEDBACK Overview

Feed the Future is a U.S. Government (USG) initiative that addresses global food insecurity by supporting agriculture sector growth and improving nutritional status in 19 focus countries. The U.S. Agency for International Development (USAID) is responsible for leading the government-wide effort to implement the Feed the Future initiative. Feed the Future FEEDBACK (FTF FEEDBACK) is a USAID-funded project designed to implement monitoring and evaluation activities for Feed the Future. FTF FEEDBACK is implemented by Westat in partnership with TANGO International, the International Food Policy Research Institute (IFPRI), and the Carolina Population Center (CPC) of The University of North Carolina at Chapel Hill.

The main objectives of the FTF FEEDBACK project are to: (1) enable USAID Missions to meet Feed the Future performance monitoring requirements and maximize the use and benefits of the data collected; (2) provide high-quality empirical evidence to inform program design and investment decisions that will promote sustainable food security; (3) ensure timely availability of high quality data for use in monitoring performance and evaluating Feed the Future’s impact; and (4) facilitate accountability and learning about which Feed the Future interventions work best, under what conditions, and at what cost.

To measure progress in addressing global food insecurity, USAID is collecting data through large-scale household surveys in geographic areas targeted by Feed the Future interventions, known as the Zones of Influence (ZOI). These population-based surveys (PBS) capture information related to agriculture, food security, food consumption, nutrition, women’s empowerment, and well-being of households in the ZOI.

1.2 Feed the Future ZOI Profile

1.2.1 Rationale for ZOI Designation

With a population of 28 million, Nepal is a severely food-deficient country recovering from a 10-year civil war. With a per capita gross domestic product of current $707 (estimated 2012), Nepal is the poorest country in South Asia and the twenty-first poorest country in the world3. Approximately 25 percent of Nepalese live below the international poverty line of $1.25/day.4

Seventy-five percent of the population works in the agriculture sector,5 which accounts for 36 percent of the GDP.6 Recent declining agricultural production has depressed rural economies and

3 The World Bank. 2013.

4 The World Bank. 2013a.

5 The CIA. 2013.

6 The World Bank. 2013b.

Feed the Future Nepal Zone of Influence Baseline Report 2 increased widespread hunger and urban migration in Nepal. This situation is compounded by a population growth rate of 1.8 percent per year7 and a high ratio of population to arable land.8

The main underlying causes of hunger, poverty and undernutrition in Nepal include low agricultural productivity, limited livelihood opportunities, weak market linkages, and inadequate production and consumption of nutritious, locally-available foods. Other major issues include decreasing land resources and biodiversity; climate change risks; low and declining investment in agricultural research and extension; poor access to quality inputs and services; limited basic infrastructure; rising food prices; and market volatility. These result in youth outmigration, declining labor availability, and more fallow land.

The national rate of stunting among children under 5 years old in 2011 was 41 percent (surpassing Sudan),9 wasting was 11 percent, and underweight was 29 percent (similar to Ethiopia),10 reflecting widespread chronic malnutrition.

In Nepal’s traditionally patriarchal social hierarchy system, women, Dalits11, and other disadvantaged groups typically have less access to social services and little access to property ownership or cash.

Dalits in the Terai (the plains) have among the highest poverty rates in Nepal (49.2 percent compared to 42.6 percent national average).12

The vast majority of Nepali women (90.5 percent)13 are engaged in agriculture. Since the current total fertility rate is 2.614 nationally, but much higher in some areas (particularly in the mid- and far-western regions), most women are involved in multiple roles such as caring for fields and livestock, caring for children, and doing domestic chores. Political uncertainty and declining employment opportunities have resulted in a significant number of male laborers migrating for work abroad, which has added more responsibilities for women.15 Women and children typically have higher levels of poverty and suffer greater hunger levels.

1.2.2 Strategic Objectives for Feed the Future in the ZOI

Feed the Future’s overall objectives in Nepal are to maximize the number of Nepalis lifted out of poverty and increase the number of children and women with improved nutritional status. Also, Nepal is undergoing changes in precipitation patterns, temperature regimes, and hydrology (due to glacier melt) linked to climate change. Feed the Future activities are part of a larger USG commitment to build the resilience of vulnerable populations to the changing climate in Nepal.

7 The CIA. 2013a.

8 The World Bank. 2013c.

9 UN. 2013.

10 NDHS. 2011.

11 Dalits are considered the most disadvantaged caste in Nepal.

12 UNDP. 2008.

13 FAO. 2013.

14 NDHS. 2011.

15 Adhikari et Al. 2010.

Feed the Future Nepal Zone of Influence Baseline Report 3

Feed the Future seeks to achieve the following key objectives in Nepal by 2015:

� An estimated 165,000 vulnerable households including Nepali women, children, and family members – mostly smallholder farmers – will receive targeted assistance to escape hunger and poverty. The interventions will focus on establishing profitable businesses that are able to provide inputs, extension services, and market linkages to targeted farmers on a sustainable basis. The interventions will increase production (availability) of vegetables while also enhancing incomes (access).

� In conjunction with the Global Health Initiative, more than 393,000 children will be reached with services to improve their nutrition and prevent stunting and child mortality. Nutrition and hygiene interventions will promote behavior change regarding diet composition, feeding practices, and spending patterns (utilization). Targeted programs also will increase resiliency (stability) in vulnerable communities and groups.

� Significant numbers16 of people residing in households in rural areas will achieve improved income and nutritional status from strategic policy and institutional reforms.

The agriculture and nutrition components will be strongly connected throughout the program, with the same households targeted by these interventions. A subset of the most vulnerable beneficiaries will be targeted by a literacy and entrepreneurship training component.

1.2.3 Government of Nepal Strategies and Investments

The Feed the Future program in Nepal aligns closely with the Government of Nepal’s agriculture and nutrition strategies and investments.

The strategic framework for agriculture and food security in Nepal has been provided in the longer-term Agriculture Perspective Plan (1995-2015). The objectives for the agriculture sector were established in the National Agriculture Policy (2004), National Agriculture Sector Development Priority Framework (2010), and the associated Country Investment Plan (CIP). The overall goal of the CIP is to reduce poverty and household food insecurity on a sustainable basis and to strengthen the national economy.

The Government of Nepal currently is updating its strategy, as embodied in the Agricultural Development Strategy (ADS). This was prepared in 2013 under the leadership of the Asian Development Bank and is being reviewed by the Government of Nepal. The ADS is intended to guide the agricultural sector of Nepal for the next 20 years. The ADS vision is that Nepal will have a “self-reliant, sustainable, competitive, and inclusive agricultural sector that drives economic growth and contributes to improved livelihoods and food and nutrition security.”17 The ADS aims to accelerate growth in the agriculture sector through four strategic components: governance, productivity, profitable commercialization, and competitiveness. It will achieve these aims while

16 According to the Feed the Future Multi-Year Strategy 2011-2015 for Nepal, these preliminary targets were estimated based on analysis at the time of strategy development using estimated budget levels and ex-ante cost-benefit ratios from previous agriculture and nutrition investments. Therefore, targets are subject to significant change based on availability of funds and the scope of specific activities designed. More precise targets will be developed through project design for specific Feed the Future activities.

17 ADB. 2013.

Feed the Future Nepal Zone of Influence Baseline Report 4 promoting social and geographic inclusiveness, natural resources and economic sustainability, development of the private sector and the cooperative sectors, and improved market (roads, collection centers, packing houses, market centers), information, and power infrastructure (rural electrification). The strategy aims to accelerate agricultural growth, increase food and nutrition security, reduce poverty, increase the agricultural trade surplus, lead to higher and more equitable income of rural households, and strengthen farmers’ rights.18 Since the ADS represents an important opportunity for the Government of Nepal to move agricultural development forward, USAID/Nepal commissioned an overall assessment of the Nepali policy-making process in 2013 to examine the strengths and current barriers for successful food security policy change focusing on the ADS. The results were reported in the Institutional Architecture for Food Security Policy Change:

Nepal (July 2013) draft report, outlining the strengths, barriers and recommendations.19

The Interim Plan of Nepal (2007-2010), renewed for 2011-2014, contains a food security component. The food security objectives, policies, programs, and monitoring mechanisms in the Food Security Interim Plan (FSIP) were prepared with technical assistance from the Food and Agriculture Organization. The principal objective of the FSIP is to make the lives of the targeted people healthy and productive by improving national food sovereignty and the food and nutrition situation. The basic FSIP objectives are as follows:

1. Increased national self-reliance in basic food products (increased food production, transportation, cold storage, irrigation).

2. Improved nutrition situation (reduced undernutrition).

3. Enhanced quality, standard and hygiene of available food products.

4. Enhanced capacities to manage food insecurity during crisis situations like famines, droughts, floods, landslides, fires, etc.

5. Improved access to food for people/groups most at risk of food insecurity (through rural infrastructure, employment and income generation opportunities).

The Government of Nepal submitted a successful application to the Global Agriculture and Food Security Program (GAFSP) in 2011, and was awarded $46.5 million for the Nepal Agriculture and Food Security Project (AFSP). The Nepal AFSP seeks to improve household food security through increased agricultural productivity, household incomes, and awareness about health and nutrition, focused in the mid-western and far-western development regions. Agricultural productivity activities will support small infrastructure development, access to locally appropriate technologies, control of diseases and pests, and identification of new and improved technologies. Increased productivity will increase food availability and household incomes, which will be complemented by efforts to change financial management behaviors that threaten to reduce income such as consumption of seed stock and sale of productive assets. Health and nutrition sub-projects will provide dietary support, increase

18 Ibid. p 4.

19 USAID. 2013.

Feed the Future Nepal Zone of Influence Baseline Report 5 the supply of nutrition foods, and promote improve nutrition, health, and hygiene behaviors through community-based programs.20

This aligns with the Ministry of Health and Population’s (MOHP) 5-year National Health Sector Plan, Phase II (NHSP II) for 2010-2015. The NHSP II contains components addressing food security and nutrition. The Government of Nepal’s nutrition priority areas outlined in this plan are:

1. Wider coverage of micronutrient initiatives (Vitamin A and zinc supplementation, iron fortification and salt iodization);

2. Increased dissemination of information on breastfeeding and complementary feeding practices;

3. Improved focus on maternal and infant nutrition;

4. Improved hygiene and sanitation, food safety and preparation;

5. Strengthened nutrition education in training curriculums for health care workers; and

6. Education on nutrition, dietary diversification and locally available nutritious foods.

Looking forward, the nutrition sector will be guided by the Multi-Sector Nutrition Plan (MSNP) for 2013-2023, which was developed by the National Planning Commission and finalized in September 2012. The MSNP has three major outcomes: (1) policies, plans and multi-sector coordination improved at national and local levels; (2) improved use of nutrition specific and nutrition sensitive services; and (3) strengthened capacity of central and local governments to provide basic nutrition services in an inclusive and equitable manner. The five year goal is to improve maternal and child nutrition, which will result in the reduction of maternal, infant and young child under-nutrition, in terms of maternal BMI and child stunting, by one-third. The 10 year goal is to significantly reduce chronic malnutrition so that it no longer becomes an impediment to improving human capital and for overall socio-economic development.21

1.2.4 Feed the Future Intervention Areas Within the ZOI

Nepal is a landlocked country divided into three primary ecological zones mainly running east-west:

the Terai in the south, the hill area in the middle, and the mountain area in the north. Crop production and poverty rates vary significantly by region and district. The mid- and far-western regions typically have the highest rates of food insecurity and hunger. And while the Terai is the ecological zone with the greatest agricultural production,22 eight districts in the Terai faced food deficits in 2010. Furthermore, despite their greater agricultural production rates, some Terai districts have high rates of malnutrition due to behavioral and cultural practices.23

20 GAFSP. 2013.

21 Government of Nepal National Planning Commission. 2012.

22 Joshi, K.D., Conroy, C., and Witcomb, J.R. 2012.

23 USAID. 2011.

Feed the Future Nepal Zone of Influence Baseline Report 6

The Terai, together with the hills, contains the most arable land and fertile soils. Irrigation potential is greater and transportation networks are present in the Terai and lower hills. Forty-seven percent of the total population lives in the Terai and 45 percent are located in the hills.24

The far-western, mid-western, and western regions have higher sub-regional hunger indexes, incidences of asset sales as a coping strategy, levels of outmigration, and numbers of female-headed households. 25 In addition, the far- and mid-western regions were prioritized by the Government of Nepal in its CIP. USAID/Nepal has aligned its economic growth program with the Government of Nepal’s priorities, and Feed the Future will build on USAID/Nepal’s economic growth programs in the ZOI.26

Thus based on need, prioritization by the Government of Nepal, and potential synergies with other USAID-funded programs in the same geographic areas, 20 districts in three regions (Figure 1) were selected as the ZOI in Nepal as follows:

� Far-western region (six districts): Achham, Baitadi, Dadeldhura, Doti, Kailali, and Kanchanpur.

� Mid-western region (ten districts): Banke, Bardiya, Dailekh, Dang, Jajarkot, Pyuthan, Rolpa, Rukum, Salyan, and Surkhet.

� Western region (four districts): Arghakhanchi, Gulmi, Kapilvastu, and Palpa.

1.2.5 Demographics

Table 1 compares the population of the ZOI with the population of Nepal as a whole. The national values in Table 1 are derived from the 2011 Census of Population and Housing.27 ZOI figures are based on a number of sources, including the 2011 Census and the Nepal Baseline PBS (2013). 28 The total population of Nepal is about 27.5 million, and the population of the ZOI is 6.8 million. Thus, the Feed the Future-supported districts in the ZOI comprise 24.87 percent of the total population.

24 Ibid. p. 12.

25 As mentioned in USAID. 2012. “Feed the Future household (HH) level indicators are disaggregated by “gendered household types” – that is: (1) HH with male and female adults (18+ years), (2) HH with at least one male adult and no female adult, (3) HH with at least one female adult and no male adults, and (4) HH with children and no adults . This categorization is somewhat different that the standard “male-headed vs. female-headed” households, and the distinction and change is very meaningful. The concept of “head of household” is highly loaded, presumes certain characteristics that may or may not be present in household gender dynamics, and often reflects the bias of the researcher or respondent. In addition, the head of household concept may perpetuate existing social inequalities and prioritization of household responsibilities that may be detrimental to women.” Note: Some of the background data presented in this report were analyzed by household head rather than gendered HH type in the cited reports, and in these cases, the household headship disaggregation is used.

26 USAID. 2011a.

27 CBS. 2012.

28 For further details on how these figures were derived, please refer to Section 2.1.1 under methods.

Feed the Future N epal Z one of Influence B aseline R eport

Figure 1. Map of Nepal: Feed the Future ZOI and approximate geographic location of intervention areas

Feed the Future Nepal Zone of Influence Baseline Report 8

Table 1. Nepal 2013 national and ZOI populations and households

Population (I) Nationala National percenta ZOIb

ZOI

percentc

Total Population 27,516,260 100.0 6,842,936 100.0 Rural 22,817,979 82.9 6,112,087 89.3 Urban 4,698,280 17.1 730,849 10.7 Male and Female Adult(s) – – 5,796,631 d 84.7 Female Adult(s) only – – 987,039 d 14.4 Male Adult(s) only – – 45,455 d 0.7 No Adults – – 13,811 d 0.2 Women of Reproductive Age (15-49 years)

7,392,012 26.9 1,874,295 27.4

Women of Reproductive Age- Rural

6,022,078 21.9 1,659,805 24.3

Women of Reproductive Age- Urban

1,369,934 5.0 214,491 3.1

Children 0-59 months 2,666,996 9.7 761,381 11.1 Males 0-59 months 1,365,668 5.0 378,990 5.5 Females 0-59 months 1,301,328 4.7 382,392 5.6 Children 6-59 months – – 687,557 10.0 Males 6-59 months – – 340,350 5.0 Females 6-59 months – – 347,207 5.1 Children 0-5 months – – 73,825 1.1 Males 0-5 months – – 38,640 0.6 Females 0-5 months – – 35,184 0.5 Children 6-23 months – – 219,430 3.2 Males 6-23 months – – 114,824 1.7 Females 6-23 months – – 104,606 1.5 Households (II) Nationala ZOIb ZOI Percentc Number of Households 5,875,623 100.0 1,343,205 100.0 Male and Female Adult(s) – – 1,035,523e 77.1 Female Adult(s) only – – 277,457e 20.7 Male Adult(s) only – – 24,559e 1.8 No adults – – 5,666e 0.4 a The national population (Section I) and household (Section II) values are based on the National Population and Housing Census 2011 (National Report).

b The ZOI population (Section I) and household (Section II) values are based on the National Population and Housing Census 2011 (National Report).

c The denominator for ZOI percent values for section I (population) is 6,842,936 (total ZOI population). The denominator for ZOI percent values for section II (households) is 1,343,205 (total number of households in the ZOI).

d Number of people living in each type of household.

e Number of households by gendered household type.

Compared to the national population in Nepal, Table 1 shows that the ZOI population is somewhat more rural and has a higher percentage of children under the age of 5. Specifically, the ZOI in Nepal is 89.3 percent rural, compared to all of Nepal at 82.9 percent rural, and 11.1 percent of the ZOI population is under the age of 5 years compared to 9.7 percent nationwide. In the ZOI, 84.7 percent live in households where both an adult female and adult male are present.

Feed the Future Nepal Zone of Influence Baseline Report 9

1.2.6 Agriculture

Feed the Future selected the value chains to be supported in Nepal using the following criteria: high unmet demand; high potential to increase production; prioritization in the CIP; significant nutritional content and share of diet; production by a large number of smallholders; and high potential and applicability in focus districts.

The U.S. Government determined that it can best support the Government of Nepal in addressing Nepal’s most pressing food security, poverty, and nutrition challenges through balanced interventions in high-value vegetable value chains and complementary support to cereals (rice and maize), pulses (lentils), and livestock. Prior to Feed the Future investments, change in the area, yield, and production of these crops between 2000-01 to 2010-11 is shown in Table 2.

Table 2. Percent change in area, yield and production of crops from 2000-01 to 2010-11

Percent change from 2000-01 to 2010-11 Value chain Area Yield Production

Rice -4.1% 10.3% 5.8% Maize 9.9% 26.7% 39.3% Lentils 16.2% 24.5% 44.6% Vegetables 55.3% 24.8% 93.8%

Source: Statistical Information on Nepalese Agriculture, 2010-2011. Government of Nepal Ministry of Agriculture and Cooperatives Agri-Business Promotion and Statistics Division, December 2011.

Feed the Future is not proposing to replace cereals with vegetables, but rather is promoting crop diversification and intercropping. Previous projects have shown that households growing vegetables for sale in markets consume 20 percent of the produce grown, thereby contributing to improved household nutrition. Increased income has proven to contribute to increased food security.

Cultivation of vegetables using improved production techniques results in a significantly higher gross margin than cereals. Under the USAID-funded Nepal Flood Recovery Program, when farmers switched from producing cereals to vegetables, their incomes increased by 200 percent. High value vegetable production can have an especially large impact on incomes and food security for producers in marginal areas and/or with small landholdings. Input and labor costs are higher for vegetables, but this is more than compensated for by increased income per unit of land.29 The increased input and labor startup costs for vegetables reflect the need for improved techniques to address labor shortages and enhance labor productivity (e.g., mechanization, conservation agriculture, and water management), as well as tackle the issues of input costs (for example, improving access to credit and financial services).

Feed the Future is investing in high value vegetables, cereals, pulses, and livestock under an integrated farming systems approach. The integrated farming systems approach includes promotion of intercropping or relay cropping during the fallow season, crop rotation to improve nutrient retention, locally-adapted improved varieties (i.e., high yielding, early harvest, and flood tolerant

29 USAID. 2011b.

Feed the Future Nepal Zone of Influence Baseline Report 10 varieties), minimal tillage systems with residue management, timely provision of quality inputs, improved water management, and mechanization adapted to the scale of farms in supported regions.

The focus subsectors of high value vegetables, cereals, pulses, and livestock present many opportunities to integrate women and youth in employment-generating activities. Livestock (e.g., poultry and goats) will also be included as part of the farming system, in order to reach the landless and most marginalized. Enhanced cereal productivity and marketing systems alongside high value vegetable investments increase the likelihood of success by ensuring sufficient local-level production of diverse foods and by increasing resilience in the system.

Conservation agriculture approaches for staple crops can save labor when machinery is used, while also conserving water and fuel and improving soil quality. The labor benefit is of particular value in Nepal, where increasing labor shortages are affecting farming, particularly in female-headed households. Conservation agriculture also is important for climate change adaptation.

Gender is an important cross-cutting issue addressed by the Feed the Future initiative, along with assisting youth and disadvantaged groups. With the high rate of male seasonal migration, in which men leave their households to migrate to India and return for festivals and harvests, women head a large percentage of rural households. By focusing on agricultural value chains, Feed the Future can have a major impact on women and children.

Investments in agriculture will be linked to household nutrition. On the supply side, nutrition will be improved by the production of nutritious foods for the household, sale of agricultural products that generate income for the purchase of nutritious foods, and distribution of these same smallholder farmer-produced nutritious foods to target smallholders as beneficiaries. This will be paired with demand-side activities, including nutrition and hygiene education.

1.2.7 13 Population-Based Indicators for the ZOI (Primary and Secondary)

The Feed the Future baseline for Nepal draws on data from both primary and secondary sources. In this document, the team reports on the 13 Feed the Future indicators. Of the 13 Feed the Future indicators reported, three were calculated using data gathered in the Nepal Baseline PBS (2013):

(1) Women’s Empowerment in Agriculture Index (WEAI); (2) prevalence of households with moderate or severe hunger (Household Hunger Scale - HHS); and (3) women’s dietary diversity.30 The following eight indicators were calculated from secondary data from the NDHS (2011)31: (1) prevalence of stunted children under 5 years of age; (2) prevalence of wasted children under 5 years of age (3) prevalence of underweight children under 5 years of age; (4) prevalence of underweight women of reproductive age (measured by body mass index - BMI);

(5) prevalence of children 6-23 months receiving a minimum acceptable diet; (6) prevalence of exclusive breastfeeding;

(7) prevalence of anemia in children 6-59 months and (8) prevalence of anemia among women of reproductive age

30 Women’s dietary diversity score and prevalence of underweight women are measured on women of reproductive age

(15-49 years).

31 NDHS. 2011.

Feed the Future Nepal Zone of Influence Baseline Report 11

[15-49 years]. The Nepal Living Standards Survey (NLSS) III (2010-2011)32 was used to calculate the following two indicators: (1) prevalence of poverty and (2) per capita expenditures. This report presents general descriptive findings for 11 population-based indicators in Section 3. The two anemia-related indictors (the prevalence of anemia in children 6-59 months and the prevalence of anemia among women of reproductive age [15-49 years]) are discussed in Section 4.0 of this report since they are part of additional analysis requested by USAID/Nepal. Refer to Table 3 on the next page for further details on all the indicators.

1.3 Purpose of this Report

This report presents baseline values established from primary and secondary data for 13 Feed the Future indicators in the ZOI in Nepal. The baseline values will be used as a reference point for measuring changes in nutrition, poverty, and gender integration in the agriculture sector in the ZOI.

Change over time in the indicators will be determined by comparing baseline data to data collected at the midline and endpoints of the Feed the Future program in Nepal. The data do not allow for conclusions about attribution or causality.

2. Methodology for Obtaining Baseline Values for the PBS Indicators

Baseline values for Feed the Future indicators in the ZOI in Nepal are derived from two types of data sources: secondary data and primary data. This methodology section first describes the methods for calculating indicators based on secondary data sources, followed by the methods for calculating indicators from PBS primary data collection.

The NDHS33 and NLSS III34 surveys were completed in 2011 and 2010-11, respectively. These surveys are excellent secondary data sources for reporting on nutritional status in women ages 15-49 and children under 5, prevalence of poverty, and per capita expenditures. These data sources had to meet two criteria to provide valid baseline estimates of indicators: (1) data were collected in a recent time window (last two years) prior to the start of Feed the Future activities, and (2) the sample size was large enough to estimate indicator values with sufficient precision and power to measure change over time. Based on sample size calculations found in Section 2.2.3, the samples available in the NDHS (for the nutritional status of women and children, indicators 3 to 10, Table 3) and in the NLSS III (for the prevalence of poverty and per capita expenditures indicators, indicators 1 and 2, Table 3) are considered sufficient to measure change over time. Thus, data for 10 out of the 13 indicators in Table 3 were obtained from the NDHS and NLSS III. Primary data were collected for the remaining three indicators (numbers 11 to 13 shaded in gray in Table 3): the prevalence of households with moderate or severe hunger known as the Household Hunger Scale (HHS), WEAI, and the women’s dietary diversity indicators in the ZOI. Although not collected in the Nepal

32 NLSSIII. 2011.

33 NDHS. 2011.

34 NLSSIII. 2011.

Feed the Future Nepal Zone of Influence Baseline Report 12

Baseline PBS (2013), the two anemia indicators (numbers 9 and 10 in Table 3) are also included in this report along with additional anemia analysis requested by USAID/Nepal with results presented in Section 4 of this report. Further, data for two additional indicators (see indicators 14 and 15 in Table 3) were collected at the request of the USAID/Nepal: percent of households using an improved sanitation facility and percent of households using an improved drinking water source.35

2.1 Secondary Data

This section presents the data sources and the procedures used to estimate the indicators of interest for the ZOI from the key secondary data sources: the NDHS (2011) and the NLSS III (2010-2011).

The 2011 Nepal Census was also used to estimate population values at the national and ZOI levels.

2.1.1 Secondary Data Sources

Table 3. Sources of data for Nepal Feed the Future ZOI: Population-based indicators (primary and secondary)

Indicator ZOI secondary analysis ZOI baseline survey Prevalence of povertya ü Per capita expenditures (as a proxy for incomes)a ü Prevalence of underweight childrenb ü Prevalence of stunted childrenb ü Prevalence of wasted childrenb ü Prevalence of underweight womenb ü Prevalence of children 6-23 months receiving a minimum acceptable dietb ü

Prevalence of exclusive breastfeedingb ü Prevalence of anemia among children 6-59 monthsc ü Prevalence of anemia among women of reproductive agec ü Prevalence of households with moderate or severe hungerd ü Women’s Empowerment in Agriculture Indexd ü

13. Women’s dietary diversityd ü Percent of HH using improved sanitation facilitye ü

15. Percent of HH using improved drinking water sourcee ü a Source: Nepal NLSS III (2010-2011).

b Source: NDHS (2011).

c Source: NDHS (2011). The anemia indicator data are analyzed and reported by FTF FEEDBACK in Section 4 of this report.

d Source: Nepal Baseline PBS (2013).

e Source: Nepal Baseline PBS (2013). These indicators were added to the Nepal Baseline PBS (2013) at the request of USAID/Nepal Mission and adapted from the male and female version questionnaires of the Suaahara Baseline Survey (2012).

Nepal Demographic and Health Survey (2011)

Publicly-available NDHS (2011) data were used to calculate anthropometric and nutrition indicators for women and children in the Nepal ZOI. In order to identify the ZOI in the nationally

35 Refer to Annex A – Attachment 3 for the Nepal Baseline PBS Questionnaire.

Feed the Future Nepal Zone of Influence Baseline Report 13 representative NDHS data, FTF FEEDBACK utilized geographic information systems data available for the NDHS. The team first identified the boundaries of the 75 districts in Nepal. Then, using global positioning system information for each cluster, the team identified the district names for all clusters within the NDHS dataset. Nepal’s ZOI includes 20 districts – Achham, Arghakhanchi, Baitadi, Banke, Bardiya, Dadeldhura, Dailekh, Dang, Doti, Gulmi, Jajarkot, Kailali, Kanchanpur, Kapilvastu, Palpa, Pyuthan, Rolpa, Rukum, Salyan and Surkhet. In the NDHS (2011) data, 87 of the 289 total number of clusters in the survey fall within the ZOI. The team flagged these clusters in the NDHS datasets, and limited the indicator analysis to only those cases within the ZOI.

The team also tabulated indicators for the entire country, and verified them with the tables in the NDHS (2011) Final Report to ensure comparability of analytic methods.

Nepal Living Standards Survey III (2010-2011)

The source of data for the poverty and expenditures indicators for the ZOI analysis is the NLSS III (2010-2011).36 This survey was conducted by the Central Bureau of Statistics to update data on living standards in Nepal. The NLSS III is a follow up to the earlier NLSS surveys conducted in 1995-96 (NLSS I) and 2003-04 (NLSS II).

Data collection was carried out over a period of 12 months to cover a complete cycle of agricultural activities and to capture seasonal variations, including the dry (February-May), rainy (June- September), and winter (October-January) seasons. The sample was nationally representative for each of the three seasons covered during the fieldwork. The data were collected throughout the year, dividing the clusters proportionately across the three seasons to reduce the seasonal effects of consumption and expenditures.

The NLSS III was designed to provide reliable indicator estimates for three types of geographic areas: urban/rural, ecological zones, and…