Improving maternal and child nutrition through participatory video, nutrition-sensitive agriculture interventions, and women’s groups: Evidence from a peer-reviewed study

Digital Green is pleased to share that The Lancet Planetary Health published a peer-reviewed study about Digital Green’s Upscaling Participatory Action and Videos for Agriculture and Nutrition (UPAVAN) project in Odisha, India. UPAVAN was designed as a four-arm cluster randomized control trial (RCT) assessing the nutrition and agricultural impact and cost-effectiveness of three types of interventions compared with a control arm. This is the first RCT to evaluate the effects of nutrition-sensitive agriculture interventions on maternal and child nutrition in rural Odisha, India.

Why conduct an RCT? Undernutrition in women has adverse pregnancy outcomes; in children, undernutrition impairs physical and cognitive development. In India, 21% of children are wasted and a quarter of women are underweight. Over a half of Indians depend on subsistence farming. Therefore, understanding the effects of integrating nutrition into agricultural programs could support the fight against undernutrition and help meet the United Nations Sustainable Development Goal 2 – End hunger, achieve food security and improved nutrition, and promote sustainable agriculture.

Study design. Our team conducted a parallel, four-arm, observer-blind, cluster RCT in the Keonjhar district of Odisha. Clusters of villages were either assigned a control group or an intervention group consisting of fortnightly women’s groups’ meetings and household visits over 32 months using one of the following approaches: (1) nutrition-sensitive agriculture videos, (2) nutrition-sensitive agriculture and nutrition-specific videos, or (3) nutrition-sensitive agriculture videos and a nutrition-specific participatory learning and action cycle meetings and videos. The London School of Hygiene & Tropical Medicine led the research activities along with University College London’s Institute for Global Health and DCOR Consulting. John Snow Research and Training Institute led formative research and built the technical capacity of partners. Voluntary Association for Rural Reconstruction and Appropriate Technology conducted field implementation, while Ekjut was responsible for the participatory learning and action activities. Digital Green coordinated all UPAVAN activities and designed the participatory video approach.

Watch the full video here.

Key findings of the RCT. The results of the RCT show that a combination of nutrition-sensitive agriculture videos, nutrition-specific videos, and participatory learning and action cycle meetings led to improvements in maternal and child diet quality, compared against the control group. These results suggest that making agriculture interventions nutrition-sensitive can improve diets. Furthermore, the participatory components of the approach could accelerate nutrition-sensitive agriculture intervention improvements in diet quality. The RCT suggests that the participatory nature of interventions may have created an enabling environment for women to adopt new dietary practices through peer support, building women’s confidence, problem-solving, and collective action.

In terms of cost-effectiveness, the RCT reveals that the cost to implement this approach is lower compared to other nutrition or health interventions with an agriculture component, such as community or homestead food production and biofortification.

Acknowledgments. Digital Green would like to thank the funders and all the partners who worked on this study. This study was funded by the Bill & Melinda Gates Foundation and UK Aid from the UK Government, with substantial co-funding from the USAID-funded project Digital Integration to Scale Gender-Sensitive Nutrition Social and Behavior Change Communication. We are extremely grateful to the women and children who participated in this study.