Comprehensive Food and Nutri on Security and Vulnerability Analysis (CFSVA+N)

MADAGASCARBriefi ng notes

Data collected in August/September 2010

In partnership with:Offi ce Na onal de Nutri onVPM/Santé PubliqueThe Gates Founda onIFADUNDPIns tut Na onal de la Sta s queDirec on Générale de la MétéorologieDSEC/Sta s que Agricole

Fift y years back Madagascar was one of the be er-performing African economies, but recurrent crises have sent the economy into decline, weakened the socio-cultural fabric of society and prompted chronic poverty.

Now it is among the least developed and poorest countries in the world, ranked 135th out of 168 according to the 2010 Human Development

from 473USD in 1970 to 410USD in 20081.

The violent presiden al coup of 2009, which culminated in the transfer of power to the High Transi onal Authority (HTA), dealt a huge blow. As a reac on, development aid packages were frozen and foreign aid decreased by 40%2, hi ng public services hard. This crisis, combined with the global fi nancial turmoil, plunged Madagascar into severe recession with GDP dropping by almost 5%. Indeed the economic situa on remains extremely fragile with recovery (and foreign aid) largely dependent on an interna onally-recognized resolu on of the poli cal crisis.

MADAGASCAR – ONE STEP FORWARD, TWO STEPS BACK

Eff orts to improve Madagascar’s food security and nutri on over the last two years have been thwarted by this poli cal instability. With up-to-date cri cal informa on needed to contribute to evidence-based decision making, UNICEF and WFP agreed to carry out a joint Comprehensive Food and Nutri on Security and Vulnerability Analysis (CFSVA+N) in 2010.

Provide an accurate and detailed assessment of the current food and nutri on security situa on

Assess the causes and risk factors for food and nutri on insecurity

Iden fy poten al ways to mi gate food and nutri on insecurity

Reveal pockets of vulnerability where special assistance may be required.

This marks Madagascar’s fi rst country-wide study of food security and vulnerability since the 2005 CFSVA. It complements the Demographic and Health Survey (DHS) 2008/2009 by upda ng its regional level data.

1World Bank, h p://go.worldbank.org/D41QD46W102

de l’impact de la crise ins tu onnelle et poli que, 2009, UNDP. The freeze in the assistance aff ected mainly development aid.

Index (HDI), with annual per capita income down The survey’s primary objec ves are to:

From an ini al USD 740 million to USD 433 million and this included USD 170 million in direct budget support. Source: Julien Chevillard, Analyse préliminaire

Food security exists when all people, at all mes, have physical, social and economic access to suffi cient, safe and nutri ous food which meets their dietary needs and food preferences for an ac ve and healthy life (1996 World Food Summit).

The survey found that na onally just over a third of households are classifi ed as food insecure and almost half are vulnerable to food insecurity. Just 17% of households are considered food secure.

This classifi ca on is iden fi ed by combining four food access indicators: the Food Consump on Score (FCS), which is a key WFP indicator measuring household food consump on, the wealth index, coping strategy index and per capita monthly expenditures.

Overall, 84% of households experience a me of the year when they don’t have enough cash or food. February and October emerge as the most diffi cult months, with around a third facing a lack of cash/food then.

Just over half of all households ‘always or oft en’ reduce their daily ra ons (thereby cu ng their calorie intake) and switch to less preferred food (which is likely to be of lower nutri onal value) to cope with shortages.

Rice is the mainstay of the Madagascan diet alongside vegetables and cassava, while vegetable and animal proteins are consumed rarely.

insuffi cient nutri ous foods to maintain an ac ve

consump on pa ern, i.e., they mainly survive on tubers (cassava 5.5 days a week) and eat cereals on 3.5 days and vegetables just twice a week. Proteins are essen ally absent from their diet.

MORE THAN A THIRD OF HOUSEHOLDS ARE ‘FOOD INSECURE’

LESS THAN HALF HAVE PLENTIFUL OR SUFFICIENTLY DIVERSE DIET

Food insecurity status

Household food consump on status

Na onally, over half (53%) of rural households, or 9.6 million people, have an unacceptable food consump on, i.e., they consume limited or

and healthy life. Of these, 12%, or about 400,000 households, have an extremely one-sided

Households with more members and higher percentage of dependents. Although larger in size, food insecure households have a weaker

less qualifi ed labour force. Households headed by a woman or by an

elderly person. Small farmers and casual labourers. Nearly

half (47%) of small farmers are food insecure and only 6% are classifi ed as food secure. Similarly, 43% of casual labourers are food insecure and only 5% are food secure.

Households that cul vate less land. While the average land size in rural Madagascar is 1.2 ha, the food insecure cul vate an average of 0.96 ha.

Es mates suggest that the food secure tend to produce 2.5 mes more than the food insecure. The food insecure grow fewer varie es of crops (3.1 on average vs 3.4 for the food secure).

Farmers who report a short harvest period i.e., less than two months.

Households whose food sources are less predictable than those who are producing their

gift s and hun ng/gathering.

This means they are more exposed to price

insecurity when prices rise.

WHO IS AT GREATEST RISK OF FOOD INSECURITY?

The southern is the most food insecure zone, with 68% of households considered as food insecure - a natural consequence of the very bad performance on all the four indicators men oned above. Over a million people are classifi ed as having poor food consump on.

The western zone has the next highest percentage of food insecure households (45%), mainly driven by the compara ve low per capita expenditures and poverty. It is followed by the HF cyclone eastern coast (43%) and the west south-western (41%). The heart of the country appears more food secure with the large farming plains and central highlands repor ng the lowest level of food insecurity (10% and 17% respec vely).

In terms of absolute es mates, the highest number of food insecure households is found in the HF cyclone eastern coast (343,291), followed by the southern (246,046) and the western (194,233). Interes ngly, the southern highlands, where the food insecurity prevalence is rela vely low, has a sizeable number of food insecure households.

SOUTHERN ZONE IS THE MOST FOOD INSECURE

human capital i.e., they can rely on a limited or

own or purchasing, i.e., they rely upon receiving

Farmers who are net consumers (i.e., in defi cit) rather than net producers (i.e., with surplus)

Those whose total cereal produc on is lower.

increases and plunged into deeper food

More than 75% of the 20 million popula on live on less than a dollar a day, severely hampering their ability to cope with food insecurity. Rural poverty rates are even higher at 82%.

Although nearly 80% of the rural working popula on is employed in agriculture, most at subsistence level, Madagascans are highly dependent on buying food and therefore exposed to price fl uctua ons. They devote some 66% of their total expenditures to food, with the lion’s share of the bill spent on rice (32%), the most consumed food and the most produced crop in the country. Some 62% of households report “purchase” as the main source for rice.

Tradi onal farming methods keep crop yields very low, perpetua ng deep poverty in rural areas. Lack of equipment, agricultural inputs and technical skills combine with the country’s outdated and badly-maintained transport network system, aff ec ng not only the connec vity between farms and consumers but also trade development between regions.

The plight of the south

In terms of poverty levels, food security, food consump on and levels of acute malnutri on

in Madagascar. Insuffi cient and irregular rainfall since 2008 had devasta ng impacts on the 2010 main harvest, leaving many vulnerable families in need of assistance. The region appears to have the poorest diet with households ea ng cassava almost every day and children having the least varied or nutri ous diets.

POVERTY, OUTDATED AGRICULTURE AND POOR INFRASTRUCTURE DRIVE FOOD INSECURITY

While the average land size is 1.2 ha, more than half of farming households cul vate less than 1 ha. Lack of land tenure reform is preven ng smallholders from gaining access to more land, and hampering extensive farming and economies of scale. Only 28% of farmers considered they had enough land to cul vate during the 2009-10 agricultural season. In fact large areas of Madagascar’s fer le lands remain unfarmed.

Many irriga on schemes are poorly maintained further contribu ng to low crop yields while 30% of households have either no irriga on or irrigate less than a quarter of their land, a propor on that rises to almost half in the southern zone, the area most exposed to droughts.

Se lements, shift ing cul va on, overgrazing, charcoal produc on, human-made bush fi res and uncontrolled expansion of farmland are destroying Madagascar’s forests. By aff ec ng the hydrological balance, deforesta on destroys rice fi elds, thus leaving the farming popula ons poorer and more food insecure.

September is the toughest month of the year for

Some 72% reduce their daily ra ons and 67% cut the number of meals they eat to cope. More than half of all households have poor consump on and 68% are considered food insecure.

Although the low cul va on of rice in favour of cassava and maize may explain why irriga on is the poorest in the country, the fact that half of households have no irriga on is alarming because of the vulnerability to droughts. These recurrent droughts reduce the harvest period to an average of just 3.3 months for the main crop.

the drought-prone southern zone is the worst

southerners in terms of food and cash shortages.

In the face of the increased vulnerability and food insecurity, households tend to shift from lowland areas into the hills to boost stagna ng yields, strategies that further contribute to the stripping of vegeta ve cover and degrada on of watersheds. Such destruc on could be avoided only by increasing land produc vity.

The country’s outdated and badly-maintained transport network system aff ects not only the connec vity between farms and consumers but also trade development between regions. Almost a quarter of the sampled Fokontany don’t have access to a market. Walking is s ll the most used means of transport in rural Madagascar, with the nearest bush-taxi typically a one to three hour walk from the community.

Lack of proper storage facili es and good road networks prevent farmers from storing their crop surpluses and selling when prices are most favourable or at a me convenient to them. During the December to March rainy season en re regions become inaccessible and prices are at their highest.

Cyclones, droughts and heavy rains are gaining in intensity and severity

Over the past 35 years at least 50 natural disasters,

famines and locust infesta ons, have aff ected more than 11 million people. Clima c disturbances are becoming more frequent and severe, leading to human casual es, loss of crops and animal produc on, infrastructure damage, natural resources degrada on (water, soil, forest) and coastal erosion.

With almost a quarter of the popula on concentrated in areas vulnerable to cyclones, fl oods or droughts, reoccurring natural disasters hit large numbers of people, causing addi onal hardship for the economically vulnerable popula on as such blows exacerbate the precarious condi ons of food security and livelihoods, water supply, irriga on systems, public health and environmental management.

Severe fl oods occur in the south-east and west of the country while drought is recurrent in the southern part of the island, where it had devasta ng impacts on the 2010 main harvest, leaving many vulnerable families in need of assistance.

Although the annual number of cyclones striking the country has not changed over the last 25 years the frequency of intense and very intense tropical cyclones is markedly up since 1994. Temperatures

are forecast to increase by 2.5-3˚C in the next 50 to 100 years. Rainfalls are predicted to drop markedly during the dry season and increase intensely during the rainy season - except in the south where drought will become more prolonged.

including cyclones, droughts, epidemics, fl oods,

have risen by about 0.5˚C over the last 30 years but

Madagascar is among the 20 countries in the world that carry the highest burden of under-nutri on3. Today about a quarter of the popula on is undernourished, a fi gure that has risen from around 20% in the 1990s. For these people, the food that they consume regularly fails to provide them with the minimum dietary energy requirement of 2,133kcal per adult per day4 to lead an ac ve and healthy life.

Among Madagascar’s children, 5.4% of under-fi ve year olds – or 176,000 children – suff er from acute malnutri on, also known as was ng and defi ned as an insuffi cient weight for a given height, with the southern zone faring the worst (7%).

The prevalence of acute malnutri on is signifi cantly higher among boys than girls. This is especially true in the HF cyclone east coast and western zones, and is most marked in the west south-western zone.

Babies and toddlers between six and 23 months of age are the most vulnerable to acute malnutri on as they explore diff erent foods and their environment and their immune systems mature. Worryingly, some 4% of babies under six months suff er acute malnutri on, despite the fact they should be exclusively breastf ed and so less exposed to the pathogens that make them ill.

WHO IS AT GREATEST RISK OF ACUTE MALNUTRITION?

Certain characteris cs have emerged as signifi cantly associated with acute malnutri on in children. In order of impact, these are:

Under fi ves whose mothers have no educa on or just have primary educa on

Under fi ves who are ill

Under fi ves in food insecure households

Under fi ves in poorer households

Those in the 6-23 month age group

For children under two years old, two addi onal factors are linked with acute malnutri on: not receiving acceptable infant feeding and gender (boys are more likely to be malnourished).

3Lancet Nutri on Series 20084The State of the World Food Insecurity, FAO, 2010

A QUARTER OF MALAGASY PEOPLE DO NOT CONSUME ENOUGH CALORIES

Breastmilk is the ideal nourishment for infants’ survival, growth and development. Exclusive breastf eeding in the fi rst six months of life s mulates babies’ immune systems protec ng them from infec ous diseases such as diarrhea and acute respiratory infec ons, as well as providing all the nutrients required for op mal growth and development. Overall 75% of babies under six months in Madagascar were exclusively breastf ed the day prior to the survey, but this fi gure falls to 57% in the southern zone; and a signifi cantly higher propor on of girls were exclusively breastf ed than boys.

Across the country, the propor on of babies put to the breast within an hour of birth stands at just 59%. Much depends on the mother’s educa on and quality of antenatal follow-up.

NEARLY HALF OF CHILDREN UNDER FIVE YEARS OLD ARE STUNTEDIn rural areas, almost half (49%) of under-fi ve year olds – or 1.6 million children – are stunted, also known as chronic malnutri on and defi ned as an insuffi cient height for a given age. This is due to the cumula ve eff ect of chronic undernutri on and/or repeated infec on, which inhibits childhood growth and development.

The highest level of stun ng is found in the central and southern zones and it is signifi cantly higher among boys (53%) than girls (45%), a diff erence that suggests that boys’ long-term development is being hampered by decisions made by their parents and caregivers in their early childhood years.

More emphasis must be placed on maternal health and nutri on to address the factors contribu ng to malnutri on in under-fi ves. It is of great concern that a fi ft h of children under six months old are already stunted, poin ng to poor nutri onal/health prac ces during pregnancy and those vital fi rst few months of life. The prevalence of stun ng in under fi ves is higher among children born with a low birth weight and among those born to short mothers. In total more than a third of mothers are less than 150cm tall.

GIRLS MORE LIKELY TO BE BREAST-FED THAN BOYSMothers educated to secondary level were more likely to ini ate breastf eeding within the hour as are mothers who sought antenatal follow-up from a health professional compared to those who sought antenatal follow-up from a tradi onal birth a endant.

The vast majority of children receive solid foods by the age of nine months. However, infants between six months and a year old have the worst dietary diversity and are fed less micronutrient-rich foods than older children, a worrying trend that fails to meet recommenda ons for this age group whose nutri onal requirements are no longer met by breast-milk alone.

ILLNESS DRIVES MALNUTRITION

Poor health is a cri cal immediate cause of malnutri on in children, with sick children needing more nutrients to fi ght disease and illness. In fact, the odds of a child suff ering from acute malnutri on in Madagascar are 64% higher if they are ill, exacerbated by the fact that sick children tend to have poorer appe tes, which in turn reduces the amount of food that they eat.

In total, 44% of children were sick during the survey period with the highest propor on in the southern zone. Morbidity varies from season to season, with May and June bringing increased incidence of diarrheal disease among children, and October and November seeing more cases of acute respiratory diseases.

Yet, all too oft en children do not receive the medical treatment they require. Treatment was sought for only a quarter of sick children with cost cited as the main reason for the lack of treatment– 56% of communi es claim they have to pay for services at their nearest health centre, with transport costs adding a further expense . LACK OF TOILETS AND SAFE WATER SUPPLIES INCREASE DISEASE

Poor access to safe water and adequate sanita on contributes to acute malnutri on because it increases disease. Only around a quarter of

A meagre 3% of households report having access to improved sanita on varying from 6% in the central highlands to 0.2% in the southern zone. Worryingly, some 58% of households state that they prac se open defeca on and 93%

JUST 13% OF UNDER TWOS HAVE ‘MINIMUM ACCEPTABLE DIET’

The concept of the minimum acceptable diet encompasses both meal frequency, and the diversity of the foods consumed. Both need to be adequate for a child’s diet to reach minimum acceptable standards to support growth and development in the early years of life. In Madagascar however, just 13% of infants under two years old receive what is considered to be the minimum acceptable diet.

A mother’s educa on has a major impact on

from mothers who are educated to at least secondary school three mes more likely to receive a diverse diet compared to children from mothers educated to primary level or less. The same disparity is seen by household wealth, with 31% of children in households in the highest quin le receiving the minimum dietary diversity compared with only 10% of children in the four lower wealth quin les.

While overall the propor on of children receiving the minimum required number of meals is acceptable at 73%, dietary diversity is too oft en inadequate: just 14% of the 6-23 month age group had received the minimum dietary diversity the day before the survey.

of Fokontany report that open air defeca on occurs in their community.

Although no link was found between maternal hand washing prac ces and acute malnutri on, child morbidity is signifi cantly higher among children whose mothers do not wash their hands with soap.

the quality of her child’s diet, with children

households have access to safe water in the dry

zone (13% in the dry season).season with the lowest access seen in the southern

1 IMPROVING FOOD DEMAND AND SUPPLY

With over 80% of the rural popula on employed in agriculture, low farm produc vity is one of the leading causes of poverty and food insecurity in Madagascar.

Boost na onal and household agricultural

incen ves (i.e., subsidized fer lizers and seeds) and technical extension assistance to subsistence farmers; and improve land tenure structure through the wide implementa on of the Na onal Land Tenure programme. Promote access to credit; improve water management.

Invest in transport infrastructure, road

areas of high agricultural poten al with defi cit areas.

Promote the development of a dynamic market

informa on system and develop market chains linking producers with poten al buyers.

the capacity of farmers’ associa ons and organisa ons to improve storage techniques, fi ght against pests and improve food processing technology.

Watershed protec on, conserva on agriculture, reforesta on, bush fi re control.

2. INVESTING IN HUMAN AND SOCIAL CAPITAL

Implement social protec on programmes

produc ve safety nets targe ng the most food insecure through community asset crea on programmes.

compulsory primary educa on for all; the re-introduc on of adult-literacy programmes, especially for women; paren ng educa on to encourage behaviour change; the opportunity to a ract children to school and feed them there by implemen ng and extending school canteen projects in food insecure areas.

3. COPING WITH SHOCKS AND DISASTERS

Improve the resilience of households

appropriate preparedness and response mechanisms to emergency food and nutri on insecurity by assessing needs, preposi oning emergency food stocks and upda ng and reviewing con ngency plans.

4. TACKLING ACUTE MALNUTRITION

Concentra ng on ac vi es that reduce the risk of disease will contribute to the reduc on of acute malnutri on in children.

RECOMMENDATIONS

construc on/repairs and market facili es. Link

and communi es in risk areas. Ensure

Improve post-harvest handling. Strengthen

system. Develop a na onal market price

Promote natural resource management.

produc on (in quan ty and quality). Provide

to combat widespread poverty. Support

Strengthen policies that promote educa on. Madagascar needs to pursue: free and

integra ng acute malnutri on management into rou ne ac vi es at the health centre/ community level; and improve surveillance and early warning systems for the early detec on of deteriora ng nutri onal situa ons to allow for rapid deployment of disaster reduc on strategies.

Concentrate on programmes to promote

a con nual focus on the promo on of exclusive breastf eeding for children under six months via community-based ac vi es and through a wide range of communica on channels, including mass media, school curricula and channels supported by the private sector.

of childhood diseases and preventa ve vaccina on programmes via communica on strategies designed for women with low levels of educa on.

include promo ng adequate water treatment methods to help reduce childhood illness.

the Fokontany level to help in the promo on of hand washing.

5. ACTIVITIES TO TACKLE STUNTING

Reinforcing ac vi es that improve the health and nutri on status of teenagers and women of child bearing age will reduce the prevalence

of low birth-weight and small stature among women, thus contribu ng to a reduc on in stun ng.

Improve the dietary intake of children aged

behaviour change programmes, promote appropriate complementary feeding for this age group, focusing on the use of products available locally.

aft er 20 years old will reduce the propor on of short women5,6, and the risk of a low birth weight infant.

Improve iron folic acid supplementa on for

full course of iron folic acid taken by pregnant and lacta ng women, thereby reducing the risk of low birth weight.

Improve the a endance of the full antenatal

the recommended four antenatal classes and have access to the WHO recommended minimum package of interven ons during the antenatal classes in order to reduce the risk of low birth weight.

Integrate nutri on counselling into

vulnerable households consume the foods they produce.

Promote the use and benefi ts of home

u liza on of micronutrient rich foods.

5Casanueva E et al 2006. Adolescents with adequate birth weight newborns diminish energy expenditure and cease growth. J Nutr 136: 2498-25016Rah JH, Chris an P, Shamim AA, Arju UT, Labrique AB, Rashid M. Pregnancy and lacta on hinder growth and nutri onal status of adolescent girls in rural Bangladesh. J Nutr. 2008;138:1505-11.

Manage acute malnutri on. Con nue

6-23 months. Through community-based

exclusive breast feeding. Ensure that there is Reduce the risk of teenage pregnancies. Ac vi es that delay the fi rst pregnancy un l

pregnant and lacta ng women. Promote the Improve access to health care for children. Promote the community-based management

classes. Ensure all pregnant women a end Improve access to safe water. Ac vi es

Facilitate access to soap at the Fokontany level. Support ac vi es to improve access to soap at

agricultural ac vi es.To ensure that

gardens. To increase household access and

WFP Madagascar

rakotonirainy@wfp.org

UNICEF MadagascarPaul Ngwakum

pngwakum@unicef.org

ONNLalaharizaka Andriantsarafara

ONNCSSE@onn.mg

WFP CFSVA Global Coordinator, RomeSiemon Hollema

siemon.hollema@wfp.org

Ministere de la SanteDr Olivier Razafi nimananana

razafi ni_olivier@yahoo.fr

The full report with detailed data by region and livelihood zone and full methodology can be accessed on the following websites:

h p://www.wfp.org/countries/Madagascar/Hunger-Infoh p://mg.one.un.org/HAYZARA

For questions or comments concerning any aspect of the survey and this briefing note, please contact:

www.unicef.org/madagascar

Maherisoa Rakotonirainy