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F R E E D O M F RO M HUNGER

RESEARCH
PAPER NO. 1

Are Credit and Savings Services Effective Against Hunger and


Malnutrition?—A Literature Review and Analysis

Barbara MkNelly and Christopher Dunford

February 1996
Contents
Executive Summary ...................... 1
Introduction .................................. 4
Part I ............................................ 8
Linkage of Income to
Food Security and
Nutritional Status .......................... 8
Linkage of Behavior
Change to Nutritional Status ........ 16
Interactions of Women’s
Empowerment with Income
and Behavior Change .................. 19
Part II ........................................ 23 Freedom from
Link Between Hunger’s Mission
Poverty Lending
and Income ................................ 23 Founded in 1946, Freedom
Link Between from Hunger promotes “Self-
Poverty Lending Help for a Hungry World.”
and Empowerment Freedom from Hunger brings
of Women .................................. 32 innovative and sustainable
self-help solutions to the fight
Linkage of Poverty Lending against chronic hunger and
to Behavior Change poverty. Together with local
and Nutrition Status .................... 35 partners, we equip families
Conclusion ................................. 41 with resources they need to
Résumé Analytique ..................... 42 build futures of health, hope
and dignity.
Resumen Executivo ..................... 45
Works Cited ............................... 48
Annex ........................................ 54
Credits
©1996 Freedom from Hunger. Design
No part of this document may be Michael Curry/
reproduced without the express written
Donna Justice
permission of
Freedom from Hunger.

Credit with Education is a


service mark of Freedom from Hunger.

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A RE CREDIT AND SAVINGS S ERVICES EFFECTIVE
A GAINST HUNGER AND MALNUTRITION ?
A LITERATURE R EVIEW AND A NALYSIS
B ARBARA M K N ELLY AND C HRISTOPHER D UNFORD
F REEDOM FROM H UNGER

EXECUTIVE SUMMARY lished program documents which are gener-


ally difficult to obtain.
Poverty lending programs like the Grameen This paper aims to go beyond what
Bank have captured the attention of an audi- Pinstrup-Andersen (1983) refers to as the
ence that extends well beyond the traditional “black box approach” to program evaluation
development community. Much of this en- to a more process-oriented approach. The
thusiasm relates to the programmatic suc- “black box approach” focuses only on whether
cesses— the repayment rates, the scale and/or the desired impact is achieved, while the lat-
the potential for financial self-sufficiency— ter approach helps illuminate how the impact
rather than the impact of the programs. Still, was achieved by tracing program impact
the value of any development strategy ulti- through relevant processes. Part I of the pa-
mately depends on its ability to achieve sus- per investigates evidence regarding the rela-
tainable improvement in the quality of life. tionship of income, empowerment, and behav-
We have examined the academic and ior change (hypothesized as the intermediate
practitioner literature to determine what are benefits of poverty lending) to food security
known, or strongly asserted, to be necessary and nutritional status—the ultimate outcome
conditions for credit and savings programs to goals. Part II examines the evidence that pov-
be effective against hunger and/or malnutri- erty lending programs have a positive impact
tion. Knowing that no literature review can on the intermediate benefits necessary for
be comprehensive, provide definitive answers, overcoming the underlying causes of hunger
or be free of interpretive bias, we aim mainly and malnutrition. Each section begins with a
to stimulate new thinking, research, and prac- hypothesized relationship, includes a review
tice—all of which should be directed toward of the evidence we found pertaining to that
building innovative, effective, sustainable, relationship, and ends with tentative conclu-
large-scale efforts to drastically reduce chronic sions regarding the relationship.
hunger and malnutrition throughout the world. The major conclusions are summarized
The approach used is a review of second- below.
ary sources of information—articles, reports,
and, whenever possible, program evaluations. PART I: Relationship of the Intermediate
In addition, interviews were conducted with a Benefits (Income, Behavior Change, and
range of practitioners having expertise prima- Empowerment) to Food Security and
rily in credit, gender issues, and nutrition (see Nutritional Status
Annex for a list of individuals consulted).
These interviews were invaluable in terms of 1. Certain conditions make more direct the
the generous sharing of insight and experience; impact of increased income on household food
they also afforded access to relevant unpub- security (access to food) and nutritional sta-
tus. Interventions are more likely to have this

Research Paper No. 1! 1


impact when they ensure that income increases and control seems likely, but we have yet to
are 1) experienced by the poorest households, find documentation of such feedback.
2) controlled by women, 3) earned as steady 5. Both economic and social manifesta-
rather than lump sum earnings, and 4) enhance tions of empowerment seem to be crucial for
the households’ overall livelihood security. women to make nutritionally important behav-
ior changes and to demand and use correctly
2. The link between household food se- health services and health technologies. In-
curity and income is more direct than the rela- dependent sources of income are likely to af-
tionship between income and nutritional sta- fect women’s status, autonomy, and self-con-
tus, for a variety of reasons. First, nutritional fidence. Social dimensions, such as greater
status is a function of an individual’s overall mobility, public interaction, and/or group iden-
health and not simply a function of access to tification, are also important to women’s ex-
food or even food intake. Second, posure to new ideas and potential openness to
intrahousehold food allocation decisions and change. Again, positive feedback of behavior
resources (such as a caretaker’s time) can change to empowerment was not documented
greatly modify the effect of increased income. but seems likely. It also seems that empower-
And third, key maternal and child health/feed- ment plays a pivotal role in creating a syner-
ing practices and use of existing health ser- gistic effect between income and important
vices also highly influence nutritional status. health/nutrition behaviors.
3. The nutritional impact of increased in-
come will be disappointing if it is not also Part II. Relationship of Poverty Lending to
coupled with improvement in the health of the Intermediate Benefits (Income,
those most vulnerable to malnutrition, namely Behavior Change, and Empowerment)
women and young children. Changes in nu-
trition and health care practices at the level of 1. Concrete evidence of the economic impact
the household are likely to be the essential first of poverty lending programs is rare. The few
line of prevention and treatment of malnutri- rigorous evaluations to date (primarily the
tion. For example, each of the following has Grameen Bank and some ACCION affiliates)
nutritional implications: the selection and dis- indicate that poverty lending programs do raise
tribution of food within the household; prac- incomes, assets, and productivity of very poor
tices related to breastfeeding, child feeding, borrowers, both men and women.
and diarrhea treatment and prevention; diets 2. Poverty lending more often preserves
during pregnancy, lactation, and/or during and an entrepreneur’s own self-employment rather
after illness; use of existing health services; than creates new jobs. Incomes are most likely
personal, food, and environmental hygiene. stabilized or moderately increased in the short
Even without the benefit of increased house- term. However, with sequential loans and ac-
hold income, these behaviors can dramatically cumulation of business experience, partici-
improve household nutritional status. Con- pants may move into potentially more profit-
versely, increased income may occur in the able activities. Labor productivity (hourly net
absence of necessary behavior change and income) is an important variable to be included
nutrition improvement. in any impact study of credit, especially for
4. Women’s ability to increase their in- women.
comes or their control over income has a posi- 3. Poverty lending is designed to support
tive effect on their empowerment (self-confi- primarily the existing economic activities of
dence, status, and bargaining power within the poor. Because of the meager returns and
their households). The possibility of positive structural constraints of women’s traditional
feedback of empowerment to income earning activities, this minimalist approach probably

A Literature Review and Analysis!2


does not bring about major economic improve- have learned. But some kind of information
ments for women. Because women constitute transfer and change promotion must occur
the bulk of the participants in most programs, before women are likely to know what to
poverty lending is unlikely to produce major change and why and how.
economic gains for poor households. How- 6. With an education program, the poten-
ever, in relative terms, these modest gains seem tial of poverty lending to counter malnutrition
likely to make very important contributions to can be realized. Without education, poverty
household survival, such as income smooth- lending may have only a weak positive effect
ing and insurance against emergencies. And on household food security and little, if any,
these are precisely the types of livelihood strat- impact on nutritional status. Education can
egies that, if strengthened, are most closely be provided to poverty lending program par-
associated with increased household food se- ticipants either by a separate program or as an
curity and nutritional status. integrated component of the poverty lending
program itself.
4. Poverty lending empowers women
participants. By providing opportunities for
self-employment, it increases women’s au-
tonomy, self-confidence, and status within the
household. Regular meetings and peer guar-
antee help foster group solidarity, which re-
duces women’s isolation and increases their
exposure to new ideas and information as well
as their skills for interacting in the public
sphere. There is even some evidence in sup-
port of the hypothesis that solidarity groups
create empowerment of their members inde-
pendently of their economic impacts by creat-
ing new bonds and social identification that
help women resist traditional restrictions and
foster new cultural norms. A wider survey of
literature on noneconomic self-help groups
would likely reveal that intragroup solidarity
has a strong, direct, and positive impact on
measures of personal and group empower-
ment.
5. Women’s empowerment is unlikely to
directly improve household food security and
nutritional status without acting through be-
havior change that is either economically or
nutritionally important. Likewise, poverty
lending programs are unlikely to directly pro-
mote either economic or nutrition-related be-
havior changes without acting through some
kind of educational process. Women’s em-
powerment is believed to make women “learn-
ing ready,” and women’s economic resources
can enable them to take action on what they

Research Paper No. 1! 3


INTRODUCTION The question we address in this paper is,
“Are credit and savings programs designed for
Despite dramatic gains in agricultural technol- the poorest of the productive poor appropriate
ogy and food production, the number of indi- responses to the problems of hunger and mal-
viduals suffering from hunger and malnutrition nutrition?” We have examined the academic
grows. Global hunger and malnutrition is no- and practitioner literature to determine what are
toriously difficult to quantify, but according to known, or strongly asserted, to be necessary
one often cited source, the Bellagio Declara- conditions for credit and savings programs to
tion: be effective against hunger and/or malnutrition.
Knowing that no literature review can be com-
! One billion people live in households prehensive, provide definitive answers, or be
too poor to obtain the food they need free of interpretive bias, we aim mainly to
for work. stimulate new thinking, research, and practice.
! Half of those are too poor even to ob- All of which should be directed toward build-
tain the food they need to maintain ing innovative, effective, sustainable, large-
minimal activity. scale efforts to drastically reduce chronic hun-
! One child in six is born underweight ger and malnutrition throughout the world.
and one in three is underweight by age
5. “Poverty Lending”
! Hundreds of millions of people suffer The Grameen Bank in Bangladesh has received
anemia, goiter, and impaired sight from widespread acclaim as an innovation in credit
diets with too little iron, iodine and/or and savings services that represents a genuine
vitamin A.1 breakthrough in poverty alleviation. Several
comparable “poverty lending” programs have
A major challenge to the international de- developed in recent years to provide financial
velopment community is to innovate solutions services to the poorest socioeconomic strata.
to hunger and malnutrition that are both effec- They all employ innovative methodologies that
tive and sustainable and have the potential to enable the poor to play a central role in their
reach very large numbers of vulnerable people. own development.2 Poverty lending programs
With the success of the Grameen Bank and have demonstrated that the poor are creditwor-
other large-scale programs in providing access thy, that subsidized interest rates are not re-
to credit for millions of poor households, credit quired to effectively serve this target group,
and savings programs are increasingly cited as and that social collateral is better than physi-
good ways to reduce hunger and malnutrition. cal collateral for securing loans.
For example, responding to the 1993 Interna- The three circles in Figure 1 represent a
tional Conference on Actions to Reduce Glo- hierarchical progression of borrower groups,
bal Hunger, the World Bank and other lending each with different economic goals and finan-
and donor institutions established The Consul- cial needs. According to Lassen (1990):
tative Group to Assist the Poorest (CGAP),
which will focus on supporting large-scale de- What distinguishes poverty
velopment of credit and savings programs for lending from other microenterprise
the very poor. support is the target group. Poverty
1
The Bellagio Declaration was produced and adopted by a group of development planners, practitioners, opinion leaders, and
scientists for 14 countries meeting at the Rockefeller Foundation Center in Bellagio, Italy, in November 1989.
2
Some of the best known examples are Badan Kredit Kecamatan (BKK) in Indonesia, Working Women’s Forum and Self
Employed Women’s Association (SEWA) in India, Production Credit for Rural Women (PCRW) in Nepal, and programs sup-
ported by ACCION and FINCA in Latin America.

A Literature Review and Analysis!4


lending assists directly the poorest around activities. Through savings (either
of the poor. Its policies and proce- mandatory or voluntary) and successful repay-
dures are designed to support the ment performance, loan sizes grow and opti-
economic development of self- mally finance a progression of loan-funded ac-
employed producers with no assets. tivities with increasingly higher return.
With poverty lending, it is legiti- Modeled after the workings of the infor-
mate to support sizes and types of mal financial sector rather than formal finan-
activities (e.g., petty trading) and cial institutions, the loan application process
uses of surplus (to feed one’s fam- for poverty lending programs tends to be in-
ily) that are not promoted with formal and transparent, often taking place in
producers and firms at higher levels the borrower’s community and requiring mini-
on the economic ladder. . . . Poverty mal written documentation rather than requir-
lending is dedicated to ing lengthy loan applica-
reaching not only tions and review pro-
those who would cesses. Peer guarantee
benefit from addi- Figure 1. Progression replaces physical collat-
tional working capital, of Borrower Groups eral requirements of ei-
but those who are ther land or assets. And
struggling to eat. repayment is scheduled
in periodic payments
The potential of credit (often weekly) rather
to alleviate poverty has long than as a lump sum at the
been appreciated. Through- end of one year or an
out the 1970s and early agricultural season.
1980s, millions of donor According to
dollars and untold govern- Lassen (1990), the char-
ment resources went toward acteristics of a poverty
rural credit programs. The Adapted from USAID, 1989a. lending program’s suc-
failure of these programs ei- cess in working with the
ther to reach small farmers or recover loans is very poor include the following: “It makes capi-
well documented. Studies show that the pro- tal available at appropriate levels of money
portion of loans in arrears in traditional rural management experience—even $20 if appro-
credit programs ranges from 30 percent to 90 priate; it develops the investment skills, confi-
percent in Africa, the Middle East, and Latin dence, and experience of the severely poor; it
America3 (Holt and Ribe, 1990). Traditional motivates financial discipline through required
rural credit programs have been characterized savings and frequent repayment; it has no bar-
by subsidized loans to “small farmers,” the size riers that impede participation of the very poor.”
of which depends on the specific agricultural However, Lassen is quick to point out that in
inputs to which they are tied. Poverty lending terms of financial principles (high repayment,
programs typically extend a series of very small cost effectiveness) and methods (commercial
(between $10 and $300), short-term loans (from interest rates), poverty lending and
one to twelve months), generally for rapid turn- microenterprise credit programs are quite simi-
lar.
3
Unfortunately, these arrears do not represent income transfers to the poor because (intentionally or not) these programs exclude
this group. Ironically, the subsidized interest rates justified on the grounds that the poor would be unable to pay commercial rates
made it less likely that the programs reached the poor since the more powerful socioeconomic elite were able to usurp the cheap
loans.

Research Paper No. 1! 5


The features that seem to be most closely ented approaches, it is necessary to know its
associated with these high recovery rates are efficacy for improving household food secu-
1) peer guarantee and shared responsibility for rity and nutritional status.
repayment; 2) short loan periods and periodic Pinstrup-Andersen (1983) characterizes
(often weekly) repayment installments; and 3) many of the evaluations of nutrition programs
terms and requirements that channel invest- as taking a “black box approach.” The impact
ment away from agriculture to activities pro- of a particular program on the nutritional sta-
viding a more steady stream of income, such tus of a specific population over a given pe-
as trade, manufacturing, processing, or sales. riod is evaluated with little or no attention to
At the same time, certain programmatic the intermediate steps or relationships lead-
features common to most poverty lending pro- ing to that impact. According to Pinstrup-
grams help to minimize administrative costs. Andersen (1983):
Peer guarantee is not only effective, but it is
much less expensive than time-consuming fea- If analyses of past and current
sibility analyses of borrowers’ investment programmes are to be truly useful
plans. The overhead of many small loans is for the choice and design of new
also reduced by bundling them into a larger programmes and policies and
single loan for solidarity groups (five to seven modifications or termination of
people) or village banks (approximately 30 current ones, it is necessary to
people) which is then disbursed to individual know not only by how much but
borrowers. Finally, poverty lending programs also how nutritional status is
tend to be “minimalist” with limited comple- influenced. . . . The job of evaluat-
mentary services, such as training in business ing a given program then becomes
skills, management or marketing services, one of tracing programme impact
accompanying the loan. This combination of through the relevant processes
program-generated revenue and cost-effective while estimating the impact on each
delivery makes financial self-sufficiency an of the relevant components.
obtainable goal.
The “black box approach” has yielded
Assessing the Nutritional Impacts of some evidence that programs providing small
Poverty Lending loans at commercial interest rates to the poor
Poverty lending programs have captured the and to women are associated with increased
attention of an audience that extends well be- household food security and improved health
yond the traditional development community. status of the participants. A comparison of
Much of this enthusiasm relates to the pro- Grameen Bank members with equally poor
grammatic successes—the repayment rates, households living in villages without the pro-
the scale and/or the potential for financial self- gram found that 40 percent of the member
sufficiency—rather than the impact of the pro- households were able to fulfill caloric require-
grams. The value of any development strat- ments during the study period compared to
egy ultimately depends on its ability to achieve only 27 percent of the nonmember households
sustainable improvement in the quality of life. (Rahman, 1987). Also in Bangladesh, an in-
The rapid expansion of poverty lending pro- dependent evaluation of a Save the Children
grams and the sustained participation of bor- credit and savings program for women found
rowers over multiple loan cycles indicate the that child mortality rates were lower and con-
tremendous demand among the poor for these traceptive use higher among households where
types of programs. However, before the value the mothers participated in the program
of poverty lending can be assessed and com- (Barkat-e-Khuda, et al., 1990). Most striking
pared to alternative hunger and nutrition-ori-
A Literature Review and Analysis!6
was that female children of program partici- We hypothesize that poverty lending can
pants had a survival rate two times higher than benefit its participants and their households
among the control group. by bringing about poverty alleviation, empow-
While very encouraging, there are limits erment of women, and/or nutritionally impor-
to the usefulness of these types of results. The tant behavior change. The program may be
sole focus on the ultimate benefit (intermedi- effective against hunger and malnutrition by
ate processes and benefits are in the “black producing one, two, or all three of these
box”—Figure 2) prevents the study from docu- changes.
menting how participation in the Grameen The relative impact on food security and
Bank was nutritionally beneficial. It cannot nutritional status and the overall strength of
provide insight into the relative contributions impact are expected to depend on the mix and
of behavioral, attitudinal, or economic changes strength of the three intermediate benefits.
stimulated by the program. If the expected Also, we anticipate that the intermediate ben-
impact had not been evident, the evaluator efits can interact. This means that poverty
could not know what steps to recommend to lending can directly cause one or two of the
increase the intended benefit of the program. intermediate benefits and, through these direct
In addition, “black box” studies are character- effects, indirectly stimulate change in other in-
ized by methodological problems such as self- termediate benefits. And it is possible that it
selection bias and/or nonequivalent compari- is one of these indirect intermediate benefits,
son groups that confound attribution of cau- rather than one of the direct benefits of pov-
sality. erty lending, that generates an intended out-
come.
The Poverty Lending Benefit Process Our inquiry of the literature is organized
It is necessary to understand what mediates to examine what is known about each of the
the program inputs of poverty lending on the linkages (arrows) hypothesized in the benefit
intended impacts of food security and nutri- process diagram in Figure 2. In other words,
tional status. Working backward from the we treat each linkage as a separate hypothesis
most immediate causes of hunger and malnu- to be tested. In Part I, we start with the link-
trition (as identified in Freedom from Hunger, ages between the intermediate benefits and the
1989 and UNICEF, 1990), we identify three intended outcomes. Then we look at the in-
types of change among poverty-lending par- teractions among the intermediate benefits. In
ticipants that are necessary to improve either Part II, we examine the evidence that poverty
household food security or individual health/ lending directly generates one or more of the
nutrition status or both (Figure 2). inter- mediate benefits. Finally, we draw
some conclusions about the pathways
by which poverty lending can bring
about the intended outcomes.

Figure 2. Proposed Benefit Process of


Poverty Lending

Research Paper No. 1! 7


PART I: RELATIONSHIP OF THE INTERMEDIATE BENEFITS (INCOME, BEHAVIOR
CHANGE, AND EMPOWERMENT) TO FOOD SECURITY AND NUTRITIONAL STATUS

LINKAGE OF INCOME TO FOOD A definition of food security recently pro-


SECURITY AND NUTRITIONAL STATUS posed by UNICEF included both the
household’s access to food and the proportion
of total household resources committed to se-
An increase of income is hypothesized to
curing food. The latter is an important theo-
increase household food security and/or
retical contribution meant to capture house-
improve nutritional status.
holds’ vulnerability to hunger (Jonsson and
Toole, 1991).
The link between household food security (as Food insecurity, or “underconsumption,”
it is most commonly conceptualized) and in- is experienced as hunger, a condition solely
come is more direct than the relationship be- and directly related to the availability of food.
tween income and nutritional status. Before Consequently, the food security literature has
this statement can be examined, it is neces- concentrated on food availability, specifically
sary to better define the terms being used. calories, as the marker for “adequate” food
Recent work by UNICEF and IFAD, in con- consumption; e.g., less than 80 percent of the
nection with the International Conference on recommended dietary allowance of calories
Nutrition (ICN) sponsored by WHO and FAO, represents “underconsumption.” However, ac-
have helped to clarify important distinctions tual consumption is quite difficult to measure
between “food security” and “nutritional sta- objectively at the individual level. Nutritional
tus” (FAO/WHO, 1992; Maxwell and status is easier to measure and often used as a
Frankenberger, 1992; UNICEF, 1990, 1992). proxy for individual and even household food
Although there has been considerable security. But this creates a problem for re-
broadening and redefinition of the term in re- search and policymaking.
cent years, household food security focuses on Nutritional status is the outcome of a
the family’s capacity to produce or acquire “process whereby living organisms utilize food
food (Maxwell and Frankenberger, 1992; (energy and nutrients) for maintenance of life,
UNICEF, 1990). In the 1970s when the con- growth and normal functioning of organs and
cept of food security was first made popular, tissues and the production of energy”
the focus was on the adequacy of food supply (UNICEF, 1992). Food quality and illness play
at the national and/or international level (Max- essential roles in determining an individual’s
well and Frankenberger, 1992). Today, the fo- nutritional status, but they are not necessary
cus is on households’ and individuals’ access for household food security.4 According to
to food. At the household level, food security UNICEF:
refers to “the ability of the household to se-
cure, either from its own production or through For a long time nutrition has almost
purchases, adequate food for meeting the di- been equated with food supply,
etary needs of its members” (FAO/WHO, primarily because for a large
1992). number of people, food accessibil-

4
There is some disagreement on this point since reference to food for “meeting the dietary needs” implies food of good nutri-
tional quality although, according to UNICEF, dietary intake is not an aspect of food security (UNICEF, 1992).

A Literature Review and Analysis!8


ity is not assured. Access to food appetite or nutrient absorption might be com-
or household food security is a promised by illness.
necessary but insufficient condition
for adequate nutrition. . . . Another IFPRI study in Rwanda (von
The underlying causes of malnutri- Braun, et al., 1991) found that doubling house-
tion [poor nutritional status] are hold caloric consumption from 1,500 to 3,000
1) insufficient household food calories per adult equivalent—a very large
security, 2) inadequate maternal change—would reduce stunting in children by
and child health/nutrition practices, about a quarter of a standard deviation (17%
and 3) insufficient health services of the z-score mean), whereas an intestinal
and/or their use and unhealthy parasite eradication treatment would have the
environment. same effect, and a clean latrine would have
twice this impact. This comparison under-
Depending on the particular circum- scores the importance of heath services and a
stances, these factors determine, either alone healthy environment and not simply food for
or in combination, the most direct causes of nutritional outcomes. Still, in the same study,
malnutrition—inadequate dietary intake and the prevalence of malnutrition was greatest
disease. among the poorest, most food insecure house-
holds. The prevalence of seriously under-
Anthropometric measures (weight,
weight children was 19 percent for households
height, and arm or head circumferences) are
with caloric deficiencies below 80 percent, and
the commonly used, objective measures of nu-
only 8 percent in other households (von Braun
tritional status. They capture more than a
et al., 1991).
person’s dietary intake and actually reflect
overall health performance (ACC-SCN, 1990). Focus on nutritional status requires more
For this reason, there is increasing agreement of an intrahousehold perspective than a focus
that nutritional status is not a valid indicator on food security, since not all members of a
for food security. Anthropometric measures family are equally vulnerable. Due to the ad-
capture much broader influences than access ditional nutritional requirements of pregnancy,
to food. lactation, and rapid growth, women and chil-
The fact that household food availability dren are most vulnerable to compromised nu-
does not ensure adequate nutritional status tritional status or “malnutrition.” Yet it is not
explains recent International Food Policy Re- only the greater nutritional requirements that
search Institute (IFPRI) research findings of a make women and children more vulnerable.
relatively weak link between the adequacy of Various sociocultural realities, such as
food consumption at the household level and intrahousehold food distribution patterns, in-
children’s nutritional status. Kennedy (1989) adequate feeding practices, or in the case of
reviewed data from Sudan, Mexico, Malay- women, excessive labor obligations, exacer-
sia, and Thailand to examine the relationship bate the situation.
between income, household caloric intake, and According to Williams, et al. (1985), “re-
preschooler caloric intake. Income was asso- peated cycles of reproduction, infection, hard
ciated with higher household caloric availabil- physical work and nutrient drainage leave
ity but not preschooler caloric intake. The re- women in a constant state of ‘maternal nutri-
port concludes, “It now appears from this data tional depletion.’” This condition in turn leads
that caloric availability within the household to low birthweight babies and a multigenera-
may not be a precise indicator of a child’s nu- tional cycle of malnutrition.
tritional status.” Even when food is available,
It is essential that policymakers and de-
it may not be offered to the child, or the child’s
velopment efforts focus on alleviating malnu-
Research Paper No. 1! 9
trition, not simply hunger. Malnutrition is even security for two reasons. First, they are the
more insidious than hunger as a block to the group most likely to experience food insecu-
development of human capacity because it di- rity. Second, marginal increases in their in-
rectly affects and potentially permanently come are most likely to be used to purchase
stunts physical and mental development food. One of the most fundamental principles
(ACC-SCN, 1993; USAID, 1993). The scope of economics is Engel’s law stating that the
of the problem is also immense. According lower the income, the higher the proportion
to UNICEF (1990), “about 150 million chil- that will be spent on food (Blumberg, 1988).
dren under five years old are underweight, and An IFPRI study conducted in The
more than 20 million suffer from severe mal- Gambia provides a good example (von Braun,
nutrition. . . . [Approximately] 350 million et al., 1989). Forty-nine percent of the poor-
women have nutritional anemia. . . . Some 40 est households consumed less than 80 percent
million children suffer from vitamin A defi- of caloric requirements, while this was the case
ciency. . . . Iodine deficiency disorders afflict for only 2 percent of the highest income group.
200 million to 300 million people.” The threat Among the poorest quartiles, an income in-
of malnutrition demands special attention to crease of 10 percent was associated with an
the most critical periods in individual human increase in food expenditures of 9.4 percent,
development—pregnancy, infancy, and child- indicating that virtually all of the income in-
hood. Yet, unlike hunger, it often goes unno- crease was channeled toward food.
ticed, even by its victims. The first step is a Food insecurity might be “acute,” the re-
clear appreciation for the causes of malnutri- sult of a specific event, or experienced chroni-
tion and the limitations of assuming a direct cally, either throughout the year or at certain
association with household food security. times of the year. Particularly in rural areas,
where seasonality is more pronounced and
markets less developed, the prevalence of food
Link Between Income and Household Food insecurity rises during the rainy season pre-
Security ceding the harvest, a time of year commonly
In examining the literature, it is clear that referred to as the “hungry season.” In either
certain conditions make more direct the rela- case, the poorest households will more pro-
tionship between income and household food foundly be affected. For example, an IFPRI
security (access to food). Development inter- study in The Gambia found that seasonal fluc-
ventions or policies that aim to increase in- tuations in caloric intake were a problem for
comes as a means for improving household the poor, not the entire rural population (von
food security should seek to maximize these Braun, et al., 1989). For the bottom income
conditions, which relate to poverty level, quartiles, caloric intake decreased by 15 per-
intrahousehold control, the type of the income cent during the wet season, while for the top
increase, and the role income plays in the quartiles, it remained constant.
household’s broader livelihood strategy. De Waal (1989) and others have ad-
vanced a framework whereby food security is
Household Poverty
only one sub-objective of households’ greater
Poor households commit a majority of their goal of livelihood security. Coping strategies,
resources to securing food. Expenditure stud- risk management, and adaptive behaviors
ies have shown that as much as 70 percent of might necessitate households’ enduring hun-
the budget of the poorest income group is de- ger in the short-term to preserve productive
voted to food purchases (World Bank, 1990). assets (seeds, animals, timely planting, etc.)
It is well appreciated that increases in the and to avoid long-term impoverishment (Max-
income of the poorest households will have well and Frankenberger, 1992).
the most direct relationship to improved food

A Literature Review and Analysis!10


dence of gender differences and support the
Households that are food insecure criticism that neoclassical household models
in spite of using a large portion of underemphasize intrahousehold bargaining
their resources are worse off. . . . and the essential differences in the two sexes’
However, many households achieve life experiences and cultural roles that lead to
household food security at the significantly different expenditure preferences
expense of [a] very large proportion (Blumberg, 1988; Bruce, 1989; Hoodfar,
of their resources (time, money, 1988).
land, etc.) . . . [These resources] are Many of these studies focus on the rela-
at great risk and should be recog- tive proportion of women’s income spent on
nized in programmes for household food (and other nutritionally important basic
food security (UNICEF, 1992). needs, such as medicine) as compared to men’s
expenditure pattern (Bruce, 1989).
From this livelihood or resource perspec-
tive, the concern is not simply with short-term ! In Cameroon, Guyer (1980) found that
food availability but “with wider issues of live- Beti women invested 74 percent of
lihood, in particular with coping strategies and their income on food, while men spent
long-term adaptation to food stress” (Maxwell only 22 percent. Of the total house-
and Frankenberger, 1992). Increases in income hold food expenditures, 33 percent
will improve food security most when it were made by men and 67 percent by
strengthens the household’s resource base or women (Blumberg, 1988). Even at
provides diversified income sources, either at higher income levels, women report-
one point in time or over the year. For ex- edly spent the same proportion of their
ample, savings schemes can be effective in incomes on food. In the lean period,
providing a form of insurance against predict- they purchased less expensive proteins,
able seasonal food deficits and unpredictable and when the profits were greater, they
medical emergencies. Weekly cash income invested in higher quality food—spe-
from trading activities can supplement much cifically more animal proteins.
more substantial, but highly seasonal, income
from agricultural activities. This type of ac- ! In the Tamil Nadu and Kerala states of
tivity can help to smooth income over the year. South India, according to Mencher
Income diversification, smoothing, and asset (1988), women allocated almost all of
accumulation, such as cash savings, are likely their income to family needs, a con-
to be very important to those living on the mar- sistently higher ratio than for men.
gin of food insecurity.
Clearly, increasing incomes of the poor- ! In Mexico City, Roldan (1988) found
est households will have the most pronounced women contributed virtually all of their
impact on household food security. earnings (primarily from the garment
and textile industry) to the household,
Women’s Control of Income while men kept a quarter or more for
Intrahousehold control over income also seems their personal use.
to affect the relationship between income in-
creases and household food security. This per- ! In Kenya, Kennedy (1989) found that
spective challenges the fundamental women’s income, as measured by the
conceptualization by neoclassical economics percentage of total household income
of the household as a single unit of analysis earned by women, had a positive ef-
with a single utility function and expenditures. fect on household caloric intake, above
Yet studies from around the world provide evi- that of household income.
Research Paper No. 1! 11
such as Guyer (1980) and Mencher (1988),
What is noteworthy in these comparisons women’s incomes were significantly smaller
is not simply women’s proportionally greater than men’s. Even though women’s income is
allocation to basic needs but a finding that men relatively small in comparison to total house-
usually reserve part of their income for per- hold income, particularly when it is earned in
sonal use even when overall income is quite small regular amounts, it leads to increased
low (Bruce, 1989). In Mencher’s (1988) study food availability in the household (Buzzard,
in South India, men continued to retain a rela- 1995). Even small amounts of income can
tively constant amount of income for their per- have a significant effect, since women’s in-
sonal use even when the household was expe- come is thought to influence spending in two
riencing periods of economic stress. ways: directly, through women’s expenditures
A number of economists have researched on food (and other nutritionally important ba-
the impact of marginal income increase by ap- sic needs, such as medicine), and indirectly,
plying a Nash bargaining model that allows since women’s cash contributions to the house-
for intrahousehold differences in allocation be- hold budget lead to greater status and control
havior (McElroy, 1990; Shultz, 1990; Thomas, over the intrahousehold distribution of food
1990). This approach was applied by Tho- and other resources (Bruce, 1989). Acharya
mas (1990) to survey data on family income, and Bennett (1982) completed a detailed study
health, and nutrition in Brazil. According to of household allocation decisions in Nepal and
Thomas (1990), while both parents’ incomes concluded that the form and level of women’s
were significantly and positively associated contributions to the family budget were related
with household per capita caloric and protein to their intrahousehold bargaining power. Spe-
intakes, “the effect of maternal income on nu- cifically, women earning cash incomes in the
trient demand [was] between four and seven market economy had more influence over sub-
times larger than income in the hands of fa- stantial household decisions than did women
thers.” who worked as unpaid family laborers.
The most common explanation for these Despite the diversity of settings in which
gender differences refers to the particular cul- gender differences in spending have been dem-
tural roles ascribed to the sexes and conse- onstrated, it is clear that contextual and cul-
quently different spending obligations tural variables influence associations between
(Blumberg, 1988). Women are expected to women’s income, expenditure patterns, and
fulfill a nurturing role and, for this reason, may ultimate impacts on food expenditures and
make less distinction between their own needs household nutrition. Certainly, there are ex-
and the needs of their family—specifically amples of cultures where women’s income is
their children. Moreover, men in many cul- not channeled toward food. For example,
tures have been socialized to believe that cer- among the Berber of Morocco and the Serahuli
tain types of nonproductive consumption— in The Gambia, men are responsible for all
drinking, cigarettes, clothing—are “proper for family maintenance and food purchases; when
men” (Bruce, 1989). There also may be cul- women received cash gifts, funds were spent
tural expectations for men to spend their on jewelry or clothing (Blumberg, 1988).
money to maintain the extended family “so- Carloni (1984) summarized the critical factors
cially, economically, and politically” that might that color these relationships: women’s level
be “important to the long-term well-being of of involvement in the market sector; the de-
the family . . . [but that] do not affect immedi- gree of income pooling; and social and cul-
ate food availability” (Buzzard, 1995). tural norms of gender spending obligations.
In the majority of the case studies cited, According to Engle (1986), there are signifi-

A Literature Review and Analysis!12


cant differences in cultural practices, even referred to earlier, a 10 percent increase in in-
within the same geographical area, pertaining come raised food expenditures by 9.4 percent,
to the allocation of money, decisionmaking but caloric consumption by only 4.8 percent
patterns, and gender obligations, that will in- (von Braun, et al., 1989). A study done in
fluence the ultimate impact of increases in in- South India found that even when increased
come. food expenditures practically matched higher
incomes one-to-one, there was almost no
Type of Income change in expenditures on nine major nutri-
The form in which increased income is earned ents (Schiff and Valdes, 1991). Such find-
may affect its relationship to food security. ings as these have led some observers to ques-
Lump-sum income tends to be invested in ma- tion the efficacy of attempting to improve nu-
jor purchases, while steady earnings tend to trition by increasing incomes since incomes
be channeled toward basic needs such as food would have to be greatly increased in order to
(Alderman, 1986). If this is the case, this might have a significant impact on caloric or nutri-
also, in part, explain the closer association of ent intake.
women’s income to food purchases. At least In response, Ravillion (1990) and others
in rural areas, men’s income is more often re- maintain that strategies for increasing income
ceived in lump sums following the harvest, among the poorest income quartile can be im-
which is more likely to be spent on “big ticket” mediately effective. They cite not only the
items, while the nonfarm income-generating finding that increased income is most likely
activities, such as petty trade commonly un- to increase caloric intake in the poorest house-
dertaken by women, may be more likely to earn holds, which are the most vulnerable to mal-
small but steady amounts of income. nutrition (e.g., The Gambian study mentioned
above), but they also point to the impact of
Link Between Income and Nutritional increased income on other nutrition-relevant
Status investment areas, including potable water,
As discussed in the introduction to this electricity, refrigerators, sewage systems, and
section, even when increases in income lead medical services (Schiff and Valdes, 1989).
to greater food availability at the level of the This broader perspective is important since
household, this will not ensure improvement malnutrition is not simply a function of low
in individual family members’ nutritional sta- incomes but of the broader socioeconomic
tus because of issues pertaining to food qual- milieu that is associated with poverty.
ity, intrahousehold dynamics, and the general
health of the individuals and their environ-
Women’s Income and Children’s Nutritional
ment. However, maximizing the nutritional
Status
benefits of increased income again requires a
As is true for food security, intrahousehold
focus on the poor, on women, and on the
control over income seems to have an impor-
broader livelihood strategy within which this
tant effect on the nutritional impact of in-
increased income is earned.
creases in income. Several studies have found
Income and Nutritionally Important
women’s income to have a more direct impact
Expenditures
Because households do not purchase foods on children’s nutritional status. Kumar (1978)
based on nutritional considerations, increased in South India found “no uniform positive in-
income has a weaker effect on the nutritional crease in child nutrition when paternal income
quality (in terms of calories or nutrients) of rose, but increasing maternal income did ben-
purchased foods than on more general access efit children.” Tripp’s (1982) research in
to food. For example, in The Gambia study northern Ghana found that children’s nutri-

Research Paper No. 1! 13


tional status was more closely related to the Tentative Conclusions or Programmatic
mother’s than the father’s engagement in trad- Implications
ing activities, despite the fact that men earned When incomes increase for the poorest quartile
considerably higher income. Similarly, De of households, there usually are comparable
Groote (1994) in Mali found that young increases in household food expenditures.
women’s nonagricultural income, while quite However, although the effect is still greatest
small relative to total household income, had for the poor (relative to higher income groups),
a positive effect on children’s nutritional sta- increased income is much less likely to im-
tus in the pre-harvest season, while no such prove the nutritional quality of diets (e.g., con-
effect was found for household income. In sumption of calories, protein, and especially
Kenya, the nutritional status of children in de micronutrients), particularly at the level of in-
facto female-headed households was better dividual women and children in the household.
than in male-headed households of comparable There is concern that only large increases
income levels, implying that female-headed in household income can improve food secu-
households used their resources in a more nu- rity and nutritional status. However, even
tritionally efficient manner (Kennedy, 1992). small increases can improve food security for
However, because of a woman’s dual role the poor by smoothing their income through
as primary caretaker and economic actor, it is the year or by being saved for emergency use
important that increased income is not earned during seasonal food deficits. Perhaps more
at the expense of her nutritionally important important than the absolute amount of income
domestic obligations (e.g., cooking, growing is whether the income helps poor households
food for the family, caring for children). There reduce their vulnerability through greater di-
is a large body of literature examining whether versification of income sources or asset accu-
women’s labor force participation competes mulation. In addition, even small increases in
with quality child care and, consequently, has income can be used for medical expenditures,
a negative impact on children’s nutrition and investment in improved sanitation, reduction
health status (Engle, 1986; Leslie, 1985; of women’s labor burdens, or other nonfood-
Nieves, 1982; Popkin and Solon, 1976). For related changes that enhance nutritional sta-
example, while increased income can mean a tus of household members.
woman has additional disposable income to In many but not all societies, economic
spend on her children, it might also mean that resources controlled by women are more
she must work longer hours, have less time closely associated with household food secu-
for rest, and leave her child with surrogate care rity and nutritional status than either men’s or
providers (Engle, 1986). general households’ income. Women usually
When improved nutritional status is the dedicate a larger proportion of their earnings
goal, a broad perspective is required rather than to nutritionally beneficial items, such as food
a narrow focus on increasing women’s cash and medicine. Even when the absolute
earnings (Buzzard, 1995). Women need op- amounts of women’s earnings may be trivial
tions that provide greater economic return but compared to the total household income, their
that, at the same time, also help them to better impact may be more significant than their size
balance their sometimes competing domestic might imply. Women’s cash contributions to
and productive roles. Some examples would the household budget are believed to lead to
be technologies that improve the productivity their greater status and influence over the
of women’s work and income-generating ac- intrahousehold distribution of food and other
tivities that are less arduous and/or more com- resources. There is also evidence that the nu-
patible with child care. tritional benefit of women’s income is great-
est when earned in small and steady amounts,

A Literature Review and Analysis!14


particularly during the hungry season. Al-
though the absolute amount of women’s in-
come is important, it is equally important to
assess whether the income is earned in a man-
ner that is compatible with women’s domes-
tic and caretaking obligations.
What is also clear from this review of the
literature is that the nutritional impact of in-
creased income will be disappointing if it is
not also coupled with improvement in the
health of those most vulnerable to malnutri-
tion, namely women and young children. This
issue is treated in more detail in the next sec-
tion of the paper.

Research Paper No. 1! 15


LINKAGE OF BEHAVIOR CHANGE TO faltering, and mortality (Kasongo Project
NUTRITIONAL STATUS Team, 1982; Waterlow, et al. 1980). In fact,
much of the malnutrition evident in older chil-
dren is explained by growth faltering during
Changes in adult diet, child care, and health the weaning period.
management practices are hypothesized to
improve household nutritional status.
Important Nutrition-Related Behaviors
The following is a brief description of specific
As discussed in the previous section, ensur- household-level attitudes and practices that
ing adequate nutritional status goes well be- make a tremendous difference in the nutritional
yond simply ensuring access to food. It is status of household members. While still me-
strongly related to behavior within the house- diated by a household’s economic resources,
hold, specifically expenditure patterns that de- the adoption of many of these practices incurs
termine the quality as well as the quantity of minimal or no economic costs.
food brought into the household and the
intrahousehold distribution of the good qual- Diet Quality During Pregnancy and Lactation
ity food to the individual members most vul- Despite the additional nutritional demands of
nerable to malnutrition. pregnancy and lactation, the quality of diets
Moreover, the etiology of malnutrition often do not improve, and in some areas, cul-
goes well beyond insufficient food or even tural taboos even restrict women’s intake at
adult diets and child feeding practices inad- this time (Williams, et al., 1985). Women re-
equate to nutritional needs. It includes poor quire three times more iron than men, which
health management and hygiene practices explains in part why nearly two-thirds of preg-
leading to frequent and prolonged infections. nant women and one-half of all other women
Because health plays such an important role, are estimated to be anemic (Smyke, 1991). The
the improvement of rural health delivery sys- detrimental effects of poor quality diets and
tems, particularly maternal and child health iron deficiency on the health of the women
care services (i.e., immunizations, prenatal and development of the fetus have been well
care, growth monitoring, and family planning), documented (Norton, 1994; Viteri, 1994).
as well as water and sanitation projects, has
been a major element in nutrition improvement Breastfeeding
strategies. Exclusive breastfeeding until an infant is about
Yet, nutrition and health care practices at six months old is optimal (UNICEF/ WHO/
the household level are also essential because UNESCO/ UNFPA, 1993). Breastmilk is a
they represent the first line of prevention and safe, affordable, and nutritionally complete
treatment. Even if health services are avail- source of food that also helps protect infants
able, their trial and sustained use depends upon against diarrhea, respiratory infections, and
decisions and behaviors at the level of the other illnesses (ibid). Replacing breastfeeding
household. Because of their particular vul- with bottlefeeding is a risky practice that un-
nerability, pregnant and lactating women and necessarily exposes infants to contaminants
preschool children are of particular concern. and potential illness. Breastfeeding also con-
Therefore, the key practices pertain to the di- tributes to birth spacing, since it delays the
ets and health of this group, especially chil- mother’s return to fertility (ACC-SCN,
dren in the weaning period between six and 1991b). However, women may lack knowl-
thirty-six months of age. The weaning period edge on the value of breastmilk, breast care,
is the stage of a child’s life when he or she is or positioning of the baby for successful
most susceptible to malnutrition, since it co- breastfeeding (Adhikari and Krantz, 1989). In
incides with the highest rates of illness, growth addition, if women lack confidence that they
A Literature Review and Analysis!16
have enough breastmilk, they will give their
babies other food and drink. When this hap- Health Management Practices and the Role of
pens, the baby sucks less often and, conse- Feeding
quently, less breastmilk is produced. Preschool children in the developing world are
Weaning Practices ill approximately 20 percent of their lives, most
Three of the most significant weaning prac- commonly with diarrhea and fevers (Brown,
tices are 1) the ages when complementary feed- 1978). Breastfeeding of infants should con-
ing begins and breastfeeding ends; 2) the types tinue and, if possible, increase in duration and
of complementary foods given to babies; 3) frequency during episodes of diarrhea. With
the feeding pattern and methods used (Mitzner, older children suffering from diarrhea, food
et al., 1984). In general, infants do not require intake should be maintained and then increased
foods complementary to breastmilk until they during the recovery period. The diminished
are about six months old. However, depend- appetites associated with illness may require
ing on the society, foods are often introduced special efforts on the part of the caretaker to
much earlier or later than this optimal time. encourage children to eat. During persistent
Traditional complementary foods are often episodes of diarrhea, oral rehydration therapy
nutritionally inadequate. In fact, recent re- or home-prepared solutions should be given
search has shown that in terms of child, and to children (ACC-SCN, 1991a).
particularly weanling, malnutrition, there may
have been “an over-emphasis on food energy Hygiene and Sanitization
production and consumption, and a corre- Personal, food, and environmental hygiene
sponding disregard for the contents and bio- practices are important for minimizing expo-
availability of macro- and micro-nutrients in sure to infection and illness. Poor personal
common food sources” (Brown, 1990). hygiene of food handlers is perhaps the most
Using data from weanling studies in Peru common cause of food contamination leading
and Nigeria, Brown (1990) demonstrates that to diarrhea and other diseases (Mitzner et al.,
with the typical feeding pattern of three times 1984). In addition, because microbial contami-
a day and the limited gastric capacity of in- nants multiply quickly in a tropical climate,
fants, weanlings require diets of significantly foods should be covered and eaten immedi-
greater energy density than is the norm. Food ately after their preparation (Barrell and
bulk can be reduced and digestibility increased Rowland, 1979).
through processes like roasting, grinding, and
fermenting (Adhikari and Krantz, 1989). Use of Existing Health Services
Simple, nutrient-dense weaning mixtures can Maternal and primary health care services can
be made from a protein-rich legume, a high- play an essential role in maintaining good nu-
energy source (such as a fat, oil, or sugar), and trition and health. The most effective services
a ground cereal (Mitzner, et al., 1984). Al- include: immunizations, pharmacies, birth at-
though each of these components is readily tendants, pre- and postnatal care, and contra-
available in virtually all parts of the develop- ceptives. Use of family planning is one of the
ing world, this type of mixture is often not pre- most nutritionally beneficial health practices
pared, primarily because caregivers are not because birth spacing greatly improves the
aware of the particular nutritional requirements health of the mother and the newborn and re-
of weaning-age children. During weaning, in- duces the overall demand on limited house-
fants also require frequent feeding and the ac- hold resources. Often these types of health
tive involvement of the caretaker in encour- services are not locally available, especially
aging the child to eat (Adhikari and Krantz, to poorer households. However, even when
1989). they are available, due to a lack of knowledge
or attitudinal barriers, the poor very often do
Research Paper No. 1! 17
not make sustained and effective use of the
services.

Micronutrient Deficiencies
Specific nutrient deficiencies might be preva-
lent in certain areas or subgroups of the popu-
lation depending upon local food availability
and/or feeding practices. The most common
micronutrient deficiencies are for vitamin A,
iodine, and iron. A major finding of the last
decade was the significant relationship of vi-
tamin A deficiency to child morbidity and mor-
tality (in addition to its better known associa-
tion with blindness) (WHO/USAID/NEI,
1992). Even when sources of vitamin A are
readily available and inexpensive, this defi-
ciency may persist because of a lack of knowl-
edge or because of the influence of traditional
beliefs.

Tentative Conclusions
Changes in nutrition and health care practices
at the household level are likely to be the es-
sential first line of prevention and treatment
of malnutrition. Through their influence on
dietary intake and health, a wide array of
household behaviors affect the nutritional sta-
tus of its members. For example, each of the
following has nutritional implications: the se-
lection and distribution of food within the
household; practices related to breastfeeding,
child feeding, and diarrhea treatment and pre-
vention; diets during pregnancy, lactation, and/
or during and after illness; use of existing
health services; personal, food, and environ-
mental hygiene.
Even without the benefit of increased
household income, these behaviors can dra-
matically improve household nutritional sta-
tus. Women have the sole, or at least primary,
responsibility for all these nutrition-related
practices in the vast majority of households
worldwide. To make these changes often re-
quires women to alter fundamental aspects of
their most traditional roles. To do so requires
not only health/nutrition information, but also
a consciousness of the nature of malnutrition,
social support, and attitudinal change.
A Literature Review and Analysis!18
INTERACTIONS OF WOMEN’S tonomy, self-confidence, openness
EMPOWERMENT WITH INCOME AND to new ideas, belief in one’s own
potential to act effectively), and
BEHAVIOR CHANGE
with a person’s status and efficacy
in social interactions—in particular,
It is hypothesized that earning and the ability to make and carry out
controlling their own income increases women’s significant decisions affecting one’s
empowerment (self-confidence, status, and own life and the lives of others
bargaining power within the household), which
(John Snow International, 1990).
feeds back to enhance their earning
and control of income and assets. It also
This definition is more appropriate to
is hypothesized that increasing women’s
empowerment predisposes them to learn
anti-hunger programming, because it involves
and adopt new nutritionally beneficial practices a greater focus on behavioral and social mani-
which feed back to enhance festations of empowerment which are more di-
their empowerment. rectly linked to the ultimate goals of improved
food security and nutritional status.
Defining Empowerment The best measures for empowerment
Empowerment is a term often used but rarely would be context-specific and would capture
well-defined, despite its intuitive importance. the participants’ perception of the positive
For some, “empowerment” has primarily po- changes in their lives caused by the program.
litical connotations, such as in the following According to the Empowerment of Women
definition: Program, the areas of inquiry appropriate for
documenting empowerment would include the
A spectrum of political activity following:
ranging from an act of individual
resistance to mass political mobili- relationships within the family,
zations that challenge the basic bargaining power and control over
power relations in our society allocation of resources within the
(Antrobus, 1989). household, control over money,
engagement in commercial transac-
However, others conceptualize empow- tions, physical mobility, contacts
erment in broader social terms that are outside the family, interactions with
grounded in an individual’s actual and per- institutions in the public spheres,
ceived (by themselves and others) capabilities ability to access health and other
to take action. A description of empowerment services (ibid).
analogous to this conceptualization is provided
by the Empowerment of Women Program:5 The specific manifestations or examples
of empowerment will depend on the cultural
In our view, empowerment has setting, although it is likely to incorporate both
various dimensions and manifesta- economic and social dimensions in virtually
tions. It has to do with an inner all settings. While women everywhere face
state (sense of self, of one’s au- sexism, change is likely to be most profound
where restrictions on women’s personal and
5
This research group is interested in documenting the impact women’s empowerment can have on contraceptive use. Interest-
ingly, they have chosen examples of poverty lending programs, such as the Grameen Bank, to research this relationship because
they believe these types of programs most effectively lead to empowerment of women.

Research Paper No. 1! 19


economic autonomy are greatest. others (Bruce, 1989).

Link Between Income and Empowerment Again, it is the increase in women’s “op-
Both the inner manifestations (e.g., self-es- tions” rather than the absolute amount of in-
teem) and the external expressions of empow- come that makes the difference.
erment (e.g., status within the household) seem
to be closely linked to increases in women’s Empowerment and Behavior Change
incomes (Berger, 1989). An intensive study Women’s lack of self-confidence has been
of household decision making in Nepal found identified as a major hinderance to the suc-
that the greater a woman’s involvement in the cess of maternal-child health programs
economic spheres outside of the household, (Griffiths, 1992; McGuire and Popkin, 1990).
the greater her influence in household resource Women’s “silence” (lack of self-confidence to
allocation and expenditure decisions (Acharya act or speak out) keeps them from obtaining
and Bennett, 1982). This study indicates that attention for themselves and their children.
it is not the “importance” of women’s work to Often, development interventions depend on
the well-being or maintenance of the family local authority figures to engage women’s par-
that affects her influence within the household ticipation in growth monitoring sessions, im-
but rather her involvement in spheres beyond munization campaigns, or health services
the household (such as the market economy) (McGuire and Popkin, 1990). This approach
and her ability to earn cash. This effect on has limitations when the adoption and sus-
status, bargaining power, and potentially self- tained use of health/nutrition behaviors, health
confidence is associated with even small services, and health technologies depend upon
amounts of income earnings. women’s self-confidence. McGuire and
There is evidence suggesting that a Popkin (1990) cite several studies that under-
woman’s status and bargaining power within score the importance of maternal confidence
the household is also dependent on her self- to nutritionally important behaviors. Research
confidence. According to Amartya Sen (qtd. done by Griffiths (1992) has found a positive
in Bruce, 1989), women’s self-perception correlation between mothers’ self-image and
strongly influences intrafamilial divisions and the health and nutrition of their children.
inequalities:
! In Cameroon, mothers gave into the
If a women undervalues herself, her self-destructive behavior of anorexic
bargaining position will be weaker children by relinquishing power to the
and she is likely to accept inferior child. However, in Swaziland, moth-
conditions. ers’ “sufficient self-confidence” en-
abled them to persist in feeding even
Outside earnings can provide sick children refusing to eat.
psychological and practical lever-
age for women by offering them a ! In Turkey, a program intended to in-
better fall back position should crease the early stimulation and cog-
negotiations break down (e.g. nitive development of children found
through divorce); an enhanced that it was first necessary to build the
ability to deal with threats and self-confidence of mothers. While
indeed to use threats (e.g. leaving some husbands and mothers-in-law
the house); and a higher “per- objected to the program’s impact on
ceived” contribution to the family women’s self-assurance, participation
economic position by them and rates were high, and the program was

A Literature Review and Analysis!20


successful in fostering beneficial ma- programs in Bangladesh (the Grameen Bank
ternal skills. and the Bangladesh Rural Advancement Com-
mittee—BRAC) empowered women and if so
! In a nutrition and health education pro- whether this empowerment led to higher lev-
gram in India, groups of women were els of contraceptive use.
organized to listen and discuss a radio The Grameen Bank was found to have a
program designed to motivate them to greater effect on contraceptive behavior, be-
make nutritionally beneficial behavior cause it empowered women both economically
changes. However, since mothers felt and socially. It put more emphasis on strength-
too powerless for independent action, ening the economic role of women, because
the fathers and grandmothers of nutri- enhancing their contribution to the family in-
tionally at-risk children also required come was believed by program implementors
education. to enable women to better make independent
Griffiths’ (1992) experience in India un- decisions as well as to play a more decisive
derscores the importance of women’s attitudes role in household joint decisions. But the
and self-perception to their adoption of criti- Grameen Bank also “created an identity for
cal health/nutrition practices. The women who women outside of their families [that gave]
had limited power within their own family felt women socially legitimate reasons to move
powerless to ensure the good care of their chil- about and to associate with one another in
dren, were afraid that trying something new public spaces . . . expose[d] them to new
would cause a problem, and refused to do ideas, and help[ed] them to become more con-
something “special” or different because it fident and more skillful at interacting in the
called attention to oneself. public sphere” (Schuler and Hashemi, 1994).
These examples demonstrate how the The rituals of Grameen membership also
empowerment (especially building self-con- helped to create a strong bond among the
fidence) of women can make them more learn- women that was believed to make it easier for
ing-ready and influence the adoption of nutri- them to resist the restrictions of the traditional
tionally important behaviors. Empowerment family. Over time, participation in the pro-
may also allow women greater mobility and gram has come to change family planning
thereby increase their exposure to new con- norms, both among members and nonmem-
tacts and information. bers in program communities. Using an ag-
In terms of specific behaviors, self-con- gregate score for empowerment, 65 percent of
fidence can be linked with greater success in “empowered” women were practicing contra-
breastfeeding, introducing weaning foods, ception, as compared to only 45 percent of
making changes in health practices, and per- those who were “not empowered.”
sisting in recommended behaviors even when
these mark a change in tradition or are resisted Tentative Conclusions
by the child (McGuire and Popkin, 1990). Em- Women’s ability to increase their incomes or
powerment is likely also to play a critical role their control over income has a positive effect
in the adoption of contraceptive technologies. on their empowerment (self-confidence, sta-
Recent work by Schuler and Hashemi tus, and bargaining power within their house-
(1994) has made a significant contribution to holds). The possibility of positive feedback
the understanding of how both the social and of empowerment to income earning and con-
economic dimensions of empowerment can trol seems likely, but we have yet to find docu-
lead to changes in important health behaviors, mentation of such feedback.
such as the use of contraceptives. Through Both economic and social manifestations
ethnographic and survey research, this study of empowerment seem to be crucial for women
examined whether participation in two credit to make nutritionally important behavior
Research Paper No. 1! 21
changes and to demand and use correctly
health services and health technologies. In-
dependent sources of income are likely to af-
fect women’s status, autonomy, and self-con-
fidence. Social dimensions, such as greater
mobility, public interaction, and/or group iden-
tification, are also important to women’s ex-
posure to new ideas and potential openness to
change. Again, the possibility of positive feed-
back of behavior change to empowerment was
not documented but seems likely.
It also seems to be the case that empow-
erment plays a pivotal role in creating a syn-
ergistic effect between income and important
health/nutrition behaviors. For example, the
relationship between increased income and
contraceptive use is synergistic (Buzzard,
1995). Women who have fewer or no young
children are better able to earn additional in-
come, and the capacity to earn greater income
increases the demand for family planning. A
similar interactive effect between income and
better quality diets for women is possible and
might also be mediated by empowerment.
Empowerment cannot act directly on
food security and nutritional status. However,
it seems to act indirectly on household food
availability by enhancing the income-earning
performance of women, increasing their sta-
tus and influence within the household, and
strengthening their economic autonomy and
self-reliance. It also seems very likely that
women’s empowerment has greater impact on
improving household nutritional status than
women’s direct earnings might imply. Em-
powerment has the potential to encourage the
adoption of key health/nutrition behaviors by
reducing women’s isolation, exposing them to
new ideas and forms of public interaction, in-
creasing their openness and self-confidence to
try new behaviors or seek out health services,
and possibly by fostering the creation of new
health/nutrition norms.

A Literature Review and Analysis!22


PART II: RELATIONSHIP OF POVERTY LENDING TO THE INTERMEDIATE
BENEFITS (INCOME, BEHAVIOR CHANGE, AND EMPOWERMENT)

LINK BETWEEN POVERTY LENDING AND ing systems and adapting program methodolo-
INCOME gies. They also have little or no resources to
carry out or commission impact evaluations.
Second, there are major methodological chal-
Poverty lending is hypothesized to increase
or stabilize the income of the poor.
lenges to rigorously and convincingly evalu-
ating the impacts of poverty lending programs,
Concrete evidence of economic impact at the most notably: the need to evaluate overall re-
beneficiary level by credit programs, or even turn to participants’ various productive strat-
by income-generating programs in general, is egies (or household income) rather than returns
rare (USAID, 1989a; Buzzard, 1984). There from just one enterprise; the difficulty of elic-
is considerable anecdotal evidence suggesting iting accurate self-reports of incomes, costs,
significant benefits of poverty lending pro- or expenditures given the high degree of illit-
grams, but few rigorous evaluations have been eracy and lack of financial records among the
conducted to date. The majority of work has target clientele; the difficulty in quantifying
focused more on the objectives, feasibility, and important social impacts, such as empower-
utility of credit to the poor than on its impact ment; and issues of endogeneity and self-se-
at the beneficiary level. Many practitioners lection, which make it difficult to attribute
regard good financial monitoring data as ad- change or differences to the effect of the pro-
equate evaluation information about a credit gram.
program. A growing number of borrowers re-
flects significant demand for credit among the General Economic Impact
poor. High repayment rates indicate the loans A guiding philosophy behind “minimalist”
are used productively. The ability of borrow- credit programs is that they provide loans for
ers to pay substantial interest rates suggests existing or familiar income-earning activities,
their loan activities are profitable (USAID, which seems to be associated with positive
1989a). Berger (1989) wrote “the preference impact (Tendler, 1987). In her review of 102
for direct credit programs has developed de- USAID-supported women-in-development
spite little evidence of net impact of these pro- programs, Carloni (1987) found that credit pro-
grams on poverty.” grams were more successful than income-gen-
Still, financial monitoring data cannot erating projects in having a genuine impact on
substitute for beneficiary-level impact infor- women’s economic status. Specific income-
mation. generating projects face the much more diffi-
For example, an evaluation of a credit cult challenge of creating profitable employ-
program for women in India found that women ment, whereas “untied” credit is a flexible in-
were maintaining good repayment rates, but put that people can use in ways that they know
the small profits they made were used to pay best to adopt any of several technologies avail-
the interest due on the loans (Berger and able to them.
Buvinic, 1989). Poverty lending (minimalist credit) pro-
The lack of impact information is attrib- grams tend to preserve and diversify the self-
utable to a number of legitimate factors. First, employment of entrepreneurs rather than cre-
the poverty lending model is relatively new, ate additional employment opportunities for
so program implementors, often indigenous or- others (Berger, 1989). The types of produc-
ganizations, are typically too busy establish- tivity improvements that small working capi-
tal loans make possible—even to the smallest

Research Paper No. 1! 23


microenterprises—include the following three steps and that they were halfway to the
(Berger, 1989): ladder’s top.
As expected, borrowers were able to im-
! Entrepreneur can buy larger quantities prove their economic returns by expanding
of inputs at lower unit prices. their existing activities, diversifying their strat-
! Lack of working capital no longer egies, or by increasing their profit margin
threatens to discontinue business op- through decreased costs. In several cases, the
erations. reduced cost was for working capital, since
! Additional products can be added to the program replaced more expensive infor-
the inventory to increase sales. mal sources of credit (Nelson, et al., 1995).
! Loans replace more costly sources of In Thailand, women participating in a Free-
informal credit. dom from Hunger program had more diversi-
fied income sources, both in the short term (in-
In the short term, program participants come from small business or animal raising
generally experience more income stability and in the preceding month) and over the course
moderate increases in income. However, one of the year (more likely to cultivate a dry sea-
central question about poverty lending pro- son garden) (MkNelly and Watetip, 1993).
grams is whether, through sequential loans and A methodological improvement for
accumulation of business experience, partici- evaluating these programs would be to quan-
pants “may over time with the succession of tify the degree of change in a borrower’s in-
loans move into more complex and potentially come, assets, savings, or labor productivity
more profitable activities” (McKee, 1989). rather than depend on participants’ self-re-
ports. Some of the most extensive, good-qual-
Self-Reported Impacts ity quantitative impact information comes
The most common methods used by practitio- from the Grameen Bank.
ners to evaluate the economic impact of their
programs are participants’ self-reports of loan- Impacts of the Grameen Bank
funded activity profitability and/or relative In a sample of over 900 borrowers, average
changes in income or the quality of life since household income of Grameen Bank members
joining the program (Nelson, et al., 1995; was 43 percent higher than for the target group
Otero, 1987). While somewhat “crude,” this in villages without the program (Hossain,
type of information provides important diag- 1988). The main reasons given for the im-
nostic information to implementors as to provement in the living standard were accu-
whether participants at least perceive the in- mulation of capital and additional employment
tended program benefits. in productive work financed by Grameen Bank
Program participants in diverse cultures loans—processing and manufacturing, trading,
and settings (El Salvador, Honduras, Ghana, and transport operations. Livestock is an im-
Senegal, Mali, and Thailand) felt that either portant asset for the rural poor; 63 percent of
their business income or general household the members owned no cattle before joining
welfare had improved because of the program the program, compared to 45 percent after two
(Nelson, et al., 1995). An evaluation of years. For those who owned cattle, the aver-
FINCA’s village bank program in El Salvador age number owned increased by 67 percent.
attempted to qualitatively capture the broader After two years in the program, 80 percent of
economic impact by asking respondents to rate the borrowers were found to have an increase
their progress up a “ten step ladder of integral in working capital, which averaged from $30
development.” On average, respondents felt to $112—an increase of 64 percent per year
that their families had been lifted more than when adjusted for inflation. The Hossain

A Literature Review and Analysis!24


(1988) study also supports the belief that, while on female than on male borrowers. For ex-
moderate in the short-term, the economic ben- ample, after two years of participation in the
efits of program participation increase after a program, women’s working capital increased
series of small loans. For example, the bor- 88 percent, compared to the increase in men’s
rowers’ share of equity in total investments working capital of 56 percent (Hossain, 1988).
rose from 28 percent for first time borrowers This difference is explained by women’s more
to 63 percent for members borrowing four limited economic involvement before the pro-
times or more. gram. After joining the program, approxi-
A more recent study of the household and mately 30 percent of the women borrowers
intrahousehold impacts of the Grameen Bank moved from unemployment to self-employ-
and similar credit programs in Bangladesh also ment, primarily in trading and processing. To
found similar positive effects on the well-be- a lesser degree, men also used their loans to
ing of poor households (Pitt and Khandker, change occupations, primarily from agricul-
1995). A methodological contribution of this tural wage labor to petty trade.
study is that, through econometric methods and
a quasi-experimental survey design that com- Impacts in Latin America
pared target and nontarget households in pro- Quite different results were found in an evalu-
gram and nonprogram communities, the po- ation of an ACCION-supported program in
tential self-selection bias and endogeneity of Peru. The incomes of male participants were
study variables were minimized. In a similar found to increase much more than the incomes
way, the analysis was able to separate the esti- of female participants, and the gap between
mates of the impact of borrowing by men and levels of informal sector earnings by men and
by women. women were quite striking (Berger and
The study concludes that program par- Buvinic, 1989). A survey of 560 female and
ticipation had a significant effect on the well- 140 male market vendors found that women
being of poor households. Program participa- earned on average $3.40 a day, while men
tion had a positive effect on household expen- earned $5.00. Follow-up surveys found that
ditures, asset accumulation, self employment, male vendors increased their incomes at a
children’s schooling, food consumption, and much higher rate, 205 percent, as compared
contraceptive use. Credit provided by the to women’s increase of 43 percent.
Grameen Bank had the most significant im- The gender difference is typically ex-
pact on variables associated with household plained by two factors. First, women are tra-
wealth, women’s power, girls’ and boys’ ditionally relegated to the income-earning ac-
schooling, women’s labor supply, women’s tivities with the lowest returns (e.g., commerce
assets, and total household expenditure (Pitt and sewing). Even more so than poor men,
and Khandker, 1995). The effect was greatest women have few productive assets that would
when women were the program participants, enable them to earn a higher return (Berger
even in terms of raising household expendi- and Buvinic, 1989). Second, a woman’s dual
tures. A dollar loaned to women raised house- role as economic provider and caretaker un-
hold expenditures by a greater absolute amount dermines her ability to earn greater returns. A
than did a dollar loaned to men (Pitt, pers. study of market women in Lima, Peru found
comm.). The authors conclude that “program that many had opted for lower incomes from
participation benefits the poor, especially vending than higher incomes from factory
women and children” (Pitt and Khandker, work, because marketing gave them greater
1995). flexibility to fulfill domestic obligations
The Hossain (1988) study also found evi- (Bunster, 1983). The need to care for young
dence of a somewhat more favorable impact and sick children was mentioned most often

Research Paper No. 1! 25


as a motivating force behind choosing mar- strates that measurements of labor productiv-
keting. Unlike men, women’s economic in- ity (hourly net income) is an important vari-
volvement, options, and opportunities are very able to be included in any impact study of
much influenced by their stage in life and the credit, especially for women.
life cycle of the family. A study in three sub- Time allocation information is also avail-
sistence communities in Guatemala docu- able for Grameen Bank participants. How-
mented how women adjusted their economic ever, the data indicate that much of the increase
activities to accommodate the demands of in women’s incomes was the result of the in-
pregnancy, childbirth, lactation, and child rear- creased number of hours worked.
ing (Cosminsky and Scrimshaw, 1982).
Female members worked an aver-
Impact on Women’s Time and age of 4.9 hours a day, of which 4.2
Productivity hours were spent in the loan-
Given the excessive labor burdens of the poor, financed activity. In comparison,
particularly poor women, time can be as im- housewives in the target-group
portant an economic asset as income. It is pos- nonparticipant households spent
sible that one of the primary benefits of a credit 0.64 hours a day in income-earning
program for women would be that they could or expenditure-saving economic
earn the same or slightly more income in less activities within the household
time, freeing them to perform other duties or (Yunus, 1988).
get much-needed rest. This possibility was
documented in a study of the PRODEM pro- These numbers indicate that participation
gram in Quito, Ecuador (Berger and Buvinic, in the program resulted in women working an
1989). additional 16 standard eight-hour days a
Approximately 300 borrowers were in- month. However, since most of these women
terviewed at the beginning of the PRODEM came from either landless or marginally land-
program and then again 12 months later. A holding households, they had only limited ag-
control group was selected from a population ricultural labor obligations and some surplus
with similar characteristics. The study found labor. This would not be the case, however,
that the monthly and hourly net incomes of in parts of Africa where women are actively
the borrowers and the controls did not differ involved in farming for much of the year and
much. However, the study did find increases would be unable to work an additional 16 days
in the productivity of the borrowers, particu- per month on a loan activity. The possibility
larly for women. “Women microproducer and of trade-offs between increased income and
microvendor borrowers increased their hourly less time for child care or needed rest make
net incomes (reducing total hours worked per the issue of productivity important. Women’s
month) from 1984 to 1985 to a significantly time management skills, and the availability
greater extent than did their male counterparts” of productivity-increasing technologies, will
(Berger and Buvinic, 1989). PRODEM influence how beneficial the impact of credit
women microentrepreneurs decreased the might be.
number of hours they worked monthly by 14
to 17 percent, as compared with women Important Context Variables
nonborrowers, who reduced their work hours The above examples demonstrate that poverty
by only 4 to 7 percent. The authors concluded lending programs can help break the cycle of
that women prefer efficiency because of their poverty and improve the lives of destitute bor-
dual responsibilities. This finding demon- rowers. However, the likelihood that credit
will help raise a given person’s productivity

A Literature Review and Analysis!26


or income will be influenced by numerous con- world by Michigan State University has drawn
textual factors and the nature of the income- attention to the importance of this sector
earning activity selected. The most important (USAID, 1989b). In the majority of countries
contextual factors include the vibrancy of the studied, over 60 percent of total manufactur-
local market economy, the strength of demand, ing is located in rural areas, with a high of 86
trends in the costs of inputs, and the availabil- percent in Sierra Leone.6 The overwhelming
ity of technology. majority of these firms were very small, em-
ploying fewer than five people. In many coun-
Rural vs. Urban Settings tries a significant number of the small enter-
Some observers feel that minimalist credit pro- prises were owned by women. Jiggins (1989),
grams may be more suited to urban than rural in her review of the income-earning strategies
areas: of poor women in sub-Saharan Africa, con-
cluded that household-based agricultural ac-
If urban markets are generally tivity remains the foundation of rural liveli-
stronger and more easily identifi- hoods, but increasingly women are dependent
able, the provision of relatively on self-employment (primarily in trading and
“minimalist” credit itself might agroprocessing) or wage work for survival.
enable low income individuals to According to the World Bank (1990), the
respond quickly to new opportuni- importance of nonfarm income is increasing.
ties. In rural areas, in contrast, In Kenya, among smallholder families, per
livelihoods may be more likely capita income from nonfarm sources climbed
constrained by a range of factors 14 percent a year between 1974/75 and 1981/
requiring a more comprehensive 82 while incomes from farm employment rose
sectoral attack (McKee, 1989). only 3 percent per year. Also in Kenya, the
rural nonfarm sector was found to be second
Another challenge pertains to the fit be- in size only to small-scale agriculture, eight
tween the terms of poverty lending and rural times as large as the urban informal sector, and
people’s economic activities. Successful pro- larger than the combined modern private and
grams demonstrate the importance of credit public sectors (Norcliffe and Freeman, 1980).
terms (loan amount, its duration, and payment Other than farming, the rural nonfarm sector
schedule) matching the productive and repay- had the largest proportion of women (one-third
ment capacity of the beneficiary (Otero, 1987). of whom vended fruit and vegetables).
Small amounts of capital, short loan periods, The demand for goods and services from
and weekly repayment are not conducive to the rural nonfarm sector depends on the health
agricultural investment, which is the primary of the local farm economy, so the two sectors
work in most rural areas. may not be as discrete as some assume (World
However, recent research has emphasized Bank, 1990).
the significance of the nonfarm economic sec- One of the particular socioeconomic char-
tor in rural areas and nonfarm income to rural acteristics of the survival economy is that
household survival strategies. Large-scale households diversify income sources: “fam-
field research conducted in the developing ily members engage in a wide range of income-

6
Research sites included Sierra Leone, Bangladesh, Jamaica, Honduras, Haiti, Egypt, and Thailand.

Research Paper No. 1! 27


earning activities in different seasons to spread agers in the design and implementation of
risk” (Carloni, 1987). Women play a particu- credit programs.
larly important role in this pattern of liveli-
hood diversification. They may have several Debates Pertaining to Poverty Lending
seasonal income-earning activities in a single The success of programs like BKK,
year or even simultaneously. The seasonality Grameen, and ACCION have greatly increased
of rural life dominates the economic activity faith in the efficacy of credit to assist even the
of rural people and must be taken into consid- very poor. However, a number of issues per-
eration in credit program planning. It is pre- taining to the desirability of poverty lending
cisely this type of livelihood strategy that, if programs continue to be debated. The follow-
strengthened, can have the most direct effect ing are brief summaries of the most important
on improving household food security. points of contention.
First, not all observers are yet convinced
Assured Supply and Demand of the creditworthiness of the poor. In a
A review of the necessary characteristics of USAID review of credit programs, one sec-
high-performance projects proposed that bor- tion focused on 32 programs targeted for the
rowers must “undertake an economic activity poorest of the self-employed and unemployed
for which they have assured supplies and an or for highly disadvantaged groups, like illit-
established demand” (Berger, 1989). Unfor- erate women in economically remote areas or
tunately, few, if any, of the survival strategies marginal urban areas. The review found the
of the poor are characterized by such certainty. programs to be very expensive and found few
A study of Ghana’s small enterprise sec- that had much positive impact on the borrow-
tor concluded “that microenterprises are con- ers’ economic status. For example, the find-
strained more by a lack of demand than a lack ings that 53 percent of borrowers experienced
of credit (credit is more important for small serious difficulties and that fewer than 50 per-
and medium-size firms)” (Holt and Ribe, cent improved their net worth were not con-
1990). However, other studies have reached sidered surprising by the reviewers. The re-
the contrary conclusion that working capital port concluded, “This result is not unexpected,
is a major constraint to the smallest entrepre- given the difficult business climate faced by a
neurs. Credit needs will certainly differ among relatively inexperienced entrepreneurial group.
poor groups and different settings. The precarious economic conditions of the cli-
A GEMINI study of microenterprise ac- ents meant earnings were not reinvested in the
tivity in Niger found that women were heavily enterprise but were used to meet consumption
concentrated in the traditional income-earn- needs. . . . Entrepreneurship is not for every-
ing activity of weaving mats (Mead, et al., one and good programs need to know when to
1990). However, the declining availability of quit” (USAID, 1989a).
palm leaves resulted in higher raw material A very different perspective was offered
prices and the reduction of women’s profits. by Stearns of ACCION:
At the same time, plastic mats imported from
China increased competition, particularly for Although there are legitimate
urban markets, making it difficult to pass on causes of delinquency that lie
the higher input costs to customers. The re- beyond the control of the credit
port concluded that women must be helped to programs, experience from around
diversify out of mat weaving. the world is showing that high
The influence of the market on profitabil- delinquency is, more often than not,
ity requires the close attention of project man- a function of a program’s objec-

A Literature Review and Analysis!28


tives, methodology and operations, cialization to adequately use credit that larger
rather than target group and eco- enterprises would use to create employment
nomic environment. In most cases, and generate demand. Women’s economic
the microenterprise program itself strategies tend to be characterized more by eco-
is the determining factor as to nomic diversity than by specialization.
whether or not delinquency However, current trends indicate that
emerges as a problem (Stearns, more and more very poor women, even in ru-
1990). ral areas, will enter the market economy as
From this vantage point, the costliness operators of their own survival-level
and high failure rate of the credit programs microbusinesses. Neglect of these very small
reviewed by the USAID report might be more activities can have negative distributional con-
related to their failure to follow the principles sequences and can frustrate poverty allevia-
of what Lassen (1990) called “New Style” pov- tion and, most certainly, food security goals
erty lending than to the inherent riskiness of (Berger, 1989).
the clientele. A third area of debate concerns the de-
A second point of contention relates to gree of help that minimalist credit can provide
the objectives of credit programs. One view to women. Because of the meager returns and
is that loans should be made to businesses most structural constraints to women’s traditional
likely to generate employment and stimulate activities, some have questioned the efficacy
links to other economic activities. This per- of the minimalist approach at bringing about
spective is summarized in the following ex- significant economic improvement and em-
cerpt: powerment (Marilyn Carr, UNIFEM, pers.
com.; Downing, 1990; McKee, 1989). Ac-
Most microenterprise assistance cording to Buvinic (1989):
programs are a reaction to the
failure of trickle-down economics Projects failed (to substantially
and are based on the assumption assist women) because the objec-
that assistance must be provided tive is to enable women to earn
directly to the beneficiary. Every- extra income for the household
one must be his or her own entre- instead of establish successful
preneur. This perspective, how- women’s enterprise. Development
ever, presumes an answer to a agencies view women’s economic
question that is only beginning to role as earning extra pin money for
be asked: trickle down from what the households, and it is easier to
level? . . . the poorest target groups implement social welfare programs
may best be reached by assisting than increase productivity and
firms with the greatest potential for incomes of the poor.
creating jobs accessible to the poor
(USAID, 1989a). McKee (1989) proposed two alternative
approaches: 1) to choose an existing subgroup
From this economic growth-oriented per- of women workers (such as a trade group) and
spective, the vast majority of the survival support a variety of program activities to im-
economy (Figure 1, p. 2) is too marginal to prove the infrastructure and conditions of that
merit program investment. Poor women, es- activity or 2) to choose economic activities
pecially in rural areas, are viewed as lacking with the potential for high returns (e.g., mecha-
the business skills, assets, and potentially even nized food processing, high-value handicrafts,
the motivation for business expansion and spe- and so on) and attempt to move women into

Research Paper No. 1! 29


those activities. Downing (1990) proposed Poverty lending more often preserves an
that this second approach is a promising alter- entrepreneur’s own self-employment rather
native to either the growth-oriented or pov- than creates new jobs. Incomes are most likely
erty alleviation-focused approach to credit. stabilized or moderately increased in the short
While both are provocative suggestions, term. However, with sequential loans and ac-
the few existing examples of these approaches cumulation of business experience, partici-
would be quite difficult to implement on a pants may move into potentially more profit-
large scale, because of the substantial costs and able activities.
specialized services involved. Moving women The gender-specific impacts of poverty
into nontraditional areas is a risky and re- lending impacts on men’s, women’s and
source-intensive task, and it would not be fea- household income and assets depend upon the
sible for poor women alone to assume this risk program context. However, it seems likely that
(Downing, 1990). Another important ques- women’s relegation to traditional income-gen-
tion would be “is it more empowering to erating activities, balanced by their domestic
achieve modest, tangible gains through an in- obligations, means that the absolute amount
cremental strategy, or to pursue a potentially of income increases may not be as great for
higher reward, risking failure?” (McKee, women. However, recent evaluations of the
1989). Grameen Bank found even greater improve-
Buvinic (1989), in an evaluation of the ment in women’s income relative to men’s and
characteristics of “better performing” credit a more positive association with increased gen-
projects, concluded: “Better performing eral household expenditures when loans were
projects are those run by specialized agencies made to women rather than men.
that focus narrowly on a particular task and Measurements of labor productivity
provide a single missing ingredient (usually (hourly net income) is an important variable
credit) rather than integrated services.” Even to be included in any impact study of credit,
programs like SEWA, that later provided their especially for women. It is possible that
participants with a variety of services, began women themselves choose to earn less income
as “minimalist programs” striving to provide so that they can better conduct both their do-
poor women with credit. This relatively nar- mestic and economic obligations. One of the
row focus expanded as the needs of the clien- primary benefits of a credit program for
tele were better understood. Such a gradual women might be that they could earn the same
process has two advantages: (1) it allowed or slightly more income in less time, freeing
time for the organization to come to under- them to perform other duties or get much-
stand the specific needs and obstacles facing needed rest. Or the credit program may pro-
the poor and women in that context, and (2) vide a women with more options to undertake
the program was not initially overcome by less arduous work and/or work that is more
multiple institutional requirements (McKee, compatible with child care.
1989). Poverty lending may have more impact
among the urban and periurban poor than in
Tentative Conclusions rural areas. The small amounts of capital, short
Concrete evidence of the economic impact of loan periods, and weekly repayment typical of
poverty lending programs is rare. The few rig- poverty lending programs are not conducive
orous evaluations to date (primarily the to agricultural investment, which is the pri-
Grameen Bank and some ACCION affiliates) mary work in most rural areas. However, re-
indicate that poverty lending programs do raise cent research has emphasized the significance
incomes, assets, and productivity of very poor of the nonfarm economic sector in rural areas
borrowers, both men and women. and nonfarm income to rural household sur-

A Literature Review and Analysis!30


vival strategies.
One of the particular socioeconomic char-
acteristics of the survival economy is that
households diversify income sources. Women
play a particularly important role in this pat-
tern of livelihood diversification. They may
have several different income-earning activi-
ties in a single year or even simultaneously.
This may be an important reason poverty lend-
ing programs involve far more women than
men.
Poverty lending is designed to support
primarily the existing economic activities of
the poor. Because of the meager returns and
structural constraints of women’s traditional
activities, this minimalist approach probably
does not bring about major economic improve-
ments for women. Because women constitute
the bulk of the participants in most programs,
poverty lending is unlikely to produce major
economic gains for poor households. How-
ever, in relative terms, these modest gains seem
likely to make very important contributions to
household survival, such as income smooth-
ing and insurance against emergencies dis-
cussed in the earlier section regarding income’s
impact on household food security. And these
are precisely the types of livelihood strategies
that, if strengthened, are most closely associ-
ated with increased household food security
and nutritional status.
From the economic growth-oriented per-
spective, the vast majority of the survival
economy is too marginal to merit program in-
vestment. However, current trends indicate
that more and more very poor women, even in
rural areas, will enter the market economy as
operators of their own survival-level
microbusinesses. Neglect of these very small
activities can have negative distributional con-
sequences and can frustrate poverty allevia-
tion, food security, and nutrition improvement
goals.

Research Paper No. 1! 31


LINK BETWEEN POVERTY LENDING AND straight to the eyes of an unknown
EMPOWERMENT OF WOMEN urban visitor (male or female).
When one talks to a Grameen
loanee woman the difference is
Poverty lending programs are hypothesized striking and very obvious. They
to directly increase women’s self-confidence
will stand confidently and speak
and other manifestations of their
empowerment, perhaps even independently
out as an equal partner in a conver-
of any economic impact. sation. Though they have veils on
the head and a baby on the lap, they
do not bow down but reflect the
Evidence of Impact on Empowerment
spirit that now they are being
Our personal observations indicate that the
valued by the society. The spirit is
earliest and most striking evidence of impact
more apparent among those women
by poverty lending programs is the increase in
loanees who have been members
women’s self-confidence. According to
for a longer period. The new ones
McKee (1989), there is significant evidence
are proceeding step by step.
that microlevel programs that improve
women’s livelihoods also bring about “more Another observer of Grameen comments
fundamental changes in their lives in terms of (Yunus, 1988):
their self-esteem, confidence, participation in Poor women have been the greatest
political and community life, and family deci- beneficiaries of the Grameen
sion-making power and status.” efforts. Rural poor women are
The following observations were made becoming income earners with the
by an evaluator of the Production Credit for help of Grameen loans and subse-
Rural Women Program in Nepal (UNICEF, quently are asserting their rights on
1989b): their male counterparts and the
society at large. They have become
Women reported that their hus- quite confident of their own ability
bands consulted them more often, and can easily stand against social
and neighbors and family members injustice.
asked for advice more often. Min-
istry of Health staff reported that Despite the importance of empowerment
PCRW members used their services and the significant progress various poverty
more and followed prescriptions lending programs have had in bringing it about,
more carefully. Women said they this program benefit is often the least well ap-
were more confident and less preciated and most casually documented. The
dependent. principal reason is the methodological diffi-
culty of defining and measuring empower-
Reports from the Grameen Bank have all ment, particularly because the specific mani-
been impressive, particularly since women in festations of empowerment depend on the so-
Bangladesh traditionally have such a socially ciocultural setting.
subordinate role. According to Yunus (1988): In most published accounts, it is not
known or stated whether it is the increased
The usual scene of a poor rural income gained by women in the poverty lend-
woman is that under a long veil she ing programs that enhances empowerment or
bows down and eyes are fixed on something about the structure or process of
the ground and she talks in a shy the program itself. From our personal obser-
and timid manner. She never looks

A Literature Review and Analysis!32


vations of the very early surge in self-confi- groups, it will only be in an atmo-
dence among program participants, we suspect sphere of trust and support pro-
the program design itself is empowering vided by these groups that women
women. Since all poverty lending is done will be able to carry out analysis
through self-help groups, generically called and courageously redefine the
“solidarity groups,” we hypothesize that the structures of their oppression—that
experience of participation in a solidarity is, to experience empowerment.
group is empowering by itself, independent of
the empowering effect of increased income- Ashe (1986) documented the functional
earning performance. benefits of the solidarity group mechanism in
a Women’s World Bank program in Cali, Co-
Link Between Solidarity Groups and lombia (Ashe, 1986). Evidence of solidarity
Empowerment was measured in terms of mutual assistance,
In many parts of the developing world, par- social support, and collective action between
ticularly in sub-Saharan Africa, women’s group members, and the tendency of the group
groups have long been important for mutual to assume responsibility for carrying out the
support and action. Women’s self-organized program functions of group formation, repay-
savings societies are often an important ment, and program promotion. Of those in-
mechanism whereby women can accumulate terviewed, Ashe found that 66 percent of the
working capital for their income-generating ac- groups had at least one member who could not
tivities or have access to funds for emergen- repay a loan; 88 percent of the groups had cov-
cies or large expenses like school fees. These ered this outstanding loan to fulfill their re-
savings societies engage in a wide variety of payment obligations; and 68 percent had
community development activities. The use loaned money to one another.
of solidarity groups by poverty lending pro- Ashe (1986) also found that evidence of
grams builds on this tradition of self-help solidarity and the social impacts of the pro-
groups of women. A study in Kenya con- gram increased with the length of program par-
cluded that membership in these women’s ticipation, as the membership internalized the
groups cuts across socioeconomic lines to in- solidarity aspects of the program. For ex-
clude the very poor as well as better-off women ample, “of those who had been with the pro-
(Muzaale and Leonard, 1985). gram more than five months, 80 percent ex-
Observers note that empowerment and changed information about sources of financ-
community development goals are achieved ing, and 92 percent shared information about
in relation to the extent that solidarity groups where to purchase less expensive merchandise;
are used and developed in poverty lending pro- this compared with 33 percent and 37 percent
grams (McKee, 1989). From an economic per- for ’new’ groups.”
spective, solidarity groups are noteworthy for Group savings schemes are another way
their potential to reduce administrative costs of building solidarity and mutual cooperation.
(e.g., bundling many small loans for easier The accumulated savings of the group can
bookkeeping and replacing costly analysis of serve economic and welfare objectives, such
loan and borrower creditworthiness with peer as when members use funds to assist those ex-
group review). However, solidarity groups are periencing emergencies. According to Yunus
also important for organizing individuals and (1988), the mutual and financial support that
creating a spirit of greater mutual support. Ac- solidarity group members offer one another
cording to Antrobus (1989): during difficult economic periods is an impor-
tant element in the Grameen Bank’s success.
Consistent with history and what is A highly innovative evaluation of a de-
known about women’s solidarity velopment program in Kenya documented
Research Paper No. 1! 33
both the outcome and the process by which ter group solidarity which reduces women’s
individual and group empowerment was isolation, increases their exposure to new ideas
achieved (Clark and Gakuru, 1982). The pro- and information, as well as their skills inter-
gram under study shared many design features acting in the public sphere. There is even some
with poverty lending. Utilizing a “before-and- evidence in support of the hypothesis that soli-
after” research design, the evaluation found darity groups create empowerment of their
that in addition to the economic benefits of members independent of their economic im-
program participation, increased confidence pacts by creating new bonds and social identi-
both at the individual and group level was also fication that help women resist traditional re-
evident. According to Clark and Gakuru, “The strictions and foster new cultural norms. A
most dramatic change was seen in interview wider survey of literature on noneconomic
data related to confidence, which increased self-help groups would likely reveal that in-
fourfold” at the individual level. Group con- tragroup solidarity has a strong, direct, and
fidence was measured by staff log entries of positive impact on measures of personal and
examples when groups exhibited either “a will- group empowerment.
ingness or unwillingness to take a risk, con-
front a problem, raise a question, or discuss a
difficult issue” (Clark and Gakuru, 1982).
Changes in the confidence indicators from be-
fore and after program participation closely
mimicked a group’s successful completion of
its collaborative activity.
More recently, the Schuler and Hashemi
(1994) study of empowerment and contracep-
tive use among Grameen Bank and BRAC par-
ticipants in Bangladesh documents how par-
ticipation in a group has an empowering ef-
fect beyond any direct economic impact.
Women’s identification with the group gave
them a socially legitimate reason to meet and
interact in the public sphere which served to
increase their exposure to new ideas, their self-
confidence, and mobility. In particular, the
more regimented and ritualistic approach of
the Grameen program (compared to the BRAC
program) was thought to develop a more in-
tense identification and bond that made it
easier for women to resist the restrictions of
traditional family life and adopt new family
planning norms.

Tentative Conclusions
Poverty lending empowers women partici-
pants. By providing opportunities for self-em-
ployment it increases women’s autonomy, self-
confidence, and status within the household.
Regular meetings and peer guarantee help fos-

A Literature Review and Analysis!34


LINKAGE OF POVERTY LENDING TO and accumulated savings for emergencies
BEHAVIOR CHANGE AND NUTRITIONAL seem to improve household food security.
Poverty lending programs have the type of eco-
STATUS
nomic impact that is most directly linked to
increased food security: income increases
Poverty lending programs are hypothesized among the poorest households, income con-
to be insufficient to significantly improve trolled by women, and income earned through
household nutritional status without nonfarm income-generating activities which
`linkage to education that specifically promotes
generate the type of small steady earnings that
nutritionally important behavior changes.
are channeled directly toward food and other
basic needs. While the productivity and profit
Figure 3 summarizes the tentative conclusions gains tend to be modest, access to loan capital
we have drawn to this point. The strongest plays an essential role in stabilizing and di-
linkages, or causal connections, in the benefit versifying poor households income. Access
pathway seem to be from poverty lending: to loan capital helps entrepreneurs weather pe-
riods of poor returns, when they might other-
! to modest increases in women’s in- wise have gone out of business, and provides
come, savings, and assets, which lead the households with an alternative income
! to women’s empowerment, which lead source that helps augment and smooth incomes
! to changes in nutritionally important throughout the year. In addition, the opportu-
practice, which lead nity to augment savings and build productive
! to improvements in household nutri- assets over multiple loan cycles provides ad-
tional status, especially for women and ditional resources for emergencies or cyclical
children in the household. periods of scarcity.
Women’s experience with the credit, in-
In addition, increased income, income creased capacity to economically contribute to
smoothing and diversification through the year, the family’s well-being, and in-
teraction with the solidarity
Figure 3. Probable Pathway of Benefits from Poverty Lending
group are also very likely mak-
ing a direct and strong contribu-
tion to women’s empowerment.
Empowerment enhances the ef-
fect of an increase in income on
spending beyond women’s di-
rect earnings, through their
greater influence over household
expenditures and/or resource al-
location. There may be positive
feedback from women’s em-
powerment to income genera-
tion and from successful behav-
ior change to empowerment.

7
Village banking is a poverty lending methodology developed by John Hatch of FINCA. This methodology is similar to the
Grameen Bank’s, in that borrower groups with approximately 30 members jointly guarantee each other’s loans and repayment and
savings are typically made at regular weekly or bi-weekly meetings. However, loans are for a shorter period (four to six months),
and groups are more self-mananged.

Research Paper No. 1! 35


The Need for Education for participatory nonformal education and to
Women’s empowerment is unlikely to directly use the same field staff to deliver both finan-
improve household food security and nutri- cial and educational services, thereby minimiz-
tional status without acting through behavior ing the extra investment in information trans-
change that is either economically or nutrition- fer and change promotion.
ally important. Likewise, poverty lending pro- Freedom from Hunger, together with its
grams are unlikely to directly promote either local partners in Bolivia, Burkina Faso, Ghana,
economic or nutrition-related behavior Honduras, Mali, and Thailand, is attempting
changes without acting through some kind of to demonstrate the feasibility of this integrated
educational process. Women’s empowerment approach, which they call Credit with Educa-
is believed to make women “learning ready,” tion (Dunford, 1990, 1992, 1994; Lassen and
and women’s economic resources can enable MkNelly, 1992; World Bank, 1993). They are
them to take action on what they have learned. implementing a village banking7 methodology
But some kind of information transfer and which directly incorporates nonformal educa-
change promotion must occur before women tion at borrower group meetings to promote
are likely to know what to change and why important health/nutrition and family planning
and how. practices, microenterprise development, and
If desirable behavior change is blocked credit group management. The education com-
only by lack of money and/or self-confidence ponent is fully integrated into the poverty lend-
(both are major blocks!), then more income ing methodology so that the delivery mecha-
and empowerment could be sufficient to bring nism for both the financial and education ser-
about desired changes. However, if lack of vices is the same, and participants simulta-
information is a major block in itself, as it al- neously have access to greater information as
most always is among the very poor women well as economic resources. This strategy aims
served by poverty lending programs, then an to enhance the food security and nutritional
educational program is required for the same impacts of poverty lending programs while
solidarity groups of women taking loans. maintaining the financial sustainability nec-
Without the extra investment in informa- essary for widespread expansion.
tion transfer and change promotion, the ben- The health and nutrition education of
efit pathway to improving household nutri- Credit with Education focuses on five topic
tional status will probably be blocked by lack areas: diarrhea management and prevention,
of change in nutritionally important practices breastfeeding, infant and child feeding, immu-
of women and other household members. nizations, and family planning. The specific
With an education program, the potential of topics, or ideal practices, addressed at the
poverty lending to counter malnutrition can be meetings vary from country to country, reflect-
realized. Without education, poverty lending ing local needs. All are within the scope of
may have only a weak positive effect on house- resources and range of decision making nor-
hold food security and little, if any, impact on mally available to women, and all relate to key
nutritional status. causes of malnutrition in the program area.
Preliminary impact research has shown that
An Integrated Approach health and nutrition education through this in-
Education can be provided to poverty lending tegrated approach can be effective for improv-
program participants either by a separate pro- ing participant knowledge and probably be-
gram or as an integrated component of the pov- havior. Further research is underway, and more
erty lending program itself. The advantages will be needed to test whether the integrated
of the second option are the opportunity to approach is more cost-effective for improv-
use the solidarity group meetings as a forum ing nutritional status than delivery of poverty

A Literature Review and Analysis!36


lending and health/nutrition in parallel, but group. And, from a program design stand-
independent, programs serving the same cli- point, these regular meetings also provide an
entele. excellent forum and opportunity for education.
The microenterprise education focuses on According to the founder of SEWA, a
four topic areas: choosing an appropriate ac- poverty lending program in India, their pro-
tivity, increasing profits, increasing sales, and gram “organizes borrowers to bring them to-
managing a microenterprise. The field agent gether to think through their common prob-
facilitates discussions that help the women use lems, agree on common issues, decide com-
the local markets and their own activities for mon action, and forge common ideologies”
case studies. They also help each other to find (Bhatt, 1989). This group capacity could be
ways to make their loan-funded activities channeled toward behavior change essential
complement rather than detract from their for improving the nutritional status of those
other obligations so that increases in income most vulnerable to malnutrition and food in-
can increase their families’ overall well-being. security. It is essential, however, that the edu-
The need and efficacy of management cation be nonformal and participatory rather
training has been questioned, particularly for than didactic if it is to be effective and build
women’s very small and typically changing upon the potential of the group.
mix of enterprises (McKee, 1989). One re- Nutrition education has great potential to
view of several microenterprise credit pro- influence attitudes and behaviors critical to
grams found that the minimalist programs pro- improve nutritional status, but evaluations of
viding little training had as strong an impact nutrition education typically find this poten-
on borrowers’ incomes as “credit-plus” pro- tial is rarely achieved (USAID, 1990). Les-
grams (Berger, 1989). However, rather than sons or messages are commonly delivered in
focus on inappropriate bookkeeping or ac- a lecture style with participation, if any, con-
counting skills, microenterprise development fined to rote repetition of predetermined solu-
education can and should focus on basic busi- tions. The manner in which messages are for-
ness principles that can assist the borrowers mulated and delivered often hinders their ulti-
to use the credit more strategically to earn a mate effectiveness. According to the Manoff
greater return. According to one review of Group (1984),
income-generation programs (Buzzard, 1984),
“All too often, people make a product and hope The reason for many failed nutri-
someone will buy it rather than searching out tion and health education programs
what people want to buy and making that prod- is that the ideas for messages have
uct.” This is an example of the type of eco- not come from investigations to
nomic behavior change that can lead to higher identify the audience, its problems,
incomes and consequently better food secu- and possible remedies, but from the
rity and nutritional status. suppositions of those planning the
programs and other experts. This
Nonformal Education During Solidarity has culminated in projects advising
Group Meetings villagers to boil drinking water
One of the defining characteristics of poverty when fuel is scarce or designing
lending programs is the regular meetings of posters with a written message
solidarity groups either on a weekly, bi-weekly, when illiteracy is prevalent. Mes-
or monthly basis. While it is true that these sages made of theories sometimes
regular meetings facilitate the installment re- have impact, but more often than
payment of the loan, they also play a crucial not they are rendered ineffective in
role in forging the solidarity of the borrower the face of long-held customs and
beliefs.
Research Paper No. 1! 37
Still, it is recognized that if nutrition edu- Second, solutions will be most appropri-
cation can be made more effective by being ate and most likely to be adopted when they
“more specific, more action-oriented, indi- are developed or modified locally. Immink
vidualized and relevant” the benefits could be (1988) proposes, “The community collectively
great (Lotfi, 1988). This is best achieved thinks about and discusses its food and nutri-
through face-to-face communication and ac- tion problems, their immediate causes and
tive participation by beneficiaries. This what priorities should be given to solving
nonformal approach, together with the excel- them. In participatory sessions the commu-
lent forum provided by the solidarity group nity decides on courses of actions and sets pri-
meetings, exemplify the characteristics of the orities.”
most effective approaches to nutrition/health A review of several nutrition education
education. programs focusing on weaning practices con-
First, the importance of beliefs and cus- cluded that the most successful examples were
toms requires that nutrition education address based on negotiations with the target popula-
social obstacles to behavior change and not tion regarding problem identification and so-
simply impart information. The program field lution formation (Chauliac, et al., 1991). This
agent “should listen to the community with a interactive process also strengthens people’s
respectful attitude, learn from them, work with capacity at a local level to analyze their reality
them and for them, and provide guidance rather and to take greater responsibility for imple-
than simply teach them” (USAID, 1990). Soli- menting change (Immink, 1988). In addition,
darity group members understand the kinds of there is some evidence that programs employ-
constraints each woman is facing much better ing a learning approach to develop adult con-
than even the most empathetic field agent. The fidence and collaborative skills also can re-
advice and support they can offer one another sult in participants’ adoption of specific, nu-
is more relevant, and the relationships within tritionally beneficial child feeding practices
the group are much longer lasting and poten- (Clark and Gakuru, 1982).
tially more influential over time.
Synergy Between Increased Income and
Even if the costs of change (in Nutrition Education
terms of time or money) are per- A great opportunity exists to combine pro-
ceived to be large, it may still take grams that increase incomes with education,
place if a firm and trusting relation- that encourage allocation of quality foods for
ship builds up between members of those must vulnerable to malnutrition, and that
the target community and the agent support the adoption of key health and nutri-
of change. . . . The relationship tion behaviors. Providing economic and infor-
between extension worker and mation resources to the same participants can
target families is an all-important have a synergistic impact that makes improve-
factor in determining whether ments in food security and nutritional status
change will occur. The extension more likely than would be the case if either
worker must show the family that resource were provided alone. The possibil-
he/she truly understands the kinds ity that the education component will posi-
of economic and social constraints tively affect expenditure patterns and
under which the family is living intrahousehold distribution of resources en-
and support the family through its hances the likely nutritional impact of in-
difficulties. Outsiders find this creased income from the credit program.
difficult to do (Nabarro, 1984). Moreover, the nutritional impact of the edu-
cation will also be strengthened by the simul-
taneous improvement in economic status.
A Literature Review and Analysis!38
For example, a study of a food supple- The logic behind combining health and
mentation program in the Philippines found nutrition education with a women’s income-
that providing households with additional eco- earning project is quite clear to the women
nomic resources (in the form of food) did not themselves. The Population Council con-
affect critical intrahousehold behaviors that ducted a study of 21 women’s groups in Zim-
would ultimately dictate whether this assis- babwe to better understand women’s percep-
tance would have a positive impact on tions of the wisdom of combining income-gen-
children’s nutritional status. Only the addi- erating, family planning, and literacy educa-
tion of an education component had this ef- tion programs (Mutambirwa, et al., 1986). The
fect. The authors concluded that: group members felt this approach was desir-
able because 1) children are better cared for
When multivariate analysis is when the mother has ready cash to use in the
employed, the nutrition education home, 2) adequate spacing of children provides
component of the scheme shows no time for women to engage in income-generat-
significant impact on household ing activities, and 3) when women engaged in
food expenditures and acquisition, successful income-generating activities, their
but food consumption and nutri- influence on the economic well-being of the
tional status of preschoolers are family increased. The interest among women
strongly affected, indicating that the for both types of assistance is also evident. A
nutrition messages increased the survey examining training needs of women
focus on children (Garcia and borrowers in an ACCION program in Peru
Pinstrup-Andersen, 1987). found that while a third of the participants were
interested in enterprise training, almost half
Not only does the ultimate nutritional
requested health-related courses in family
benefit of increased economic resources de-
planning, hygiene, and nutrition (Reichman,
pend upon complementary nutrition educa-
1984).
tion, but the reverse is also true. Greater nu-
While many of the most nutritionally
trition knowledge may only be effective if steps
important behaviors are not costly, the eco-
are taken to ensure a minimum socioeconomic
nomic status of the household, and particularly
status. This was the conclusion of a study of
the role of women, will greatly influence
the mediating effect of maternal nutrition
whether they are adopted. For this reason, pro-
knowledge on the association between mater-
grams that combine credit with education are
nal schooling and child nutritional status in
increasingly recognized as important and nec-
Lesotho (Ruel, et al., 1992):
essary to “break the deadlock on women’s re-
The effect of maternal schooling on sources for nutrition” (McGuire and Popkin,
weight-for-age was mediated by the 1990).
mother’s nutrition knowledge only Simultaneously, providing both economic
among wealthier households. and information resources in a manner that
These results imply that, in fosters the problem-solving capacity of the par-
Lesotho, nutrition education for ticipant has the potential to overcome the ma-
mothers could contribute to im- jor blocks to behavior change and conse-
proving children’s growth, but only quently improved nutritional status. Accord-
in households that have access to a ing to Nabarro (1984), even when a nutrition
minimum level of resources. For or health message has been presented well and
poorer households, nutrition educa- understood by the mother, change often still
tion would not be sufficient. does not occur. This often happens because
of a number of different kinds of “blocks.”

Research Paper No. 1! 39


First, the “pragmatic” block refers to a With or without the 15- to 20-minute
mother’s resistance to adopt a behavior education session held at each
change, because it runs counter to her per- regular village bank meeting, the
ception of the problem. field agent’s transportation costs,
Second, the “ritual block” refers to tra- salary, and schedule for attendance at
ditional practices and customs, like the be- the meetings remains the same.
lief that pregnant women should not eat spe- Each agent is expected to handle a
cific foods. Since adherence to these prac- portfolio of at least ten village banks,
tices is associated with adherence to the sta- which is the same minimum ratio as
tus quo, social support and empowerment are other village banking programs that
necessary to overcome this block. Third, the lack an education component.
perceived value of beneficial practices, to-
gether with the capacity of the household to 2. The education component employs a
implement them, is necessary to address what nonformal and minimalist approach
Nabarro (1984) calls the “economic capac- so that program operating costs that
ity” block. Increased income from poverty solely pertain to the education
lending can play an important role in over- component are quite small. Rather
coming this type of block to key behaviors than depending on expensive flip
that require added expense or time; for ex- charts or story boards, the education
ample, additional protein in the diet or the sessions involve stories, skits, and
preparation of weaning foods. the women’s own active discussions.
The program has supervisory and
training staff who are education
Integration for Financial Sustainability
specialists and whose benefits,
While the nutritional benefits of incorporat-
travel, and support costs do represent
ing quality, nonformal education directly into
additional expenses. However, these
a poverty lending program are clear, this ad-
additional costs for personnel and
ditional service imposes additional delivery
their support should constitute only
costs. The added cost might seem to under-
about 3 percent of total nonfinancial
mine the program’s progress toward self-fi-
costs of a large-scale program (Free-
nancing sustainability in a timely manner.
dom from Hunger, unpublished
However, if tightly integrated and delivered
data).
in a cost-effective manner at large scale, the
marginal cost of the education services can
In brief, the impact of a poverty lending
be negligible, as Freedom from Hunger is
program is likely to be greatly amplified and
demonstrating through the Credit with Edu-
broadened by an education component, and
cation version of village banking, for two
these major benefits can be provided with
reasons:
modest additional investment. It is even likely
that the program’s financial performance and
1. The education component of Credit
long-term success will be enhanced by a
with Education is so tightly woven
healthier, better nourished, more informed, and
into the credit service delivery
more productive clientele.
mechanism that it represents virtu-
ally no additional cost at the level of
the village bank. The same field
agent who organizes and trains
village banks to manage loan capital
also facilitates nonformal education.

A Literature Review and Analysis!40


CONCLUSION
Incorporating nonformal health/nutrition and
microenterprise education directly into the
delivery system and organizational structure
of a poverty lending program is a promising
strategy for enhancing the food security and
nutrition impact of these programs. Doing so
builds upon the likely increases in women’s
economic capacity and empowerment to pro-
mote the adoption of key nutrition and health
behaviors that play such a critical role in re-
dressing or preventing malnutrition. Through
their cost-effective methods and remarkable
repayment rates, poverty lending programs
offer the possibility of reaching hundreds of
thousands of poor households in a financially
sustainable manner. Poverty lending com-
bined with education could translate the likely
modest increases in income and productive
assets these households will enjoy into genu-
ine improvement in household food security
and nutritional status.
It is interesting to note that this integrated
strategy embodies many of the factors essen-
tial to successful nutrition programs identified
at the 1989 International Conference of Inter-
national Nutrition Planners in Korea (USAID,
1990):

! The need to address the problems of


poverty and nutrition in an integrated,
multisectoral manner.
! Active and genuine participation of the
community, through decentralization
of power, which promotes local
searches for solutions.
! The targeting of the poorest and most
marginalized.
! Greater attention to sustainability and
cost-effectiveness and a central role for
women’s groups.

Research Paper No. 1! 41


RÉSUMÉ ANALYTIQUE comme étant l’approche de la “boite noire’ lors
d’une évaluation de programme, en choisissant
Les programmes de prêt à la pauvreté comme une approche plus orientée vers le processus.
celui de la Banque Grameen ont capturé Cette approche de “boite noire” se concentre
l’attention d’une audience qui s’étend seulement sur le fait de voir si l’impact désiré
beaucoup plus loin que la communauté est atteint, tandis que la deuxième approche
traditionnelle de développement. Beaucoup de aide à éclairer comment l’impact a été atteint
cet enthousiasme est lié aux succès—les taux en suivant l’impact du programme à travers
de remboursements, l’échelle et/ou le potentiel des processus adéquats. La première partie de
pour une autosuffisance financière—plutôt ce document étudie l’évidence concernant les
qu’aux impacts des programmes. Néanmoins, liens entre le revenu, la prise de pouvoir, le
la valeur de toute stratégie de développement changement de comportement (hypo-
dépend finalement de sa capacité à atteindre thétiquement en tant que bienfaits
une amélioration pérennisée de la qualité de intermédiaires du prêt à la pauvreté) et la
vie. sécurité alimentaire et le statut nutritionnel—
Nous avons examiné la littérature les buts du résultat ultime. La deuxième partie
académique et praticienne pour déterminer examine l’évidence que les programmes de
quelles conditions nécessaires sont connues, prêt à la pauvreté ont un impact positif sur les
ou solidement soutenues, pour que les bienfaits intermédiaires nécessaires pour
programmes du crédit et de l’épargne puissent surmonter les causes sous-jacentes de la faim
être efficaces contre la faim et/ou la malnutri- et de la malnutrition. Chaque section com-
tion. En sachant qu’aucune revue littéraire ne mence avec un lien hypothétique, comprend
peut être complète, ne peut fournir de réponses une revue de l’évidence que nous avons
définitives, ou ne peut être sans préjudice trouvée pertinente à ce lien, puis finit avec des
interprétatif, nous visons principalement la conclusions tentatives en ce qui concerne le
stimulation d’une pensée, d’une recherche et lien.
d’une pratique nouvelles. Toutes devraient être Les conclusions principales sont
menées vers l’édification d’efforts innovants, résumées ci-dessous.
efficaces, pérennisés et à grande échelle pour
réduire radicalement la faim chronique et la 1ère PARTIE: Le lien entre les bienfaits
malnutrition à travers le monde entier. intermédiaires (revenu, changement de
L’approche utilisée est une revue des comportement, et prise de pouvoir) et la
sources secondaires d’information—articles, sécurité alimentaire et le statut
rapports et, chaque fois que possible, nutritionnel.
évaluations de programme. De plus, des in-
terviews ont été menées avec une variété de 1. Certaines conditions rendent plus direct
praticiens qui sont principalement experts en l’impact du revenu augmenté sur la sécurité
matière de crédit, des questions de sexe et de alimentaire du foyer (accès à la nourriture) et
nutrition (voir ”annex” pour une liste des sur le statut nutritionnel. Il est plus probable
individus consultés). Ces interviews se sont que des interventions auront cet impact quand
révélées inestimables quant à leur part elles s’assurent que les augmentations de
généreuse de perspicacité et d’expérience; revenus sont 1) vécues par les foyers les plus
elles ont aussi permit un accès à des documents démunis, 2) contrôlées par les femmes, 3)
de programmes non publiés qui sont gagnées de manière régulière plutôt que par
généralement difficiles à obtenir. somme forfaitaire, et 4) qu’elles améliorent la
Ce document vise à aller plus loin que ce sécurité générale de subsistance des foyers.
que Pinstrup-Andersen (1983) mentionne 2. Le lien entre la sécurité alimentaire du

A Literature Review and Analysis!42


foyer et le revenu est plus direct que celui en- possibilité d’un feed-back positif de prise de
tre le revenu et le statut nutritionnel pour une pouvoir concernant le gain et le contrôle des
variété de raisons. Premièrement, le statut revenus semble probable, mais il nous faut
nutritionnel est une fonction générale de encore trouver de la documentation sur un tel
l’individu et non simplement une fonction de feed-back.
l’accès à la nourriture ou même à la 5. Les manifestations économiques et
consommation de celle-ci. Deuxièmement, les sociales de la prise de pouvoir semblent toutes
décisions et les ressources concernant deux être cruciales pour que les femmes
l’allocation de la nourriture à l’intérieur des effectuent des changements importants de
foyers (tel que le temps du responsable) comportement nutritionnel et qu’elles
peuvent considérablement modifier l’effet du demandent ainsi qu’utilisent correctement les
revenu augmenté. Et troisièmement, les pra- services et les technologies sanitaires. Des
tiques clés de l’alimentation de la mère et de sources indépendantes de revenus ont de fortes
l’enfant et l’utilisation des services sanitaires chances de toucher le statut, l’autonomie et la
existants influencent beaucoup aussi le statut confiance en soi des femmes. Des dimensions
nutritionnel. sociales, telles qu’une mobilité plus
3. L’impact nutritionnel du revenu importante, une interaction publique, et/ou une
augmenté sera contrecarré s’il n’est pas ajouté identification du groupe, sont aussi
à l’amélioration de la santé des personnes les importantes pour la familiarisation des femmes
plus vulnérables à la malnutrition, à savoir les aux idées nouvelles et à une découverte
femmes et les jeunes enfants. Des potentielle du changement. En outre, un feed-
changements dans les pratiques de soin back positif sur le changement de
sanitaire et nutritionnel au niveau du foyer ont comportement envers la prise de pouvoir n’a
plus de chance d’être la première direction de pas été documenté, mais parait probable. Il
prévention et de traitement de la malnutrition. semble aussi que la prise de pouvoir joue un
Par exemple, chacun des faits suivants a des rôle essentiel en créant un effet synergique
implications nutritionnelles: la sélection et la entre le revenu et les comportements
distribution de la nourriture dans le foyer; les importants sanitaires/nutritionnels.
pratiques liées à l’allaitement maternel, à
l’alimentation de l’enfant, et au traitement et 2ème PARTIE. Le lien entre le prêt à la
à la prévention de la diarrhée; l’alimentation pauvreté et les bienfaits intermédiaires
lors de la grossesse, l’allaitement , et/ou durant (revenu, changement de comportement, et
et après une maladie; l’utilisation des services prise de pouvoir).
sanitaires existants; l’hygiène personnelle,
alimentaire et du milieu. Même sans le bienfait 1. Une évidence concrète de l’impact
d’un revenu augmenté du foyer, ces économique des programmes de prêt à la
comportements peuvent améliorer de manière pauvreté est rare. Les quelques évaluations
dramatique le statut nutritionnel du foyer. rigoureuses à ce jour (principalement la
Réciproquement, un revenu augmenté peut se Banque Grameen et certains affiliés
produire en absence d’un changement de d’ACCION) indiquent que les programmes de
comportement nécessaire et d’une prêt à la pauvreté augmentent en effet les
amélioration nutritionnelle. revenus, les actifs et la productivité des
4. La capacité des femmes d’augmenter emprunteurs très démunis, à la fois hommes
leurs revenus ou leurs contrôles sur le revenu et femmes.
a un effet positif sur leur prise de pouvoir 2. Le prêt à la pauvreté préserve plus
(confiance en soi, statut, et pouvoir de souvent le propre emploi de l’entrepreneur qui
négociation à l’intérieur de leurs foyers). La travaille à son compte plutôt que de créer de

Research Paper No. 1! 43


nouveaux emplois. Les revenus ont de fortes économiques en créant de nouveaux liens et
chances d’être stabilisés ou plus ou moins une identification sociale. Ceci aide les
augmentés durant une période de temps courte. femmes à résister aux restrictions
Cependant, avec des prêts séquentiels et une traditionnelles et à encourager de nouvelles
accumulation de l’expérience commerciale, les normes culturelles. Une étude littéraire plus
participants peuvent passer à des activités étendue sur les groupes d’auto-assistance non
potentiellement plus rentables. Une économique aurait de fortes chances de révéler
productivité salariale (revenu net de l’heure) qu’une solidarité entre les groupes a un im-
est un variable important qu’il faut inclure dans pact solide, direct et positif sur les mesures de
toute étude de l’impact du crédit, surtout pour la prise de pouvoir de la personne et du groupe.
les femmes. 5. La prise de pouvoir des femmes ris-
3. Le prêt à la pauvreté est mis au point que guère d’améliorer directement la sécurité
pour soutenir principalement les activités alimentaire du foyer et le statut nutritionnel
économiques existantes des démunis. A cause sans agir à travers un changement de
des rendements pauvres et des contraintes comportement qui soit important soit
structurelles des activités traditionnelles des économiquement soit nutritionnellement. De
femmes, cette approche minimaliste n’amène même, les programmes de prêt à la pauvreté
probablement pas d’amélioration économique risquent guère de promouvoir directement des
importante chez les femmes. Parce que les changements de comportement qui sont liés
femmes constituent la masse des participants soit à l’économie soit à la nutrition sans agir
dans la plupart des programmes, le prêt à la grâce à une sorte de processus éducatif. La
pauvreté risque guère de produire des gains prise de pouvoir des femmes est considérée
économiques importants pour les foyers comme un fait qui rend les femmes “prêtes à
démunis. Cependant, relativement parlant, ces l’apprentissage”, et les ressources
gains modestes semblent faire des contribu- économiques des femmes peuvent leur
tions importantes, telles qu’un revenu régulier permettre de mettre en pratique ce qu’elles ont
et une assurance contre les urgences, à la survie appris. Mais un type de transfert d’information
du foyer. Et ces dernières stratégies sont et de promotion du changement doit se
précisément celles qui, si renforcées, sont produire avant que les femmes aient de fortes
associées de manière la plus proche avec une chances de savoir pourquoi, comment et que
augmentation de la sécurité alimentaire du changer.
foyer et du statut nutritionnel. 6. Avec un programme éducatif, le
4. Le prêt à la pauvreté donne du pouvoir potentiel du prêt à la pauvreté pour riposter
aux femmes participantes. En fournissant des contre la malnutrition peut se réaliser. Sans
occasions pour un emploi indépendant, il l’éducation, le prêt à la pauvreté peut n’avoir
augmente l’autonomie, la confiance en soi et qu’un seul effet possible et faible sur la sécurité
le statut à l’intérieur du foyer des femmes. Des alimentaire du foyer et qu’un peu d’impact,
réunions régulières et une garantie de leurs s’il existe, sur le statut nutritionnel.
pairs aide à favoriser la solidarité de groupe, L’éducation peut être fournie aux participants
ce qui réduit l’isolation des femmes et du programme de prêt à la pauvreté soit avec
augmente leur familiarisation aux nouvelles un programme séparé soit en tant qu’élément
idées et à l’information aussi bien que leurs intégré du programme même du prêt à la
compétences pour dialoguer avec le secteur pauvreté.
publique. Il y a même une preuve qui soutient
l’hypothèse que les groupes de solidarité créent
une prise de pouvoir de leurs membres
indépendamment de leurs impacts

A Literature Review and Analysis!44


RESUMEN EXECUTIVO a un método más orientado al proceso. El
método “black box” se enfoca solamente en
Los programas de crédito para gente de el logro del impacto deseado, mientras que el
recursos escasos como el Banco Grameen han último método ayuda iluminar como se logró
captado la atención de una audiencia que al impacto por seguir el impacto del programa
extende mucho más allá de la comunidad a través de procesos pertinentes. La Parte I
tradicional de desarrollo. Mucho de ese del informe investiga la evidencia con respecto
entusiasmo está relacionado con los éxitos a la relación entre los ingresos, el
programáticos—el índice de devolución, la fortalecimiento de confianza en si misma, y el
escala y/o la potencial para autosuficiencia— cambio de comportamiento (creido como los
en vez del impacto de los programas. Sin em- beneficios intermediatos de crédito para gente
bargo, el valor de cualquier estratégia de de recursos escasos) a la seguridad de
desarrollo últimamente depende de la alimentos y el estado nutritivo—las últimas
habilidad de alcanzar al mejoramiento metas. La Parte II examina la evidencia que
sostenible de la calidad de vida. programas de crédito para gente con recursos
Hemos examinado la literatura escasos tienen un impacto positivo en los
académica y profesional para determinar qué beneficios intermediatos necesarios para
está conocido, o fuertemente mantenido, como sobrepasar las causas fundamentales del
condiciones necesarias para la eficacia de hambre y la desnutrición. Cada sección
programas de crédito y ahorros contra el empieza con una relación hipotética, incluye
hambre y/o la malnutrición. Por saber que un repaso de la evidencia que encontramos
ninguna literatura puede ser comprensiva, no pertinente a la dicha relación, y termina con
puede ofrecer respuestas definitivas, y no las conclusiones tentativas con respecto a la
puede faltar el prejuicio interpretivo, queremos relación.
actuar como estimulante para el pensamiento, Las conclusiones principales están
la investigación, y las prácticas nuevas-- todos resumidas abajo.
los cuales deben estar dirigidos hacia la
construcción de esfuerzos innovadores, PARTE I: La relación de los beneficios
efectivos, sostenibles, y de gran escala para intermediatos (Ingresos, Cambio de
reducir drásticamente el hambre crónico y la comportamiento, y el fortalecimiento de
malnutrición por todo el mundo. confianza en si misma) a la seguridad de
El método implementado es un repaso de alimentos y el estado nutritivo.
fuentes secundarios de información—
artículos, informes, y cuando posible, 1. Ciertas condiciones hacen más directo el
evaluaciones de programas. Además, hicieron impacto de ingresos aumentados en la
entrevistas con varios profesionales expertos, seguridad de alimentos (el acceso a alimentos)
principalmente en el crédito, los asuntos del y el estado nutritivo. Las intervenciones
género, y la nutrición (vea el Annex para una probablemente tendrán este impacto cuando
lista de individuos consultados). Estas aseguran que los aumentos de ingresos son
entrevistas eran invalorables en cuanto al 1)experimentados por las familias más pobres,
comparto generoso de ideas y experiencia; 2)controlados por mujeres, 3)ganados como
también ofrecieron el acceso a documentos no ingresos continuos en vez de ingresos
publicados de programas, los cuales por lo recibidos en suma global, y 4)buenos para la
general no se puede obtener fácilmente. seguridad total de la familia.
Este informe aspira ir más allá del método 2. La liga entre la seguridad de alimentos
de la evaluación de programas llamado por de la familia y el ingreso es más directo que la
Pinstrup-Andersen “black box” (caja negra), relación entre el ingreso y el estado nutritivo,

Research Paper No. 1! 45


por varios razones. Primero, el estado nutritivo 5. Tanto la manifestacion económica
es una función del salud total de un individuo como la social del fortalecimiento de confianza
y no simplemente una función del acceso a en si misma parecen ser críticas para que las
comida, ni siquiera el consumo de alimentos. mujeres hagan cambios importantes del
Segundo, las decisiones y recursos del reparto comportamiento nutritivo y para que
de alimentos entre familias (como el tiempo demanden y usen correctamente los servicios
de la persona responsable del cuidado) pueden de salud y la tecnología de salud. Es probable
modificar mucho el efecto de ingresos que los fuentes independientes de ingresos
aumentados. Y tercero, las prácticas claves afecten al estado social de las mujeres, la
de cuidado y alimentación de infantil y ma- autonomía, y la auto-confianza. Las
terna y el uso de los servicios establecidos dimensiones independientes, como la
también influyen al estado nutritivo. movilidad amplia, la interacción pública, y/o
3. El impacto nutritivo del ingreso la identificación con un grupo, también son
aumentado será decepcionante si no está importantes para la exposición de la mujer a
juntado al mejoramiento de la salud de los más nuevas ideas y la potencial para cambios. De
vulnerables a la malnutrición, especialmente nuevo, la información positiva sobre los
las mujeres y los niños. Cambios en la cambios de comportamiento a habilitarse tiene
nutrición y las prácticas del mantenimiento de un papel principal en crear un efecto
la salud al nivel de la familia estarán la primera sinergística entre los ingresos y los
ruta de la prevención y el tratamiento de la comportamientos importantes de la salud y la
malnutrición. Por ejemplo, cada de los nutrición.
siguientes tiene implicaciones nutritivas: la
selección y distribución de alimentos dentro PARTE II. La relación de crédito para gente
de la familia; las prácticas relacionadas a la de recursos escasos a los beneficios
lactancia materna, alimentacion de niños, y el inmediatos (Los ingresos, el cambio de
tratamiento y la prevención de la diarrhea; las comportamientos, y el fortalecimiento de
dietas durante el embarazo, la lactancia, y/o confianza en si misma).
mientras de y después de una enfermedad; el
uso de servicios establecidos de salud; la 1. La evidencia sólida del impacto económico
higiene personal, ambiental, y de la comida. de programas de crédito para gente de recursos
Aún sin el beneficio del ingreso aumentado escasos es rara. Las pocas evaluaciones
de la familia, estos comportamientos pueden rigurosas hasta hoy (principalmente el Banco
mejorar dramáticamente el estado nutritivo de Grameen y algunos asociados de ACCION)
la familia. A la inversa, el ingreso aumentado indican que los programas de crédito para
puede ocurrir en la ausencia de cambios gente de recursos escasos suben los ingresos,
necesarios del comportamiento y el los bienes, y la productividad de los
mejoramiento nutritivo. prestatarios más pobres, ambos mujeres y
4. La capacidad de las mujeres de hombres.
aumentar sus ingresos o su control de los 2. El crédito para gente de recursos
ingresos tiene un efecto positivo en su escasos a menudo preserva el auto-empleo del
habilitación (la auto-confianza, el estado, y el empresario en vez de crear trabajos nuevos.
poder de negociar dentro del hogar). La Es probable que los ingresos establezan o
posibilidad de refuerzo entre el fortalecimiento aumenten en un corto plazo. Sin embargo, con
de confianza en si misma y los niveles de préstamos consecutivos y la acumulación de
ganancia y control parece posible, pero todavía experencia comercial, los participantes podrían
falta la documentación de tal retro- cambiar hacia las actividades económicas más
alimentación.

A Literature Review and Analysis!46


rentables. La productividad laboral (el ingreso las nuevas normas culturales. Una inspección
total por hora) es una variable importante de más amplia de la literatura de grupos no
incluir en cualquier estudio del impacto de económicos de auto-ayuda revelaría que la
crédito, especialmente para las mujeres. solidaridad entre grupos tiene un impacto
3. El crédito para gente de recursos fuerte, directo, y positivo en los medidos de
escasos está diseñado para apoyar fortalecimiento de confianza en si misma per-
principalmente las actividades económicas sonal y de grupos.
establecidas de los pobres. Por sus ingresos 5. Es improbable que el fortalecimiento
bajos y los límites estructurales de las de confianza en si misma de mujeres mejore
actividades tradicionales de mujeres, este directamente la seguridad de alimentos de la
punto de vista minimalista probablemente no familia y el estado nutritivo sin actuar a través
lleva a cabo mejoramientos económicos del cambio de comportamiento que es
mayores para mujeres. Por el hecho que las importante economicamente o nutritivamente.
mujeres constituyen la mayoría de los Del mismo modo, es improbable que los
participantes en tales programas, es improb- programas de crédito para gente de recursos
able que el crédito para gente de recursos escasos promuevan directamente los cambios
escasos produzca ganancias económicas de comportamiento económicos o los
significativas para los pobres. Sin embargo, relacionados a la nutrición sin actuar a través
en terminos relativos, estas ganancias módicas de algún tipo de proceso educativo. Se cree
pueden hacer una contribución importante a que el fortalecimiento de confianza en si
la supervivencia de la familia, como la misma de mujeres las hace “lista para
regularización de los ingresos y los seguros aprender”, y los recursos económicos de
contra emergencias. Son precisamente los mujeres les permiten a realizar lo que han
tipos de estratégias de ganarse la vida que, si aprendido. Sin embargo, debe pasar algún tipo
reforzadas, son las más asociadas con la de transferencia de información y fomento de
seguridad aumentada de alimentación famil- cambio antes que sabrían las mujeres qué
iar y el estado nutritivo. cambiar y por qué y cómo.
4. El crédito para gente de recursos 6. Con un programa educativa, se puede
escasos fortaleza la confianza en si misma de realizar la potencial de crédito para gente de
las participantes mujeres. Por proveer recursos escasos de luchar contra la
oportunidades de auto-empleo, sube la malnutrición. Sin educación, el crédito para
autonomía de la mujer, su auto-confianza, y gente de recursos escasos solamente tendría
su estado dentro de la familia. Las reuniones poco efecto positivo en la seguridad de
regulares y la garantía de las otras ayudan a alimentación de la familia y poco, si lo hay,
facilitar la solidaridad del grupo, que reduce impacto en el estado nutritivo. Se puede
la aislación de la mujer y aumenta su proveer la educación a los participantes de
exposición a nuevas ideas e información, tanto programas de crédito para gente de recursos
como las habilidades de interactuar dentro del escasos por un programa separado o como un
ambiente público. Existe la evidencia en componente integrado del programa de crédito
apoyo de la hipótesis que los grupos de misma.
solidaridad crean el fortalecimiento de
confianza en si misma de sus participantes
independientemente de los impactos
económicos por crear nuevas ligas y la
identificación social que ayudan a mujeres
resistir las restricciones tradicionales y alentar

Research Paper No. 1! 47


WORKS CITED
ACC-SCN. “Measuring Children: The Uses of Royal Society of Tropical Medicine and
Anthropometry.” SCN News. United Hygeine 73, no. 1 (1979): 85-90.
Nations, Administrative Committee on
Berger, Marguerite. “Giving Women Credit: The
Coordination—Subcommittee on Nutrition,
Strengths and Limitations of Credit as a
no. 5, Early 1990, pp. 8-18.
Tool for Alleviating Poverty.” World
ACC-SCN - “Some Options for Improving Nutrition Development 17, no. 7 (July 1989): 1017-
in the 1990s.” Supplement to SCN News. 32.
United Nations, Administrative Committee
Berger, Marguerite and Mayra Buvinic, eds.
on Coordination—Subcommittee on
Women’s Ventures: Assistance to the
Nutrition, no. 7, Mid-1991a, pp. 1-19.
Informal Sector in Latin America. Con-
ACC-SCN. “Breastfeeding, Birth Spacing, and necticut: Kumarian Press, 1989.
Nutrition.” SCN News. United Nations,
Bhatt, Ela. “Toward Empowerment.” World
Administrative Committee on Coordina-
Development 17, no. 7 (July 1989): 1059-
tion—Subcommittee on Nutrition, no. 7,
65.
Mid-1991b, pp. 7-14.
Blumberg, Rae Lesser. “Income under Female
ACC-SCN. “Addressing Micronutrient Malnutri-
Versus Male Control; Hypotheses from a
tion.” SCN News. United Nations, Admin-
Theory of Gender Stratification and Data
istrative Committee on Coordination—
from the Third World.” Journal of Family
Subcommittee on Nutrition, no. 9, Mid-
Issues 9, no. 1 (March 1988): 51-84.
1993, pp. 1-10.
Brown, K. “The Importance of Dietary Quality
Acharya, Meena and Lynn Bennett. “Women and
Versus Quantity for Weanlings in Less-
the Subsistence Sector; Economic Participa-
Developed Countries: A Framework for
tion and Household Decisionmaking in
Discussion.” Paper Presented at the
Nepal.” Staff Working Paper no. 526,
International Nutrition Symposium, 74th
World Bank, Washington, DC, 1982.
Annual Meeting of the Federation of
Adhikari, Ramesh Kant and Miriam Krantz. Child American Societies of Experimental
Nutrition and Health. Kathmandu: Jeewan Biology, Washington, DC, April 3, 1990.
Printing Support Press, 1989.
Brown, R. “Weaning foods in Developing Coun-
Alderman, Harold. “The Effect of Food Prices and tries.” American Journal of Clinical
Income Changes on the Acquisition of Food Nutrition 331 (1978): 2066-72.
by Low-Income Households.” Washington,
Bruce, Judith. “Homes Divided.” World Develop-
DC: International Food Policy Research
ment 17, no. 7 (July 1989): 979-91.
Institute. 1986.
Bunster, Ximena. “Market Sellers in Lima, Peru:
Antrobus, Peggy. “The Empowerment of Woman,”
Talking about Work.” In Women and
edited by Gallin, Arnoff, and Ferguson. The
Poverty in the Third World, edited by
Women and International Development
Buvinic, Lycette, and McGreevey. Balti-
Annual, vol. 1. Boulder: Westview Press,
more: Johns Hopkins University Press;
1989.
1983.
Ashe, Jeffrey. “Solidarity Groups and the Women’s
Buvinic, Mayra. “Investing in Poor Women: The
World Bank: Experiences from Cali,
Psychology of Donor Support.” World
Colombia.” ACCION International,
Development 17, no. 7 (July 1989): 1045-
Massachusetts, March 1986.
1057.
Barkat-e-Khuda, Islam, Sanjeeda, Sultana, Rifat,
Buzzard, Shirley. “Income-Generating Projects of
Sirajee, Salina, Laila, Rawnaq. “Women’s
Small-Scale Development Organizations: A
Savings Groups and Contraceptive Behavior
Field Study.” Rhode Island: Foster Parents
among Rural Bangladesh Women: Some
Plan International, June 1984.
Insights about the Process.” Bangladesh:
University Research Corporation, Dec. Buzzard, Shirley, Ph.D. “Paths to Household Food
1990. Security: The Role of Credit to Women.” A
Policy Discussion (unpublished). (Impact
Barrell, R. and M. Rowland. “Infant Foods as a Office, United States Agency for Interna-
Potential Source of Diarrhoeal Illness in tional Development) Washington, D.C.
Rural West Africa.” Transactions of the February 1, 1995.

A Literature Review and Analysis!48


Carloni, Alice Stewart. “The Impact of Maternal World’s Hunger by the Year 2000. Report
Employment and Income on the Nutritional of the Fifth Annual Research Briefing and
Status of Children in Rural Areas of Exchange, Brown University. April 1992.
Developing Countries: What is Known,
_______. “Learning and Earning Nutrition Security:
What is Not Known and Where the Gaps
The Challenge of Delivering Integrated
Are.” United Nations Administrative
Services to Very Large Numbers of Very
Committee on Coordination—Subcommit-
Poor Women.” Presentation to Seventh
tee on Nutrition, April 1984.
Annual Hunger Research Briefing and
Carloni, Alice Stewart. “Women in Development: Exchange, Brown University. April 1994.
AID’s Experience, 1973-1985.” Synthesis
Engle, Patricia. “The Intersecting Needs of Working
Paper, Vol. 1. Washington, DC: U.S.
Mothers and Their Young Children: 1980 to
Agency for International Development,
1985.” Department of Psychology and
April 1987.
Human Development, California Polytech-
Chauliac, Michel, Anne-Marie Masse-Raimbault, nic State University, January 1986.
and Micheline D’Agostino. “Nutrition
FAO/WHO. “Major Issues for Nutrition Strategies:
Education.” In Children in the Tropics.
Summary.” International Conference on
International Children’s Center no. 192,
Nutrition—1992.
Paris, 1991
Freedom from Hunger. “Statement of Strategic
Clark, Noreen and O. Nyaga Gakuru. “The Effect on
Direction,” Freedom from Hunger, Septem-
Health and Self-Confidence of Participation
ber 1989.
in Collaborative Learning Activities.”
Hygie: International Journal of Health Garcia, Marito and Per Pinstrup-Andersen. “The
Education 1, no. 2 (1982): 47-56. Pilot Food Price Subsidy Scheme in the
Philippines: It’s Impact on Income, Food
Cosminsky and Scrimshaw. “Sex Roles and Subsis-
Consumption, and Nutritional Status.”
tence: A Comparative Analysis of Three
Research Report 61. International Food
Central American Communities.” In Sex
Policy Research Institute, August, 1987.
Roles and Social Change in Native Lower
Central American Societies, edited by Griffiths, Marcia. “How to Improve Child Well-
Christine Loveland and Franklin Loveland. Being? First, Increase Mothers’ Self-
Chicago: University of Illinois Press, 1982. Confidence” Sharing Experiences: How to
End Half the World’s Hunger by the Year
De Groote, Hugo. “Women’s Income Versus Family
2000. Report of the Fifth Annual Hunger
Income as a Determinant for Food Security,
Reasearch Briefing and Exchange Brown
an Example from Southern Mali.” A paper
Univesity, April 1992.
prepared for the XXII International Confer-
ence of Agricultural Economists, Harare, Guyer, J. “Household Budgets and Womens’
Zimbabwe, 1994. Incomes.” African Studies Center Working
Papers no. 28, Boston University, 1980.
de Waal, A. Famine that Kills: Darfur, Sudan,
1984-1985. Oxford, U.K.: Clarendon Press. Holt, Sharon and Helena Ribe. “Developing
1989. Financial Institutions for the Poor: Reduc-
ing Gender Barriers.” Draft. World Bank,
Downing, Jeane. “Gender and the Growth and November 1990.
Dynamics of Microenterprise.” Growth and
Equity through Microenterprise Investments Hoodfar, H. “Household Budgeting and Financial
and Institutions (a USAID-sponsored Management in a Lower-Income Cairo
Neighborhood,” Research Report 65,
project). September 1990.
Washington, DC: International Food Policy
Dunford, Christopher. “Alleviating Hunger through Research Institute, February 1988.
Credit with Education.” Presentation to Hossain, Mahabub. “Credit for Alleviation of Rural
The World Bank, Population and Human Poverty: The Grameen Bank in
Resources Division, Fall Nutrition Seminar Bangladesh.” Washington, DC: Interna-
Series. November 1990. tional Food Policy Research Institute,
_______. “Credit with Education for Women: February 1988.
Engaging Bankers in Hunger Prevention.” Immink, Maarten. “Community-Based Food and
Sharing Experiences: How to End Half the Nutrition Surveillance as an Instrument of

Research Paper No. 1! 49


Socio-Economic Development in Central Leslie, J. Women’s Work and Child Nutrition in the
America: A Point of View.” Food and Third World. Washington, DC: Interna-
Nutrition Bulletin, 10(1988): 13-15. tional Center for Research on Women,
1985.
Jiggins, Janice. “How Poor Women Earn Income in
Sub-Saharan Africa and What Works Lotfi, Mahsid. “Growth Monitoring: A Brief
Against Them.” World Development 17, Literature Review of Current Knowledge.”
no.7 (July 1989): 953-63. Food and Nutrition Bulletin, 10(1988): 3-
10.
John Snow, International. Empowerment of Women
Program. Program Description, John Snow, Manoff Group, Inc. “Nutrition Communication and
Inc., November 1990. Behavior Change Component; Indonesia
Nutrition Development Program.” Wash-
Jonsson, Urban and Daniel Toole. “Household Food
ington, DC: Manoff Group, Inc., May
Security and Nutrition a Conceptual
1984.
Analysis” (mimeograph draft). UNICEF,
27 January 1991. Maxwell, Simon and Timothy R. Frankenberger.
“Household Food Security: Concepts,
Kasongo Project Team. “Weight, Height and Arm
Indicators, Measurements.” A Technical
Circumference in O to 5 Year-Old Children
Review. United Nations Children’s Fund -
From Kasango (Zaire).” Ecology of Food
International Fund for Agricultrual Devel-
and Nutrition 12 (1982): 19-28.
opment, 1992.
Kennedy, Eileen. “The Effects of Sugarcane
McElroy, M. “The Empirical Content of Nash-
Production on Food Security, Health, and
Bargained Household Behavior.” The
Nutrition in Kenya: A Longitudinal
Journal of Human Resources. 1990; 25(4):
Analysis.” Research Report 78. IFPRI,
559-580.
1989.
McGuire, Judith and Barry Popkin. Helping Women
_______. “Effects of Gender of Head of Household
Improve Nutrition in the Developing World:
on Women’s and Children’s Nutritional
Beating the Zero Sum Game. Washington,
Status.” Paper presented at the workshop
DC: World Bank, 1990.
on The Effects of Policies and Programs on
Women. International Food Policy Re- McKee, Katharine. “Microlevel Strategies for
search Institute, Washington, DC, January Supporting Livelihoods, Employment, and
1992. Income Generation of Poor Women in the
Third World: The Challenge of Signifi-
Kennedy, E. and B. Cogill. “Income and Nutritional
cance.” World Development 17, no. 7 (July
Effects of the Commercialization of
1989): 993-1006.
Agriculture in Southwestern Kenya.”
Research Report 63, Institute of Food Mead, Donald, Thomas Dichter, Yacob Fisseha, and
Policy Research, Washington, DC, 1987. Steven Haggblade. “Prospects for Enhanc-
ing the Performance of Micro and Small
Kumar, S. “Role of Household Economy in Child
Scale Nonfarm Enterprises in Niger.”
Nutrition at Low Incomes; A Case Study in
Growth and Equity through Microenterprise
Kerala.” Occassional Paper no. 95, Depart-
Investments and Institutions (a USAID-
ment of Agricultural Economics, Cornell
University, December 1978. sponsored project), February 1990.
Lassen, Cheryl. “Poverty Lending: Something Mencher, J. “Women’s Work and Poverty:
Distinct within Micro Enterprise Credit.” Women’s Contribution to Household
Growth and Equity through Microenterprise Maintenance in South India,” edited by
Investments and Institutions (a USAID- Bruce and Dwyer. Homes Divided; Women
sponsored project). September 1990. and Income in the Third World. California;
Stanford Press, 1988: 99-119.
Lassen, Cheryl A. and Barbara MkNelly. Freedom
from Hunger’s New Credit-Led Approach Mitzner, Scrimshaw, and Morgan (eds.) Improving
to Alleviating Hunger: Is It Working? Mid- the Nutritional Status of Children During
term Evaluation of USAID Partnership the Weaning Period: A Manual for
Grant, Cooperative Agreement No. OTR- Policymakers, Program Planners, and
0158-A-00-8147-00, Freedom from Hunger, Fieldworkers. Massachusetts, Massachu-
Davis, CA, January 1992. setts Institute of Technology, 1984.

A Literature Review and Analysis!50


MkNelly, Barbara and Chatree Watetip. Impact May 4, 1995.
Evaluation of Freedom from Hunger’s
Pitt, Mark M. And Shahidur R. Khandker. “House-
Credit with Education Program in Thailand.
hold and Intrahousehold Impacts of the
Freedom from Hunger, Davis, CA: May
Grameen Bank and Similar Targeted Credit
1993.
Programs in Bangladesh.” Paper presented
Mutambirwa J, Coeytaux, McEvoy. “Zimbabwean at workshop sponsored by the World Bank
Women’s Thinking on Family Planning and in Dhaka, Bangladesh on March 19-22,
Its Relationship to Personal Development 1995.
and Income Generation. Paper presented at
Popkin, B, and F. Solon. “Income, Time, the
APHA Conference, The Population Coun-
Working Mother and Child Nutrition.”
cil, October 1986.
Environmental Child Health (1976): 156-
Muzaale, Patrick and David Leonard. “Kenya’s 66.
Experience with Women’s Groups in
Rahman, Atiur. “Impact of Grameen Bank on the
Agricultural Extension: Strategies for
Nutritional Status of the Rural Poor.”
Accelerating Improvements in Food
Working Paper No.7, Grameen Bank
Production and Nutritional Awareness in
Evaluation Project. Bangladesh:
Africa.” Agricultural Administration 19
Bangladesh Institute of Development
(1985): 13-28.
Studies, Agriculture and Rural Development
Nabarro, D. “Social, Economic, Health and Environ- Division, December 1987.
mental Determinants of Nutritional Status.”
Ravillion, Martin. Is Undernutrition Responsive to
Food and Nutrition Bulletin 6, no. 1 (1984).
Changes in Incomes? Policy Planning and
Nelson, Candace, Barbara MkNelly, Kathleen Stack, Research Working Paper, Washington, DC:
and Lawrence Yanovitch. Village Banking: World Bank, 1990.
The State of the Practice. The Poverty
Reichman, Rebecca. “Women’s Participation in
Lending Working Group of SEEP and
Progreso: A Microenterprise Credit Pro-
Participants at the Interantional Conference
gram Reaching the Smallest Businesses of
of Village Bank Practitioners. April 1995.
the Poor in Lima, Peru.” ACCION Interna-
Nieves, Isabel. “The Interface Between Poor tional, Massachusetts, October 1984.
Women’s Nurturing Roles and Productive
Roldan, M. “Renegotiating the Marital Contract:
Responsibilities.” The International Center
Intrahousehold Patterns of Money Alloca-
for Research on Women, Washington, DC,
tion and Women’s Subordination Among
1982.
Domestic Outworkers in Mexico City.”
Norcliffe, G. B. and D. B. Freeman. “Nonfarm edited by Bruce and Dwyer. Homes
Activities in Market Centers of Central Divided: Women and Income in the Third
Province, Kenya.” Canadian Journal of World. California: Stanford Press, 1988.
African Studies 14, no. 3 (1980): 503-17. 229-47.
Norton, Rebecca. “Maternal Nutrition During Ruel, Marie T., Jean-Pierre Habicht, Per Pinstrup-
Pregnancy as It Affects Infant Growth, Andersen, and Yrjö. “The Mediating Effect
Development and Health” ACC/SCN, SCN of Maternal Nutrition Knowledge on the
NEWS, mid-1994. Association between Maternal Schooling
and Child Nutrition Status in Lesotho.”
Otero, Maria. A Question of Impact; Solidarity
American Journal of Epidemology 135 (8)
Group Programs and their Approach to
1992: 904-914.
Evaluation. Private Agencies Collaborating
Together. Honduras: Lithopress Industrial, Schiff, Maurice and Alberto Valdes. “Poverty, Food
October 1987. Intake, and Malnutrition: Implications for
Food Security in Developing Countries.”
Pinstrup-Andersen, Per. “Estimating the Nutritional
Reprint no. 206. Washington, DC: Interna-
Impact of Food Policies: A Note on the
tional Food Policy Institute, 1991.
Analytical Approach.” Food and Nutrition
Bulletin 5, no. 4 (Dec. 1983). Schuler, Sidney R. And Sayed M. Hashemi. “Studies
in Family Planning” Credit programs,
Pitt, Mark. Department of Economics, Brown
women’s empowerment, and contraceptive
University. Telephone conversation with
use in rural Bangladesh 25(2): 65-76. 1994.
Barabara MkNelly, Freedom from Hunger,

Research Paper No. 1! 51


Shultz, TP. “Testing the Neoclassical Model of ______. “Crucial Elements of Successful Commu-
Family Labor Supply and Fertility.” The nity Nutrition Programs.” Report of the
Journal of Human Resources. 1990; 25(4): Fifth International Conference of the
599-625. International Nutrition Planners Forum,
Seoul, Korea, 15-18 August 1989. Wash-
Smyke, Patricia. Women and Health. United
ington, DC: U.S. Agency for International
Kingdom: Zed Books, 1991.
Development, 1990.
Stearns, Katherine. “The Hidden Beast: Delin-
______. “Micronutrients. Increasing Survival,
quency in Microenterprise Credit Pro-
Learning, and Economic Productivity.” A
grams.” In Frontiers of Financial Assis-
report on the USAID Micronutrient Pro-
tance to Microenterprise Development.
gram. The United States Agency for
GEMINI, Virginia, 1990.
International Development, Washington,
Tendler, Judith. “What Ever Happened to Poverty D.C., 1993.
Alleviation?” A Report Prepared for the
Viteri, Fernando E. “The Consequences of Iron
Mid-Decade Review of the Ford
Deficiency and Anaemia in Pregnancy on
Foundation’s Programs on Livelihood,
Maternal Health, the Foetus and the Infant.”
Employment, and Income Generation.
SCN NEWS Mid-1994: 14-18.
March 1987.
von Braun, J. and E. Kennedy. “Commercialization
Thomas, Duncan. “Intra-Household Resource
of Subsistence Agriculture: Income and
Allocation: An Inferential Approach.” The
Nutritional Effects in Developing Coun-
Journal of Human Resources 25, no. 4 (Fall
tries.” Working Paper on Commercializa-
1990): 635-61.
tion of Agriculture and Nutrition no. 1,
Tripp, R. “Farmers and Traders; Some Economic International Food Policy Research Insti-
Determinants of Nutritional Status in tute, Washington, DC, 1986.
Northern Ghana.” Food and Nutrition 8,
von Braun, Joachim, Metlev Puetz, and Patrick
no. 1 (1982): 15-22.
Webb. “Irrigation Technology and Com-
UNICEF. “Production Credit for Rural Women: A mercialization of Rice in the Gambia:
Tripartite Review.” HMG Negal, Govern- Effects on Income and Nutrition.” Research
ment of the Netherlands, UNICEF, 29 Report 75. IFPRI, 1989.
August-21 September, 1989a.
von Braun, Joachim, Hartwig de Haen, and Juergen
_______. “Production Credit for Rural Women: An
Blanken. “Commercialization of Agricul-
Impact Evaluation Study.” Centre for
ture under Population Pressure: Effects on
Women and Development, UNICEF, 1989b.
Production, Consumption, and Nutrition in
_______. “Strategy for Improved Nutrition of Rwanda.” Research Report 85. IFPRI,
Children and Women in Developing 1991.
Countries.” A UNICEF Policy Review.
Waterlow, JC, Ashworth, A, and Griffiths, MF.
United Nations Children’s Fund, New York,
“Faltering in Infant Growth in Less Devel-
N.Y., June 1990.
oped Countries.” Lancet. 1980; 2:1176-
_______. “UNICEF’S Position on the Problem of 1178.
Malnutrition,” Nutrition Section, UNICEF
WHO/USAID/NEI Report of a Joint Consultation of
New York. December 1992.
Principle Investigators “Vitamin A, Mortal-
UNICEF/WHO/UNESCO/UNFPA. Facts for Life: ity and Morbidity Studies.” 1992.
A Communication Challenge. Revised
Williams, Cicely, Naomi Baumslag, and Derick
edition 1993.
Jelliffe. Mother and Child Health Deliver-
USAID. “A.I.D. Microenterprise Stocktaking: ing the Services. London: Oxford Medical
Synthesis Report.” Evaluation Special Publications, 1985.
Report 65. A.I.D., December 1989a.
World Bank. “Poverty: World Development Report
______. “Experiments in Small- and 1990.” Washington, DC: World Bank,
Microenterprise Development.” USAID 1990.
Science and Technology in Development
_______. “West Africa: Credit with Education for
Series. AID, 1989b.
Women.” Overcoming Global Hunger.

A Literature Review and Analysis!52


Proceedings of a Conference on Actions to
Reduce Hunger Worldwide, The American
University, Washington, DC. November
30-December 1, 1993.
Yunus, Muhammad. Grameen Bank: Organization
and Operations. World Conference on
“Support for Microenterprise.” USAID/
World Bank/IADB, Washington, DC, June
1988.

Research Paper No. 1! 53


ANNEX

Individuals consulted who contributed Noreen Clark—Professor and Chair, De-


their advice, opinions, and guidance to the lit- partment of Health Behavior and Health Edu-
erature review. (Titles reflect positions at time cation, School of Public Health, University of
of consultation.) Michigan
Marcia Griffiths—Manoff Group, Inc.
Alan Berg—Nutrition Advisor, World
Bank Nina Bowen—Africa Officer, Women
and Development Office, United States As-
Angela Van Rynbach—Country Director, sistance for International Development
Save the Children (SAVE), Bangladesh (USAID)

Barry Sidman—Director, (IMPACT) Per Pinstrup-Andersen—Director,


Cornell Food and Nutrition Policy Program
Claudia Fishman—Deputy Director, Nu-
trition Communication Project, Academy for Peter Gottert—Program Officer, Africa,
Educational Development Academy for Educational Development

Dan Toole—Household Food Security, Reka Mehra—International Center for


Project Officer, United Nations Children’s Research on Women
Fund (UNICEF)
Sidney Schuler—John Snow, Inc., Em-
Eileen Kennedy—Senior Researcher, In- powerment of Women Program
ternational Food Policy Research Institute
Shelly Feldman—Faculty Member,
Eugenia Eng—Department of Public Cornell Food and Nutrition Group and Em-
Health, University of North Carolina, Chapel powerment Group, Department of Rural So-
Hill ciology

Jeffrey Ashe—Independent Consultant Trudy Sharpe—Program Director Asia/


Pacific Region, Save the Children (SAVE)
Julia Rosenbaum—Project Officer LAC/
Asia, Academy for Educational Development Urban Jonsson—Senior Advisor, (Nutri-
tion), United Nations Children’s Fund
Kenneth H. Brown—Department of Nu- (UNICEF)
trition, University of California, Davis
Valerie Uccellani—Program Officer
Lynn Bennett—Women and Develop- Training, Academy for Educational Develop-
ment Division, World Bank ment

Marilyn Carr—Senior Advisor, United Virginia Lambert—John Snow, Inc., Em-


Nations Fund for Women (UNIFEM) powerment of Women Program

A Literature Review and Analysis!54