Malnutrition in Ethiopia is a systems problem requiring coordinated action across sectors
Ethiopia and many other low- and middle-income countries face a double burden of malnutrition. Undernutrition coexists with rising overweight or obesity, particularly amongst women in urban areas. Most policies and programmes have focused on undernutrition and emphasised nutrition education and behavioural change. With the support of the Marie Skłodowska-Curie Actions (MSCA) programme, the TAMMIE project set out to examine this double burden holistically, moving beyond these traditional approaches. It explored shared drivers of malnutrition, community perspectives, existing policies, priorities and key stakeholders.
Bringing women’s lived experiences into the evidence
Women of reproductive age and children under five are among the most vulnerable to malnutrition. Improving their diets today is essential and can help break the intergenerational cycle of different forms of malnutrition. TAMMIE focused on these population groups in Ethiopia.[RP5.1] Using a participatory photography approach, PhotoVoice(opens in new window), TAMMIE empowered women to communicate their lived experiences and daily challenges in feeding themselves and their children, and to propose solutions. “By treating women as partners in the research process rather than subjects of it, the project integrated lived experiences with scientific and policy evidence to develop recommendations that were both evidence-based and grounded in everyday realities,” explains MSCA fellow and project lead Rebecca Pradeilles of the French National Research Institute for Sustainable Development and the International Food Policy Research Institute. Results were shared with researchers, decision-makers and the wider public through exhibitions, a photography booklet(opens in new window) and a policy brief(opens in new window).
Financial and structural barriers outweigh information gaps
The project’s findings highlighted a disconnect between the challenges women face in accessing healthy diets and the common focus of many approaches – nutrition information/education and individual behavioural change. “The women in Addis Ababa consistently highlighted financial and structural challenges to adopting healthy diets, such as insufficient income and time constraints linked to unequal household responsibilities, particularly childcare. Women noted inadequate cooking facilities at home, high food prices, concerns about food safety and unhealthy food environments as well,” [RP6.1]underscores Pradeilles[RP7.1][AB7.2]. Women also proposed solutions, including making healthy foods more affordable and creating community-based support mechanisms and policies to regulate the promotion of unhealthy foods. Identified barriers and proposed solutions differed across socio-economic groups, pointing to the need for tailored interventions.
Addressing fragmentation and setting priorities
Project research showed that Ethiopia’s many nutrition-related policies addressing different forms of malnutrition remain fragmented and largely focused on undernutrition. Stakeholder mapping also revealed a complex nutrition ecosystem involving government, donors, researchers and civil society, while highlighting the importance of stronger collaboration among these actors. Stakeholders identified maternal nutrition, breastfeeding and nutrition-sensitive agriculture as key priorities for action. One of TAMMIE’s key contributions is to reframe malnutrition as a systems problem rather than purely a health issue. “The double burden of malnutrition in Ethiopia is driven by interconnected dietary, social, economic and institutional factors; thus, it must be addressed through multisectoral approaches with meaningful involvement of the people most affected in shaping solutions,” explains Pradeilles[RP8.1]. “The project’s findings will inform the development of an intersectoral roadmap for tackling all forms of malnutrition in Ethiopia,” adds project collaborator Kaleab Baye of the University of Addis Ababa. Coordinated action across health, education, social protection and food systems could help reduce both undernutrition and overweight/obesity and limit its impact on future generations. It could also support more efficient use of resources and curtail[MH9.1] the longer-term costs associated with malnutrition and related diseases.
