A Prepandemic Nutrition-Sensitive Social Protection Program Has Sustained Benefits for Food Security and Diet Diversity in Myanmar during a Severe Economic Crisis.

BACKGROUND: One-third of preschool children in Myanmar were stunted in 2015-2016, and three-quarters of children 6-23 mo had inadequate diet diversity. In response, a large-scale nutrition-sensitive social protection program was implemented over 2016-2019. In 2020, however, Myanmar's economy was hit hard by the COVID-19 pandemic and harder still by a military takeover in 2021. OBJECTIVE: The objective of this study was to examine whether former beneficiaries of this program experienced better food security, food consumption, and diet diversity outcomes in the wake of major economic shocks. METHODS: In a previous cluster-randomized controlled trial conducted over 2016-2019, pregnant women and their children aged <2 y were randomly assigned to either: 1) CASH; 2) CASH + social and behavioral change communication (SBCC); or 3) a control group. Subsamples of these former participants were then resurveyed 10 times from June 2020 to December 2021 during Myanmar's protracted economic crisis. Randomized treatment exposure was used in a regression analysis to test for postprogram impacts on Food Insecurity Experience Scale indicators, household food consumption, and maternal and child diet diversity. We also examined the impacts on household income as a secondary outcome and potential impact pathway. RESULTS: Both intervention arms reported lower food insecurity, more frequent consumption of nutritious foods, and more diverse maternal and child diets compared with households in the control group. However, the improved dietary outcomes were larger for mothers and children exposed to CASH+SBCC compared with CASH, as was their monthly household income. CONCLUSIONS: The findings suggest that a program combining cash transfers with nutrition-related education can yield sustained benefits 1-2 y after the program was completed. This strengthens the evidence to support the expansion and scale-up of nutrition-sensitive social welfare programs to redress chronic malnutrition and enhance nutritional resilience in the face of a severe economic crisis.

Poverty and food insecurity during COVID-19: Phone-survey evidence from rural and urban Myanmar in 2020.

Myanmar first experienced the COVID-19 crisis as a relatively brief economic shock in early 2020, before the economy was later engulfed by a prolonged surge in COVID-19 cases from September 2020 onwards. To analyze poverty and food security in Myanmar during 2020 we surveyed over 2000 households per month from June-December in urban Yangon and the rural dry zone. By June, households had suffered dramatic increases in poverty, but even steeper increases accompanied the rise in COVID-19 cases from September onwards. Increases in poverty were much larger in urban areas, although poverty was always more prevalent in the rural sample. However, urban households were twice as likely to report food insecurity experiences, suggesting rural populations felt less food insecure throughout the crisis.

Economic shocks predict increases in child wasting prevalence.

In low and middle income countries macroeconomic volatility is common, and severe negative economic shocks can substantially increase poverty and food insecurity. Less well understood are the implications of these contractions for child acute malnutrition (wasting), a major risk factor for under-5 mortality. This study explores the nutritional impacts of economic growth shocks over 1990-2018 by linking wasting outcomes collected for 1.256 million children from 52 countries to lagged annual changes in economic growth. Estimates suggest that a 10% annual decline in national income increases moderate/severe wasting prevalence by 14.4-17.8%. An exploration of possible mechanisms suggests negative economic shocks may increase risks of inadequate dietary diversity among children. Applying these results to the latest economic growth estimates for 2020 suggests that COVID-19 could put an additional 9.4 million preschoolers at risk of wasting, net of the effects of preventative policy actions.

COVID-19 pandemic leads to greater depth of unaffordability of healthy and nutrient-adequate diets in low- and middle-income countries.

Unaffordability of healthy diets affected 3 billion people before the COVID-19 pandemic, 2.5 billion of whom lived in 63 low- and middle-income countries. In these 63 countries, income losses due to the pandemic have markedly worsened the affordability gap. The proportion of people unable to afford half the cost of a healthy diet increased from 43% to 50%; this increased unaffordability will aggravate undernutrition, micronutrient deficiencies and diet-related non-communicable diseases.

The COVID-19 crisis will exacerbate maternal and child undernutrition and child mortality in low- and middle-income countries.

The economic crisis and food and health system disruptions related to the COVID-19 pandemic threaten to exacerbate undernutrition in low- and middle-income countries (LMICs). We developed pessimistic, moderate and optimistic scenarios for 2020-2022 and used three modelling tools (MIRAGRODEP, the Lives Saved Tool and Optima Nutrition) to estimate the impacts of pandemic-induced disruptions on child stunting, wasting and mortality, maternal anaemia and children born to women with a low body mass index (BMI) in 118 LMICs. We estimated the cost of six nutrition interventions to mitigate excess stunting and child mortality due to the pandemic and to maximize alive and non-stunted children, and used the human capital approach to estimate future productivity losses. By 2022, COVID-19-related disruptions could result in an additional 9.3 million wasted children and 2.6 million stunted children, 168,000 additional child deaths, 2.1 million maternal anaemia cases, 2.1 million children born to women with a low BMI and US$29.7 billion in future productivity losses due to excess stunting and child mortality. An additional US$1.2 billion per year will be needed to mitigate these effects by scaling up nutrition interventions. Governments and donors must maintain nutrition as a priority, continue to support resilient systems and ensure the efficient use of new and existing resources.

Impacts of COVID-19 on agricultural production and food systems in late transforming Southeast Asia: The case of Myanmar.

The objective of this contribution is to report the initial impacts of measures taken to contain the COVID-19 pandemic on Myanmar's agri-food system. Myanmar is one of several late-transforming low-income countries in Southeast Asia where agriculture still plays a large role in rural livelihoods, and where food prices are a key factor affecting nutrition security for poor urban and rural households. Whereas the economic impacts of COVID-19 disruptions on tourism and manufacturing were obvious to policymakers, the impacts on the agri-food system were less evident and often more indirect. This resulted in the rural sector being allocated only a very small share of the government's initial fiscal response to mitigate the economic impacts of COVID-19. To correct this information gap, a suite of phone surveys covering a wide spectrum of actors in the agri-food system were deployed, including farm input suppliers, mechanization service providers, farmers, commodity traders, millers, food retailers and consumers. The surveys were repeated at regular intervals prior to and during the main crop production season which began shortly after nationwide COVID-19 prevention measures were implemented in April. While the results indicate considerable resilience in the agri-food system in response to the initial disruptions, persistent financial stress for a high proportion of households and agri-food system businesses indicate that the road to a full recovery will take time. The experience provides important lessons for strengthening the resilience of the agri-food system, and the livelihoods of households that depend on it.