Nutrition in Assam State in India

Assam is among one of India’s poorest states. With a population of 34 million, one-third live in poverty and 86 percent live in rural areas and are primarily engaged in agriculture. Undernutrition in Assam is a major concern. More than a third of children under five years of age are stunted and 22 percent are acutely malnourished or wasted and only 8 percent of children 6–23 months are fed a minimally acceptable diet, ranking next to last for this indicator among all states in India (NFHS-5). Evidence suggests that the COVID-19 pandemic worsened malnutrition and socioeconomic conditions, particularly among women. For example, according to one report, 90 percent of households surveyed reported reduced food intake during the national lockdown, and even six months after lockdowns were lifted, about 20 percent still reported a similar trend.

Using Formative Research to Inform Nutrition-Sensitive Agriculture Activities 

To mitigate the pandemic’s effects on nutrition, USAID Advancing Nutrition India supports the empowerment of rural women to increase their access to economic opportunities and improve the consumption of healthy diets in rural Assam, India. To inform target nutrition-sensitive approaches, we undertook social and behavior change (SBC) formative research in 2022 to better understand priority behaviors that, from the point of view of the program participants, could improve their incomes and positively affect household nutrition. Critical to our process, the project took a human-centered design approach, which positions program participants in the driver’s seat to select behaviors and design solutions with the project. 

Women's Empowerment Perceived as a Potential Threat to Local Customs

In focus group discussions, participants prioritized two behaviors that they felt would have the greatest impact on their agricultural productivity, and thus have a positive impact on income and overall household dietary diversity. These included: 1) Men and women (or households) make joint decisions about household assets related to agriculture, and 2) Women grow nutrient-dense vegetables, fruits or fish for household consumption and sales, employing improved practices. 

Important to both behaviors, we found that gender and social norms are critical factors affecting women’s involvement in livelihood development activities, as well as other household activities that may affect nutrition. The project has honed in on three critical factors (see graphic below), which, interestingly, all stem from a gender and/or social constraint. For example, our formative research highlights that women are not seen as capable producers or capable of participating in decisions about household assets and are perceived to lack the skills, knowledge and confidence to meaningfully participate in agriculture, livelihood development and household decision-making activities. These external perceptions have internalized effects for women in rural Assam. Namely, women do not feel they have the requisite knowledge or skills to be successful in agriculture and therefore lack the confidence and belief in themselves to be successful. Further, male research participants noted that men are often hesitant to support their wives’ participation in livelihood activities since they can pull women away from household chores and caretaking responsibilities, and they have limited confidence in the women’s ability to be successful. However, recent research from India from CGIAR, demonstrates that women’s participation in income-generating activities improves household diet diversity and does not negatively impact the completion of caretaking or household chores — though these additional activities may increase women’s overall time burdens.  

Next Steps of Empowering Women in India for Nutrition

Often, programs view women’s empowerment as an “add on” to their agriculture and food systems development programming. However, our research shows that considering women’s empowerment and deep-seated social norms is a prerequisite for success in promoting increased productivity and consumption of safe, healthy foods in rural Assam. 

Using a human-centered design approach, the USAID Advancing Project, along with female  program participants identified several activities to address these gender and social factors that affect behavior change. These include activities that will increase women’s confidence in themselves as capable producers, such as nutrition-sensitive agriculture trainings in their women-self help groups and conducting exposure visits, where women can visit other successful female producers to see firsthand their experiences and practices. To address social norms held by husbands and other community members, program participants highlighted that their husbands and men in the village need to be brought along. Therefore, USAID Advancing Nutrition will facilitate household visits where local community influencers can discuss agricultural, nutrition and women’s empowerment messages with both spouses, among other activities. 

The findings from our research in Assam, India, mirror similar constraints faced by women that are presented in USAID’s Working within the Food System: Gender Considerations for Achieving Improved Diets. Additionally, USAID’s Focusing on Social Norms: A Practical Guide for Nutrition Programmers to Improve Women’s and Children’s Diets, provides tips and tools to design programs that are responsive to social norms.