Introduction
In every region of the world, the cost of protein- and micronutrient-dense foods, such as animal-source foods, fruits, and vegetables, is often considerably higher than the cost of energy-dense yet micronutrient-poor staples, oils, and sugars. It is well established that healthier diets cost more than unhealthy diets. Because the poor tend to be more sensitive to food prices, they are more likely to be affected by the relatively higher costs of more nutritious foods. Consequently, poor households are more likely to consume lower quality diets and suffer associated negative health outcomes.
Recent research illustrates that stunting in children aged 6-23 months is negatively correlated with the consumption of animal-source foods and that high relative prices of these foods are a key factor limiting their consumption.
Despite the constraining impact of relatively higher-priced nutrient-dense foods, agricultural and food security policies largely remain focused on the production of energy-dense staple crops. Similarly, poverty monitoring is rooted in the cost of calorically adequate diets that are consistent with food consumption patterns of poor households.
Fortunately, in recent years, efforts to reduce undernutrition are shifting toward more comprehensive approaches that recognize the critical role of diets that are both calorically adequate and composed of a diverse set of protein- and micronutrient-dense foods.
The Government of Myanmar is making strides to do this with its five-year (2018-2022) Multi-Sectoral National Plan of Action for Nutrition (MS-NPAN). Acknowledging the integral role of nutrition in achieving a myriad of development goals, MS-NPAN is working across ministries to reduce malnutrition in mothers, children, and adolescent girls. Key areas of action target health, social welfare, education, and agriculture outcomes, and include promoting nutrition-sensitive agriculture as well as improving food security via small-scale horticulture, fishery, and livestock development.
The cost of the recommended diet
The success of ambitious and multi-layered plans such as MS-NPAN requires a set of tools designed to monitor access to nutritious foods. One tool for this purpose is the Cost of the Recommended Diet (CoRD) metric, which is used to assess the cost of nutritious diets that meet national policy and nutrition messaging in food-based dietary guidelines (FBDG). Many countries have national FBDG, and several key messages recur across countries; similarities are particularly strong within regions. Myanmar is in the early stages of developing FBDG and does not yet have quantified dietary recommendations.
This work is guided by general food group messages for Myanmar together with specific food group quantities provided in a composite South Asian recommended diet assembled by Dizon and Herforth. We further developed the CoRD metric for use in Myanmar by costing two different sets of foods: (1) minimum cost foods in each food group foods and (2) a range of foods weighted to reflect food preferences. These costs are then compared to household food consumption expenditure to assess the affordability of the recommended diet.
Affordability of the recommended diet
Our analysis shows the CoRD for Myanmar, using two nationally representative Myanmar household surveys (2010 and 2015).
In 2015, just over half of the population (52%) lived in a household that could not afford the food preference CoRD relative to actual household food consumption expenditure, and about one quarter (24%) could not afford the minimum CoRD.
However, the affordability of the recommended diet has improved compared to 2010, when 70% of the population lived in a household that could not afford the food preference CoRD and 32% could not afford the minimum CoRD. This improvement is consistent with a 24% decline in the poverty headcount from 42 to 32% over the same time period.
The food preference CoRD is 47% more expensive than the minimum CoRD in Myanmar. While the minimum CoRD is the bare minimum cost of meeting dietary guidelines, the food preference CoRD captures the additional cost of acquiring a recommended diet based on a set of foods that reflect dietary customs and habits.
Analysis of household food consumption patterns relative to the recommended diet indicates that a majority of households considerably under-consume protein and micro-nutrient dense foods.
In 2015, only 38%, 16%, and 9% of the population lived in households that consumed the recommended quantities of protein-rich foods, vegetables, and fruits, and less than 1% consumed the recommended quantity of dairy products. Consumption of each of these food groups increases considerably with total household expenditure.
Consistent with recent research from countries throughout South and Southeast Asia, Myanmar prices per calorie of the most nutrient-dense foods are considerably higher than that of rice, suggesting that relative prices could be a key factor in the over-consumption of rice in lieu of nutrient-dense foods. For example, the price per calorie of chicken, papaya, and fish are 24, 10, 18 times higher, respectively, than the price per calorie of rice.
Policy recommendations
The relatively high cost of many micronutrient-dense foods is a key constraint to consuming a nutritious diet, especially for the poor. Dietary habits and individual-level factors also play an important role in food consumption decisions, illustrated by the fact that 88% of relatively wealthy households (in the highest expenditure quintile) have sufficient food consumption expenditure to consume the food preference CoRD, yet only 19 and 36% consume the recommended diet quantities of vegetables and fruits, respectively.
This result highlights the need for policies designed to increase the consumption of nutritious diets and address the issue from multiple fronts including promoting healthy food habits and choices and addressing the high relative prices of nutrient-dense foods.
You can read the full paper by Kristi Mahrt here, in English.
This work was undertaken as part of the CGIAR Research Program on Policies, Institutions, and Markets (PIM) and the CGIAR Research Program on Agriculture for Nutrition and Health (A4NH), which are both led by the International Food Policy Research Institute (IFPRI). Funding support for this study was provided by PIM, A4NH, the United States Agency for International Development (USAID), the Livelihoods and Food Security Trust Fund (LIFT), and the Changing Access to Nutritious Diets in Africa and South Asia (CANDASA) project.
This blog was prepared by Kristi Mahrt, Senior Research Analyst in the Development Strategy and Governance Division of IFPRI, Washington, DC.