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How does nutrition improve? We need to understand better what drives both positive and negative change in different contexts, and what more can be done to reduce malnutrition. Since 2015, the Stories of Change in Nutrition studies have analysed and documented experiences in many different African and Asian countries, to foster empirically-grounded experiential learning across contexts. This article provides an overview of findings from 14 studies undertaken in nine countries in South Asia, sub-Saharan Africa, and Europe between 2017 and 2021. The studies used a combination of methods, including regression-decomposition analyses of national datasets to assess determinants of nutritional change; policy process and food environment analyses; and community-level research assessing attitudes to change. This article takes a narrative synthesis approach to identify key themes across the studies, paying particular attention to multisectoral determinants, changes in the food environment, the role of structural factors (including longstanding social inequities), and changes in political commitment, cross-sectoral coherence and capacity. Given the inherent multisectoral nature of nutrition, many countries are experimenting with different models of ensuring coherence across sectors that are captured in this body of work. The relative immaturity of the policy sector in dealing with issues such as obesity and overweight, and associated influences in the wider food environment, adds a further challenge. To address these interrelated issues, policy must simultaneously tackle nutrition’s upstream (social/economic/equity) and downstream (health and dietary) determinants. Studies synthesised here provide empirically-driven inspiration for action.

Food systems are currently facing unprecedented challenges. More than 690 million people still suffer hunger while climate change, rapid depletion of natural resources, and loss of biodiversity further threaten future food systems. Influential global reports emphasize the need for fundamental transformations of food systems for human and planetary health, but few incorporate economic considerations. This review adopts an economic lens to assessing potential transitions to ideal food systems that are productive, sustainable, nutritious, resilient, and inclusive. Our findings show that new technologies, policies, institutions, and behavior changes can leverage synergies for achieving multiple food system targets, but rigorous economic analysis is needed to further analyze trade-offs and to overcome complex behavioral, institutional, and political barriers. This review also points to important knowledge gaps that economists and other social scientists must address to contribute to the radical transformation of food systems.

This paper advances previous literature that has posited a climate-nutrition link without identifying a specific pathway via agriculture. We measure the specific effects of exposure to extreme heat on maize yields in Tanzania, and then test whether prenatal heat-induced yield losses predict subsequent child growth outcomes. In the first stage we find that substituting one full day (24 h) exposure to 39 °C for a day at 29 degrees reduces predicted yield for the entire growing season by 6–11%. In the second stage we find that in utero exposure to growing degree days greater than 29 °C predicts lower postnatal HAZ scores for Tanzanian boys 0–5 years of age, but not girls. Consistent with a maternal malnutrition mechanism, we also find a negative association between maize yields and women’s body mass. Insofar as climate change is likely to increase the incidence of heat shocks in much of sub-Saharan Africa, our results suggest a significant risk of adverse nutritional impacts.

The 21st Century has been marked by increased volatility in food prices, with global price spikes in 2007-08, 2010-11, and again in 2021-22. The impact of food inflation on the risk of child undernutrition is not well understood, however. This study explores the potential impacts of food inflation on wasting and stunting among 1.27 million pre-school children from 44 developing countries. On average, a 5 percent increase in the real price of food increases the risk of wasting by 9 percent and severe wasting by 14 percent. These risks apply to young infants, suggesting a prenatal pathway, as well as to older children who typically experience a deterioration in diet quality in the wake of food inflation. Male children and children from poor and rural landless households are more severely impacted. Food inflation during pregnancy and the first year after birth also increases the risk of stunting for children 2-5 years of age. This evidence provides a strong rationale for interventions to prevent food inflation and mitigate its impacts on vulnerable children and their mothers.

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 the COVID-19 crisis on maternal and child nutrition outcomes, and productivity losses due to childhood stunting and mortality, in 118 low- and middle-income countries are projected under optimistic, moderate and pessimistic scenarios. Six nutrition interventions to mitigate excess stunting and child mortality are financially costed.

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.

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. An economic model estimates increases in the number of people unable to afford even half the cost of healthy diets in low- and middle-income countries due to the COVID-19 crisis.

Background India has high rates of child undernutrition and widespread lactovegetarianism. Objectives The objective of this study was to examine how nutrition outcomes varied among Indian preschool children in relation to the vegetarian status of their parents. Methods The 2015–2016 National Family Health Survey (NFHS) and the 2011–2012 National Sample Survey (NSS) were used to explore associations between parental vegetarian status and child stunting and wasting at ages 0–59 mo and anemia at ages 6–59 mo. In the NFHS, self-reports on usual consumption of foods were used to classify maternal diets, whereas in the NSS lactovegetarianism was defined at the household level. Results Compared with children of nonvegetarian mothers, children aged 24–59 mo of lactovegetarian mothers were 2.9 percentage points (95% CI: −4.0, −1.9) less likely to be stunted and children aged 6–23 mo were 1.6 points less likely to be wasted (95% CI: −3.0, −0.03), whereas children aged 6–23 mo with vegan mothers were 5.2 points more likely to be stunted (95% CI: 0.1, 9.4). When compared with nonvegetarian households, lactovegetarian households had better socioeconomic status and were more likely to consume dairy frequently. Children in nonvegetarian households consumed nondairy animal-sourced foods (ASFs) with relatively low frequency. The frequency of maternal dairy consumption was significantly associated with lower risks of child stunting and wasting. Conclusions Anthropometric outcomes differed by maternal vegetarian status, which is itself strongly associated with socioeconomic position, location, religion, and caste.

Background Relative prices of healthy/unhealthy foods have been implicated in the obesity epidemic, but never extensively quantified across countries or empirically linked to undernutrition. Objectives This study compared relative caloric prices (RCPs) for different food categories across 176 countries and ascertained their associations with dietary indicators and nutrition outcomes. Methods We converted prices for 657 standardized food products from the 2011 International Comparison Program into caloric prices using USDA Food Composition tables. We classified products into 21 specific food groups. We constructed RCPs as the ratio of the 3 cheapest products in each food group, relative to the weighted cost of a basket of starchy staples. We analyzed RCP differences across World Bank income levels and regions and used cross-country regressions to explore associations with Demographic Health Survey dietary indicators for women 15–49 y old and children 12–23 mo old and with WHO indicators of the under-5 stunting prevalence and adult overweight prevalence. Results Most noncereal foods were relatively cheap in high-income countries, including sugar- and fat-rich foods. In lower-income countries, healthy foods were generally expensive, especially most animal-sourced foods and fortified infant cereals (FICs). Higher RCPs for a food predict lower consumption among children for 7 of 9 food groups. Higher milk and FIC prices were positively associated with international child stunting patterns: a 1-SD increase in milk prices was associated with a 2.8 percentage point increase in the stunting prevalence. Similarly, a 1-SD increase in soft drink prices was associated with a reduction in the overweight prevalence of ∼3.6 percentage points. Conclusions Relative food prices vary systematically across countries and partially explain international differences in the prevalences of undernutrition and overweight adults. Future research should focus on how to alter relative prices to achieve better dietary and nutrition outcomes.

Child dietary diversity is poor in much of rural Africa and developing Asia, prompting significant efforts to leverage agriculture to improve diets. However, growing recognition that even very poor rural households rely on markets to satisfy their demand for nutrient-rich non-staple foods warrants a much better understanding of how rural markets vary in their diversity, competitiveness, frequency and food affordability, and how such characteristics are associated with diets. This article addresses these questions using data from rural Ethiopia. Deploying a novel market survey in conjunction with an information-rich household survey, we find that children in proximity to markets that sell more non-staple food groups have more diverse diets. However, the association is small in absolute terms; moving from three non-staple food groups in the market to six is associated with an increase in the number of non-staple food groups consumed by ˜0.27 and the likelihood of consumption of any non-staple food group by 10 percentage points. These associations are similar in magnitude to those de-scribing the relationship between dietary diversity and household production diversity; moreover, for some food groups, notably dairy, we find that household and community production of that food is especially important. These modest associations may reflect several specific features of our sample which is situated in very poor, food-insecure localities where even the relatively better off are poor in absolute terms and where, by international standards, relative prices for non-staple foods are very high.

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.

Graphical abstract, Highlights • Policies and programs often aim to bring nutritious diets within reach of the poor. • We use food prices and composition to compare least-cost diets around the world. • Globally, nutrient adequacy costs 2.66 times the cost of subsistence daily energy. • Affordability of nutritious diets is negatively associated with rural travel times. • Differences in least-cost foods across countries reveal targets for intervention., Many policies and programs aim to bring nutritious diets within reach of the poor. This paper uses retail prices and nutrient composition for 671 foods and beverages to compute the daily cost of essential nutrients required for an active and healthy life in 177 countries around the world. We compare this minimum cost of nutrient adequacy with the subsistence cost of dietary energy and per-capita spending on all goods and services, to identify stylized facts about how diet cost and affordability relate to economic development and nutrition outcomes. On average, the most affordable nutrient adequate diet exceeds the cost of adequate energy by a factor of 2.66, costing US$1.35 per day to meet median requirements of healthy adult women in 2011. Affordability is lowest in Sub-Saharan Africa. The sensitivity of diet costs to each requirement reveals the high cost of staying within acceptable macronutrient ranges, particularly the upper limit for carbohydrates. Among micronutrients, total diet costs are most sensitive to requirements for calcium as well as vitamins A, C, E, B12, folate and riboflavin. On average, about 5% of dietary energy in the least-cost nutrient adequate diets is derived from animal source foods, with small quantities of meat and fish. Over 70% of all animal products in least-cost diets is eggs and dairy, but only in upper-middle and high-income countries. In lower income countries where egg and dairy prices are significantly higher, they are replaced by larger volumes of vegetal foods. When controlling for national income, diet costs are most significantly correlated with rural travel times and rural electrification. These data suggest opportunities for targeted policies and programs that reduce market prices and the cost of nutritious diets, while improving affordability through nutrition assistance, safety nets and higher earnings among low-income households.

Nigeria is a high burden country for stunting. Stunting reduction has been slow and characterized by unequal progress across the 36 states and federal capital territory of the country. This study aimed to assess the changes in prevalence of stunting and growth determinants from 2003 to 2018, identify factors that predicted the change in stunting, and project future stunting prevalence if these predicted determinants improve. Trend and linear decomposition analyses of growth outcomes and determinants were conducted using 2003, 2008, 2013, and 2018 Nigeria Demographic and Health Survey data. Pooled data included 57,507 children 0 to 59 months old. Findings show that stunting and severe stunting significantly reduced from 43 to 37% and 23% to 17%, respectively (p0.001), between 2003 and 2018. Disturbingly, height-for-age z-scores at birth significantly decreased, indicating risks of potential future stunting increase. Improvements in nine stunting determinants (maternal body mass index, maternal height, ≥ 4 antenatal care visits, health facility delivery, reduced child illnesses, asset index, maternal education, paternal education, and preceding birth interval) predicted stunting reductions in children 0-59 months. Few of these nine determinants improved in subpopulations with limited stunting progress. Intra-sectoral and multisectoral coordination were potentially inadequate; 12% of children had received all of three selected health sector interventions along a continuum of care and 6% had received all of six selected multisector interventions. Forward looking projections suggest that increased efforts to improve the nine predictors of stunting change can reduce under-five stunting in Nigeria to ≤ 27% in the short term.The online version contains supplementary material available at 10.1007/s12571-022-01279-8.

Rapid urban expansion has important health implications. This study examines trends and inequalities in undernutrition and overnutrition by gender, residence (rural, urban slum, urban non-slum), and wealth among children and adults in India. We used National Family Health Survey data from 2006 and 2016 (n = 311,182 children 0-5y and 972,192 adults 15-54y in total). We calculated differences, slope index of inequality (SII) and concentration index to examine changes over time and inequalities in outcomes by gender, residence, and wealth quintile. Between 2006 and 2016, child stunting prevalence dropped from 48% to 38%, with no gender differences in trends, whereas child overweight/obesity remained at ~7–8%. In both years, stunting prevalence was higher in rural and urban slum households compared to urban non-slum households. Within-residence, wealth inequalities were large for stunting (SII: -33 to -19 percentage points, pp) and declined over time only in urban non-slum households. Among adults, underweight prevalence decreased by ~13 pp but overweight/obesity doubled (10% to 21%) between 2006 and 2016. Rises in overweight/obesity among women were greater in rural and urban slum than urban non-slum households. Within-residence, wealth inequalities were large for both underweight (SII -35 to -12pp) and overweight/obesity (+16 to +29pp) for adults, with the former being more concentrated among poorer households and the latter among wealthier households. In conclusion, India experienced a rapid decline in child and adult undernutrition between 2006 and 2016 across genders and areas of residence. Of great concern, however, is the doubling of adult overweight/obesity in all areas during this period and the rise in wealth inequalities in both rural and urban slum households. With the second largest urban population globally, India needs to aggressively tackle the multiple burdens of malnutrition, especially among rural and urban slum households and develop actions to maintain trends in undernutrition reduction without exacerbating the rapidly rising problems of overweight/obesity.

Suboptimal diets are a major risk factor for avoidable death and disease in low- and middle-income countries. Evidence shows that some foods or food components (e.g., processed red meat, saturated fat, salt, sugar) significantly elevate the risk of noncommunicable diseases and mortality, while others protect health (e.g., vegetables, fruits, pulses, nuts/seeds, fish, whole grains—referred to in this document as “protective foods†). We used household surveys to compare dietary patterns in Ethiopia, Kenya, Tanzania, and Uganda to the EAT-Lancet healthy reference diet and to quantify and explain consumption gaps for nutritious foods. Compared to the EAT-Lancet healthy reference diet, consumption gaps for pulses and nuts/seeds, vegetables, and fruits are large for both poor and rich consumers in rural and urban areas in the four countries studied, while consumption gaps for meat, fish, and eggs and dairy foods are much larger for lower income groups. Food expenditures of most households in these four countries are far too low to allow consumption of the healthy reference diet; animal-source foods and vegetables are the largest cost components of food expenditures, although quantities consumed of both food groups are much lower than the EAT-Lancet healthy reference diet. Income elasticities of demand for pulses and nuts/seeds and vegetables are often low or moderate, suggesting weak consumer preference for these foods, while income elasticities for fruits and animal-source foods are relatively high. Income growth alone will not solve dietary problems in East Africa; in addition to supply-side interventions to improve affordability, special interventions are required to increase consumer demand for underappreciated protective (nutritious) foods such as pulses and nuts/seeds and vegetables.

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

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.

Myanmar had one of the lowest confirmed COVID-19 caseloads in the world in mid-2020 and was one of the few developing countries not projected to go into economic recession. However, macroeconomic projections are likely to be a poor guide to individual and household welfare in a fast-moving crisis that has involved disruption to an unusually wide range of sectors and livelihoods. To explore the impacts of COVID-19 disruptions on household poverty and coping strategies, as well as maternal food insecurity experiences, this study used a telephone survey conducted in June and July 2020 covering 2,017 mothers of nutritionally vulnerable young children in urban Yangon and rural villages of Myanmar’s Dry Zone. Stratifying results by location, livelihoods, and asset-levels, and using retrospective questions on pre-COVID-19 incomes and various COVID-19 impacts, we find that the vast majority of households have been adversely affected from loss of income and employment. Over three-quarters cite income/job losses as the main impact of COVID-19 – median incomes declined by one third and $1.90/day income-based poverty rose by around 27 percentage points between January and June 2020. Falling into poverty was most strongly associated with loss of employment (including migrant employment), but also with recent childbirth. The poor commonly coped with income losses through taking loans/credit, while better-off households drew down on savings and reduced non-food expenditures. Self-reported food insecurity experiences were much more common in the urban sample than in the rural sample, even though income-based and asset-based poverty were more prevalent in rural areas. In urban areas, around one quarter of respondents were worried about food quantities and quality, and around 10 percent stated that there were times when they had run out of food or gone hungry. Respondents who stated that their household had lost income or experienced food supply problems due to COVID-19 were more likely to report a variety of different food insecurity experiences. These results raise the concern that the welfare impacts of the COVID-19 crisis are much more serious and widespread than macroeconomic projections would suggest. Loss of employment and casual labor are major drivers of increasing poverty. Consequently, economic recovery strategies must emphasize job creation to revitalize damaged livelihoods. However, a strengthened social protection strategy should also be a critical component of economic recovery to prevent adversely affected households from falling into poverty traps and to avert the worst forms of food insecurity and malnutrition, particularly among households with pregnant women and young children. The recent second wave of COVID-19 infections in Myanmar from mid-August onwards makes the expansion of social protection even more imperative.

The COVID-19 crisis in Myanmar poses a very serious risk to the nutritional status of vulnerable populations, notably women and children, as well as poor urban populations and internally displaced persons. The COVID-19 crisis will hit vulnerable groups through multiple mechanisms.

There is an urgent need to anticipate and mitigate the threat posed by COVID-19 to Myanmar’s agricultural sector and to rural households that depend on farming for income and for food and nutrition security. We evaluate options to address the threat and to support farmers to prepare their land and plant their crops on time in the short window before the start of the 2020 monsoon cropping season. Recognizing that no single intervention can address the full range of vulnerabilities faced by rural households, we recommend a combination: • Expansion of access to seasonal farm credit with extended loan repayment schedules; • Limited agricultural input subsidies targeting certified seed; and • Implementation of a cash transfer program to smallholder farmers. Despite the high cost of a cash transfer program, there are good reasons to expect that the benefits of such support to farm households will outweigh program costs in monetary terms – even more so if the economic benefits from the consequent lower incidence of malnutrition to which the program would contribute can be measured.

In developing 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 growth shocks over 1990-2018 by linking wasting outcomes collected for 1.256 million children from 52 countries to lagged annual changes in national income. Difference-in-difference estimates suggest that a 10% annual decline in national income increases moderate/severe (WHZ

This policy note presents results from five rounds of a telephone survey with food vendors conducted in different rural and urban zones of the country, focusing on results from the last round completed. The purpose of the survey is to provide data and insights to the government, development partners, and interested stakeholders to understand the COVID-19 related shocks on Myanmar’s food markets. In particular, the note explores prevention measures, changes in shopping behavior, difficulties in food vendor operations due to the COVID-19 crisis, changes in availability and prices of foods, perceived changes in consumption, and suggested policy actions by these food vendors.

Eggs have high potential for improving nutrition outcomes in low-income countries, yet very few children in such settings consume eggs on a regular basis despite widespread poultry ownership. To redress this disconnect, a number of interventions have been implemented to improve household production of poultry products, as well as caregiver awareness of the nutritional benefits of eggs and other animal-sourced foods. However, very few of these interventions have tried to leverage food markets to improve nutrition, even though most rural people predominantly rely on markets for the majority of their non-staple food consumption. This study was implemented to better understand the constraints to purchasing eggs for consumption by young children in rural Ethiopia, with a view to informing the design of marketoriented interventions that might cost-effectively increase children’s egg consumption. To do so we analyzed secondary datasets on poultry ownership, household and child egg consumption, and retail egg prices to understand egg markets and the egg value chain in Tigray. Similar to other contexts in sub-Saharan Africa, we find that two-thirds of households own poultry, though only onequarter of young children consumed eggs in the past 24 hours. Although markets in Tigray are well integrated – likely because of the important role of egg aggregators – egg prices remain high. A modest consumption level of 2.5 eggs per person per week would cost around 10 percent of the total budget of households in the poorest quintile of households, even though eggs are more affordable than other animal-sourced foods. We find that egg consumption among young children is not constrained by fasting associated with Orthodox Christianity. High prices are likely the main constraint and are a function of low levels of intensification in egg production, which is dominated by backyard poultry systems characterized by high mortality rates and low productivity. Localized increases in egg production will therefore be needed to lower prices, at least in the short to medium term. We hypothesize that extending the presence of private sector poultry input suppliers in Tigray – who provide chicks through semi-independent agents – offers an entry point for increasing production, lowering prices, and increasing consumption. These input suppliers already have a scalable micro- ranchising model that provides strong economic returns to raising poultry. That model could potentially also be leveraged to raise awareness of the nutritional benefits of eggs.

To better understand the economic and social impacts of the COVID-19 crisis on Myanmar’s diverse rural and urban communities, a multi-round large-scale community telephone survey is being conducted. The first round of the survey took place in June and July 2020, while the second round was done in August. This report focuses on key findings from the third round of survey done in August and September 2020. The survey obtained information from community respondents that had participated in the first or second rounds as well as from additional communities. In total, the third round obtained responses from 186 townships across Myanmar.

To better understand the economic and social impacts of the COVID-19 crisis on Myanmar’s diverse rural and urban communities, a large-scale community telephone survey was conducted. The first survey round was implemented in June and July 2020 with respondents from 308 different communities covering 168 of Myanmar’s 356 townships. A second survey round was conducted in July and August 2020 with respondents from the same communities and from communities in an additional 185 townships. We report key findings from this second round, comparing to those from the first round.

The COVID-19 pandemic has triggered a global economic crisis from which very few countries will be spared. As a result of few COVID-19 cases, a relatively short-lived lockdown, and economic momentum prior to COVID-19, Myanmar is one of the few developing countries that the World Bank (2020) forecasts will not go into recession in 2020 – a very modest expansion of just 0.87 percent is forecast. A Social Accounting Matrix multiplier analysis by IFPRI projected a 0.50 percent expansion under a fast economic recovery scenario, but a 2.00 percent contraction under a slow economic recovery scenario (Diao et al., 2020). The IFPRI study projects massive declines in GDP across a range of sectors during lockdown periods, including large increases in unemployment (5 million during the lockdown period) and declines in household income of 20 to 30 percent for April to June, albeit with fast recovery thereafter.

The COVID-19 pandemic has all the makings of a perfect storm for global malnutrition. The crisis will damage the nutritional status of vulnerable groups through multiple mechanisms. We can expect a dangerous decline in dietary quality in low- and middle-income countries (LMICs) stemming from the income losses related to government-mandated shutdowns and de-globalization, as well as from the freezing of food transfer schemes such as school feeding programs and the breakdown of food markets due to both demand shocks and supply constraints. But malnutrition will also increase due to healthcare failures, as already strained healthcare systems are forced to divert resources from a range of nutritionally important functions — including antenatal care, immunization, micronutrient supplementation, and prevention and treatment of childhood diarrhea, infections, and acute malnutrition — toward combating COVID-19.

Myanmar had one of the lowest confirmed COVID-19 caseloads in the world in mid-2020 and was one of the few developing countries not projected to go into economic recession. However, macroeconomic projections are likely to be a poor guide to individual and household welfare in a fast-moving crisis that has involved disruption to an unusually wide range of sectors and livelihoods. To explore the impacts of COVID-19 disruptions on household poverty and coping strategies, as well as maternal food insecurity experiences, this study used a telephone survey conducted in June and July 2020 covering 2,017 mothers of nutritionally vulnerable young children in urban Yangon and rural villages of Myanmar’s Dry Zone. Stratifying results by location, livelihoods, and asset-levels, and using retrospective questions on pre-COVID-19 incomes and various COVID-19 impacts, we find that the vast majority of households have been adversely affected from loss of income and employment. Over three-quarters cite income/job losses as the main impact of COVID-19 – median incomes declined by one third and $1.90/day income-based poverty rose by around 27 percentage points between January and June 2020. Falling into poverty was most strongly associated with loss of employment (including migrant employment), but also with recent childbirth. The poor commonly coped with income losses through taking loans/credit, while better-off households drew down on savings and reduced non-food expenditures. Self-reported food insecurity experiences were much more common in the urban sample than in the rural sample, even though income-based and asset-based poverty were more prevalent in rural areas. In urban areas, around one quarter of respondents were worried about food quantities and quality, and around 10 percent stated that there were times when they had run out of food or gone hungry. Respondents who stated that their household had lost income or experienced food supply problems due to COVID-19 were more likely to report a variety of different food insecurity experiences. These results raise the concern that the welfare impacts of the COVID-19 crisis are much more serious and widespread than macroeconomic projections would suggest. Loss of employment and casual labor are major drivers of increasing poverty. Consequently, economic recovery strategies must emphasize job creation to revitalize damaged livelihoods. However, a strengthened social protection strategy should also be a critical component of economic recovery to prevent adversely affected households from falling into poverty traps and to avert the worst forms of food insecurity and malnutrition, particularly among households with pregnant women and young children. The recent second wave of COVID-19 infections in Myanmar from mid-August onwards makes the expansion of social protection even more imperative.