Food And Nutrition - UNDP

The State ofFood andNutritionInsecurity inLiberiaComprehensive Food Security andNutrition Survey2010REPUBLIC OFLIBERIAMonroviaOctober 2010Data collected betweenMay – August 2010

Liberia:The State of Food and Nutrition Security October 2010 was conductedwithin the framework of a Comprehensive Food Security and Vulnerability Survey (Datacollected in May –August 2010)Prepared by Bernard Owadi (WFP), Andi Kendle (UNICEF Consultant) and Tarnue Koiwu(MOA)Reviewed by Deroe A. Weeks and Sayba Tamba of MOA, Getachew Diriba, Siemon Hollema,Jean‐Martin Bauer and Naouar Labidi of WFP, Pragya Mathema and John Agbor of UNICEF,Francis Wreh of LISGIS, Stella Subah of MOHSW.Survey design and data processing was done by the World Food Programme in collaborationwith Liberia Institute of Statistics and Geo Information Services and UNICEF.October 2010 Ministry of agriculture and World Food Programme, VAM Food Security AnalysisCover photo: Ministry of AgricultureThe 2010 State of Food and Nutrition Security in Liberia is available gis.org

The State of Food and NutritionInsecurity in LiberiaComprehensive Food Security and Nutrition Survey 2010Key MessagesFood security Food security status is improving compared to 2006 but remains unacceptably high with 41% ofthe population’s food intake below acceptable. Liberia remains highly dependent on foreign markets for food (two‐thirds is imported). This foodimport dependency is increasing. Structural problems of inequality, poverty, unemployment and food insecurity that led to the 14years of civil conflict remain largely unaddressed. Under‐ and unemployment, especially among young people, is very high. The farm sector which employs two thirds of the 3.5 million population is underperforming dueto low investment and impact of the civil war. However, rice production, helped by the 2008 foodprice crisis, is gradually mounting. Liberia is a cash‐crop oriented economy and issues ofcompetitive food imports, limited infrastructure and pressure to keep food prices low for theurban population hinder agricultural food crop production. Infrastructure development including roads and bridges remains a key government challenge inorder to facilitate access to markets. Education achievements are low. Net primary school enrolment is as low as 65%. Secondaryschool enrolment is even lower at 38%.Nutrition Thirty‐five percent of mortality in under‐five year old children is related to malnutrition The 1,000 days from the beginning of pregnancy to the second year of life of the child is thecritical period to intervene for nutrition Children under two years of age consume relatively little food, but need nutrient dense food,good caring practices and effective treatment of childhood illnesses to avoid malnutrition Improved infant and young child feeding is critical for children’s nutrition (exclusivebreastfeeding, continued breastfeeding and complementary nutrient dense foods) Stunting continues to be a significant huge problem in children Acute malnutrition is improving and efforts should be sustained for its effective management inorder to see significant impact on child mortality. The double burden of malnutrition is increasingly becoming a public health concern with theoccurrence of undernutrition among children and overnutrition among older women. Malnutrition in children is closely related to malnutrition in women. Greater efforts are neededto improve nutrition in women and delay women’s first birth until after completion of adolescentgrowth.

ContentList of Figures . 6List of Maps . 7List of Tables . 7Appendices. 7List of acronyms . 9Executive summary . 14Where do the food‐insecure or malnourished people live? . 151. Background and introduction . 222. Food consumption in Liberia . 253. Vulnerabilities in the post‐conflict situation . 283.1 Increasing reliance on world markets for food. 283.1.1 Trade balance and foreign exchange . 303.1.2 Dependency on markets and price stability . 313.1.3 Cross border trade . 333.1.4 Rice subsidies . 353.2 Performance of the crop farming sector . 363.2.1 Rice . 363.2.2 Cassava . 393.2.3 Other food crops . 393.2.4 Cash crop production . 393.2.4.1 Palm oil . 393.2.4.2 Rubber . 403.2.4.3 Cocoa . 403.2.4.4 Fisheries . 413.2.4.5 Livestock . 413.2.5 Farming at household level. 433.2.6 Agricultural constraints . 453.3 Persistent poverty, high levels of unemployment and low educationalachievements . 473.3.1 Who are the poor? . 473.3.2 Household expenditure . 483.3.3 Wealth . 523.3.4 Livelihoods . 523.3.5 Low education and unemployment . 563.4 Limited road infrastructure. 583.5 Political stability and security . 604. State of Food Insecurity . 634.1 Food availability, access and utilization . 634.2 Inability to access sufficient food versus poor utilization of food . 634.3 Which groups have the highest food insecurity levels? . 654.4 Where do Liberians source their food? . 694.5 How do the seasons affect food security?. 704.6 Where are the food insecure? . 714.7 Coping with food insecurity . 73

4.7.1 Migration and remittances . 754.7.2 External assistance . 765. State of Nutrition Security . 785.1 Malnutrition in children . 795.2 Nutritional status of women . 835.2.1 How child malnutrition and illness relates to characteristics and nutritionalstatus of mothers/caretakers . 865.3 Infant and young child feeding practices (IYCF) . 875.4 Health and Environment . 905.4.1 Access to safe drinking water and adequate sanitation . 90Figure 5.7: Child malnutrition and illness by improved water source and sanitation. 915.4.2 Access to health services . 915.5 Linking food insecurity and child malnutrition . 935.5.1 Linking household livelihoods with child nutrition and sickness. 946. Towards ensuring food and nutrition security in Liberia: Recommended actions96Appendices. 99Annex 1: Objective, methodology and limitations . 99Survey Objectives . 99Definition of Terms, Food Security and Nutrition Conceptual Framework . 99Stakeholders and Implementation Process . 101Survey Instruments . 101Scope and Sampling Procedure . 102Data Entry and Statistical Analysis . 103Survey Limitations, Challenges and Lessons Learnt . 104Annex 2: The food consumption score as a Proxy Indicator of Food Security . 106Annex 3: Wealth index . 110Annex 4A: Analysis of age distribution issue. 112Annex 4B: NUTRITION SECURITY . 1144.1.1 How many children and women are malnourished? . 115Acute Malnutrition . 115Chronic Malnutrition ‐ Stunted . 120Underweight . 122Chronic and Acute Malnutrition Trends by Age . 1254.1.2 Infant and Young Child Feeding Practices . 1254.1.3 Children’s Health. 128Children’s Health and Nutrition. 1284.1.4 Nutritional Status of Women . 129Body Mass Index . 129Stuntedness amongst Women . 130Low MUAC amongst Women . 1314.1.5 Linkage Between Mother & Child Nutrition . 132a)Characteristics of Mothers/Caretakers . 1324.2 Where are the malnourished children?. 1354.3 Who are the malnourished and sick children? . 136

4.3.1 Household Demography and Nutrition . 1374.3.2 Housing & Living Conditions and Nutrition Status of Children . 1384.3.3 Access to Water & Sanitation Services . 1394.3.4 Free Health Care and Child Malnutrition & Sickness . 1404.3.5 Child Nutrition & Sickness and Household Livelihoods . 140Annex 5: Tables and Figures . 143Annex Table 5‐8: Plausibility checks – summary table from ENA for SMART . 149Table 5‐9: Standardization exercise compared to group means ( 5 mm height andMUAC) – precision & accuracy by person ‐ OK . 150List of FiguresFigure 2.1:Figure 3.1:Figure 3.2:Figure 3.3:Figure 3.4:Figure 3.5:Figure 3.6:Figure 3.7:Figure 3.8:Figure 3.9:Figure 3.10:Figure 3.11:Figure 3.12:Figure 4.1:Figure 4.2:Figure 4.3:Figure 4.4:Figure 4.5:Figure 4.6:Figure 4.7:Figure 4.8:Figure 4.9:Figure 4.10:Figure 4.11:Figure 5.1:Figure 5.2:Figure 5.3:Figure 5.4:Figure 5.5:Figure 5.6:Figure 5.7:Figure 5.8:Figure 5.9:Trends in Food Security Status for Greater Monrovia (2006‐10)Rice self‐sufficiency ratioPrice inflation 2007‐2009Price of imported butter ricePrice Variations for imported riceRice production gapRice self‐sufficiency by county, 2009Area under rice cultivationRice yields in selected West African Countries, 2009Land ownership and cultivationAgricultural ConstraintsFCS and share of food expenditureWealth and livelihoodsWealth and food consumptionFood consumption and livelihoodsFood consumption and employmentEducation status of head of the householdSources of foodFood sources by CountySeasonality in rice production and food securityFood consumption (rural vs urban)Food consumption by countyConsumption coping strategiesUtilization of coping Strategies at county levelChild’s main caretakerEducation level of caretakerTrends in IYCF practices, 2006, 2008 and 2010Breastfeeding and complementary feeding practices by ageChild malnutrition and illness by improved water source and sanitationMalnutrition by child illnessChild malnutrition and illness by household food securityLivelihoods and child healthHousehold Shock and child health

List of MapsMap 2.1:Map 3.1:Map 3.2:Map 3.3:Map 3.4:Map 3.5:Map 3.6:Map 4.1:Map 5.1:Map 5.2:Poor and borderline food consumption in 2006 and 2010Palm oil cross border tradeGari cross border tradeCash and crop production by countryPovertyWealth by CountyRoad infrastructureExternal assistanceAcute, Chronic and Underweight among children aged 6 – 59 monthsUnder and Overnutrition among Women aged 15 ‐49 yearsList of TablesTable 1.1:Table 2.1:Table 3.1:Table 3.2:Table 3.3:Table 3.4:Table 3.5:Table 3.6:Table 3.7:Table 4.1:Table 4.2:Table 4.3:Table 4.4:Table 4.5:Table 4.6:Table 4.7:Table 5.1:Table 5.2:Table 5.3:Table 5.4:Trends in Human Development Index (2002‐2009)Proportion and number of undernourishedFood importsPrice correlationsOwnership of livestock (% households)Share of households’ expenditure on food and non‐food itemsLivelihood Profiles in Rural and Urban Liberia, 2010Livelihood Group's source of foodSchool enrollmentAccess to landMarket access and costsPer capita expenditureDemographic and living conditionsEnrolment in school by food consumption groupExisting and Loans/Credits Taken Within last Three MonthsSupport received (% of households)Child malnutrition in LiberiaWomen’s malnutrition statusPrevalence of recommended infant and young child feeding practicesChild morbidity by countyAppendicesAnnex Figure 1‐1:Annex Figure 2‐1:Annex Figure 3‐1:Annex Figure 5‐1:Annex Figure 5‐2:Annex Figure 5‐3:Annex Table 1‐1:Annex Table 1‐2:Annex Table 2‐1:Annex Table 1‐2:Conceptual Framework for understanding Food and NutritionSecurity in LiberiaFood consumption scoreComposition of wealth index in rural LiberiaYields/Hectare‐1960 to 2010Coping strategies and child healthCalendar of local eventsThe CFSNS implementation process 2010Weights for estimating national averagesWeights for Computation of FCSFCS Standards for Liberia

Annex Table 2‐3:Annex Table 2‐4:Annex Table 3‐1:Annex Table 4:Annex Table 4‐1:Annex Table 5‐1:Annex Table 5‐2:Annex Table 5‐3:Annex Table 5‐4:Annex Table 5‐5:Annex Table 5‐6:Annex Table 5‐7:Annex Table 5‐8:Number of days on which food groups were consumed in a weekbefore the surveySpearman's rho: Correlation MatrixRural AreasUrban AreasNumber of households surveyed and number of children, womenand pregnant women in the completed sample (overall and bycounty)Estimated rice production and needs in 2009/10Agricultural production in Liberia‐main food and cash crops grown in2009Food or Cash crop production by CountyExternal assistance programmes received by householdsFinal food consumption scoresPrevalence of recommended Infant and Young Child FeedingPractices by countyComposition of survey teamStandardization exercise compared to group means ( 5 mm heightand MUAC) – precision & accuracy by person ‐ OK