Fueling Change Through Nutrition in Nepal’s Madhesh Province

This story was originally published on the World Bank website.

Chandrika Kumari Yadav, a young woman from Haripur in Siraha of Madhesh Province, got married at an early age of 17. She has two sons, aged five and three. Chandrika went through a difficult pregnancy and did not receive a proper diet due to limited resources.

“My mother used to send me some money for nuts, vegetables, and dairy products, but it was never enough,” she recalls. “Besides, traditional beliefs that fruits like oranges and papaya are bad for pregnant women held me back from spending on nutritious food.”

Chandrika somehow managed to get some iron and vitamin tablets from the local primary health post but due to lack of nutritious diet, Chandrika’s deliveries remained difficult, and her children also suffered from many health issues.

Child marriage is endemic in Madhesh Province and is a leading cause of women’s poor health and nutrition, with more than half of the women suffering from anemia.

According to the Nepal Multiple Indicator Cluster Survey 2019, only 31 percent of Nepali children aged 6 to 23 months receive a minimum acceptable diet. This number is lowest in Madhesh Province, despite its reputation as the country's 'food basket’ for its fertile flatlands.

Chandrika’s life changed for the better when she learned about the nutritional food requirements from the Nutrition Field School introduced by the Food and Nutrition Security Project (FANSEP) in 2022.

FANSEP, led by Nepal’s Ministry of Agriculture and Livestock Development and financed by the World Bank through the Global Agriculture Food Security Program (GAFSP) is a five-year project that started from 2018.

Through the project, Chandrika learned not only about how to grow nutritious crops such as vegetables and fruits but also about recipes for preparing a variety of healthy food for her family. She soon began to grow seasonal vegetables and fruits in her own garden of one kattha (3,645 square feet).

Today Chandrika is a proud member of the Nutrition Group in Bayarpatti, Haripur through which she actively promotes good nutritional practices in her community. 

“Now, I don’t get tired as easily, even while managing two kids and household chores, thanks to my regular balanced diet,” Chandrika said. “I am also making sure my children get the nutrition for their better health and wellbeing.”

Chandrika’s story is an example of how poverty and societal norms are key drivers of poor nutrition in Nepal, further exacerbated by the lack of information on the nutritional value of available foods as well as produceable crops and the importance of dietary diversity.

Daisy Pandey, a facilitator at the Nutritional Field School, spent time dispelling age-old beliefs and educating women of various age groups on the importance of nutrition. “It took me a long time to convince them that eating nutritious food during pregnancy is essential as 80 percent of a child’s development occurs from conception to age two.”

It took me a long time to convince the women in the community that eating nutritious food during pregnancy is essential as 80 percent of a child’s development occurs from conception to age two.

Daisy Pandey, Facilitator, FANSEP Nutrition Field Schools

Empowering women, nourishing communities 

FANSEP's nutrition initiative benefited close to 21,000 women through 144 Nutrition Field Schools, 861 Nutrition Groups, and 840 Home Nutrition Gardens in Madhesh, Gandaki, and Bagmati Provinces of Nepal. In Madhesh alone, 463 Nutrition Groups supported 11,391 beneficiaries.  

The Nutrition Field Schools used a skill-based learning approach to provide inputs and services, promoting behavior change to improve food-based nutrition practices. The establishment of Home Nutrition Garden is a part of the field school curriculum developed to address the barriers faced by the communities in improving women’s dietary diversity and complementary feeding practices.

Similarly, the Nutrition Groups focused on ‘Golden 1000 days’, i.e. the critical period for new mothers and children below two years that sets the foundation for the child's future health and well-being. The Home Nutrition Gardens supplied iron-and vitamin-rich seeds, fast-growing fruit saplings, improved crop varieties, vegetable seedlings, and fertilizers.

Giving an example of such improved practices, Mina Devi, chairperson of the Fuleswori Nutrition Group in Dhanusha said, “Previously, women in our villages did not feed nutrient-rich colostrum to newborns immediately after birth, instead giving them goat or cow milk. Through the Nutrition Field School, we learned that this is crucial information to share with new mothers to help protect their children from infections.”

"Previously, women in our villages did not feed nutrient-rich colostrum to newborns immediately after birth, instead giving them goat or cow milk. Through the Nutrition Field School, we learned that this is crucial information to share with new mothers to help protect their children from infections"

Mina Devi, Chairperson, Fuleswori Nutrition Group

The project also provided small grants to support poultry and livestock production for better access to animal-based food sources, small processing tools like cereal grinders, boreholes for sanitation and garden watering, and improved cookstoves.

These resources have helped women establish and manage home gardens for seasonal vegetables and increase access to animal-based food sources.

Chandrawati Yadav, 65, a grandmother and an active member of Bajarang HNG in Bishnupur Rural in Saptari, shared that women in her group have learned a lot about the importance of nutrition, health, and hygiene. “We now understand how crucial nutrition is for our children, and the value of locally available foods such as moringa and pumpkin. We also learnt how to wash and prepare leafy vegetables grown in our gardens.”

"We now understand how crucial nutrition is for our children, and the value of locally available foods such as moringa and pumpkin. We also learnt how to wash and prepare leafy vegetables grown in our gardens."

Chandrawati Yadav, Member, Bajrang Nutrition Group

Raj Kumar Sah, Chairperson of Dhanauji Rural Municipality in Dhanusha, agreed that the FANSEP initiatives have significantly helped improve the health of not only mothers and children but the entire community.

“The nutrition groups and nutrition field schools have become influential in changing the behavior regarding dietary practices in the village, playing a crucial role in promoting health and developing leadership among local women,” Chairperson Shah said. “Women taking charge of their family’s health and speaking confidently in their communities is a remarkable achievement.”

Women in our community taking charge of their family’s health and speaking confidently in their communities is a remarkable achievement.

Rajkumar Sah, Chairperson, Dhanauji Rural Municipality, Dhanusha

These results are a testament to the visible changes fueled by FANSEP.

Nutrition is at the heart of human capital development and the World Bank is committed to support the Government of Nepal and work with vulnerable communities to build resilience, paving the way for a prosperous future for all Nepalis.