The State Of Food Insecurity In The World 2005

Eradicating world hunger –key to achieving

the Millennium Development Goals

The State of Food Insecurity in the World

2005

Acknowledgements

The State of Food Insecurity in theWorld 2005 was prepared as acollaborative effort within FAO led by theEconomic and Social Department (ES).

Overall leadership was provided byHartwig de Haen, Assistant Director-General, ES, assisted by Prakash Shetty,Chief of the Nutrition Planning,Assessment and Evaluation Service(ESNA), who served as chair of the coretechnical team. Valuable conceptual andeditorial assistance was provided byAndrew Marx.

Other members of the core technicalteam in the ES Department were:Kostas Stamoulis, Agricultural andDevelopment Economics Division; AliArslan Gurkan, Commodities and TradeDivision; Jorge Mernies, StatisticsDivision.

The following FAO staff providedtechnical contributions: JosefSchmidhuber, Global PerspectiveStudies Unit (ES); Jakob Skoet, Office ofthe Assistant Director-General (ES);Haluk Kasnakoglu, Ricardo Sibrian,Amanda Gordon, Cinzia Cerri andSeevalingum Ramasawmy, StatisticsDivision (ES); Gero Carletto, MarcellaVigneri and Carlo Azzarri, Agriculturaland Development Economics Division(ES); Gina Kennedy and Frank Martinez-Nocito, Food and Nutrition Division (ES);Mark Smulders, FIVIMS CoordinationUnit (ES); Alexander Sarris, HenriJosserand and Harmon Thomas,Commodities and Trade Division (ES);Marcela Villareal, Gabriel Rugalema andYianna Lambrou, Gender and PopulationDivision (Sustainable DevelopmentDepartment [SD]); Lavinia Gasperini,Mirella Salvatore and Jeff Tschirley,Research, Extension and TrainingDivision (SD).

The key estimates on food consumptionand undernourishment used in TheState of Food Insecurity in the World2005 were produced by the Basic Foodand Agriculture Statistics Service andthe Socio-Economic Statistics andAnalysis Service of the FAO StatisticsDivision, respectively.

The Publishing Management Service ofthe General Affairs and InformationDepartment (GI) provided editorial,language editing, graphic andproduction services. Translations wereprovided by the Meeting Programmingand Documentation Service of GI.

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Eradicating world hunger –key to achieving

the Millennium Development Goals

The State of Food Insecurity in the World

2005

As the international communityreviews progress towards theMillennium Development

Goals (MDGs) and prepares for themid-term review of the World FoodSummit (WFS), The State of FoodInsecurity in the World 2005 focuseson the critical importance ofreducing hunger, both as the explicittarget of the WFS and MDG 1 and as

an essential condition for achievingthe other MDGs.

The first section of the reportanalyses long-term trends inreducing undernourishment andexplores the impact of economicgrowth, governance and naturaldisasters.

The second section examineseach of the MDGs separately,

highlighting ways that hunger holds back development and hungerreduction could accelerate progress.

Tables (pp. 30–35) provide: FAO’slatest estimates of undernourishmentand of progress towards the WFSand MDG targets for reducinghunger; and key indicators for theother MDGs.

The State of Food Insecurity in the World 20052

About this report

The Millennium Development Goals and links to reducing hunger

MDGs Selected targets Links to reducing hunger

1 Eradicate extreme poverty and hunger

2 Achieve universal primary education

3 Promote gender equality and empowerwomen

4 Reduce child mortality

5 Improve maternal health

6 Combat HIV/AIDS, malaria and otherdiseases

7 Ensure environmentalsustainability

8 Develop a global partnership for development

• Halve, between 1990 and 2015, the proportion of peoplewhose income is less than US$1 a day

• Halve, between 1990 and 2015, the proportion of peoplewho suffer from hunger

• Ensure that, by 2015, children everywhere, boys and girlsalike, will be able to complete a full course of primaryschooling

• Eliminate gender disparity in primary and secondaryeducation, preferably by 2005, and in all levels ofeducation no later than 2015

• Reduce by two-thirds, between 1990 and 2015, the under-five mortality rate

• Reduce by three-quarters, between 1990 and 2015, thematernal mortality ratio

• Have halted, by 2015, and begun to reverse the spread ofHIV/AIDS

• Have halted, by 2015, and begun to reverse the incidenceof malaria and other major diseases

• Integrate the principles of sustainable development intocountry policies and programmes and reverse the loss ofenvironmental resources

• Halve the proportion of people without sustainableaccess to safe drinking water and basic sanitation

• Develop further an open, rule-based, predictable, non-discriminatory trading and financial system

• Address the special needs of the least developed countries• Deal comprehensively with the debt problems of

developing countries

• Hunger perpetuates poverty byreducing productivity

• Poverty prevents people from producingor acquiring the food they need

• Hunger reduces school attendance andimpairs learning capacity

• Lack of education reduces earningcapacity and increases the risk of hunger

• Hunger reduces school attendancemore for girls than for boys

• Gender inequality perpetuates the cyclein which undernourished women givebirth to low-birth weight children

• More than half of all child deaths arecaused directly or indirectly by hungerand malnutrition

• Undernourishment and micronutrientdeficiencies greatly increase the risk ofmaternal death

• Hunger spurs risky behaviour thataccelerates the spread of HIV/AIDS

• Undernourished children are more thantwice as likely to die of malaria

• Hunger leads to unsustainable use ofresources

• Restoring and improving ecosystemfunctions are key to reducing hungeramong the rural poor

• Subsidies and tariffs in developedcountries hamper hunger-reducingrural and agricultural development

Foreword

4 Towards the World Food Summit and Millennium Development Goal targets:

food comes first

Undernourishment around the world

6 Counting the hungry: long-term trends in the developing world

8 Economic growth and hunger reduction

10 The role of governance in hunger reduction

12 Hunger hot spots: the complex impact of natural disasters

Towards the Summit commitments

14 Education and undernourishment: the virtuous cycle of feeding bodies and minds

16 Gender equality and the empowerment of women: keys to progress in

reducing poverty and hunger

18 Reducing hunger, saving children’s lives

20 Improving maternal health and breaking the cycle of poverty, hunger and malnutrition

22 Combating HIV/AIDS, malaria and tuberculosis: the role of undernutrition

as both symptom and cause

24 Improving environmental sustainability and food security by empowering

the rural poor

26 Increased aid and more equitable trade: keys to forging a global partnership

for development

28 The way ahead: shifting into forward gear on the twin-track approach to the WFS

and MDG goals

30 Tables

36 Sources

The State of Food Insecurity in the World 2005 3

Contents

Only ten years now remain beforethe 2015 deadline by whichworld leaders have pledged to

reduce hunger and extreme poverty byhalf and to make substantial gains ineducation, health, social equity,environmental sustainability andinternational solidarity. Withoutstronger commitment and more rapidprogress, most of those goals will notbe met.

If each of the developing regionscontinues to reduce hunger at thecurrent pace, only South Americaand the Caribbean will reach theMillennium Development Goal (MDG)target of cutting the proportion ofhungry people by half. None willreach the more ambitious WorldFood Summit (WFS) goal of halvingthe number of hungry people.

Progress towards the other MDGtargets has also lagged, particularlyin the countries and regions whereefforts to reduce hunger havestalled, as the accompanying graphclearly illustrates.

Most, if not all, of the WFS andMDG targets can still be reached.But only if efforts are redoubled andrefocused. And only by recognizingand acting on two key points:1. without rapid progress in reducing

hunger, achieving all of the otherMDGs will be difficult, if notimpossible; and

2. the fight to eliminate hunger andreach the other MDGs will be wonor lost in the rural areas wherethe vast majority of the world’shungry people live.

Food comes first

As this report documents, hunger andmalnutrition are major causes of thedeprivation and suffering targeted byall of the other MDGs (see diagram,facing page): • Hungry children start school

later, if at all, drop out sooner andlearn less while they do attend,stalling progress towardsuniversal primary and secondaryeducation (MDG 2).

• Poor nutrition for women is one ofthe most damaging outcomes ofgender inequality. It undermineswomen’s health, stunts theiropportunities for education andemployment and impedes progresstowards gender equality andempowerment of women (MDG 3).

• As the underlying cause of morethan half of all child deaths,hunger and malnutrition are thegreatest obstacle to reducingchild mortality (MDG 4).

• Hunger and malnutrition increaseboth the incidence and the fatalityrate of conditions that cause amajority of maternal deaths duringpregnancy and childbirth (MDG 5).

• Hunger and poverty compromisepeople’s immune systems, forcethem to adopt risky survivalstrategies, and greatly increasethe risk of infection and deathfrom HIV/AIDS, malaria and otherinfectious diseases (MDG 6).

• Under the burden of chronicpoverty and hunger, livestockherders, subsistence farmers,forest dwellers and fisherfolk mayuse their natural environment inunsustainable ways, leading tofurther deterioration of theirlivelihood conditions. Empoweringthe poor and hungry as custodiansof land, waters, forests andbiodiversity can advance both foodsecurity and environmentalsustainability (MDG 7).


Foreword

Towards the World Food Summit and MillenniumDevelopment Goal targets: food comes first

“We pledge our political will and our common and national commitment to achieving foodsecurity for all and to an ongoing effort to eradicate hunger in all countries, with animmediate view to reducing the number of undernourished people to half their presentlevel no later than 2015.” (Rome Declaration, 1996)

“We will spare no effort to free our fellow men, women and children from the abject anddehumanizing conditions of extreme poverty …”. (Millennium Declaration, 2000)

Progress towards the MDG targets by subregion

Number of MDG targets (out of 20 selected targets)

On track, low risk Progress lagging, moderate risk

No change or worsening, high risk

Hunger reduction on track Hunger reduction lagging or worsening

15

12

9

6

3

0

Source: UN Department of Economic and Social Affairs

North East Southeast Latin Western Oceania South Sub-Africa Asia Asia America/ Asia Asia Saharan

Caribbean Africa

Giving priority to rural areas

Given the importance of hunger as acause of poverty, illiteracy, diseaseand mortality, given the fact that 75percent of the world’s hungry peoplelive in rural areas, it is hardlysurprising that these same ruralareas are home to the vast majorityof the 121 million children who donot attend school, of the nearly 11 million children who die beforereaching the age of five, of the 530 000 women who die duringpregnancy and childbirth, of the 300 million cases of acute malariaand more than 1 million malariadeaths each year. Clearly, to bringthese numbers down, to reach theMDG targets, priority must be givento rural areas and to agriculture asthe mainstay of rural livelihoods,through sustainable and securesystems of production that provideemployment and income to the poor,thus improving their access to food.

Yet, in recent decades, agricultureand rural development have lostground on the development agenda.Over the past 20 years, resources forthese sectors have declined by morethan 50 percent. That must change.And we can be encouraged by signsthat it is indeed changing, that bothnational governments andinternational donors are recognizingthe critical importance of rural areasas the location and agriculture as theengine for reaching the MDGs.

After years of dwindling supportto agriculture, the countries of theAfrican Union have committedthemselves to increasing the shareof their national budgets allocated toagriculture and rural developmentto 10 percent within five years. TheCommission for Africa hasemphasized that “agriculture is keyto Africa”. The United NationsMillennium Project has stated that

“the global epicenter of extremepoverty is the smallholder farmer”.If increased recognition leads toscaled-up action, the MDGs can stillbe reached.

For far too long, hunger andpoverty have driven an infernalengine of deprivation and suffering(see diagram). The time and theopportunity have finally come tothrow that engine into forward gear– to turn hunger reduction into thedriving force for progress and hope,as improved nutrition fuels betterhealth, increases school attendance,reduces child and maternal

mortality, empowers women, lowersthe incidence and mortality rates ofHIV/AIDS, malaria and tuberculosis,and helps reverse the degradation ofsoil and water resources, thedestruction of forests and the loss ofbiodiversity.

It can be done.

Jacques DioufFAO Director-General


Running in reverse: persistent hunger slows progress towards otherMillennium Development Goals

Source: FAO

MDG 1

MDG 8

MDG

7

MDG 6MDG 5 MDG 4

MDG 3

MDG 2

MDG 8

MDG 2M

DG 7

MDG 1

MDG 6MDG 5 MDG 4

MDG 3Hunger and malnutrition

lead to…

…poverty and...

…reducedschool attendance, learning capacity...

…weakenedimmune systems,

rising childmortality...

…impaired maternal and infanthealth...

…risky survivalstrategies,spread ofHIV/AIDS,

malaria, otherdiseases...

…unsustainableuse of naturalresources...

…reduced capacityto accessmarkets

and resources…

…less educationand employment

for womenand girls...

Both the World Food Summit in 1996 and the MillenniumSummit in 2000 set goals for

reducing hunger by half between abaseline period (c. 1990) and theyear 2015. The target date isdrawing near, but the targetsthemselves are not.

Although significant progress hasbeen made towards achieving theMDG target of halving the proportionof the population who areundernourished, the pace will needto be accelerated if the goal is to bereached by 2015.

Achieving the WFS goal ofreducing the absolute number ofhungry people from about 800million to 400 million will provemore challenging, requiring muchmore rapid progress (see graphs,below). The world population isexpected to grow by approximatelytwo billion between the baselineperiod (1990–92) and 2015. So, evenif the proportion of that largerpopulation who are undernourished

is reduced by half, nearly 600 millionpeople in the developing world willstill suffer from chronic hunger. Toreach the WFS target of 400 million,the proportion of the population whoare undernourished would need tobe reduced not by half, but by two-thirds.

Regional-level progress uneven

Among developing regions, onlyLatin America and the Caribbeanhas been reducing the prevalence ofhunger quickly enough since 1990 toreach the MDG target by maintainingits current pace. The Asia–Pacificregion also stands a good chance ofreaching the MDG target if it canaccelerate progress slightly over thenext few years.

In the Near East and North Africa,on the other hand, the prevalence ofhunger is low, but it is increasing,rather than decreasing. To reach thetarget, the region needs to reverse

the rising trend experienced in thepast decade.

In sub-Saharan Africa, theprevalence of undernourishment hasbeen decreasing very slowly,although the speed of progressimproved in the 1990s. The regionwill need to step up the pacedramatically to reach the MDG target.

Progress towards the WFS goalhas been even slower and moreuneven. Global gains in the 1980swere owed entirely to progress inAsia. In all other developing regions,the number of hungry peopleactually increased.

Since the WFS baseline period,progress has slowed significantly inAsia and stalled completelyworldwide. Only Latin America andthe Caribbean reversed the negativetrend of the 1980s to registerprogress in the 1990s, although sub-Saharan Africa did succeedsignificantly in slowing the rise inthe number of undernourishedpeople.



Counting the hungry: long-term trends in the developing world

Long-term trends in the proportion and number of undernourished by region, 1980–82 to 2000–02

Source: FAO

Proportion undernourished (%) Number of undernourished (millions)

1980–82 1990–92 2000–02 2015 (MDG) 1980–82 1990–92 2000–02 2015 (WFS)

40

35

30

25

20

15

10

5

0

1 000

800

600

400

200

0

Developing world Sub-Saharan Africa Asia/Pacific Latin America/Caribbean Near East/North Africa

Country progress towards the MDG target

To gauge progress towardsachieving the MDG target at thenational level, it is useful to look atthe ratio of the prevalence of hungerin 2000–02 to the prevalence in thebaseline period, 1990–92.

Hunger is not a problem in sixdeveloping countries where fewerthan 2.5 percent of the populationare undernourished. Another sevencountries have already effectivelyreached the MDG target by reducingthe proportion of hungry people intheir population by at least half.

More than 40 other countries aremaking progress towards achievingthe target, although many will need to

step up the pace to reach it by 2015.23 countries have seen little change,and in 14 countries the prevalence ofhunger has been increasing.

To put these numbers inperspective, it is important to takeaccount of levels of hunger in thesecountries. If countries are dividedinto groups based on the currentprevalence of undernourishment, itbecomes apparent that progress hasbeen most difficult where hunger ismost widespread.

Only 4 of the 16 countries wheremore than 35 percent of thepopulation are undernourished aremaking progress towards achievingthe MDG target. None has yetreached it. The prevalence ofundernourishment is either

increasing or effectively unchangedin the other 12 countries in thisgroup, where hunger will remain amajor problem even if the goal isreached.

Most of the countries in all othergroups have succeeded in reducinghunger, including two-thirds ofcountries in the group wherebetween 20 and 34 percent of thepopulation are undernourished.None of the countries in this grouphas yet reached the target, however.At the other end of the spectrum, 15of the 23 countries where fewer than10 percent of the population areundernourished are makingprogress in reducing hunger,including five countries that havealready reached the MDG target.


MDG 1

Progress and setbacks: ratio of prevalence of undernourishment in 2000–02 to prevalence in 1990–92 Countries grouped by prevalence of undernourishment in 2000–02 (MDG target = 0.5)

Con

go

Ang

ola

Hai

ti

Moz

ambi

que

Rw

anda

Cen

tral

Afr

ican

Rep

.Zi

mba

bwe

Zam

bia

Yem

en

Mad

agas

car

Sier

ra L

eone

Uni

ted

Rep

.of

Tan

zani

a

Libe

ria

Bur

undi

Dem

. Peo

ple’

sR

ep. o

f Kor

eaD

em. R

ep. o

fth

e C

ongo

Nam

ibia

Cha

d

Thai

land

Gui

nea

Mal

awi

Pak

ista

n

Bol

ivia

Lao

Peo

ple’

sD

em. R

ep.

Sri L

anka

Cam

eroo

n

Togo

Suda

n

Mon

golia

Cam

bodi

a

Ken

ya

Nig

er

Indi

a

Phi

lippi

nes

Dom

inic

anR

ep.

Nic

arag

ua

Ban

glad

esh

Hon

dura

s

Sene

gal

Mal

i

Pan

ama

Gam

bia

Bot

swan

a

Gua

tem

ala

Gha

na

Per

u

Viet

Nam

Mau

rita

nia

Chi

na

Leso

tho

Ben

in

Jam

aica

Suri

nam

e

Col

ombi

a

Côt

e d’

Ivoi

re

Par

agua

y

Nep

al

Uga

nda

El S

alva

dor

Trin

idad

and

Toba

go

Bur

kina

Fas

o

Swaz

iland

Bol

ivar

ian

Rep

.of

Ven

ezue

la

Kuw

ait

Guy

ana

Mya

nmar

Gab

on

Indo

nesi

a

Bra

zil

Nig

eria

Mau

ritiu

s

Alg

eria

Mex

ico

Mor

occo

Jord

an

Cub

a

Chi

le

Ecua

dor

Uru

guay

Cos

ta R

ica

Syri

anA

rab

Rep

.

Egyp

t

Saud

i Ara

bia

Isla

mic

Rep

.of

Iran

Leba

non

Turk

ey

≥ 35% undernourished 20–34% undernourished

10–19% undernourished 5–9% undernourished 2.5–4% undernourished

2.5

2

1.5

1

0.5

0

2.5

2

1.5

1

0.5

0

Source: FAOThe graph does not include countries where the prevalence of undernourishment is less than 2.5 percent and those for which there are insufficient data,including Afghanistan, Iraq, Papua New Guinea and Somalia. Ethiopia and Eritrea are not included because they were not separate entities in 1990–92.

Already reached MDG

Progressing

Little change

Worsening

Logic suggests, and ampleevidence confirms, thatsustained economic growth

leading to increased productivity andprosperity at the national level willresult in reduced hunger (see graph,below). That being the case, it istempting to conclude that countriesneed only speed up economic growthto reach the hunger reductiontargets of the MDGs and the WFS.

Cross-country analysesconducted across the developingworld suggest, however, thateconomic growth alone, in theabsence of specific measures tocombat hunger, may leave largenumbers of hungry people behindfor a long time, particularly in ruralareas. These analyses have alsoshown that economic growth has afar greater impact on hunger when itoccurs in rural areas and incountries that have already createdfertile conditions through rural andhuman resource development.

If rates of economic growth arecompared for countries grouped

according to progress in reducinghunger, no clear pattern emerges(see graph). As might be expected,the group of countries where hungerincreased during the 1990s alsoregistered the worst economicperformance. Far from growing,their per capita gross domesticproduct (GDP) shrank at an averagerate of 1.4 percent per year. Everyother group recorded gains.

Among these other groups, thereis no evident correlation betweenthe pace of economic growth and therate of progress in reducing hunger.Paradoxically, the group that madethe most rapid progress in reducinghunger registered relatively sloweconomic growth.

Similarly, if changes in GDP forindividual countries during the1990s are plotted against progresstowards the MDG target of reducingthe proportion of people who sufferfrom hunger by half, the trendline isalmost flat (see graph). Examiningchanges over a longer period,however, reveals evidence that

economic growth and hungerreduction are indeed related. Ifprogress towards the MDG target isplotted for countries that registeredpositive economic growth duringboth the 1980s and 1990s, thetrendline is clearly steeper,indicating a stronger correlationbetween the pace of economicgrowth maintained over a longerperiod and the rate of progress inreducing hunger.

This trend suggests that sustainedgrowth may have a cumulative andstronger impact on hunger reduction.It could also be interpreted asevidence that the impact of economicgrowth on hunger only becomesevident over time. An FAO study foundthat it takes longer for economicgrowth to have an impact on hungerreduction than for improved nutritionto stimulate economic growth.

Certainly the relationship betweeneconomic growth and hungerreduction flows in both directions. Anexamination of the costs of hunger inThe State of Food Insecurity in the



Economic growth and hunger reduction

GDP in the 1990s andprevalence ofundernourishment in 2000

GDP growth in the 1990s and hunger reduction byquintile

Economic growth and hunger reduction

Source: FAO; World Bank

Log of average per capita GDP, 1990s

Prevalence of undernourishmentfor country group, 2000

8.0

7.5

7.0

6.5

6.0

5.5

5.0

0.0

Change in undernourishment, 1990s

Countries with growth in 1980s and1990sCountries with growth only in 1990sFitted for growth in 1980s and 1990sFitted for growth only in 1990s

10

0

-10

-20

-30

Average growth in per capita GDP (%)

Countries’ progress in reducing hungerby quintile, 1990–92 to 2000–02

Worsening Slow Progressingprogress rapidly

2.0

1.5

1.0

0.5

0.0

-0.5

Source: FAO; World BankSource: FAO; World Bank

Average growth in per capita GDP (%)0 1 2 3 4

< 5 5–9 10–19 20–35 > 35

World 2004 concluded that thepresent discounted value of the lossof productivity over the lifetimes ofpeople whose physical and cognitivecapacities are impaired by low birthweight, protein-energy malnutritionand shortages of essential vitaminsand minerals adds up to 5 to 10percent of GDP in the developingworld. Another FAO study analysedthe relationship between nutritionintake and economic growth in SriLanka. It found that GDP growthresponds quickly to improvements innutrition, with a 1 percent increase inprotein intake yielding a 0.49 percentincrease in GDP in the long run.

The key role of agricultural growth

Numerous studies have providedevidence that the impact ofeconomic growth on reducinghunger and poverty depends asmuch on the nature of the growth ason its scale and speed. A WorldBank analysis of data from India, forexample, found that growth in rural

areas and in the agriculture sectorhad a much greater impact onreducing poverty than did urban andindustrial growth.

Analysis of the relationshipbetween growth and reductions inhunger reveals a similar pattern. Ifcountries are grouped based ontheir success in reducing hungerduring the 1990s, the group thatmade progress towards the MDGhunger reduction target was the onlyone where the agriculture sectorgrew (see graph).

Comparisons within and betweencountries yield further evidence thatthe composition of growth matters.In India, for example, the prevalenceof hunger decreased sharply duringthe 1980s, while the agriculturesector thrived and the nationaleconomy stagnated. But progress inreducing hunger stalled during thesecond half of the 1990s, precisely

when the national GDP took off andagricultural growth stumbled. Asimilar link between agriculturesector growth and hunger reductioncan be seen when comparingBotswana and Peru – countries thatboth boasted rapid growth in GDP inthe 1990s, but with different impactson hunger (see box).

These and other examples tend tosupport the conclusions that economicgrowth alone is important, but notsufficient to reduce hunger, and thatgrowth in the agriculture sector ofdeveloping countries has a muchgreater impact in reducing hungerthan do urban and industrial growth.Furthermore, progress also hingeson many other factors, includingrates of HIV infection, trade opennessand political stability, control ofcorruption and other features oftengrouped under the rubric of“governance” (see pages 10–11).


MDG 1

Economic growth and the reduction of hunger in Botswana and Peru,1990–2000

Both Botswana and Peru registered strongeconomic growth during the 1990s. But interms of reducing the prevalence of hunger,the two countries parted ways. Peru reducedthe prevalence of hunger by almost 70 percent to reach the MDG target 15 yearsahead of schedule. In Botswana, on the otherhand, the prevalence of hunger increasedeven as the national economy surged ahead.

Tellingly, the agricultural GDP in Perugrew even faster than the rest of theeconomy, fueled in part by diversificationinto value-added, non-traditional exportsthat boosted farm incomes and createdprocessing jobs. The agricultural GDP inBotswana fell by almost 40 percent.

Many other factors contributed to thedisparity between Botswana and Peru.Botswana has been hit extremely hard by

the HIV/AIDS pandemic, for example, withmore than 35 percent of the adultpopulation infected. In Peru, the infectionrate is less than 1 percent.


Agricultural GDP growth in the 1990s and progresstowards the MDG target


Average growth of agricultural GDP (%/year)0.6

0.3

0.0

-0.3

-0.6

-0.9

-1.2

-1.5

Countries grouped by progresstowards the MDG hunger target

Worsening Stagnant Progressing

Economic growth and hungerreduction in Botswana and Peruin the 1990s

Change 1990–2000 (%)-60 -40 -20 0 20 40

BotswanaGDP per capita

AgriculturalGDP per capita

Proportionundernourished

PeruGDP per capita

AgriculturalGDP per capita

Proportionundernourished

Analysis of the impact ofeconomic growth on hungerand poverty suggests that

initial conditions make a bigdifference (see pages 8–9). Povertyfalls significantly faster and fartherwhen growth occurs in places wherethe political situation is stable,corruption is rare and farmproductivity and literacy rates arehigh. Many of these favourable initialconditions can be regarded asindicators of what is often called“good governance”.

Definitions and measures ofgovernance vary considerably. TheWorld Bank defines it as “the set oftraditions and institutions by whichauthority in a country is exercised”and gathers more than 350 variablesto compile six aggregate indicators.

Other development agencies,such as the International FoodPolicy Research Institute (IFPRI),have argued that good governanceextends to providing essential“public goods”, ranging from peaceand security to roads and electricityin rural areas. Advocates of a“rights-based” approach todevelopment maintain that goodgovernance must also includesupport for essential human rights,including the right to food.

All three of these dimensions ofgovernance are important toreducing hunger and achieving foodsecurity.

World Bank indicators

Economic analysis confirms that theWorld Bank’s governance indicatorscan be used to differentiate, withconsiderable accuracy, betweenthose developing countries that haveachieved relatively low levels ofhunger and those that have not.Using just four of the indicators – political stability, government

effectiveness, rule of law and controlof corruption – it is possible todifferentiate accurately for two-thirds of the countries, withoutreferring to any other factors thatare known to be important forhunger reduction, such as economicand agricultural growth (see pages8–9), education levels and thedegree of inequality in access tofood.

These governance indicators arefar less successful, however, indifferentiating between countriesthat made progress in reducinghunger during the 1990s and thosewhere the prevalence ofundernourishment has remainedunchanged or has increased (seegraph).

As might be expected, countrieswhere food security deterioratedwere also the least stable politically,had the weakest rule of law and hadthe most rampant corruption. Manywere countries where conflict hadshredded the political and legalfabric of governance. But thesesame governance indicators werealso slightly negative for the groupof countries that succeeded in

decreasing undernourishment. As agroup, only the countries wherehunger remained unchanged scoredpositive marks on the World Bankgovernance indicators.

This analysis suggests that theabsence of these aspects of goodgovernance can be a major obstacleto hunger reduction but thatachieving progress depends onmany other factors.

Delivering essential public goods

Many of these other factors areincluded among the “public goods”cited by IFPRI as responsibilities andindicators of good governance.Internal peace, rule of law, ruralinfrastructure and agriculturalresearch, for example, are allessential for increasing agriculturalproduction and reducing hunger andpoverty in the rural areas that arehome to three-quarters of theworld’s hungry people.

When governments cannotpreserve internal peace, violentconflict disrupts agriculturalproduction and access to food. InAfrica, per capita food production



The role of governance in hunger reduction

Governance indicators, food security and hunger reduction in the 1990s

Source: World Bank; FAO

Indicator average for country group0.50.40.30.20.10.0

-0.1-0.2-0.3-0.4-0.5

Indicator average for country group0.3

0.0

-0.3

-0.6

-0.9

-1.2

-1.5More food secure

(≤ 15%undernourished)

Food insecure(≥ 15%

undernourished)

Progress No change Worsening

Progress in reducing hunger 1991–2001

Political stability Government effectiveness Rule of law Control of corruption

has dropped by an average of 12.4 percent during times of conflict.

Weak rule of law also erodesagricultural productivity and foodsecurity by making land tenure andcontracts precarious and investmentunattractive. Failure to developroads, electricity andcommunication links in rural areasmakes it difficult and expensive forfarmers to get their produce tomarket and to obtain fertilizer andother agricultural inputs.

Studies in China and India haveidentified building roads as “thesingle most effective public goodsinvestment in terms of povertyreduction” (see graph). Evidencesuggests that it has a similar impacton reducing hunger. When Chinaintroduced secure household landcontracts and started investingheavily in rural infrastructure andagricultural research in the late1970s, agricultural productionsoared and hunger fell rapidly. Overthe next two decades, total grainoutput increased by 65 percent andthe prevalence of hunger wasreduced by almost two-thirds.

Tellingly, rural infrastructuretends to be least developed incountries and regions with thehighest levels of hunger. Roaddensity in Africa in the early 1990s,for example, was less than one-sixth the density in India around the time of independence, in 1950 (see graph).

Another way of gauginggovernance is to consider how wellgovernment investment inagriculture and agriculturalresearch corresponds with thesector’s importance to the nationaleconomy and well-being. In thecountries with the highest levels ofhunger, where an average of about70 percent of the population dependon agriculture, the share of public

budget expenditures invested inagriculture in proportion to theimportance of agriculture to thenational economy falls far below thescale of investment in countrieswhere the incidence of hunger islower (see graph).

Governance and the right to food

The affirmation at the World FoodSummit of the “fundamental right ofeveryone to be free from hunger”highlighted another dimension ofgood governance – the obligation ofstates to respect human rights andfundamental freedoms. And theadoption in 2004 of “Voluntaryguidelines to support theprogressive realization of the right toadequate food in the context ofnational food security” by the FAOCouncil provided a practical tool toassist national efforts to fulfil thatobligation.

The impact on governance andfood security can be seen in severalcountries that have alreadyrecognized a “justiciable” right tofood. In India, for example, theSupreme Court mandated cooked

lunches in all of the country’sschools. Both nutrition and schoolattendance have improveddramatically where the programmehas been implemented, particularlyamong girls. Given the critical roleof maternal nutrition and educationin breaking the cycle of hunger andpoverty, the benefits will be felt forgenerations to come (see pages 16and 20).


Rural public investment andpoverty reduction in India

Source: Fan et al.

Commitment to agriculture forcountries grouped by prevalenceof undernourishment

Source: FAO

0 30 60 90 120

Roads

AgriculturalR&D

Education

Ruraldevelopment

Soil and waterconservation

Health

Irrigation

Number of poor lifted out ofpoverty per 1 million rupees

0 10 20 30

% of population undernourished

≤ 4

5–19

20–34

≥ 35

Agricultural orientation index** The share of agriculture in public-sector expendituredivided by the share of agriculture in GDP.

Rural road density in selectedAfrican countries, early 1990s

Source: Spencer

100 300 500 700

Côte d’Ivoire

Ghana

Mozambique

Nigeria

United Rep. of Tanzania

Road density (km/1 000 km2)ExistingRequired to match India in 1950(adjusted for population density)

MDG 1

The reasons are complex, butthe trend is clear – naturaldisasters have become more

frequent, more deadly and morecostly. One simple measure provesthe point: the average annual lossfrom hurricanes, droughts,earthquakes and other naturaldisasters during the 1990s was ninetimes higher than it had been threedecades earlier (see graph).

The impact of natural disasters ismuch greater on poorer countriesthan on wealthier countries, in bothabsolute and relative terms. Theirpopulations often cannot afford torelocate from disaster-prone areasor to make their homes and farmsless vulnerable. Their economiesand infrastructure tend to be lessdiverse and more fragile, so anatural disaster can set back theentire development process.

Natural disasters can also affectfood security in uneven or complexways. Their impact on differentcommunities and groups variesaccording to people’s locations,occupations and social status, aswell as being divided along

economic, political and culturallines. Evidence of this can be seen inthe effects of two recent disasters – the drought and desert locustinfestation that scourged North andWest Africa in 2003–04, and the IndianOcean earthquake and tsunami in2004, especially as it struck theIndonesian province of Aceh.

Drought and locusts in Africa

In late 2003, favourable weatherconditions led to a sharp increase indesert locust populations in theMaghreb and part of the Sahel. FAOissued warnings of a locustinfestation. By early 2004, swarms oflocusts were spreading across Northand West Africa and beyond, rangingas far as Cyprus, Egypt, Guinea andYemen. Most of the swarms stayedin northwestern Africa and theSahel, however, feeding on cropsand natural vegetation.

Rainfall in the Sahel follows agradient, becoming scarcer thefurther north one goes until it givesout almost entirely in the Sahara.The southern part of a country such

as Mali, for instance, receives abouttwice the annual rainfall of thenorthernmost inhabited areas. Thepattern of agricultural activitymirrors the rains, with intensivefarming concentrated along thesouthern fringe, subsistenceagriculture and livestock-raising inthe middle, and nomadic goat- andcamel-herding in the extreme north.

In 2004, differences in rainfallbetween north and south in the Sahelwere more pronounced than usual.Drier areas of the north suffered asevere drought, while rainfallincreased in the wetter areas of thesouth (see map). Desert locusts,which are extremely sensitive toenvironmental conditions, tended toprefer the dry weather and scantvegetation of the north. Theycompletely devastated northernpastures and crops that are marginalin the best of years and largelyspared the lusher areas of the south.

Since the southern areas producethe greater share of the food, mostcountries in the region were spareda major disaster. Regionwide,agricultural production in 2004 was



Hunger hot spots: the complex impact of natural disasters

Economic losses from natural disasters

Source: UNDP

Locusts and changes in rainfall and vegetation in the Sahel, 2003–04

Source: FAO

1960s 1970s 1980s 1990s

Average annual value, constant US$ billions

700

600

500

400

300

200

100

0

Locusts

Rainfall and vegetationSeverely reducedReducedLittle changeIncreased

close to the five-year average. Butthe locust swarms had acatastrophic impact on Mauritania,where they stayed the longest, andon the northern areas of othercountries. Many northern herdersmoved south with their livestock,sparking conflicts over land andwater resources. Others were forcedto sell their animals at a loss or toabandon their farms. For many ofthe most impoverished areas andpopulation groups of the Sahel, thesituation would remain desperateuntil the October 2005 harvest,prompting several countries tolaunch an emergency appeal in May.

The Indian Ocean tsunami

The earthquake that struck off thecoast of Sumatra, Indonesia, on 26 December 2004 was thestrongest in 40 years. It triggered atsunami that caused an estimated240 000 deaths and displaced morethan 1.6 million people from theirhomes. Fisheries and coastal

agriculture were destroyed in manyareas, depriving communities oftheir main sources of food andincome. The impact on nationaleconomies varied greatly. In a largecountry like Indonesia, economicdamage was severe locally butrelatively insignificant nationwide,amounting to an estimated 2.2 percent of GDP. In the Maldivesand several other small countries,on the other hand, the tsunamiswept away as much as 60 percentof annual GDP.

The impact on food security wasalso very uneven. The limitedagriculture sectors of small islandstates like the Maldives andSeychelles were ravaged. Riceproduction in Indonesia, Sri Lankaand Thailand was not severelyaffected at the national level.

Many coastal provinces sufferedsevere damage, however, often inthe very communities plagued byhigh levels of poverty and hungerbefore the disaster. Nearly 30 percent of the population in the

Indonesian province of Aceh, forexample, lived below the poverty linebefore the tsunami, almost twice thenational average. More than 35 percent of children below the ageof five were already underweight.With fishing boats, nets and otherequipment destroyed and manyfishing families uprooted, the outputfrom both marine and coastalfisheries in Aceh was expected tofall by half in 2005. Although theprovince was still expected toproduce a rice surplus of 200 000tonnes, many coastal farmers losttwo consecutive paddy seasons.

In Aceh, as in Sri Lanka, foodsecurity problems were exacerbatedby long-standing conflict betweenthe government and a separatistmovement. After the tsunami,persistent insecurity complicatedemergency relief and rehabilitationactivities.

Natural disasters and development

As these two different emergenciesillustrate, even when naturaldisasters do not reduce aggregatefood supplies substantially, they canhave a catastrophic impact oncertain population groups. Often thepoorest and most vulnerable arehardest hit, worsening poverty andmalnutrition. Disasters also affectfragile livelihoods to such an extentthat populations are displaced andlong-term rehabilitation is required.Finally, they tend to affect countriesthat are both poor and unprepared,setting them back on the path todevelopment.

This devastation is why the WorldConference on Disaster Reductionthat was held in Kobe, Japan, inJanuary 2005 strongly emphasizedthe need to build disaster preventionand mitigation explicitly into nationaldevelopment strategies.


MDG 1

Impact of the tsunami on Indian Ocean countries

India10 672 dead

600 000 displaced

Maldives83 dead12 000 displaced

Myanmar61 dead

3 205 displaced

Thailand5 395 dead

8 500 displacedSri Lanka33 916 dead518 698 displaced

Indonesia166 000 dead

514 000 displacedSource: Pacific Disaster Management Information Network

Education has long beenacclaimed as one of the mostpowerful engines for reducing

hunger and poverty. And deservedlyso. Lack of education underminesproductivity, employability andearning capacity, leading directly topoverty and hunger. Every year ofschooling increases individual wagesby about 10 percent, worldwide.Investments in education haveresulted in higher returns thaninvestments in physical capital.

In the rural areas where the vastmajority of the world’s hungry peoplelive, research shows that a farmerwith four years of primary educationis, on average, almost 9 percentmore productive than a farmer withno education. When combined withthe availability of inputs such asfertilizers, new seeds or farmmachinery, the productivity increaserises to 13 percent.

It is not only by increasingproductivity and incomes thateducation reduces hunger andmalnutrition. Better education forwomen, in particular, is stronglyassociated with improvement intheir children’s nutrition and infamily health (see page 16).

The MDGs set the target ofensuring that every child in theworld receives a primary schooleducation by the year 2015. Butprogress towards the goal ofuniversal primary education hasbeen slow and uneven. More than121 million school-age childrenremain out of school. Two-thirds ofthem are girls, and most of themlive in rural areas in the regionswhere hunger and poverty are mostwidespread.

Among those children who doattend school, one-third drop outbefore they acquire basic literacyand arithmetic skills. On average,adults have completed only 3.5 years

of school in sub-Saharan Africa andonly 4.5 years in South Asia. Theseare also the two subregions wherehunger is most prevalent and whereprogress in reducing it has lagged(see map and graph). To reach theMDG target, the rate at which out-of-school children are beingenrolled in schools would have toquadruple. If enrolments in sub-Saharan Africa continue at the

current pace, fewer than half thecountries in the region will reach thetarget (see graphs, facing page).

Hunger asan obstacle to education

One reason that the drive foruniversal primary education haslagged is the persistence of hungerand malnutrition. Just as lack of



Education and undernourishment: the virtuous cycle of feeding bodies and minds

Primary school completion and undernourishment in the developing world

School attainment and undernourishment by region, 2000

Number of years of school completed (average)Prevalence of undernourishment (%)

Sub-Saharan Africa

South Asia

Near East/North Africa

Latin America/Caribbean

East Asia

Source: UNESCO; FAO

35 30 25 20 15 10 5 0 1 2 3 4 5 6 7 8

Countries with primary school completion < 80%Countries withundernourishment > 20%

Countries with primary school completion < 80% and undernourishment > 20%Countries with primary schoolcompletion > 80% andundernourishment < 20%

No data available

education condemns people to livesof poverty and hunger, hunger andmalnutrition deprive millions ofchildren of the opportunity toacquire an education.

Poor, food-insecure families oftencannot afford school fees anddepend on children, particularlygirls, for tasks such as fetchingwater and fuelwood. Also, poorhealth and stunting caused bymalnutrition often prevent or delayenrolment in school. In a number ofcountries in Africa and South Asia,more than half of all children fromthe poorest 40 percent of thepopulation never even enrol inschool.

Attendance and completion ratesare lowest among rural children,especially girls. In almost half of 41 countries in Africa, Asia and LatinAmerica included in a recent survey,primary school attendance in ruralareas fell 20 percentage points ormore below attendance in urbanareas. The “gender gap” betweenschool attendance and attainmentfor boys and girls is often two tothree times greater in rural areas.In several African countries, primaryschool completion rates amongrural girls fall below 15 percent.Only 1 percent of girls and 1.6 percent of boys in rural Ethiopiacomplete the eight-year primaryeducation cycle.

Hunger and malnutrition impairchildren’s performance even whenthey do attend school. Low birthweight, protein-energy malnutrition,anaemia and iodine deficiency allimpair cognitive abilities and reducechildren’s ability to learn. Even mildto moderate levels of stunting havebeen associated with significantlylower mental capacity and schoolperformance. Iron-deficiencyanaemia, which affects more thanhalf of all school-age children,

damages their ability to learn byeroding attention span and memory.

Universal educationand the MDGs

Reducing hunger and malnutrition isessential to improving schoolattendance and children’s learningcapacities and performance,especially among rural people, whomake up the vast majority of boththe unschooled and the hungry.

Likewise, attaining the MDGtarget for universal education wouldmake a powerful contributiontowards achieving the goals forreducing poverty and hunger andwould accelerate progress towardsother MDGs, such as empoweringwomen and halting the spread ofHIV/AIDS. A recent study by theGlobal Campaign for Educationconcluded that providing universalprimary education could save atleast 7 million young people fromcontracting HIV over a decade. Byintroducing free primary education

in the mid-1990s, Ugandasucceeded not only in doublingschool enrolments but also inhelping to reverse the tide ofHIV/AIDS. With 10 million youngpeople achieving basic literacy andreceiving AIDS education in theclassroom, HIV prevalence rates fellfrom 15 percent in 1990 to 4 percentin 2004. Other studies suggest thatuniversal primary education wouldcontribute to improving maternalhealth, gender equality and naturalresource management.

In order to reach the goal,however, developing countries andthe international community willneed to step up their commitmentsignificantly. The World Bankestimates that spending on primaryeducation in developing countrieswill have to increase by aroundUS$35 billion per year in order toeliminate school fees, providesubsidies for the neediest families,build schools, employ more teachersand rehabilitate and upgradeexisting systems.


MDG 2

Progress towards universal primary education by region, 1990–2000

Source: UNESCO; World Bank

1990 1995 2000 2005 2010 201530 20 10 0 10 20

Sub-Saharan Africa

South Asia

East Asia



Seriously off track On trackOff track Have achieved MDG

Primary school completion rate (%)

Number of countries with MDG status

100

80

60

40

MDGtarget

Sub-Saharan Africa South AsiaLatin America/Caribbean Near East/North Africa East Asia

United Nations Secretary-General Kofi Annan has callededucating and empowering

women “the greatest weapon in thewar against poverty”. The samecould be said of the criticalimportance of eliminating genderinequality for efforts to reducehunger and malnutrition.

Research confirms that educatedwomen have healthier families.Their children are better nourished,less likely to die in infancy and moreliable to attend school. A recentstudy of 63 countries concluded thatgains in women’s education madethe single largest contribution todeclines in malnutrition during1970–95, accounting for 43 percentof the total progress.

The entire family also benefitswhen women are able to work andearn on an equal footing. In thedeveloping world, women commonlyuse almost all of their income to meethousehold needs, while men use atleast 25 percent for other purposes. AWorld Bank study in Guatemala foundthat it takes 15 times as muchspending to reduce child malnutritionwhen income is earned by the fatherrather than the mother.

But cultural traditions and legalobstacles often prevent women andgirls from attending school, holdingjobs or accessing resources andservices that would allow them toimprove their families’ livelihoods. Inmany countries and communities,for example, women are barred bytradition or law from owning land.Although at least 70 percent of thefemale labour force on the Indiansubcontinent is engaged in foodproduction, fewer than 20 percent ofwomen farmers in India and Nepalown land.

Without secure land tenure,women often cannot obtain thecredit they would need to makeimprovements – such as irrigationand drainage systems – that wouldincrease production and maintainthe fertility of the soil. In sub-Saharan Africa, where the numbersof women and men farmers areroughly equal, women farmersreceive only 10 percent of loansgranted to smallholders and lessthan 1 percent of the total creditadvanced to the agriculture sector.Not surprisingly, their householdsare often the hardest hit bymalnutrition and food insecurity.

Closing the education “gender gap”

In most of the developing world,school attendance and completionrates for girls fall significantly belowthose for boys at all levels, from primary school through university.The MDGs set the target ofeliminating this “gender gap” inprimary and secondary education by2005 and at all levels by 2015.Although significant progress hasbeen made worldwide, it has not beensufficient to reach the 2005 target andhas lagged most notably in countriesand regions plagued by widespreadand persistent hunger (see graph).

While school attendance andliteracy rates for both girls and boysare lowest in sub-Saharan Africa,gender inequalities are greater inSouth Asia than in any otherdeveloping region. Women in theregion complete only about half asmany years of school as men, andsecondary school attendance ratesare more than 30 percent lower.

Further analysis reveals that thegender gap is higher where hungeris more prevalent (see graph).Significantly, in these countries, thegap is even greater for secondary



Gender equality and the empowerment of women: keys to progress in reducing poverty and hunger

Country predictions by region for progress in closing the gender gap in primary and secondary education by 2005

Source: UNESCO;Millennium Project

Gender enrolment ratio by prevalence of undernourishment

Source: UNESCO; FAO

15 10 5 0 5 10 15 20Number of countries

Off track(ratio < 0.70)

Falling behind(0.70–0.89)

Close to target(0.90–0.99)

Gender parity or reverse gap (≥1)

East Asia



South Asia

Sub-SaharanAfrica

Primary

Secondary

Primary

Secondary

Primary

Secondary

Primary

Secondary

Primary

Secondary

< 5 5–9 10–19 20–34 ≥ 35Prevalence of undernourishment

for country group

Gender enrolment ratio (female/male)1.00.90.80.70.60.0

Primary Secondary

school than for primary school. Inthe countries where the smallestshare of the population goes hungry,the opposite is true: schoolenrolment for girls almost equalsthat of boys in primary school andsurpasses it in secondary school.

This distinct pattern correlateswith research suggesting thateliminating the gender gap wouldaccelerate economic growth andreduce undernutrition and childmortality. A recent study supported bythe World Bank analysed the impactof failing to achieve gender equality inprimary and secondary school in the45 countries that appear likely to fallshort of the MDG target. The studyconcluded that achieving the goal inthese countries could save the lives ofmore than 1 million children eachyear and reduce malnutrition rates byseveral percentage points.

Breaking the cycle of hunger

Poor maternal nutrition and healthcan be considered the hub of thevicious cycle that passes hungerfrom one generation to the next – from malnourished mothers to low-birth weight babies who are at highrisk of stunting during childhood, ofreduced working and earningcapacity as adults and of giving birthto low-birth weight babiesthemselves (see page 21).

Perhaps the main force driving thiscycle is inequality between womenand men. That was the conclusion ofan expert analysis of “the Asianenigma” – the fact that a far higherproportion of children aremalnourished in South Asia than in even the poorest countries of sub-Saharan Africa.

A report for the United NationsChildren’s Fund (UNICEF) identifiedthree main reasons for theextraordinarily high levels of child

malnutrition in South Asia. Two ofthese – the far higher incidences oflow birth weight and of inadequategrowth during breastfeeding andtransition to solid foods – were traceddirectly to the fact that extremegender inequality cuts South Asianwomen off from education,employment opportunities andparticipation in making decisions.

As a result, millions of SouthAsian mothers “have neither theknowledge nor the means nor thefreedom to act in their own and theirchildren’s best interests”. And theyare far more likely to be severelymalnourished themselves. In partsof South Asia, men and boysconsume twice as many calories,even though women and girls domuch of the heavy work.

“The ‘key of keys’” for breakingthis cycle of hunger, the analysisconcluded, “is the education of girls”.

Other evidence from South Asiasupports this conclusion. In India asa whole, for example, progress inreducing the education gender gaphas lagged and barely half of thewomen can read. For more than

50 years, however, successivegovernments in the State of Keralahave demonstrated a strongcommitment to women’s education.Nearly 90 percent of the state’sfemale population is literate, andalmost every girl under the age of 14in Kerala attends school.

The impact on family health andwelfare is striking. Kerala does notrank among India’s wealthier statesin per capita GDP. But it stands headand shoulders above the rest interms of maternal and childnutrition and health. Rates ofanaemia and underweight amongwomen and stunting in children areless than half the national average,and infant and child mortality lessthan one-quarter (see graph).

The Kerala example suggests thatpromoting gender equality andempowering women could do moreto reduce hunger and malnutritionthan any of the other MDGs. It alsosuggests that addressing thenutritional needs and knowledge ofwomen is essential both toempowering women and to breakingthe cycle of hunger.


MDG 3

Impact of better education and nutrition for women in Kerala, India

Source: National Family Health Survey, India * Body mass index is the weight in kg divided by the height in metres squared.

Better education and nutrition for womenFemale literacy (age 6+)

Females in school (ages 6–14)

Mothers receiving three-monthsupply of iron and folic acid

Women aged 15–49 with any anaemia

Underweight women (BMI* below 18.5)

Improved nutrition and health for familiesInfant mortality

Under-five mortality

Stunted children

0% 20% 40% 60% 80% 100%

KeralaIndia as a whole

Every year, nearly 11 millionchildren die before they reach their fifth birthday.

Almost all of these deaths occur indeveloping countries, three-quartersof them in sub-Saharan Africa andSouth Asia, the two regions that alsosuffer from the highest rates ofhunger and malnutrition. That is nocoincidence.

Hunger and malnutrition are theunderlying cause of more than halfof all child deaths, killing nearly 6 million children each year – a figure that is roughly equivalentto the entire preschool population ofJapan. Relatively few of thesechildren die of starvation. The vastmajority are killed by neonataldisorders and a handful of treatableinfectious diseases, includingdiarrhoea, pneumonia, malaria andmeasles. Most would not die if theirbodies and immune systems had notbeen weakened by hunger andmalnutrition.

Analysis of ten community-basedstudies of children under the age of

five found that the proportion ofdeaths that could be attributed tobeing underweight ranged from 45 percent, in the case of measles,to more than 60 percent, fordiarrhoea (see graph). Children whoare mildly underweight are abouttwice as likely to die of infectiousdiseases as children who are betternourished. For children who aremoderately to severely underweight,the risk of death is five to eighttimes higher.

Lack of essential vitamins andminerals also increases the risk ofdying from childhood diseases.Vitamin A deficiency, for example,increases the risk of death fromdiarrhoea, measles and malaria by20 to 24 percent. For children whosediets lack sufficient zinc, the risk ofdying from diarrhoea, pneumoniaand malaria is increased by 13 to 21 percent. In many regions of thedeveloping world, more than one-third of all children suffer fromdeficiencies in these and othermicronutrients. Shortages of

vitamin A and zinc alone cause thedeaths of more than 1.5 millionchildren each year (see graphs).

Progress towards MDG lagging

The MDGs set a target of reducingthe rate of death among childrenunder five by two-thirds between1990 and 2015. But progress inreducing child mortality has beenslowing, not accelerating. Between1960 and 1990, the number of childdeaths fell at a rate of 2.5 percenteach year. Since 1990, the baselineyear for the MDGs, the pace hasslowed to just 1.1 percent. Amongdeveloping regions, only LatinAmerica and the Caribbean iscurrently on pace to reach the MDGtarget (see graph, facing page).

A study of trends in 59 developingcountries found that much of thesuccess in reducing child mortalitybetween 1966 and 1996 could becredited to improved nutrition. Steepreductions in the proportion ofunderweight children led to a steep



Reducing hunger, saving children’s lives

Global child deaths by cause

Source: Black, Morris and Bryce

Prevalence of childunderweight and micronutrientdeficiencies by region

Source: Mason et al.

Child deaths from infectiousdiseases attributed to hunger and malnutrition

0 5 10 15 20 25 30 35% of child deaths

Neonataldisorders

Diarrhoea

Pneumonia

Malaria

Other

AIDS

Measles

Unknown 0 10 20 30 40 50 60Prevalence of deficiency (%)

Number of deaths per year (‘000)South Asia

East Asia/Pacific

LatinAmerica/

Caribbean

Sub- Saharan

Africa

Near East/ NorthAfrica

1 500

1 200

900

600

300

0

Proportion due to being underweightUnderweight Vitamin A deficiencyIodine deficiency Anaemia

Underweight Vitamin A deficiencyZinc deficiency

Diarrh

oea

Malaria

Pneumonia

Measles

Source: WHO

declines in child mortality – 16 percent in Latin America andalmost 30 percent in both Asia andthe Near East and North Africa.

Looking to the future, the studyconfirmed that one sure way toreduce child mortality would be tomake further improvements in childnutrition. Reducing the prevalenceof underweight by another fivepercentage points could reduce childmortality by about 30 percent.Analysis of recent trends confirmsthat child mortality has fallen fastestin the countries that are making themost rapid progress in reducinghunger (see map and graph).

The World Health Organizationand UNICEF have targeted thedeadly interaction betweenmalnutrition and treatable childhooddiseases as the key to reducing childmortality. Their joint strategy forIntegrated Management ofChildhood Illness (IMCI) emphasizesthe importance of improved dietsand feeding practices at home andattention to the risks of hunger andmalnutrition when children arebrought to clinics for treatment ofcommon childhood ailments.

A review of results in the UnitedRepublic of Tanzania foundsignificant improvements inchildren’s weights and levels ofvitamin A and iron in districts wherethe IMCI approach had beenimplemented. Although childmortality had not been reduced asrapidly as expected, it was falling sixtimes faster in IMCI districts than incontrol districts nearby.

Reaching the MDG target willrequire a comparable acceleration ofprogress worldwide, fueled byredoubled efforts to reduce hungerand malnutrition, the mostimportant causes of child deaths.


MDG 4

Progress in reducing child mortality and hunger since 1990

Source: FAO; UNICEF

Reductions in child mortalityand the MDG target by region,1990–2003

Source: WHO

Changes in child mortality for countries grouped by hunger reduction

Source: FAO; UNICEF

1990 2003 MDGtarget

Under-five deaths per 1 000 live births

Change in prevalence of hunger forcountry group

Rapid Slow Little Worseningprogress progress change

Average change in child mortality (%)

5

0

-5

-10

-15

-20

-25

-30

Countries that have made progress in reducing both childmortality and undernourishmentCountries that have reduced child mortality but have made littleor no progress in reducing undernourishmentCountries that have reduced undernourishment but have madelittle or no progress in reducing child mortalityCountries that have registered little progress or have sufferedincreases in both child mortality and undernourishment

200

150

100

50

0

Sub-Saharan Africa

South Asia



East and Southeast Asia

Improving maternal health is key to both saving the lives of more than half a million

women each year and breaking the vicious cycle that perpetuatespoverty, hunger and malnutritionfrom one generation to the next.

Every year nearly 530 000 women die as a result ofcomplications from pregnancy and childbirth. Ninety-nine percentof these deaths take place in thedeveloping world, where maternalmortality rates are typically 100 to 200 times higher than inindustrialized countries. Almost all of these deaths could beprevented if women in developingcountries had access to adequatediets, safe water and sanitationfacilities, basic literacy and healthservices during pregnancy andchildbirth.

The MDGs set the target ofreducing the maternal mortality rate by 75 percent between 1990 and 2015. With little or no

reliable data available from manycountries, estimating progresstowards this target has provendifficult. The best availableestimates, however, suggest that,globally, levels of maternal mortality remained stable between1995 and 2000 at a level of around400 maternal deaths for every 100 000 live births. What is certain is that in most developingregions, maternal mortality rates remain alarmingly high (seegraph).

South Asia and sub-SaharanAfrica account for more than 85 percent of all maternal deathsworldwide. Maternal mortality ratios in these regions are estimated at 570 and 920 per 100 000 live births, respectively,compared to 20 per 100 000 indeveloped regions. Unless progress accelerates rapidly in æthese developing regions, there is little chance of reaching the MDG target.

Malnutrition and maternal death

Hunger and malnutrition have beenfound to increase both the incidenceand the fatality rate of the conditionsthat cause up to 80 percent ofmaternal deaths (see graph).

Women who are underweightbefore starting pregnancy and gaintoo little weight during pregnancyface increased risks ofcomplications and death. Thatdescription applies to more than halfthe pregnant women in India, whoseannual toll of 130 000 maternaldeaths outstrips any other countryby far.

Stunting during childhood leaveswomen particularly vulnerable toobstructed labour, in which thebaby’s head is too large to fitthrough the birth canal. Obstructedlabour causes more than 40 000maternal deaths each year and is farmore common in short women.

Anaemia is one of the mainindirect causes blamed for



Improving maternal health and breaking the cycle of poverty, hunger and malnutrition

Maternal mortality ratio by region, 2000 Cause of maternal deaths: global estimates

Source: WHO

South East Latin Sub- NearAsia Asia America/ Saharan East/

Caribbean Africa NorthAfrica

Maternal deaths per 100 000 live births

1 000

800

600

400

200

0

Source: WHO

Ectopic pregnancy, embolism andother direct causes – 8%

Unsafe abortion – 13%

Obstructed labour – 8%Risk greatly increased

by stunting due to childhood undernutrition

Eclampsia – 12%Links with deficiencies of calcium

and other micronutrients havebeen suggested

Sepsis – 15%Anaemia and vitamin A deficiency

increase the risk of sepsis

Anaemia, malaria, HIV/AIDS,heart disease and otherindirect causes – 20%

Haemorrhage – 25%Anaemia is a major risk factor for haemorrhage

20 percent of maternal deaths andhas also been found to heighten therisk of haemorrhage and post-delivery infection (sepsis), whichtogether cause another 40 percent.More than half of all pregnantwomen in developing countries areanaemic, including more than 80 percent in some parts of SouthAsia. Iron deficiency is consideredthe main cause of anaemia amongpregnant women.

Other micronutrient deficienciesalso threaten the health and lives ofmothers and newborn children.Severe vitamin A deficiency has beenfound to increase vulnerability tosepsis. Iodine deficiency can lead tomiscarriages and stillbirths. Andlack of dietary calcium appears toincrease the risk of high bloodpressure and other symptoms ofeclampsia.

As might be expected, countrieswhere hunger is widespread alsosuffer from high rates of maternalmortality (see graph). And maternal

mortality has fallen in at least somecountries as they have succeeded inreducing malnutrition.

Thailand provides strikingevidence that improving householdnutrition can produce a steepdecline in maternal mortality. Aspart of the country’s NutritionSecurity Compact, village volunteersidentify pregnant women and makesure that they receive foodsupplements to improve overallnutrition, as well as iron and folicacid treatment to combat anaemia.The programme also promoteshome gardening and theconsumption of fruits andvegetables to improve micronutrientintake. Maternal mortality inThailand fell from 230 per 100 000live births in 1992 to 17 in 1996.

Maternal malnutrition and the cycleof hunger and poverty

The damage caused by poormaternal nutrition and health

extends far beyond the half a milliondeaths each year.

Malnourished mothers are farmore likely to give birth to low-birthweight babies. So are women whoseown growth was stunted bymalnutrition during childhood. Insome developing countries, morethan 30 percent of children are bornwith low birth weights.

These low-birth weight babies facea greatly increased risk of dying ininfancy. They are also far more likelyto suffer stunting during childhoodthat will greatly increase their ownrisk of dying during childbirth orgiving birth to another generation oflow-birth weight babies.

And so the cycle of sufferingcontinues (see diagram). Reachingthe MDG target for improvingmaternal health could break the hubaround which it revolves. Improvingnutrition for women and girlsthroughout their lives couldaccelerate progress to bring theMDG target within reach.


MDG 5

Maternal mortality ratio forcountries grouped byprevalence of hunger

Source: FAO; WHO

Maternal health and the cycle of poverty, hunger and malnutrition

Source: FAO

Proportion of populationundernourished (%)

< 5 5–9 10–19 20–34 ≥ 35

Maternal deaths per 100 000 live births

1 000

800

600

400

200

0

Mother (pregnancy)• Poor weight gain

• Increased risk of miscarriage,stillbirth

Child (female)• Stunting, underweight

• Impaired cognitive abilities• Increased mortality

Mother (term)• Increased complications

and mortality

Baby• Low birth weight

• Increased mortality

Woman• Underweight

• Reduced productivity

Adolescent (female)• Stunting, underweight

• Reduced school attendance and attainment

Poor maternal nutrition and health

• Stunted• Underweight

• Anaemic• Micronutrient deficiencies

(zinc, vitamin A, iodine)• Weakened immune system

• Increased incidence andseverity of malaria

infections

HIV/AIDS, malaria andtuberculosis kill more than 6 million people each year,

the vast majority of them in thedeveloping world, and most of themin sub-Saharan Africa. Tens ofmillions more become infected orfall ill, including more than 5 millionnewly infected with HIV, 8 millionnew active cases of tuberculosis andmore than 300 million acute malariaattacks. Millions of households arepushed deeper into hunger andpoverty by the illness and death ofbreadwinners and by the costs ofhealth care for the sick, funerals forthe dead and support for orphansand other dependents who survive.

The MDGs have set targets forhalting and reversing the spread ofHIV/AIDS, malaria and tuberculosis.Achieving these targets would savemillions of lives and tens of billionsof dollars and would significantlyslow the vicious cycle of hunger andpoverty that has stalled progresstowards many of the other MDGs.Conversely, reducing hunger andmalnutrition would help halt thespread and roll back the death toll ofthese diseases.

HIV/AIDS, malaria andtuberculosis are all diseases ofhunger and poverty. Theoverwhelming majority of casesoccur in developing countries,especially in sub-Saharan Africa andsouthern Asia, the two regions thatalso suffer from the highest rates ofundernourishment and extremepoverty (see map and graphs). Withinthose countries and regions, thehungry and poor are hit the hardest.

Approximately 40 million peopleare now living with HIV, more than60 percent of them in sub-SaharanAfrica. Each year another 5 millionpeople become infected with HIV andmore than 3 million people die ofAIDS.

Malaria kills more than 1 millionpeople per year. More than 90percent of these deaths take place inAfrica, mainly among youngchildren. Of the 8 million new activecases of tuberculosis each year,more than 5 million occur in SouthAsia and sub-Saharan Africa.

Hunger as a cause of disease

Hunger and malnutrition alterpeople’s behaviour and weaken their

bodies and immune systems, greatlyincreasing their vulnerability toHIV/AIDS, malaria and tuberculosis.

In the case of HIV/AIDS, hungerand poverty drive men to becomemigrant labourers, women to turn toprostitution or other dangeroussexual relationships, children to dropout of school. All face greatlyincreased risk of infection. Recentstudies confirm, for example, thatyoung people with little or noeducation are more than twice as



Combating HIV/AIDS, malaria and tuberculosis: the role of undernutrition as both symptom and cause

HIV/AIDS, malaria and hunger in the developing world

Source: Gallup and Sachs; FAOSource: UNAIDS; FAO

Prevalence of undernourishment for country group (%)

2.5–4 5–9 10–19 20–34 ≥ 35

Hunger and HIV prevalence by country group, 2001

HIV prevalence rate, ages 15–49 (%)

8

6

4

2

0* Fraction of population at risk of malaria multiplied byfraction of malaria cases that are of the variety that causesmost deaths and severe illness


2.5–4 5–9 10–19 20–34 ≥ 35

Hunger and malaria risk, 1994

0.8

0.6

0.4

0.2

0.0

Malaria index*

Source: FAO; UNICEF

Countries with relatively low levels of undernourishment and of HIV/AIDS and malariaCountries with relatively high risk of malaria but low undernourishment andHIV/AIDS

Countries with high prevalence of HIV/AIDS but low undernourishment and malariaCountries with high prevalence of undernourishment but low HIV/AIDS and malariaCountries that have high levelsof undernourishment plus high levels of one or both ofHIV/AIDS and malaria

likely to contract HIV as those whohave completed a primary education(see pages 18–19). Among those whohave already been infected with HIV,malnutrition increases vulnerabilityto opportunistic infections,accelerating the progression of thedisease to full-blown AIDS and death.

Hunger and malnutrition alsoincrease the risk of infection anddeath from malaria andtuberculosis. Severe malaria attacksare more common and more oftenfatal for children and pregnantwomen who already suffer fromanaemia and other micronutrientdeficiencies. Malaria attack ratescan be substantially reduced, forexample, by increasing vitamin Aand zinc through supplements orimproved diets.

Tuberculosis spreads quicklyamong poor people living in crowdedconditions, whose immune systemshave been weakened bymalnutrition. In India, for example,researchers found that tuberculosisrates were twice as high amongpeople who earned less than US$7per month as they were amongthose who earned more than US$20per month.

Disease as a cause of hunger

Because they strike at people duringtheir most productive working years,these diseases cause poverty andhunger not only for those who areinfected, but also for their familiesand communities. When aggregatedat national and regional levels, thecosts are staggering.

In half of the countries in sub-Saharan Africa, per capita economicgrowth is estimated to be falling bybetween 0.5 and 1.2 percent eachyear as a direct result of AIDS. Theeconomic losses from lostproductivity are compounded by

soaring costs of medical care andsupport for orphans. In thecountries that have been hardest hit,public health spending related toHIV/AIDS often exceeds 2 percent ofGDP. The costs of the pandemic havebeen estimated at more than US$25billion per year and rising fast.

Malaria and tuberculosis alsotake a heavy toll on productivity,prosperity and food security. Malariacosts Africa an estimated US$12billion every year in lost GDP andaccounts for between 20 and 50percent of all hospital admissions incountries where the disease isendemic. Tuberculosis victims whosurvive their illness typically losethree to four months of work timeand 20 to 30 percent of their annualhousehold income.

Relative costs of inertia and action

Compared to the human sufferingand economic losses caused bythese diseases, the investmentsneeded to scale up prevention andtreatment to meet the MDG targets

are small (see graph). Less thanUS$1 billion per year, for example,would provide insecticide-treatedbed nets for 70 percent of thechildren in Africa, preventivetreatment for pregnant women andbetter first-line treatment for peoplesuffering from malaria attacks.Vitamin A supplements to boostresistance to malaria and otherdiseases can be supplied for as littleas US$0.10 a year per child.

Given the strong linkagesbetween malnutrition and infectiousdisease, coordinated and aggressiveaction to combat both hunger anddisease could accelerate the paceand reduce the costs of progress inboth areas. A programme in twodistricts in the United Republic ofTanzania that simultaneouslyfocused on improved child nutritionand distribution of bed netsillustrates the point. Five years afterthe start of the programme, childmortality in both districts haddeviated sharply from the prevailingtrend and was on track to reach theMDG target (see graph).


MDG 6

Estimated annual costs ofdiseases and required actions

Source: ILO; Stop TB Partnership; Millennium Project

Under-five mortality in theUnited Republic of Tanzania

Source: IDRC/TEHIP

HIV/AIDS Malaria* Tuberculosis

* Estimates for sub-Saharan Africa only.

US$ billions

25

20

15

10

5

0

1990 1995 2000 2005 2010 2015

MorogoroDistrictRufijiDistrict

UNICEF nationaltrend data

1997 start of healthsystem intervention

MDG target trajectory

Under-five mortality per 1 000 live births

200

180

160

140

120

100

80

60

40

20

0

Annual economiclossesInvestment required in 2005 for progresstowards MDG target

No segment of humanitydepends more directly onenvironmental resources and

services than the rural poor, whomake up an estimated 80 percent ofthe world’s 800 million hungrypeople. They make daily use of soiland water for farming and fishing, offorests for food, fuel and fodder, ofthe biodiversity of a wide range ofplants and animals, bothdomesticated and wild. Their livesare interwoven with the surroundingenvironment in ways that make themboth particularly valuable ascustodians of environmentalresources and particularly vulnerableto environmental degradation.

A large proportion of the hungryare concentrated in areas that arehighly vulnerable to environmentaldegradation and climate change,including forests and semi-aridrangelands (see map). Whenpopulation pressure grows and foodis scarce, hunger can drive them toplough under or overgraze fragilerangelands and forest margins,threatening the very resources uponwhich they depend.

The MDGs established severaltargets for ensuring environmentalsustainability. Key indicators includemeasures of deforestation and useof solid fuels, as well as access toimproved water and sanitationfacilities. Progress towards all ofthese targets would have a directimpact on reducing hunger andmalnutrition, as well as improvingthe environment. But progress hasbeen slow and uneven at best.

Worldwide, forests were felledand burned during the 1990s at a

rate of 9.4 million hectares a year(an area roughly the size ofPortugal). In proportional terms, themost rapid deforestation took placein Africa and the Caribbean andamong the countries with thehighest prevalence of hunger. Thecountries where hunger is mostprevalent are also marked by thehighest reliance on solid fuels, thelowest levels of access to safe waterand sanitation and the slowestprogress towards the MDG targets(see graphs).



Improving environmental sustainability and food security by empowering the rural poor

Changes in forest cover, 1990–2000, by undernourishmentprevalence group

Source: FAO

Access to improved water and prevalence of undernourishment

Source: WHO; UNICEF; FAO

Access to improved sanitationand prevalence of undernourishment

Source: WHO; UNICEF; FAO

Deforestation, barren lands and undernourishment

Source: UNEP/GRID-Arendal; FAO

* A hot spot is an area where major changes in the forest cover have been initiated during the past five years or are expected to takeplace within the next five years.


< 5 5–9 10–19 20–34 ≥ 35


< 5 5–9 10–19 20–34 ≥ 35

30

25

20

15

10

5

0

Number of countries

10080604020

0

Population with access to safe water (%)


< 5 5–9 10–19 20–34 ≥ 35

10080604020

0

Population with access to sanitation (%)

Burned areas

Deforestation hot spot*

Deserts

Very high vulnerability to desertification

Country with high prevalence (≥ 20 percent) of undernourishment

1990 2002

Rapid decrease Little changeSlow decrease Increase

1990 2002

Dependency and vulnerability

The activities of poor farmers,herders, forest dwellers andfisherfolk have shaped andconserved much of the ruralenvironment over thousands ofyears. But they have alsocontributed to environmentaldamage, particularly when hungerand population pressure have driventhese people to expand fields andherds beyond the carrying capacityof the land. Their multiple roles assustainable users, sometimedespoilers and potential guardiansof environmental resources areexemplified by the forests.

Worldwide, an estimated 350million people depend on forests astheir primary source of income andfood. Wild plants, animals and otherforest foods are important to thediets and food security of anestimated 1 billion people. Forestsalso provide grazing and fodder formany of the 500 million poorlivestock producers whoselivelihoods depend on keeping a fewanimals. Particularly in countrieswhere hunger is widespread, most ofthe rural poor burn wood gatheredfrom forests and other solid fuels tocook their food (see graph). A study in

six Indian states found that poorpeople depended on forests andother common lands for around 20 percent of their income, 75 percentof their fuel and 80 percent of grazingfor their livestock (see graph).

Because they rely so heavily onforest resources, many of the ruralpoor have developed techniques forexploiting them sustainably. Smallfarmers in forested areas, forexample, often cultivate crops andraise animals among trees that helpcapture water, prevent erosion andprovide fuel, food and fodder. Inrural India, where more than half ofdomestic energy comes fromburning fuelwood, a study found thatnearly 90 percent of this wood wasobtained by gathering or cuttingbranches rather than felling trees.

Dependence on forest resourcesalso leaves the rural poor particularlyvulnerable to the destruction anddegradation of forests. When forestsare cleared and converted to otheruses and private ownership, poorlocal residents lose important partsof their incomes and diet and may beforced to travel even greaterdistances to gather fuel and water,increasing the threats to their foodsecurity from polluted water andunsafe food preparation.

Food security and sustainability

Efforts to promote food security andenvironmental sustainability canoften reinforce each other. All toooften, however, ill-conceived policieshave favoured large-scale, industrialproduction of crops and livestock atthe expense of mixed farmingsystems employed by the poor. Bydevoting large tracts of land to asingle use, industrial productionoften contributes to deforestation,land degradation, contamination ofsurface and groundwater suppliesand loss of biodiversity. Changes intaxation and subsidy policies thatmake industrial producersresponsible for environmental“externalities” can improve both theeconomic viability and environmentalsustainability of small-scaleproduction by the rural poor.

Another promising approachinvolves recognizing and rewardingthe environmental services providedby small farmers and livestockproducers. A number of schemeshave been devised to compensatefarmers for planting trees in andaround their fields and pastures toimprove carbon sequestration,biodiversity conservation andwatershed management. In manycases, the more environmentallyfriendly techniques may also proveto be more productive. Early resultsfrom one project in Latin Americasuggest that participating livestockproducers can raise more animalsper hectare while earning paymentsfor planting trees and other plantsthat remove climate-warmingcarbon from the atmosphere andenhance biodiversity.

Adopting similar approachesmore widely and ensuring that theyare targeted to benefit the poorcould improve both food security andenvironmental sustainability.


MDG 7

Solid fuel use in countriesgrouped by prevalence of undernourishment

Source: WHO; FAO

Dependence of poor and wealthy in India on common land resources


< 5 5–9 10–19 20–34 ≥ 35

Income Fuel Grazing

10080604020

0

Share of population using solid fuel (%)80

60

40

20

0

Proportion derived from common lands (%)

PoorWealthy

Source: Jodha, cited in Parikh

The first seven MDGs focus onobjectives that must beattained largely through the

efforts of the governments andpeople of developing countriesthemselves. MDG 8 highlights theresponsibility of wealthierindustrialized nations to assist thoseefforts. It calls for increased aid,more equitable trade, relief from thecrushing burden of debt and betteraccess to technology, medicines and jobs.

At the International Conferenceon Financing for Development,convened in Monterrey, Mexico, twoyears after the Millennium Summit,governments agreed on theframework for a global partnershipbetween developed and developingcountries to achieve the MDGs.Within this framework, countriescommitted themselves “to soundpolicies, good governance at alllevels and the rule of law ... [and] ...to mobilizing domestic resources,attracting international flows,promoting international trade as anengine for development, increasinginternational financial and technicalcooperation for development,sustainable debt financing andexternal debt relief, and enhancingthe coherence and consistency ofthe international monetary, financialand trading systems”.

As tools for increasing financingfor development, the Conferencefocused on the critical importance ofexternal aid for many of the poorestcountries and on the role of trade as“the single most important externalsource of development financing” inmany cases.

Reversing the decline in aid

The Monterrey Consensusrecognizes that Official DevelopmentAssistance (ODA) is “a crucial

instrument for supportingeducation, health, publicinfrastructure development,agriculture and rural development,and to enhance food security” formany countries in Africa, leastdeveloped countries (LDCs), smallisland developing states andlandlocked developing countries. Aspart of their commitment to provideadditional resources, donorcountries vowed to boost ODA to thelong-standing target of 0.7 percentof their gross national income (GNI).Although this target had first beenproposed by the United NationsGeneral Assembly more than 30 years earlier, aid from theindustrialized countries had fallen toan all-time low of 0.22 percent ofGNI in 2001 (see graph).

Since the Conference, thisdownward trend has finally beenreversed. G8 members preliminarilyagreed in June 2005 to forgiveUS$40 billion in debt owed by 18 ofthe world’s poorest countries.Several donors have made specificpledges to raise their developmentassistance to 0.7 percent of GNI. InMay 2005, the European Uniondetailed plans to reach this goal,announcing specific targets for

member countries. But several ofthe world’s wealthiest nations havemade no such commitments, andthe commitments that have beenmade still must be translated intoconcrete action targeting the poor.

In addition to increasing thevolume of aid, it is also essential tomake sure that aid reaches thecountries where it is most neededand the sectors where it will havethe most impact. That is decidedlynot the case today.

External assistance is critical forvery poor countries with limitedability to mobilize domestic privateand public savings for investment.And it is particularly critical foragriculture, which is largelybypassed by foreign privateinvestors. Yet at the time of theMonterrey Conference, less than aquarter of ODA went to the 49 LDCs,which are home to more than one-third of the world’s hungry people.And both the volume and share ofaid directed to agriculture had fallento less than half the levels of the1980s (see graph).

It also appears that externalassistance to agriculture (EAA) is notrelated to need. Data on EAA for1998–2000 indicate that countries



Increased aid and more equitable trade: keys to forging a global partnership for development

Aid to developing and least developed countries, 1990–2003 and targets

Source: UN Statistics Division

All developing Least developedcountries countries

0.70.60.50.40.30.20.10.0

Share of donors’ gross national income (%)

Share of aid to agriculture in total Official Development Assistance

Source: OECD

1980 1985 1990 1995 2000 2002

35

30

25

20

15

10

5

0

Assistance to agriculture in total ODA (%)

BilateralMultilateral

1990 2001 2003 target 1990 2001 2003 target

where fewer than 5 percent of thepopulation were undernourishedreceived three times the amount ofassistance per agricultural workerthat went to countries where morethan 35 percent of the populationwent hungry. In sub-Saharan Africa,where two-thirds of the populationdepend on agriculture, bilateral aidto agriculture fell by 60 percent in adecade, from US$1.3 billion in 1990to US$524 million in 2001.

The decline in domesticinvestment and EAA has resulted ina large and growing investment gapbetween countries where theprevalence of undernourishment ishigh and those that have managedto reduce hunger. In the group of countries where more than one-third of the people areundernourished, the value of capitalstock in primary agriculture peragricultural worker has fallen byalmost one-quarter over the past 25 years (see graph).

Since the Monterrey Conference,the share of aid to LDCs in donorGNI has increased to 0.08 percent –a distinct improvement, but wellshort of the 0.15–0.20 percenttarget. The level of EAA hasremained essentially unchanged.

More equitable trade

Increasing aid to developing countrieswould certainly help fuel progresstowards the MDGs. Reducingagricultural subsidies and tariffs indeveloped countries and improvingthe capacity of LDCs to participate intrade through investments inagricultural productivity, trade-related infrastructure and exportindustries might help even more.

Every year, wealthier countrieshand out more than US$250 billion insubsidies to agricultural producers.Most of this largesse goes to largefarms in the United States of Americaand Europe, resulting in hugesurpluses that are often sold onworld markets at less than half theircost of production. Poor developingcountries and their consumers gainfrom the low prices, but their farmersfind it difficult, if not impossible, tocompete. Exporting countries arealso penalized by rich-country tariffsthat are often four to five timeshigher for agricultural products thanfor manufactured goods.

Removing trade barriers andimproving infrastructure to increasetrade among developing countriescould also have a big impact on

improving both incomes and foodsecurity. In Africa, for example, localdemand for food is expected tooutpace growth of export marketsover the next 20 years. As theCommission for Africa points out,growing staple foodstuffs for partsof Africa that suffer from regularfood shortages could bring growth tothe continent’s potentialbreadbaskets, while reducing theneed to import more than US$20billion worth of food each year.

So far, the MDG 8 call for an open,non-discriminatory trading andfinancial system has not led to anysignificant reduction in farmsubsidies and tariffs. In fact, producersupport to farmers in industrializedcountries increased from US$226billion in 2002 to US$280 billion in2004 (see graph). While a number ofinitiatives are under way to boost thetrading capacity of the poorestcountries, support from internationalfinancial and development institutionshas fallen far short of what is needed.Reversing these trends and scalingup aid to meet the Monterreycommitments are essential to forgingan effective partnership fordevelopment.

Meeting the aid targets of MDG 8would substantially contribute tonational efforts to meet the rest ofthe MDGs. Cancelling the debt ofpoor countries would allow them tostop spending more on servicingdebts than they receive as aid, aswas the case in 2003. Account mustbe taken, however, of countries’ability to absorb large additionalamounts of aid. Where necessary,this ability must be enhancedthrough capacity-building. With suchassistance, all of these increasedflows of resources could be used tostep up the investments in ruraldevelopment, education and healthservices needed to reach the MDGs.


MDG 8

Capital stock in agriculture by prevalence of undernourishment

Source: FAO

Farm subsidies in OECD* countries, 1986–2004

Source: OECD

8 0007 0006 0005 0004 0003 0002 0001 000

0

% undernourished

US$/worker

< 5 5–19 20–34 ≥ 35

+33%

+2%+12%-22%

1986–88 2002 2003 2004

300

250

200

150

100

50

0

Producer support to farmers (US$ billions)

* Organisation for EconomicCo-operation and Development

1975–771998–2000



The way ahead: shifting into forward gear on the twin-track approach to the WFS and MDG goals

A twin-track approach to reach the WFS goal and accelerate progress towards the MDG targets

World Food Summit Goal

1 2 3 4 5 6 7 8

1 1

7 1

2

3

4

5

6

7

8

4

7

7

8

4

3

7

7

Track 1: strengthen productivityand incomes

Simple, inexpensive technology packages (water management, use of green manures,

crop rotation, agroforestry)

Rural infrastructure (roads, water, etc.)

Improved irrigation and soil fertility

Natural resource management (including forestry and fisheries)

Market and private sector development

Food safety and quality

Farmer Field Schools, participatory training

Track 2: provide direct access to food and social safety nets

Mother and infant feeding programmes (including nutritional supplements)

School meals and school gardens

Unemployment and pension benefits

Food-for-work and food-for-education

Targeted conditional cash transfers

Feeding programmes for HIV/AIDS patients, their families and orphans

Emergency rations

Connections tothe Millennium Development Goals

Eradicate extreme poverty and hunger

Achieve universal primary education

Promote gender equality and empower women

Reduce child mortality

Improve maternal health

Combat HIV/AIDS, malaria and other diseases

Ensure environmental sustainability

Develop a global partnership for development

4 5

2 3

2 3

2 3

2 6

4

2 3

Source: FAO

At the International Conferenceon Financing for Developmentheld in Monterrey, Mexico, in

2002, FAO, the International Fund forAgricultural Development (IFAD) andthe World Food Programme (WFP)mapped out a practical and affordable“twin-track approach” for combatinghunger. Track one: strengthen theproductivity and incomes of thehungry and poor, targeting the ruralareas where the vast majority of themlive and the agriculture sector onwhich their livelihoods depend. Tracktwo: provide direct access to food andcreate social safety nets for thehungry.

Since that time, we have seenencouraging signs of revitalizedcommitment to fight hunger and ofan emerging consensus that thetwin-track approach provides thecore of an effective strategy forwaging that fight. The mainelements of the approach, forexample, were incorporated into therecommendations of the HungerTask Force of the United NationsMillennium Project.

Building upon the solid foundationof the twin-track approach, at themeeting of the United NationsEconomic and Social Council(ECOSOC) that was convened toprepare the World Summit ofSeptember 2005, FAO, IFAD andWFP proposed elements of abroader strategy to reach the targetsfor reducing hunger and povertyspecified in MDG 1. If the strategysucceeds in shifting the drive to endhunger into high gear, it will alsokick-start more rapid progresstowards all the other MDGs.

Twin tracks to the MDGs

Although the twin-track approachwas proposed primarily as a way tocombat hunger, many of its keyelements explicitly target areaswhere efforts to reduce hungerintersect with achieving the otherMDGs (see diagram).

Introducing improved watermanagement, use of green manures,agroforestry and other low-cost,simple technologies, for example, will

enhance not only the productivity andincomes of small farmers, but alsotheir role as custodians of land,water, forests and biodiversity.Similarly, investing in roads, improvedwater facilities and other ruralinfrastructure can reduce the lethalimpact of water-borne illnesses,improve access to health care andprevent thousands of needless childand maternal deaths, even as it rollsback hunger by opening links tomarkets where farmers can sellsurplus produce and acquire fertilizerand other inputs at reasonable prices.

Measures to provide direct accessto food for the neediest families canalso contribute to several MDGssimultaneously. Feeding programmesfor mothers and infants target the hubof the vicious cycle that perpetuateshunger and malnutrition from onegeneration to the next, underminingmaternal health, stunting children’sphysical and cognitive growth,impairing school attendance andperformance and impeding progresstowards gender equality and theempowerment of women.

Extending twin-track synergy

As with the twin-track approachitself, the broader strategy formeeting MDG 1 put forward atECOSOC will also serve toaccelerate progress towards theother MDGs. Key elements of thestrategy include: • setting targets, agreeing on

coordinated actions in each countryand mobilizing resources to exploitsynergies among the MDGs;

• using participatory approachesthat build local institutions andskills, strengthen legal rights andaccess to resources, and empowerwomen, indigenous people andother vulnerable groups;

• giving priority to “hot spots”where a high proportion of thepopulation suffer from hungerand extreme poverty and oftenalso from illiteracy, disease,social marginalization and childand maternal mortality;

• using food assistance to developand enhance skills or to createphysical assets, such as foodstorage facilities or water anderosion control structures, thatwill help communities weathercrises and build the foundation forlonger-term development;

• focusing policies and investmentson rural areas and agriculture inways that promote sustainableuse of natural resources, improverural infrastructure, facilitate thefunction of markets and enhancerural institutions;

• supporting dynamic rural growthby improving the productivity ofsmallholder agriculture and bydiversifying into rural non-farmactivities and strengtheningmicroenterprises in which ruralwomen play a major role;

• strengthening poor urbanlivelihoods with an urban twin-

track approach that combines pro-poor employment and assetgeneration programmes withmeasures to help the poor meettheir basic needs for food, housing,clean water, health and education;

• accelerating progress towards anopen and fair international tradingsystem, with special attention toimproving market access andreducing export subsidies andtrade-distorting domestic supportin agriculture.All of these approaches are

proven, practical and affordable. Allcan be effectively adapted and

applied to meet local requirements,monitored to ensure that they areeffective and scaled up as they provesuccessful and sufficient resourcesare mobilized.

If developing countries gear uptheir efforts to revitalize agriculturaland rural development and ensurethe hungry have access to food, ifdonor countries fulfil their pledgesto increase development assistancesubstantially, we can still reach theWFS and MDG hunger reductiontargets. And in the process, we willshift progress towards all of theother MDGs into high gear as well.


Shifting into forward gear: eliminating hunger is key to achieving the Millennium Development Goals

Source: FAO

MDG 1

MDG 8

MDG

7

MDG 6MDG 5 MDG 4

MDG 3

MDG 2

MDG 8

MDG 2M

DG 7

MDG 1

MDG 6MDG 5 MDG 4

MDG 3Reduction of hunger

and malnutrition leads to…

…increased productivity,incomes and…

…improvedschool attendance,

learning and literacy...

…reduced diseasevulnerability

and lower childmortality...

…improvedmaternal and infant

health...

…greaterresistance to

HIV/AIDS,malaria and

other diseases...

…reducedpressure on theenvironment...

…greaterparticipationin trade and

development…

…improvedgender equality

and empowermentof women…


TablesTable 1. Prevalence of undernourishment and the distance from Millennium Development Goal1 and WorldFood Summit2 targets in developing countries

DEVELOPING WORLD 4058.7 4796.7 823.8 814.6 20 17 0.8 1.0

ASIA AND THE PACIFIC* 2815.2 3256.1 569.2 519.0 20 16 0.8 0.9East Asia 1241.5 1364.5 198.8 151.7 16 11 0.7 0.8China 1175.7 1292.5 193.5 142.1 16 11 0.7 0.7Dem. People's Rep. of Korea 20.3 22.4 3.7 8.1 18 36 2.0 2.2Mongolia 2.3 2.5 0.8 0.7 34 28 0.8 0.9Rep. of Korea 43.3 47.1 0.8 0.7 – – 0.9 0.9Southeast Asia 444.2 522.8 78.4 65.5 18 13 0.7 0.8Cambodia 10.1 13.5 4.3 4.4 43 33 0.8 1.0Indonesia 185.2 214.3 16.4 12.6 9 6 0.7 0.8Lao People's Dem. Rep. 4.2 5.4 1.2 1.2 29 22 0.8 1.0Malaysia 18.3 23.5 0.5 0.6 3 – 0.9 1.1Myanmar 41.2 48.2 4.0 2.8 10 6 0.6 0.7Philippines 62.5 77.1 16.2 17.2 26 22 0.9 1.1Thailand 55.1 61.6 15.2 12.2 28 20 0.7 0.8Viet Nam 67.5 79.2 20.6 14.7 31 19 0.6 0.7South Asia 1125.3 1363.3 291.3 301.1 26 22 0.9 1.0Bangladesh 112.1 140.9 39.2 42.5 35 30 0.9 1.1India 863.3 1033.3 215.8 221.1 25 21 0.9 1.0Nepal 19.1 24.1 3.9 4.0 20 17 0.8 1.0Pakistan 113.7 146.3 27.7 29.3 24 20 0.8 1.1Sri Lanka 17.0 18.8 4.8 4.1 28 22 0.8 0.9

LATIN AMERICA AND THE CARIBBEAN 443.4 521.2 59.5 52.9 13 10 0.8 0.9North America 84.8 100.5 4.6 5.2 5 5 1.0 1.1Mexico 84.8 100.5 4.6 5.2 5 5 1.0 1.1Central America 28.8 36.9 5.0 7.4 17 20 1.2 1.5Costa Rica 3.2 4.0 0.2 0.2 6 4 0.7 0.9El Salvador 5.2 6.3 0.6 0.7 12 11 0.9 1.1Guatemala 9.0 11.7 1.4 2.8 16 24 1.5 2.0Honduras 5.0 6.6 1.1 1.5 23 22 1.0 1.3Nicaragua 3.9 5.2 1.2 1.4 30 27 0.9 1.2Panama 2.5 3.0 0.5 0.8 21 26 1.3 1.5Caribbean 28.5 31.7 7.8 6.7 27 21 0.8 0.9Cuba 10.7 11.2 0.8 0.4 8 3 0.4 0.4Dominican Rep. 7.2 8.5 1.9 2.1 27 25 0.9 1.1Haiti 7.0 8.1 4.6 3.8 65 47 0.7 0.8Jamaica 2.4 2.6 0.3 0.3 14 10 0.7 0.8Trinidad and Tobago 1.2 1.3 0.2 0.2 13 12 0.9 1.0South America 301.3 352.2 42.0 33.6 14 10 0.7 0.8Argentina 33.0 37.5 0.7 0.6 – – 0.8 0.9Bolivia 6.8 8.5 1.9 1.8 28 21 0.8 0.9Bolivarian Rep. of Venezuela 20.0 24.8 2.3 4.3 11 17 1.5 1.9Brazil 151.2 174.0 18.5 15.6 12 9 0.7 0.8Chile 13.3 15.4 1.1 0.6 8 4 0.5 0.6Colombia 35.7 42.8 6.1 5.7 17 13 0.8 0.9Ecuador 10.5 12.6 0.9 0.6 8 4 0.5 0.7Guyana 0.7 0.8 0.2 0.1 21 9 0.5 0.5Paraguay 4.3 5.6 0.8 0.8 18 14 0.8 1.0Peru 22.2 26.4 9.3 3.4 42 13 0.3 0.4Suriname 0.4 0.4 0.1 0.0 13 11 0.8 0.8Uruguay 3.1 3.4 0.2 0.1 6 4 0.6 0.6

(continued)

DEVELOPING WORLD Total population Number of people Proportion Ratio RatioRegion/subregion/country undernourished of undernourished current/baseline current/baseline

in total population prevalence of number ofundernourished3 undernourished3

1990–92 2000–02 1990–92 2000–02 1990–92 2000–02 Ratio for MDG1 Ratio for WFS2

(millions) (millions) (%) target = 0.5 target = 0.5

NEAR EAST AND NORTH AFRICA* 322.8 399.4 24.8 39.2 8 10 1.3 1.6Near East* 202.5 255.0 19.4 33.1 10 13 1.4 1.7Islamic Rep. of Iran 58.0 67.3 2.1 2.7 4 4 1.1 1.3Jordan 3.4 5.2 0.1 0.4 4 7 1.9 2.9Kuwait 2.1 2.3 0.5 0.1 23 5 0.2 0.3Lebanon 2.8 3.5 0.1 0.1 – 3 1.2 1.5Saudi Arabia 17.1 22.8 0.7 0.8 4 3 0.8 1.1Syrian Arab Rep. 13.1 17.0 0.7 0.6 5 4 0.7 1.0Turkey 58.7 69.3 1.0 1.8 – 3 1.6 1.9United Arab Emirates 2.1 2.9 0.1 0.1 4 – 0.5 0.6Yemen 12.5 18.7 4.2 6.7 34 36 1.1 1.6North Africa 120.4 144.4 5.4 6.1 4 4 1.0 1.1Algeria 25.6 30.8 1.3 1.7 5 5 1.0 1.2Egypt 57.0 69.1 2.5 2.4 4 3 0.8 1.0Libyan Arab Jamahiriya 4.4 5.3 0.0 0.0 – – 1.2 1.4Morocco 25.0 29.6 1.5 2.0 6 7 1.1 1.3Tunisia 8.4 9.6 0.1 0.1 – – 0.9 1.0

SUB-SAHARAN AFRICA* 477.3 620.0 170.4 203.5 36 33 0.9 1.2Central Africa 63.4 82.0 22.7 45.2 36 55 1.5 2.0Cameroon 12.0 15.4 4.0 3.9 33 25 0.8 1.0Central African Rep. 3.0 3.8 1.5 1.6 50 43 0.9 1.1Chad 6.0 8.1 3.5 2.7 58 34 0.6 0.8Congo 2.6 3.5 1.4 1.3 54 37 0.7 1.0Dem. Republic of the Congo 38.8 49.9 12.2 35.5 32 71 2.3 2.9Gabon 1.0 1.3 0.1 0.1 10 6 0.7 0.8East Africa* 167.8 217.7 76.4 86.2 46 40 0.9 1.1Burundi 5.7 6.4 2.7 4.4 48 68 1.4 1.6Eritrea** na 3.9 na 2.8 na 73 na naEthiopia** na 67.3 na 31.3 na 46 na naKenya 24.4 31.1 10.7 10.3 44 33 0.8 1.0Rwanda 6.4 8.0 2.8 3.0 44 37 0.9 1.1Sudan 25.5 32.2 8.0 8.5 32 27 0.8 1.1Uganda 17.9 24.2 4.2 4.6 24 19 0.8 1.1United Rep. of Tanzania 27.0 35.6 9.9 15.6 37 44 1.2 1.6Southern Africa 71.0 90.1 34.1 35.7 48 40 0.8 1.1Angola 9.6 12.8 5.6 5.1 58 40 0.7 0.9Botswana 1.4 1.7 0.3 0.6 23 32 1.4 1.7Lesotho 1.6 1.8 0.3 0.2 17 12 0.7 0.8Madagascar 12.3 16.4 4.3 6.0 35 37 1.1 1.4Malawi 9.6 11.6 4.8 3.8 50 33 0.7 0.8Mauritius 1.1 1.2 0.1 0.1 6 6 0.9 1.0Mozambique 13.9 18.2 9.2 8.5 66 47 0.7 0.9Zimbabwe 10.7 12.7 4.9 5.6 45 44 1.0 1.1Namibia 1.5 1.9 0.5 0.4 35 22 0.6 0.9Swaziland 0.9 1.1 0.1 0.2 14 19 1.4 1.6Zambia 8.4 10.6 4.0 5.2 48 49 1.0 1.3

WEST AFRICA 175.1 230.3 37.2 36.4 21 16 0.7 1.0Benin 4.8 6.4 1.0 0.9 20 15 0.7 1.0Burkina Faso 9.2 12.3 1.9 2.3 21 19 0.9 1.2Côte d'Ivoire 12.9 16.1 2.3 2.2 18 14 0.8 1.0Gambia 1.0 1.4 0.2 0.4 22 27 1.3 1.7


Table 1. Prevalence of undernourishment and the distance from Millennium Development Goal1 and WorldFood Summit2 targets in developing countries

(continued)






TablesTable 1. Prevalence of undernourishment and the distance from Millennium Development Goal1 and WorldFood Summit2 targets in developing countries

Ghana 15.7 20.0 5.8 2.5 37 13 0.3 0.4Guinea 6.4 8.2 2.5 2.1 39 26 0.7 0.9Liberia 2.1 3.1 0.7 1.4 34 46 1.3 2.0Mali 9.3 12.3 2.7 3.6 29 29 1.0 1.3Mauritania 2.1 2.7 0.3 0.3 15 10 0.6 0.8Niger 7.9 11.1 3.2 3.8 41 34 0.8 1.2Nigeria 88.7 117.8 11.8 11.0 13 9 0.7 0.9Senegal 7.5 9.6 1.8 2.3 23 24 1.0 1.3Sierra Leone 4.1 4.6 1.9 2.3 46 50 1.1 1.2Togo 3.5 4.7 1.2 1.2 33 26 0.8 1.0

NOTES

Countries revise their official statistics regularly for the past as well as thepresent. The same holds for population data of the United Nations.Whenever this happens, FAO revises its estimates of undernourishmentaccordingly. Therefore users are advised to refer to changes of estimatesover time only within the same The State of Food Insecurity in the Worldpublication and refrain from comparing the data published in editions fordifferent years.

Table does not list countries for which there were insufficient data.

1 Millenium Development Goal 1, target 2: halve, between 1990 and 2015,the proportion of people who suffer from hunger.2 World Food Summit goal: halve, between 1990–92 and 2015, the number ofundernourished people.3 Current refers to 2000–02 estimates and baseline refers to 1990–92estimates.

* Although not listed separately, provisional estimates for Afghanistan, Iraq,Papua New Guinea and Somalia have been included in the relevant regionalaggregates.** Eritrea and Ethiopia were not separate entities in 1990–92, but estimatesof the number and proportion of undernourished in the former People'sDemocratic Republic of Ethiopia are included in regional and subregionalaggregates for that period.

KEY

– proportion less than 2.5% undernourishedna data not available0.0 zero or less than half the unit shown

SOURCES

Total population: UN Population Prospects, 2002 revision.Undernourishment: FAO estimates.






Table 2. Selected indicators of the Millennium Development Goals in developing countries, classified bycategory of prevalence of undernourishment

LESS THAN 2.5% UNDERNOURISHEDArgentina 2 3 na 5 94 na 1.04 1.00 28 20 100 82 14 13Libyan Arab Jamahiriya na na na 5 96 na 0.94 1.00 42 16 220 97 0 0Malaysia 2 2 25 12 94 93 1.00 1.00 21 7 80 41 66 59Rep. of Korea na 2 na na 100 100 1.01 1.00 9 5 130 20 64 63Tunisia 2 2 10 4 94 97 0.89 0.96 52 24 170 120 3 3United Arab Emirates na na na 7 99 83 0.97 0.97 14 8 26 54 3 4

2.5 TO 4% UNDERNOURISHEDChile 6 2 2 1 88 86 0.98 0.98 19 9 65 31 21 21Costa Rica 5 2 3 5 87 90 0.99 0.98 17 10 55 43 42 39Cuba na na na 4 92 93 0.97 0.96 13 8 95 33 19 21Ecuador 2 18 17 12 98 100 0.99 1.00 57 27 150 130 43 38Egypt 4 3 10 9 84 91 0.83 0.95 104 39 170 84 0 0Islamic Rep. of Iran 2 2 na 11 92 86 0.90 0.97 72 39 120 76 4 4Lebanon na na na 3 78 91 0.96 0.97 37 31 300 150 4 4Saudi Arabia na na na 14 59 54 0.86 0.96 44 26 130 23 1 1Syrian Arab Rep. na na 12 7 92 98 0.90 0.95 44 18 180 160 3 3Turkey 2 2 10 8 90 86 0.92 0.93 78 39 180 70 13 13Uruguay 2 2 6 na 92 90 0.99 0.98 24 14 85 27 5 7

5 TO 9% UNDERNOURISHEDAlgeria 2 2 9 6 93 95 0.85 0.93 69 41 160 140 1 1Brazil 14 8 7 6 86 97 0.94 0.95 60 35 220 260 67 64Gabon na na na 12 86 78* 0.98 0.99 92 91 500 420 85 85Guyana 8 3 18 14 89 99 0.98 0.98 90 69 na 170 81 79Indonesia 17 8 40 26 97 92 0.98 0.98 91 41 650 230 65 58Jordan 2 2 6 4 94 92 1.01 1.01 40 28 150 41 1 1Kuwait na na 11 2 49 83 0.95 1.00 16 9 29 5 0 0Mauritius na na 24 15 95 97 1.00 1.01 25 18 120 24 8 8Mexico 8 10 17 8 99 99 0.98 0.99 46 28 110 83 32 29Morocco 2 2 12 9 57 90 0.69 0.90 85 39 610 220 7 7Myanmar na na 32 35 98 84 0.95 1.01 130 107 580 360 60 52Nigeria 66 70 35 29 60 67 0.78 0.81 235 198 1 000 800 19 15

10 TO 19% UNDERNOURISHEDBenin na na 35 23 45 58* 0.50 0.72 185 154 990 850 30 24Bolivarian Rep. of Venezuela 3 14 8 4 88 91 1.03 0.98 27 21 120 96 59 56Burkina Faso 63 45 33 38 26 36 0.63 0.74 210 207 930 1 000 26 26China 33** 17** 17** 10** 97** na 0.93** 1.00** 49** 37** 95** 56** 16 18Colombia 2 8 10 7 68 87 1.15 0.99 36 21 100 130 50 48Côte d'Ivoire 10 11 12 21 46 61 0.71 0.80 157 192 810 690 31 22El Salvador 21 31 15 10 73 90 1.01 0.95 60 36 300 150 9 6Ghana 18 45 30 22 52 63 0.83 0.95 125 95 740 540 33 28Jamaica 8 2 7 4 96 95 0.99 0.99 20 20 120 87 35 30Lesotho 30 36 16 18 73 86 1.21 1.01 120 84 610 550 0 0Mauritania 47 26 48 32 35 68 0.73 0.97 183 183 930 1 000 0 0Nepal na 39 na 48 81 70* 0.61 0.89 145 82 1 500 740 33 27Paraguay 5 16 4 5 93 89 0.97 0.96 37 29 160 170 62 59Peru 2 18 11 7 88 100 0.97 1.00 80 34 280 410 53 51Suriname na na na 13 78 97 1.00 0.98 48 39 na 110 90 90Swaziland 8 na na 10 77 75 0.98 0.93 110 153 560 370 27 30

(continued)

CATEGORY OF Proportion Prevalence of Net enrolment Ratio of Under-five Maternal ProportionPREVALENCE OF of population underweight rate in girls to boys mortality rate mortality ratio of land areaUNDERNOURISHMENT below US$1 children under primary in primary (per 1 000 (per 100 000 covered byin total population 2000–02 PPP per day five years of age education education live births) live births) forest

MDG 1 MDG 4 MDG 6 MDG 9 MDG 13 MDG 16 MDG 25

1990 2004 1990 2004 1990 2002 1990 2002 1990 2003 1990 2000 1990 2000Country (%) (%) (%) (%)


TablesTable 2. Selected indicators of the Millennium Development Goals in developing countries, classified bycategory of prevalence of undernourishment

Trinidad and Tobago 4 na 7 6 91 91 0.99 0.97 24 20 90 160 55 50Uganda 88 85 23 23 53 na 0.80 0.98 160 140 1 200 880 26 21Viet Nam 15 2 45 33 91 94* 0.93 0.93 53 23 160 130 29 30

20 TO 34% UNDERNOURISHEDBangladesh 36 36 66 52 71 84 0.86 1.04 144 69 850 380 9 10Bolivia 6 14 11 8 91 95 0.91 0.99 120 66 650 420 50 49Botswana 31 na na 13 85 81 1.08 1.00 58 112 250 100 24 22Cambodia na 34 na 45 67 93 0.81 0.90 115 140 900 450 56 53Cameroon na 17 15 21 74 na 0.86 0.85 139 166 550 730 56 51Chad na na 35 28 37 63 0.45 0.64 203 200 1 500 1 100 11 10Dominican Rep. 4 2 10 5 58 96 1.02 1.02 65 35 110 150 28 28Gambia 54 na na 17 48 79 0.68 0.98 154 123 1 100 540 44 48Guatemala 35 16 33 23 64 87 0.88 0.93 82 47 200 240 31 26Guinea na na na 23 26 65 0.47 0.77 240 160 1 600 740 30 28Honduras 38 21 18 17 90 87* 1.05 1.02* 59 41 220 110 53 48India 42 35 64 47 na 88 0.76 0.94 123 87 570 540 21 22Kenya 34 23 23 20 74 66 0.95 0.94 97 123 650 1 000 32 30Lao People's Dem. Rep. 8 26 44 40 63 85 0.79 0.87 163 91 650 650 57 54Malawi na 42 28 22 50 na 0.83 0.96 241 178 560 1 800 35 27Mali 16 na 31 33 20 44 0.60 0.76 250 220 1 200 1 200 12 11Mongolia na 27 12 13 90 79 1.02 1.02 104 68 65 110 7 7Namibia 35 na 26 24 83 78 1.09 1.01 86 65 370 300 11 10Nicaragua 48 45 11 10 72 85 1.06 0.99 68 38 160 230 37 27Niger 42 61 43 40 24 38 0.58 0.69 320 262 1 200 1 600 2 1Pakistan 48 13 40 38 35 59* na 0.71 130 103 340 500 4 3Panama 12 7 6 7 92 100 0.96 0.97 34 24 55 160 46 39Philippines 20 15 34 31 97 94 0.99 0.99 63 36 280 200 22 19Senegal 45 22 22 23 47 58 0.73 0.92 148 137 1 200 690 35 32Sri Lanka 4 8 37 29 90 na 0.96 0.99 32 15 140 92 35 30Sudan na na 34 41 43 46* 0.77 0.87 120 93 660 590 30 26Thailand 18 2 25 18 76 85 0.96 0.96 40 26 200 44 31 29Togo na na 25 25 75 91 0.66 0.83 152 140 640 570 13 9

35% OR MORE UNDERNOURISHEDAngola na na 20 31 58 61* 0.92 0.86* 260 260 1 500 1 700 57 56Burundi 45 55 38 45 53 57 0.84 0.81 190 190 1 300 1 000 9 4Central African Rep. 67 na na 24 54 na 0.63 0.68 180 180 700 1 100 37 37Congo na na 24 14 79 54 0.90 0.93 110 108 890 510 65 65Dem. People's Rep. of Korea na na na 21 na na na na 55 55 70 67 68 68Dem. Rep. of the Congo na na na 31 55 na 0.75 0.90* 205 205 870 990 62 60Eritrea na na 41 40 16 45 0.94 0.81 147 85 1 400 630 14 13Ethiopia na 23 48 47 23 47 0.66 0.73 204 169 1 400 850 5 4Haiti na na 27 17 22 na 0.94 na 150 118 1 000 680 6 3Liberia na na na 27 na 70* na 0.73* 235 235 560 760 38 31Madagascar 46 61 41 33 65 79 0.98 0.96 168 126 490 550 22 20Mozambique na 38 na 24 45 55 0.76 0.81 235 158 1 500 1 000 40 39Rwanda na 52 29 27 67 87 0.98 1.00 173 203 1 300 1 400 19 12Sierra Leone 57 na 29 27 41 na 0.69 0.70* 302 284 1 800 2 000 20 15United Rep. of Tanzania 49 na 29 29 50 69 0.98 0.97 163 165 770 1 500 45 44Yemen 4 16 30 46 52 72 0.35 0.69 142 113 1 400 570 1 1Zambia 65 64 25 28 79 68 0.91 0.93 180 182 940 750 53 42Zimbabwe 33 56 12 13 86 80 0.99 0.98 80 126 570 1 100 57 49

CATEGORY OF Proportion Prevalence of Net enrolment Ratio of Under-five Maternal ProportionPREVALENCE OF of population underweight rate in girls to boys mortality rate mortality ratio of land areaUNDERNOURISHMENT below US$1 children under primary in primary (per 1 000 (per 100 000 covered byin total population 2000–02 PPP per day five years of age education education live births) live births) forest

MDG 1 MDG 4 MDG 6 MDG 9 MDG 13 MDG 16 MDG 25

1990 2004 1990 2004 1990 2002 1990 2002 1990 2003 1990 2000 1990 2000Country (%) (%) (%) (%)

(continued)


Table 2 . Selected indicators of the Millennium Development Goals in developing countries, classified bycategory of prevalence of undernourishment

NOTES

* Refers to a previous year.** Figures refer only to Mainland China. Other figures include data forMainland China, Hong Kong Special Administrative Region of China, MacaoSpecial Administrative Region of China and Taiwan Province of China.

Proportion of population below US$1 purchasing power parity (PPP) perday (poverty headcount ratio at US$1 a day [PPP]): The proportion of peoplebelow US$1 a day is the percentage of the population with averageconsumption expenditures less than US$1.08 a day measured in 1993 pricesconverted using PPP rates. As a result of revisions in PPP exchange rates,poverty rates cannot be compared with poverty rates reported previously for individual countries. All 2% headcount estimates indicate that actualvalues are less than or equal to 2% and should be treated with caution.Dates of the surveys vary. For each country, data were included for the yearclosest to 1990 from the decade 1985–94 and for the most recent year fromthe decade 1995–2004, with at least a period of five years between thesurveys.

Prevalence of underweight children under five years of age: This is theproportion of children under the age of five whose weight is less than that oftwo standard deviations below the median weight-for-age for theinternational reference population aged 0 to 59 months, as adopted by theWorld Health Organization (WHO). It refers to moderately or severelyunderweight. Dates of the surveys vary. For each country, data wereincluded for the year closest to 1990 from the decade 1985–94 and for themost recent year from the decade 1995–2004, with at least a period of fiveyears between the surveys. Some surveys may refer to different age groups.

Net enrolment rate in primary education: Net enrolment ratio is the ratio ofthe number of children of official school age (as defined by the nationaleducation system) who are enrolled in school to the population of thecorresponding official school age. Primary education provides children withbasic reading, writing and mathematics skills along with an elementaryunderstanding of such subjects as history, geography, natural science,social science, art and music.

Ratio of girls to boys in primary education: Primary education includes bothpublic and private schools. The ratio of girls to boys is calculated as thegross enrolment ratio (GER) of girls divided by the GER of boys. GER refersto enrolment at a given level of education, regardless of age, expressed as apercentage of the population in the theoretical school-age groupcorresponding to this level of education.

Under-five mortality rate: probability that a newborn baby will die beforereaching age five, assuming current age-specific mortality rates. Data arefrom different surveys and hence may reflect different methodologies.

Maternal mortality ratio (per 100 000 live births): Maternal death refers tothe death of woman while pregnant or within 42 days of termination ofpregnancy, irrespective of the duration and site of the pregnancy, from anycause related to or aggravated by the pregnancy or its management but notfrom accidental causes. Data are from different surveys and hence mayreflect different methodologies. The margin of uncertainty associated withthe estimated maternal mortality ratios is very large, and the estimatesshould not, therefore, be used to monitor trends in the short term. Inaddition, cross-country comparisons should be treated with considerablecircumspection because different strategies are used to derive theestimates for different countries, making it difficult to draw comparisons.

Proportion of land area covered by forest: Forest area is land under naturalor planted stands of trees, whether productive or not.

KEY

na data not available

SOURCES

Data from the United Nations Statistics Division (UNSD) MDG onlinedatabase have been complemented with more recent data from primarysources, where available.

Proportion of population below US$1 purchasing power parity (PPP) perday: World Bank, World Development Indicators 2005.

Prevalence of underweight children under five years of age: United NationsChildren's Fund (UNICEF) online database; WHO online database; WorldBank, World Development Indicators 2005.

Net enrolment rate in primary education: 1990 data from the United NationsEducational, Scientific and Cultural Organization (UNESCO), as cited in theUNSD MDG online database; most recent data from UNESCO online database.

Ratio of girls to boys in primary education: 1990 data from UNESCO, ascited in the UNSD MDG online database; most recent data from UNESCOonline database. Some data are UNESCO Institute for Statistics or nationalestimates.

Under-five mortality rate: UNICEF online database.

Maternal mortality ratio (per 100 000 live births): 1990 data from WHO,UNICEF, the United Nations Population Fund, as cited in the UNSD MDGonline database; most recent data from UNICEF online database.

Proportion of land area covered by forest: FAO, Global Forest ResourcesAssessment 2000.

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The FIVIMS initiative and the Millennium Development Goals

In the Millennium Declaration, world leaders pledged “to spare no effort to free ourfellow men, women and children from the abject and dehumanizing conditions ofextreme poverty”. The associated Millennium Development Goals (MDGs) establishedtargets and indicators to measure progress towards the lofty vision of “freeing theentire human race from want”.

Today, with only ten years remaining until the 2015 deadline for reaching the MDGtargets, a great deal of attention has been focused on MDG 1, on the target ofreducing by half the proportion of people struggling to survive on less than a dollar aday, on the goal of “making poverty history”. But MDG 1 is not only about reducingincome poverty. It also includes a commitment to reduce by half the proportion ofpeople who suffer from hunger, because freedom from hunger is a fundamental rightof every human being.

When the MDGs were framed, the halving of extreme poverty and hunger werelisted first and together. And rightfully so. Hunger is both one of the most painfulsymptoms and one of the most important causes of extreme poverty. Yet hunger isoften all but ignored in discussions of MDG 1, just as it has, for far too long, been allbut invisible on the development agenda.

As this edition of The State of Food Insecurity in the World clearly demonstrates,reducing hunger is perhaps the most critical element if we are to meet most of theother MDGs. Hunger undermines health, education, productivity and environmentalsustainability. Hungry women give birth to hungry babies, with greatly increased risksof both maternal and infant mortality. Hungry children cannot learn. Hungry adultscannot work as hard or earn as much. Hungry people are more likely to catchinfectious diseases and to suffer severe illness and death once they do. Hungrypeople need to use all the means at their disposal to survive, even if that meansdespoiling the natural resources upon which they depend.

We cannot allow this vicious cycle of deprivation to continue. If we want toeliminate extreme poverty and reach the other MDGs, we must first mobilizeresources, energy and political commitment to make hunger history.

The Inter-Agency Working Group on Food Insecurity and Vulnerability Informationand Mapping Systems (IAWG-FIVIMS) is dedicated to doing just that by providing theinformation needed to galvanize, target and monitor effective action to end hunger.The core mandates of our different member agencies cover all of the MDGs. In theIAWG-FIVIMS team we bring together all the elements of those mandates pertinent tothe fight against hunger.

Based on a comprehensive, independent assessment of our activities, structuresand processes, we are gearing up to be more relevant, more timely, and moreeffective. Learning from what we did well and, more importantly, what we did not, weare formulating a new business plan and revising our operating structure. Thechanges will serve not to alter but to reinforce our core mandate - to provide aframework for a wide range of national and international activities to gather, analyseand disseminate improved information that can be actively used to reduce hunger andachieve food security for all.

We recognize that the fight against hunger will be long and tough and that we mustbe prepared to meet the challenge. We believe that at the end of our businessplanning process we will be up to the task at hand.

Lynn Brown (World Bank)Chairperson, IAWG-FIVIMS

IAWG-FIVIMS members include bilateral aid and technical agencies, United Nationsand Bretton Woods agencies, international agricultural research organizations,international non-governmental organizations and regional organizations. Moreinformation about FIVIMS and its member agencies is available at www.fivims.net or bye-mailing [email protected].

The State ofFood Insecurity in the WorldOnly ten years now remain before the 2015 deadline by which world leadershave pledged to reduce hunger and extreme poverty by half and to makesubstantial gains in education, health, social equity, environmentalsustainability and international solidarity. The State of Food Insecurity inthe World 2005 examines progress towards the World Food Summit goalsand the Millennium Development Goals (MDGs), focusing on the criticalimportance of reducing hunger, not only as the explicit target of MDG 1 butas an essential condition for reaching the other MDGs.

The report presents compelling evidence that hunger and malnutrition aremajor causes of the deprivation and suffering targeted by all of the otherMDGs. Progress towards those targets has lagged, particularly in thecountries and regions where efforts to reduce hunger have stalled.

The State of Food Insecurity in the World 2005 emphasizes that most, if notall, of the MDG targets can still be reached. But only if efforts are redoubledand refocused. And only by recognizing and acting on two key points:without rapid progress in reducing hunger, achieving all of the other MDGswill be difficult, if not impossible; and the fight to eliminate hunger andreach the other MDGs will be won or lost in the rural areas where the vastmajority of the world's hungry people live.

The State Of Food Insecurity In The World 2005

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