The Effect of Smallholder Vegetable Production on Children’s Dietary Quality and Nutritional Outcomes: Evidence from Vietnam

Abstract

Children’s undernutrition remains a major health concern in rural communities in northwest Vietnam. Recent studies propose leveraging agriculture to improve children’s dietary quality and nutritional status. Increased vegetable production is a sustainable way to enhance their nutritional status and is a viable economic option to augment farm income, especially in rural communities where agriculture is the main source of livelihood. However, the overall impact of vegetable production in addressing children’s undernutrition remains unexplored. This study presents empirical evidence on the role smallholder vegetable production plays in improving children’s dietary quality and nutritional outcomes using three pathways that link agriculture and nutrition at the household level: 1) direct pathway via consumption of household’s own food production due to lack of markets; and 2) indirect pathways via (a) consumption of diverse food due to market access and/or sales of agricultural produce, and (b) women’s empowerment in agriculture. Data comes from a unique cross-sectional household survey that was collected in 2016, covering 510 households from four districts in northwest Vietnam. Chapter 2 focuses on 653 children aged six months to 17 years old from 298 households. Nine models are estimated using a Poisson Generalised Linear Model and ordinary least squares (OLS) to explore the association of vegetable production diversity, market engagement, and women’s empowerment with the Dietary Diversity Score (DDS) of children and adolescents. The results of this chapter suggest that market access and market participation can significantly improve DDS, especially of schoolchildren and adolescents. For young girls, market access is associated with a significantly higher DDS (by two food groups). Chapter 3 focuses on nutritional outcome measures for children aged six months to five years from 188 households. Nine models are estimated using several estimation strategies for boys and girls: three-stage least squares, OLS, logistic regression, and seemingly unrelated regression to explain variations in several nutritional outcome measures, including height-for-age (HAZ), weight-for-height (WHZ), weight-for-age (WAZ) z-scores, and prevalence of stunting, wasting, and underweight. Results suggest that market participation is an important factor in improving young girls’ HAZ and WHZ, and in reducing the probability of young boys being stunted and underweight. Chapter 4 explores the parental food choice motivations of the 510 households using Exploratory Factor Analysis and two-step cluster analysis. Four distinct food choice factors exist: ‘Natural and healthy’, ‘Familiarity’, ‘Balanced diet’, and ‘Convenience’. Two distinct consumer clusters are identified that are significantly different in household dietary quality, wealth, education, ethnicity, and geographic location: ‘Health-conscious’ households and ‘Pragmatic’ households. Results show the importance of incorporating food choice motivations in future dietary change interventions to ensure that they are tailored to different groups with distinctive motivational factors. Overall, the study finds an indirect association between smallholder vegetable production on dietary quality and nutrition outcomes. The results imply that additional income from selling vegetables allows households to purchase diverse food, which could have a positive impact on the dietary quality and nutritional outcomes of these children. Understanding these associations and parental food choice motivations can help the Government of Vietnam to develop dietary change interventions that, by using a targeted approach, will be more resource-efficient.