# **Introduction**

Malnutrition is prevalent in South Asia. The region has among the highest burdens of child undernutrition in the world. Thirty-six percent of children under age five are stunted, or too short for their age, an indicator of chronic undernutrition. Sixteen percent are wasted, or too thin for their height, an indicator of acute malnutrition (UNICEF, WHO, and World Bank 2017). South Asia also has a high prevalence of micronutrient deficiencies, overconsumption, and diet-related noncommunicable disease (Development Initiatives 2017).

Globally, evidence is growing on how food and agricultural policies and interventions can help enhance nutrition. Several recent reviews have synthesized this global knowledge.<sup>1</sup> Among the strategies discussed in the literature, an increasingly prominent one is the promotion of nutritionsensitive food and agricultural interventions. This strategy seeks to tackle malnutrition and micronutrient deficiencies by emphasizing the production and consumption of foods that are rich in nutrients. Indeed, the evidence suggests that nutrition-sensitive food and agricultural interventions can increase the consumption of nutritious foods and improve dietary diversity (Ruel et al. 2018). The evidence also suggests that dietary diversity, particularly the inclusion of animal-source foods, is associated with improved nutrition (Bhutta et al. 2013; Kim et al. 2017; Headey et al. 2018). The evidence tends to be weaker on a direct link between nutrition-sensitive food and agricultural interventions and improvements in nutrition.

This paper reviews the evidence on nutrition-sensitive food and agricultural interventions in South Asia. It contributes to the discussion in the literature by improving the understanding of the proven links between these interventions and nutrition in the region.

The paper differs from existing reviews in two important ways. First, we focus our review on evidence from eight South Asian countries: Afghanistan, Bangladesh, Bhutan, India, Maldives, Nepal, Pakistan, and Sri Lanka. This allows us to narrow the discussion to evidence that is contextualized to South Asia (Webb and Kennedy 2014). Reviews covering evidence across many countries tend to have more stringent requirements on the methodological rigor of the studies they include, while those covering specific countries tend to be more comprehensive and include studies using weaker methodologies. Our work falls between these two ends of the spectrum. We include an extensive set of studies, which provides broad insight into the region and topics of interest, but we also impose clear standards for inclusion. In addition, we examine a wider set of food and agricultural interventions, which allows for a review of nutrition sensitivity from farm to fork—ranging from food production and supply to food demand and consumer behavior.<sup>2</sup> In the first part of the review, we focus on consumers and the factors that influence their choices for acquiring and consuming nutritious foods, drawing on evidence from South Asia. The overarching food environment plays a big part in determining what foods consumers purchase

> 1 See Bhutta et al. (2013) for a review of nutrition-specific interventions, Bhutta et al. (2015) for a review of delivery platforms, and Masset et al. (2012), Girard et al. (2012), and Ruel, Quisumbing, and Balagamwala (2018) for a review of nutrition-sensitive agri-food interventions.

> 2 Note that we exclude certain links between agriculture and nutrition that are not necessarily food-related, such as those between livestock, health and sanitation, and nutrition.

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