Abstract/Summary

Rural areas of low- and middle-income countries are experiencing growth in labour productivity and rural incomes, but these have not translated into proportional improvements in nutritional outcomes. Instead, the incidence of undernutrition has fluctuated over time, while overweight and obesity are rapidly increasing. The persistence of malnutrition in the face of rural and agricultural transformation require investigating the hypothesized nutrition factors beyond the issues of income and productivity. Taking the agriculture-nutrition approach forward, this research adopts the rural transformation framework to study the influence of time use, physical activity, and diet composition on nutritional outcomes. First, this research identified pathways linking the rural transformation processes with nutritional outcomes. Three of these linkages, framed independently into research questions, were investigated in three empirical chapters of this thesis. The first research question presented evidence on couple interdependencies in time use and nutritional outcomes. The empirical analysis adopts the Actor-Partner Interdependence Model (APIM) to examine own and partner effects of time use on nutritional outcomes. Results indicates that there are large differences in the time allocation patterns between spouses in a household – and the time allocation patterns of the spousal partners have an effect on an individual’s nutritional outcomes; larger allocation of time to economic activities by the male spouse reduces the energy intake adequacy of the female spouse. Larger allocation of time to domestic activities by the female spouse reduces the energy intake adequacy of the male spouse. The results suggest that reducing the gender differences in the allocation of time could improve nutritional outcomes for male and female spouses. The second research question empirically assessed the change in energy expenditure if participation in agricultural activities increases. The hypothesis here is that, as agricultural time use increases, the nature of the change to wellbeing will depend on the energy demands of the activity that agriculture is substituting in rural livelihoods. Using compositional data analysis methods and a novel datasets that combines information on individual’s 24-hour time use, physical activity energy expenditure, and socio-demographic characteristics, this chapter provides empirical evidence on the change in human energy expenditure resulting from time trade-offs to agriculture. The notion that more energy is required when more agricultural work – relative to other work-related time use – is performed is not supported by the results, as other time use domains in rural livelihoods are equally energy-intensive, and the effects of time use on well-being are not peculiar to agriculture. The results imply that the negative well-being consequences that may derive from the feminization of agriculture are not likely from increased energy burdens. The findings provide a justification to focus on women’s time allocation instead of energy expenditure in understanding the agriculture-gender-nutrition pathways. Along with declining physical activity levels, nutrition transition in low and middle income countries is characterized by rising per-capita calorie consumption buoyed by the rapid displacement of traditional foods by ultra-processed foods. The third research question assessed physical activity, time use and diet composition in relation to nutritional outcomes for adolescents in Telangana State in India as well as in Dhading and Nawalparasi districts in Nepal. Quantile regression in compositional data analysis methods were used to assess the relationship between nutritional outcomes and the composition of daily time allocated to sedentary, light, moderate and vigorous activity. In addition, the relationship of nutritional outcomes with the composition of diet involving ultra-processed and non-ultra-processed foods were assessed. The situation that adolescents in low- and middle-income countries are facing is that of increasing sedentary lifestyles through technology and improved infrastructures. Although these are avenues where physical activity is reducing, the data shows that there is still substantial physical labour under which adolescents continue to perform. The substitution of non-ultra-processed food by ultra-processed food improves nutritional (calorie) outcomes but likely presents a burden of unhealthy diets. That the influence of physical activity and diets varies across the spectrum of nutrition status implies that addressing all forms of malnutrition among rural adolescents will require different kinds of interventions – some targeted at the lower ends of the nutrition status and a different set for the upper end of the nutrition status. This research concludes by summarizing the role of time use, physical activity and diet on nutritional outcomes in rural livelihoods. The implications of the research findings and the suggestions for addressing malnutrition based on the identified rural transformation-nutrition pathways were discussed.