Intercultural models to improve nutrition and health of indigenous populations through gender-sensitive agroforestry practices in Peru

High levels of food insecurity and malnutrition persist in Peru, particular amongst remote indigenous populations. The Government of Peru has expressed its commitment to addressing this inequity, through inclusive health services which accommodate cultural diversity. For indigenous people in the Peruvian Amazon, local health systems often reflect an integrated understanding of the world. Many households practise agroforestry, in which trees are included in agricultural systems. This not only provides income and supports local ecosystems, but also influences human nutrition and health.

Potential positive and negative effects of agroforestry on human nutrition and health have been described, but there has been little research to document these impacts. Beyond the products derived from trees, crops and livestock, agroforestry systems can also support wild biodiversity of plants and animals which contribute to food and nutrition security in various ways across seasons. There is a particular need to understand how women's involvement in agroforestry affects their nutritional status, time use, care-giving behaviours and household diets.

The goal of our research is to work with indigenous communities involved in coffee- and cocoa-based agroforestry, and with local public health, agriculture and forestry institutions, to co-develop options to improve nutrition and health in the Peruvian Amazon. Our approach will focus on strategies which are appropriate to local conditions and cultures, and which respond to the priorities and interests of women.

The early stages of our project will build an in-depth understanding of the social and ecological setting (including how this has changed in recent decades) and community members' perceptions and priorities relating to nutrition and health. We will develop an inventory of agroforestry practices, including the roles of men and women; the spectrum of local plant and animal biodiversity which contribute to food and nutrition security; and the ways in which these contribute to food and nutrition security at different times of the year. We will also document the roles and time spent by women in agroforestry and other household activities, including care-giving and food preparation.

Through a study of children under five years and their mothers, we will measure nutritional status (including height, weight and anaemia status), and the nutritional adequacy of diets during the rainy and dry seasons. We will evaluate the influence of agroforestry practices, use of wild biodiversity and women's time use on the nutritional status and diets of women and children. Our research aims to use the information collected to map the multiple pathways by which agroforestry systems, and their associated biodiversity, are linked to human nutrition and health, and how this relates to environmental sustainability.

The final stages of our project focus on devising effective and acceptable strategies to address identified nutrition and health challenges. We will formulate food-based recommendations to be trialled with women of different cultural groups, and develop context-appropriate extension materials to guide households in following these recommendations. At community workshops, research findings will be presented and discussed, and collaborative approaches used to co-design, prioritise and evaluate different strategies to improve nutrition and health.

This project responds to the Peruvian Government's priority to better meet the nutrition and health needs of indigenous populations, and to increase the holistic and inclusive nature of national health services. By combining diverse research expertise with community knowledge and interests, and by building an evidence-based understanding of how to harness agroforestry systems in support of nutrition and health, this project has the potential to inform sustainable strategies using approaches which may be replicated in other regions of Peru.

For indigenous groups in the Peruvian Amazon, agroforestry is widely practised and contributes to livelihoods, natural resource management, nutrition and health. This interdisciplinary project will use participatory approaches and intercultural models to co-develop gender-sensitive agroforestry options with the potential to sustainably address high levels of chronic undernutrition and anaemia in indigenous populations.

The study will be conducted along a transect of coffee and cocoa-based agroforestry systems which support the livelihoods of indigenous groups in the Peruvian Amazon. Research activities will be conducted in the Amazonas Region on the Cenepa River Basin (4 native Awajun indigenous communities) and on the La Jalca district (4 migrant indigenous communities or 'colonos'). An initial census will identify households that practice agroforestry and contain a child <=5 years of age. Random sampling will be used to enrol 200 Awajun and 200 colonos households.

Research activities will involve five steps, starting with (1) a participatory appraisal of socio-ecological contexts; and (2) a survey of agroforestry practices and local biodiversity contributing to food security across seasons. These two steps will inform (3) an observational study to evaluate the influence of specific agroforestry practices, use of local biodiversity, and gender, socioeconomic and cultural factors on maternal and child dietary adequacy (i.e. individual nutrients & mean probability of adequacy over a range of nutrients), anthropometric outcomes (i.e. height-for-age & weight-for-height in children, BMI in women) and anaemia status.

Findings from steps 1-3 will contribute to (4) determining the pathways through which agroforestry impacts diets and the nutrition and health status. This model will guide (5) the development of culturally-appropriate and gender-sensitive agroforestry options and food-based recommendations to address identified nutrition and health challenges.

To ensure maximum impact, public health and agricultural agencies, development practitioners and indigenous community members will be engaged fully in the implementation of research activities, interpretation of findings and design of interventions. This will ensure that approaches and strategies are feasible and acceptable in the study setting, and that barriers to their use are recognised and addressed. National and sub-national public health and agricultural authorities will benefit through direct involvement in our research to better understand the determinants of undernutrition in indigenous communities and the extent to which culturally-appropriate and gender-sensitive agroforestry practices and food-based recommendations can impact upon nutrition and health outcomes. This information will support the development of integrated and multi-sectoral policies, programmes and interventions which have agroforestry, biodiversity, cultural sensitivity and gender dimensions at the core of their design.

Our study's iterative design, through a sequence of carefully facilitated participatory tools, aims to empower local men and women as sources of knowledge and agents of change, rather than recipients of information and beneficiaries of interventions, as occurs in 'top-down' research approaches. Besides evidence-based health and agricultural policies that respect their cultural identity, community members will benefit from being engaged in the research activities and the discussions generated by the participatory exercises. The learning process will also demonstrate recognition and respect for indigenous knowledge and perspectives, both within communities and by external researchers; and provide a space for societal debate on local norms, rules, and power relations. The study will particularly benefit women by applying a gender-sensitive approach which considers their roles and workloads in agroforestry systems, socio-cultural drivers of food choice, priorities and outcomes. Simple concrete measures will be taken to increase women's involvement in the research process, such as scheduling research activities to accommodate women's availability and preferences and engaging female community leaders.

In our research, we will work with local communities, public health and agricultural authorities and local students to study and develop techniques to bridge social and cultural divides for indigenous nutrition and health in Peru. This will create a pipeline of researchers and practitioners within Peru equipped with skills to conduct interdisciplinary research and employ participatory approaches to understand socio-cultural, environmental and economic factors underlying the varying nutritional and health status of indigenous and non-indigenous peoples.

Globally, our results will aid researchers and public authorities in integrating disciplinary expertise from natural and social sciences with indigenous knowledge to promote nutrition-sensitive agroforestry practices. Currently, there is inadequate evidence on the influence of sociocultural norms on food and nutrition security. This project will assist public health agencies and development practitioners by demonstrating methods and outcomes of an approach which integrates traditional and conventional knowledge using approaches that harness local agroforestry systems, and their associated biodiversity, in support of good nutrition and health.