Agriculture and Nutrition in Mali through a Gender Lens

Lauren Bailey, SPRING

SPRING/Mali's goal is to improve the nutritional status of women of reproductive age (WRA), pregnant and lactating women (PLW), and children under two years of age (CU2) in the Mopti region. Because our primary focus is on WRA and PLW, conducting an analysis of gender barriers in Mali, and more specifically Mopti, was necessary for understanding the challenges women face in their environment. Through this research, we hope to identify behaviors and strategies we can incorporate into our programming to reduce these barriers.

The literature reviewed for this study focuses on gender barriers with regard to specific topics related to our activities: household decision making, access to land and seeds for gardening, household food distribution, access to health facilities, and women's aspirations for economic autonomy. Fifty journal articles, assessments, and conference proceedings were identified; thirty-seven were included in the literature review. The study locations for the articles cover all regions in Mali, with the majority focusing on Bamako, Mopti, Sikassou, Ségou, Koulikoro, Kayes, Gao, and Timbuktu. Two studies included all of southern Mali and 12 studies appeared to include data representative of the entire country.

Key findings show that men are the primary decision makers within the household—they uphold family norms, control and manage household wealth, decide how to use family land, and make decisions about the family's subsistence. Men mainly produce the cash crops, while women produce the foods crops. The average woman works 15-hour days in rural areas compared to the 13-hour days the average rural man works. Older women tend to have more time to devote to agriculture activities or other income-generating activities because they are not rearing young children and more junior household members are responsible for completing household chores. Women rely on community groups to increase their economic power, and their participation in women's groups increases their employment security. In general, civil society organizations are strong in Mali and should be used as a way to build collective influence. Given the man's high status in the family, it may be assumed that men also make the health decisions for the family. In reality, the mother-in-law has the greatest influence over health decisions for her grandchildren. Birth spacing is a major influencing factor for cases of severe malnutrition. Availability of water is a major concern for the residents of Mopti, and women are the main users of water and the ones who are responsible for fetching it and recruiting other family members to help them fetch it. However, despite water being a critical resource, and women being the primary users, they are often not included in the decision making about the location and management of water points.

Mali Snapshot

Table References

Introduction

SPRING/Mali

SPRING/Mali's goal is to improve the nutritional status of women of reproductive age (WRA), pregnant and lactating women (PLW), and children under two years of age (CU2) in the Mopti region. We do this by promoting the adoption of Essential Nutrition Actions and Essential Hygiene Actions (ENA/EHA), improving delivery of nutrition in health services, and increasing the availability and consumption of nutritious and diverse diets.

To achieve improved nutritional outcomes, we will pursue three primary objectives:

Objective 1: Increased access to diverse and quality foods

Objective 2: Increased access to quality nutrition services

Objective 3: Increased demand for key agriculture; nutrition; and water, sanitation, and hygiene (WASH)-related practices and services

Because our project focuses primarily on WRA and PLW, conducting an analysis of gender barriers in Mali, and more specifically Mopti, was necessary for understanding the challenges women face in their environment. Through the study, we hope to identify behaviors and strategies that we can incorporate into our programming to reduce these barriers. The study will look at gender barriers and evaluate household decision making, access to land and seeds for gardening, household food distribution, access to health facilities, and women's aspirations.

Our team developed a set of study questions to guide the literature review. The questions span three overarching areas: agriculture and livelihoods; nutrition and health; and WASH (Appendix A).

The overall results of SPRING/Mali's gender barrier study will inform the development of our social behavior change communication (SBCC) plan, which will use a gender-sensitive lens to focus all activities.

Methodology

John Snow, Incorporated (JSI) Librarian, John Carper, conducted the first database search on January 28, 2015. Using the search terms "gender," "Mali," "agriculture," and "Mopti," the JSI Librarian searched through the ProQuest, CAB, Elton B. Stephens Co (EBSCO), and Web of Science databases. The author conducted her own Google and Google Scholar search using the terms "Gender in Mali" and "women in Mali." A second Google Scholar search was conducted on February 3, 2015, using the terms "WASH," "Mali," and "Gender"; the author also searched SPRING's Zotero library for any journal articles containing the word "Mali." In total, 50 journal articles, assessments, and conference proceedings were identified; 37 of the 50 documents were included in the literature review (Appendix B). Documents were excluded if they were published more than 10 years ago (2005 or before), unless the research was heavily cited by peers. Documents were also excluded if the results of the research were not relevant to the study questions or if the study was of poor quality.

The study locations for the articles covers all regions in Mali, with the majority focusing on Bamako (12), Mopti (7), Sikassou and Ségou (6), Koulikoro (4), Kayes (3), Gao and Timbuktu (2). Two studies included all of southern Mali and 12 studies appeared to include data representative of the entire country. In many cases, the journal article did not mention the ethnic groups of the study participants. Ethnic group was considered as an influencing factor in the research in Castle (1993) and Simon, Adams, and Madhavan (2002). Castle studied the Dogon and Fulani, and Simon, Adams, and Madhavan focused on the Bamanan and Fulbe ethnic groups. Mali has eight main ethnic groups: the Bambara (or Bamanan), the Malinke (Mandingo), the Sarakolé (Soninke or Marka), the Peul (Fula), the Senufo/Minianka, the Dogon (or Dogonon Habé), the Sonraï (and Songhoï Arma), and the Tuareg (CPS/SSDSPF et al. 2014).

Context in Mali

The West African country of Mali is one of the poorest countries in the world and is considered to be one of the worst environments for women in regard to gender equality (UNDP 2014a; World Economic Forum 2014). The Gross Domestic Product per capita (Purchasing Power Parity) for this country of over 14 million people is a meager USD $1,195 (UNESCO 2012). UNDP ranked Mali 176 out of 187 countries on the Human Development Index and 143 out of 148 in the Gender-Related Development Index (UNDP 2014b). More than half of the population is under the age of 15, and the average life expectancy is 55 years (World Bank 2014). The Food and Agriculture Organization (FAO) of the United Nations has classified the country as a Low-Income Food Deficit Country (FAO 2015). Seventy-eight percent of the poor live in rural areas (CPS/SSDSPF et al. 2014); likewise, the poverty rate in rural areas is 76 percent compared with 30 percent in urban areas (World Bank 2006a).

Regarding international commitments to gender equality, Mali has consistently ratified treaties and conventions that support equal rights for women and girls. In 1986, Mali ratified the Convention on the Elimination of All Forms of Discrimination against Women (UN 1979). In 1990, Mali was one of the first countries to ratify the Convention on the Rights of the Child (UN 1989); in 2004, Mali signed the Protocol to the African Charter on Human and Peoples' Rights on the Rights of Women in Africa (African Union 2003; Rupp, Diallo, and Phillipps 2012).

According to the World Bank, attempts at addressing gender inequality at the policy level have fallen short—the Ministry for the Promotion of Women, Children and the Family (MPFEF) does not have the ability to work across sectors or ministries, and thus remains a vertically oriented, stand-alone institution (World Bank 2006a, 64). The MPFEF lacks the power to truly influence policies and programs and as a consequence did not provide input in the design and implementation of two major national programs: Programme Décennal de Développement de l'Education (PRODEC), (a 10-year educational development program, and Programme de Développement Sanitaire et Social (PRODESS), a health and social development program. As of 2012, the government had not developed a gender strategy, often cited instead are the four obstacles to gender equality described in the Poverty Reduction Strategy Paper (PRSP): 1) illiteracy, 2) women's health, 3) the persistence of socio-cultural obstacles that negatively affect the legal and social status of women, and 4) the high fertility rate that keeps women from fully participating in "the management of public life." However, without robust gender disaggregated data, the removal of these obstacles cannot be effectively measured (World Bank 2006a, 57).

Civil society organizations have been wary of working with the MPFEF because they feel as if the ministry is "encroaching on its territory"; likewise, the MPFEF sees civil society as purposely leaving it out of the loop and failing to share information that could be used to inform its work (World Bank 2006a, 60).

From 2001 to 2011, Mali's average annual economic growth was 5.5 percent, higher than the 3.9 percent regional average within the West African Economic and Monetary Union (Konaté, Dicko, and Diarra 2015). A military coup on March 22, 2012, combined with political unrest and violence in the north, negatively impacted the macroeconomic and fiscal frameworks of the country, resulting in a slowdown in economic activity. The political instability caused negative economic growth of -1.2 percent; foreign aid was temporarily suspended (CPS/SSDSPF et al. 2014; Konaté, Dicko, and Diarra 2015). However, despite the economic downturn, the primary sector continued to see growth (8.6 percent in 2012), thanks primarily to agriculture, which grew 13.9 percent. The livestock, fishing, and forestry industries were not so lucky and saw negative growth during this period (CPS/SSDSPF et al. 2014, 3). After the presidential and parliamentary elections in 2013, Mali began to recover economically, and foreign aid resumed. Positive economic growth returned, but the social situation has not been so quick to recover. Before 2012, Mali was on track to meet Millennium Development Goal (MDG) targets for universal primary education, controlling the spread of HIV/AIDS, and access to safe drinking water, but these goals were ultimately not reached (Konaté, Dicko, and Diarra 2015).

Findings

Sociocultural Environment

Regarding the socio-cultural environment, Mali is a patriarchal society: men are seen as superior to women and hold most of the power when it comes to decision making, while women are expected to be subordinate to men. Mali exhibits a gendered "socialization that assigns specific roles to boys and girls, women and men, determines responsibilities, duties and division of labor in the family and in the society" (World Bank 2006a, 65). For example, business and politics are viewed as men's domains, requiring authority and power which are attributes that only men can possess (World Bank 2006a). Gender stereotypes and prejudices reinforce values and norms adopted by the community, resulting in a hierarchy that is based on age and gender (World Bank 2006a; Rupp, Diallo, and Phillipps 2012).

Men are the key decision makers within the household: they make the rules, control, and manage household wealth; decide how to use family land; and make decisions about their families' subsistence. Men's authority also often extends to decisions about the health of the wife and when or how often she can visit her family. The absolute authority of the male cuts across all wealth quintiles and education levels (CPS/SSDSPF et al. 2014, 273). Girls' education is closely tied to gender equity in Mali. In families that cannot send all their children to school, the boys are enrolled first. Parents justify this choice because they know someday the boy will be the head of a household (World Bank 2006a, 20). Girls are not being enrolled in school because they are expected to work in the home; they are often married young and are expected to have children right away. Their duties as a wife and mother are prioritized over education (World Bank 2006a).

Women are expected to respect and obey the male head of the household and support him as the decision maker for the family and the representative of the family within the community. Household chores (such as cooking, collecting fuel, and fetching water) and care for children are the sole responsibility of women (World Bank 2006a, 65). The rural exodus of men to urban areas creates yet another burden for women as they are responsible for even more work than before (World Bank 2006a, 15). This rural exodus is often seasonal and can include young girls and boys as well, who leave rural areas for cities to work as maids or for other small jobs part of the year and return home for the harvest; they give the money they earned to their families. Women also have responsibilities within their community; they are the ones who organize events, such as marriages and other family ceremonies, as well as care for the sick. Men have community responsibilities as well, but theirs are more related to decision making (World Bank 2006a, 17). Women are not usually consulted in public fora where decisions are made (Gottlieb 2014, 21). Women are more likely to participate in decision making if they are: paid in cash for work (15 percent versus 5 percent not paid in cash); have some formal education; and are the highest wealth quintile (12 percent compared with 6 percent in the medium quintile) (CPS/SSDSPF et al. 2014).

No matter whether a woman lives in a rural or urban area, she still faces many of the same obstacles because of her status as a woman. Women own few assets, and it is only through social capital and networks within interest groups that they gain any decision making power within the community. In all regions of the country, a woman's workload is greater than men's mainly because they are often participating in income-generating activities in addition to meeting the demands of the household, which includes rearing children. Rural women in Mali are "extremely overworked," spending seven to eight hours on domestic chores and then devoting any remaining time to agricultural activities, leaving little time to attend school (Rupp, Diallo, and Phillipps 2012). Given all these duties, women have little time left to actively engage in the advancement of their communities (Bourdet, Doumbia, and Persson 2010; World Bank 2006a). A women's ability to care for herself and her children and the excess time and energy expenditure resulting from the workload distribution is a key underlying causes of malnutrition (Ruel and Alderman 2013).

Marriage

The social status of men and women is strongly tied to marriage, both in the northern and southern regions of Mali (World Bank 2006a, 18). Eighty-five percent of women ages 15–49 and sixty-three percent of men in the same age group are married (CPS/SSDSPF et al. 2014, 53). The majority of women marry by age 18, while men marry later, on average at around 24 years of age (World Bank 2006b). "After marriage, women live with their husband's family, where men have legally recognized authority over them" (Konate, Djlbo, and Djlre 1998; Boye et al. 1991). The husband's family usually will pay a bride price, and the bride will bring with her a dowry with bedding, cooking pots, kitchen utensils, and a small wardrobe" (Walle 2013). If a woman is widowed or divorced, her assets return to the husband or the husband's family, including her right to the husband's land (Walle 2013).

Polygamy is considered to be a sign of a man's power in a patriarchal society and is practiced throughout Mali. The practice is more common in the south than the north, with 35 percent of women and 19 percent of men in a polygamous union (World Bank 2006a, 17; CPS/SSDSPF et al. 2014). In Mopti, 38 percent of women reported living in a polygamous union, and 25 percent of men reported having more than one wife (World Bank 2006a, 19). Forced marriages are also common in Mali, particularly among the Peul ethnic group, where girls as young as 12 can be married (World Bank 2006a, 19).

In addition to polygamy, levirate and sororate marriages are a common practice. A levirate marriage is when a widow marries her late husband's brother, and a sororate marriage is when the widower marries his late wife's sister. A levirate marriage is advantageous because the husband's family is able to keep the widow's bride price, as well as the children born from the marriage. Two issues that arise with levirate marriages are women are often forced remarry and these marriages can increase the risk of exposure to HIV/AIDS because the late husband's brother may already have one or more wives (World Bank 2006a, 19). Dominique van de Walle (2013, 3) points out that in some places, levirate marriages are becoming less common, but no "alternative livelihood opportunities" exist for these widows.

A closer examination of widowhood exposes an often unseen problem: widows often face more poverty than married women, and they pass on the "detrimental effects" of their widowhood to their children, even when they remarry. If widows remarry, they often join polygamous households where they are the second, third, or fourth wife. This is often the case for women who divorce, as well (Walle 2013).

Education

In Mopti, 79 percent of women have not received any formal education (compared to 67 percent overall). Less than 1 percent of women surveyed in Mopti had completed secondary school, and 15 percent had completed some primary school (Abu-Ghaida and Klasen 2004). Of the men surveyed in Mopti, 75 percent had no formal education, while 16 percent had completed some primary school (Abu-Ghaida and Klasen 2004). Eighty-seven percent of women age 15–49 have not had any formal education and 79 percent of men age 15–49 have not had any formal education (Abu-Ghaida and Klasen 2004). Only 10 percent of women in Mopti age 15–49 are literate compared to 20 percent of men.

Dina Abu-Ghaida and Stephen Klasen (2004) estimated that the economic consequences of Mali not reaching its MDG target of equal access to education for men and women by 2015 resulted in a poor economic growth rate of 0.4 percentage points per year for the period of 2005–2015.

Agricultural Economy

Most Malians are employed in the formal and informal agricultural sectors. Very few people are employed in public service (42,000 jobs) and the private sector (36,500 jobs), while an estimated 3.97 million people work in the rural sector and 1.18 million people work in the informal sector, totaling 5.2 million (World Bank 2006a, 34). The only instance when more women are employed in the formal sector more than men is for women ages 15–19, otherwise a higher percentage of men are employed in the formal sector than women (Bourdet, Doumbia, and Persson 2010, 14). The majority (95 percent) of Malian women work in one of four domains: agriculture, commerce, manufacturing, or household work.

Employment security is positvely correlated with several cross-cutting factors, such as: increasing age, the job stability of a spouse, female empowerment, and working in the agricultural sector. Higher fertility levels and increased time to fetch water were negatively correlated with employment security (Jacobi 2014). Interestingly, research conducted in 2014 revealed a positive relationship between women being able to actively engage in community events and employment security. This relationship was especially apparent for the subgroup of women ages 25–34 and for mothers of 5 to 6 children (moderate high fertility) (Jacobi 2014, 848).

Women's Time and Labor

Forty-three percent of women are involved in the informal sector (World Bank 2006a, 42; DNSI - Ministère de l'Economie, de l'Industrie et du Commerce 2003). Other informal income comes from the production of handicrafts and working in restaurants and local produce processing (World Bank 2006a). Because women are largely involved in the informal sector, national data and statistics are not an accurate reflection of their true economic contribution (World Bank 2006a, 67). Women are primarily involved in productive activities, which are often not acknowledged as work, and their efforts for this work are unpaid (World Bank 2006a, 17; Bourdet, Doumbia, and Persson 2010, 20; Gottlieb 2014). This productive work in agriculture often includes physically taxing activities such as "threshing, transplanting in rice fields and gathering on cotton plantations" (World Bank 2006a, 17). Off-farm activities also play an important role in income generation. Women often produce charcoal and shea nut butter and make hand brooms (Wooten 2003).

Malian women, more often than not, work more hours than men. In rural areas, women work 15-hour days compared to 13-hour days for the average rural man (World Bank 2006a, 37). Women ages 15–49 living in rural areas spend an hour a day collecting wood and fetching water; men only spend a fifth of that time involved in those activities, freeing up more time to devote to leisure or income-generating activities. Women's workload only begins to decrease once they reach their later years (ages 50–65), mainly due to a decrease in childrearing responsibilities (Bourdet, Doumbia, and Persson 2010). The evidence is clear that for women to be involved in development activities, their workload must be lightened and their informal and domestic work recognized as equal value to work done in the formal sector (World Bank 2006a).

In Mopti, 34 percent of the households fall in the lowest economic quintile, 31 percent in the second, 21 in the third, 9 in the fourth, and only 6 in the highest quintile (DNSI - Ministère de l'Economie, de l'Industrie et du Commerce 2003, 275). Compared to the other regions included in the Demographic and Health Survey (DHS), the region of Mopti has the largest percentage of the population in the lowest quintile. Ninety-six percent of men currently work a paying job compared to thirty-nine percent of women (DNSI - Ministère de l'Economie, de l'Industrie et du Commerce 2003, 275). There does not seem to be a correlation between level of educational instruction and whether a person is employed (DNSI - Ministère de l'Economie, de l'Industrie et du Commerce 2003, 275).

As for income, 84 percent of women in Mopti say they think they earn less than their husbands do (DNSI - Ministère de l'Economie, de l'Industrie et du Commerce 2003, 275). In Mopti, 74 percent of women say they alone decide how they will use the money they earn, while 5 percent of women make the decision with their partners, and 21 percent say their partners decide for them. Ninety-three percent of husbands in Mopti say they do not include their wives in deciding how to spend the money they earn; however, 86 percent of women say they help decide how money earned by the husband will be spent (DNSI - Ministère de l'Economie, de l'Industrie et du Commerce 2003, 275). Among the Bamanan ethnic group, wives and husbands do not share incomes (DNSI - Ministère de l'Economie, de l'Industrie et du Commerce 2003, 275).

Financial Inclusion

At the national level, women ages 15–19 (66 percent) and women living in households in the lowest wealth quintile (66 percent) are the least likely to decide for themselves how their money is spent. Level of education seems to have an influence over financial autonomy, as 74 percent of women with no formal education decide how to spend their money compared to 84 percent of women with a primary education; 81 percent of women with the most education say they have financial autonomy (DNSI - Ministère de l'Economie, de l'Industrie et du Commerce 2003, 275). One of the main reasons women continue to work in the informal sector is because their access to traditional financial services is very limited. While progress has been achieved in "the micro-finance sector through savings and credit unions, access to financial services remains limited" (World Bank 2006a, 67). According to the Malian Minister of Economy and Finance, in 2005, 40.3 percent of microfinance clients were women, with their participation increasing by 73.5 percent from 2001 to 2005. However, the majority, if not most, savings groups are made up of women; each group is only counted once, no matter how many women make up the group. This makes it difficult to determine the exact number of women participating, but it appears to be fewer than men (Koloma 2007).

Because women often cannot access credit individually, networking associations, such as women's solidarity groups, work collectives, women's groups organized in support of their microenterprise, and credit and savings associations (tontines), are a way in which women can build their social capital and gain access to financial resources as a group. By forging alliances through these networking associations, Malian women gain political and economic power within their communities (Downs 2007).

Women's Associations

Considering that a woman's social safety net is built through participation in community groups (World Bank 2006a, 55; Wooten 2003), it is no surprise that economic empowerment for women is most easily achieved through these groups. In fact, Jacobi (2014, 843) found that a woman's membership in an association or group was positively correlated with social participation overall. Simon, Adams, and Madhavan (2002) found that "women's passivity/helplessness is lower and felt control greatest "for women who participate in village credit schemes, a type of women's association.

In general, civil society organizations are strong in Mali (Rupp, Diallo, and Phillipps 2012), perhaps thanks in part to the creation of the Coordination of Women's Non-Governmental Associations and Organizations (CAFO) in 1992. The CAFO brings together women's associations and non-governmental organizations (NGOs) to help build capacity. Since 2006, CAFO has grown considerably and has a nationwide presence, strong political influence, and high visibility. According to the World Bank's 2006 gender assessment of Mali, CAFO "serves as a strategic instrument for the promotion of women in Mali." The CAFO's goal is to be involved in making "important decisions related to the management of public affairs." This includes providing input in the formulation, implementation, and follow-up of the PRSP (World Bank 2006a).

The effects of the growth of the women's association movement are varied. One positive outcome comes in the form of economic benefits (e.g., productivity, income, and sales) (Baden 2013). However, Baden (2013, 304) found that many women continue to sell their products on their own to meet daily income needs, in addition to selling them through the women's group, even though their profits are much higher when they go through the group. Besides the economic benefits, women are increasing their knowledge and strengthening their negotiation skills, which in turn boosts their confidence and entrepreneurial spirit (World Bank 2006a, 21). On the negative side, women often must get permission from their husbands before joining a group. While there does not seem to be direct opposition from men in allowing their wives to join, Baden (2013) noted that in many cases women dropped out of women's groups because their husbands disapproved of their participation.

For women, joining an association or group does not absolve them of their other duties, making it difficult for most women to participate (Baden 2013). Many women's groups attempt to accommodate women's schedules and workload, but most of them do not include activities to reduce their workload or try to change attitudes to help women gain better access to markets (Baden 2013, 304). Therefore, it is not surprising that the majority of active participants in women's collective action groups seem to be older married women who can delegate household chores to their co-wives or daughters (Baden 2013, 301).

One way women have adapted to the constraints of the patriarchal system is to include men in women's collective action groups. Having a few men in the group as "honorary" members opens up more opportunities for group members than if the group was solely made up of women. These honorary members help the women negotiate with the village chief and communicate with other community leaders. In addition, they can help gain support from other men in the community who are involved in aspects of production and marketing typically handled by men, such as "land preparation, irrigation, looking for new buyers, and transporting goods to more distant markets." Because men have more time to leave the village and "fewer cultural restrictions on their movement," it is quite strategic to have the male members of the group be the ones to take the product to market for sale (Baden 2013, 303; Baden and Pionetti, 2011).

Access to Land

The goal of many women's groups in Mali is to increase agricultural productivity and income. To achieve this goal, the issue of land rights—access to and use of land—must be addressed. According to Malian law, all land belongs to the state, but the village and customary chiefs manage it. In many cases, village leaders believe land should be reserved for men only, even though the Government of Mali has a policy of "allocating 10 percent of developed lands to women and youth" (Groupe de la Banque Africaine de Développement). However, according to Rupp, Diallo, and Philipps (2012), women rarely are able to take advantage of this policy.

The majority of Malians are Muslim, and traditional Islamic inheritance rules of descent dictate that houses and land are to be passed down to men. Husbands are the sole owners of family property, and daughters inherit half of what sons inherit. As a result, 51 percent of women do not own a home and 61 percent do not own land for cultivating (CPS/SSDSPF et al. 2014, 279). In many cases, women only have the right to use their husband's land. If a woman is widowed or divorced, however, these land use rights are usually revoked (Walle 2013, 2).

The issue does not stop with having access to any land—access to fertile land for women is crucial. Men are always prioritized in the allocation of plots, and thus get the most fertile ones, while women are given the less fertile plots of land left to fallow. In addition, women are given smaller plots—female heads of household get 0.3 hectares of land, while male heads of household get 3.5 hectares (World Bank 2006a, 40). These smaller plots must meet household consumption needs, as well as produce enough to sell in the market to generate income to pay for school fees, clothing, and other household needs (Gottlieb 2014, 8).

Providing more women with their own land for cultivation can facilitate their access to credit, and is critical for increasing agricultural productivity in Mali and supporting rural development (Bourdet, Doumbia, and Persson 2010, 62). From 2007 to 2012, the Millennium Challenge Corporation (MCC) implemented a large-scale project to increase access to farmland for rural women farmers. The Alatona Irrigation Project created 54 women's associations that would own and manage 500 square meters of market garden land. These associations were legal entities that included, on average, 20 beneficiary households. One of the biggest successes for this project was the joint titling of land, i.e. having the land in the name of both the husband and wife. Forty percent of beneficiaries adopted joint titling of their land (Rolfes and Seitz 2013, 11).

Under the Alatona Irrigation Project, Malian citizens purchased 4,940 hectares of irrigated land, 37 percent of which was owned by women. The MCC's biggest lesson learned over the five years of the project was the "importance of gender–responsive public outreach." A well -designed, well-implemented outreach program was a critical component because it educated beneficiaries about their rights and responsibilities as landowners and the benefits of joint titling for their entire family (Rolfes and Seitz 2013, 13).

In addition to land rights, studies and analyses have shown that lack of equal access to "agricultural inputs, technology and extension services" is to blame for smaller farm yields for women compared to men (Ajeigbe et al. 2013) and thus is a major handicap to economic growth (Bourdet, Doumbia, and Persson 2010, 47; Ajeigbe et al. 2013). Married senior men almost always have "priority access to the most lucrative domains" (Wooten 2003, 168). Women's (2003, 175) exclusion "from commercial farming activities inhibits improvement to their standard of living" in Mali. Indeed a domino effect for women in which lack of access to land impedes access to credit, which then makes it difficult to invest in new technologies and modern farming techniques; this keeps agricultural production and revenues low for rural women (Bourdet, Doumbia, and Persson 2010, 47; Ajeigbe et al. 2013).

Agricultural Production

Source: Lauren Bailey, SPRING

When it comes to agricultural production, men mainly produce the cash crops, while women produce the food crops. With regards to livestock, men traditionally rear the cattle and women the small ruminants. Both women and men rear poultry. For fishing, men usually catch the fish, and women prepare it for sale. The fish is prepared at home most of the time so women can do other activities simultaneously (World Bank 2006a). When women contribute to the cultivation of male family members' cash crops, they are often not paid for that work. This agricultural work is done in addition to their domestic duties and household chores (World Bank 2006a, 37; Rupp, Diallo, and Phillipps 2012; Wooten 2003). Before working on their own plots, women are expected to help with the household plot the senior male household member manages (Walle 2013, 2). Unmarried girls are rarely involved in agriculture; rather, they are mainly responsible for domestic chores (Wooten 2003, 168).

Women who work on other plots besides their own often do not receive remuneration for their work – thus exacerbating gender inequity. Of women ages 15–49 working in agriculture, 57 percent are not paid. Fifty-seven percent of women work for themselves; forty-two percent work for a family member, and for seventy-six percent of all women, their work is seasonal (CPS/SSDSPF et al. 2014, 45).

Increased demand for horticultural produce has made market gardening an increasingly lucrative business. Once an exclusively woman's activity, it is now quite popular among men looking for additional income (Wooten 2003; World Bank 2006a). In fact, market gardens have the potential to yield high profit margins, especially for those cultivating shallots and potatoes (versus rice, maize, or tomatoes). However, three major barriers exist for market gardening: limited available market, seasonal activity, and proper storage and packaging conditions. In Mopti, water scarcity is the fourth, and quite possibly the most significant barrier, because water must be rationed between horticulture crops and cereals. While the reasons why men would be drawn to the potentially high profits of market gardening are understandable, their entry into this activity "threatens women's ability to participate because they have less capital to invest in inputs than men and decreased access to land" (World Bank 2006a, 38). Men also have more helping hands at their disposal, as brothers and other male household members are often recruited to pitch in. Women, on the other hand, do not necessarily have a readily available labor force from which to recruit (Wooten 2003, 172). This constraint is on top of the other gendered constraints previously described for female workers, such as domestic duties and child-rearing. The added workload of a market garden on an already overburdened woman can have a negative impact on nutrition for her and her children (SPRING 2014b).

Initiatives (from the government and from NGOs) have targeted women working in agriculture. The National Strategic Plan for Agricultural Investment in Mali targets the value chains women dominate, such as milk and fish-production, and supports the improvement of non-agricultural activities, such as retail trade and processing (Rupp, Diallo, and Phillipps 2012; Republique du Mali 2010).

The International Crops Research Institute for the Semi-Arid Tropics (ICRISAT) in Mali has set up and executed several participatory plant breeding projects using the Farmer Field School approach. Since sorghum is considered a man's crop and groundnuts are considered a woman's crop, ICRISAT focused on working with female groundnut producers. In Mali, over 50 percent of the groundnut plots belong to women. Mali has set up and executed several farmer field schools and participatory plant breeding projects. Because women are the main producers of groundnuts in Mali, ICRISAT encouraged these female groundnut producers to form an association called Bankora. By 2008, there were 195 women in the group. Bankora uses a "community-based seed production (CBSP) approach," which allows the women farmers to produce more affordable seeds at the local level. Furthermore, the women have the opportunity to enhance their seed production and seed marketing skills. Thanks to their success, the women sell their groundnuts outside the district. The success has also led to the expansion of the project to five districts in Koulikoro through a partnership with ICRISAT and Plan Mali, reaching 150 women (Ajeigbe et al. 2013, 364).

Agriculture in Mopti

Mopti lies in the Sahelien agro-ecological region, which is arid with rainfall between 250 and 550 mm per year, with a long dry season of 9 to 11 months. Within this Sahelien zone lays the Niger River delta and its flood plains. Both agro-ecological zones pose their own unique challenges for agriculture (Coulibaly 2003). According to the most recent DHS survey, 66 percent of people in Mopti reported being within 15 minutes of a water source (DNSI - Ministère de l'Economie, de l'Industrie et du Commerce 2003). However, these water sources do not provide water year-round. In Mopti, 98 percent of the population is rural; for two-thirds of these rural inhabitants, drought is the main underlying cause of poverty (World Bank 2006a, 31). Forty-two percent of women in Mopti work in agriculture as do seventy-seven percent of men. Married women are more frequently involved in agricultural activities (29 percent) compared to non-married women (16 percent) and separated women (13 percent) (CPS/SSDSPF et al. 2014, 42).

Fifty-nine percent of women in Mopti do not own land. Of the women who do own land: twelve percent of women are the sole owner; twenty-six percent of women own it with someone else; and three percent of women own some land as the sole owner and other land is co-owned with someone else. Thirty percent of men in Mopti are the sole owner of land; twenty-three percent of men co-own land with someone else; and forty-seven percent of men do not own any land at all. The likelihood that a person will own land increases with age for men and women (CPS/SSDSPF et al. 2014, 280).

According to the World Bank, "in the reclaimed areas of Mopti, every married woman is entitled to a personal plot situated on the land" belonging to her family. She has complete claim over all money or produce that comes from the cultivation of this plot and can choose how to spend this money. Further analysis of this system shows that women were allocated these lands so that they could produce food for the household, like "the sauce foods" such as Tigedegena and green okra sauce that are the responsibility of women. It is, in fact, an obligation of the community to make sure women have land upon which to produce these foods for their household. A woman loses access to this land if she divorces or separates from her husband (World Bank 2006a, 46).

There are women's associations for fish wholesalers in Mopti; the Mopti Fish Office, Office de Pêche Mopti (OPM) works with the Rural Development Office of Selingue, Office de Developpement Rural de Selingue (ODRS), to provide training and supervision for the members. "The OPM has 19 extension bases, which supervise 16,469 households, who live mainly on fishing, and supports 135 women's associations" (World Bank 2006a, 39).

OPM works with village associations, as well, provisioning land to men and women for rice cultivation. To qualify for a rice paddy, the person "must be a head of family or head of a production unit and possess adequate equipment or sufficient financial resources to develop the land." This is a major barrier for most women to have their own rice paddy because men are usually the ones designated as the head of household, not their wives, and men are given priority in their request for land. When a woman manages to get her own land to grow rice, the Mopti Rice Office only allocates 0.21 hectares to her but allocates 0.3 hectares to men (World Bank 2006a, 45; Gottlieb 2014).

Linking Agriculture and Nutrition

The conceptual pathways between agriculture and nutrition help us understand and measure how various agricultural investments or activities can improve access to food and health care; how they affect and are affected by the enabling environment; and how they ultimately affect the nutrition of women and children (see Annex C) (SPRING 2014a). Agriculture can also pose threats to family nutrition, especially when women must work at times and in places that interfere with the feeding of their infants and young children (UNICEF and Liverpool School of Tropical Medicine 2011); this is why gender barriers related to agriculture and nutrition practices in Mali need to be explored. SPRING's Improving Nutrition through Agriculture Technical Brief Series (SPRING 2014a) offers a more detailed introduction to the pathways, including the pathway from women's empowerment to improved nutrition. Research has shown that one of the most effective ways to improve program nutrition-sensitivity is to "optimize women's nutrition, time, physical and mental health, and empowerment" (Ruel and Alderman 2013).

Nutrition and WASH

Women in Mali are the primary patrons of health services because of their reproductive functions within the household and their duties as mothers and caregivers. Because they are frequent users of the health system, women are often more invested in the availability of services and quality of care that public and private health care providers offer (World Bank 2006a, 25).

Most Malians do not have health insurance (97 percent); the case is the same for the majority of the residents in Mopti, 98 percent of whom do not have insurance (CPS/SSDSPF et al. 2014, 46). Of the reasons cited for why women in Mopti do not access healthcare, the primary reason was not having enough money (70 percent). The second most common reason was distance to the health facility (57 percent); this was followed by not having permission to seek treatment (41 percent) and not wanting to go to the facility alone (35 percent). Even in rural areas, money, rather than distance to a health facility, was the number one reason why women did not seek care (CPS/SSDSPF et al. 2014, 120).

In Malian society, the family unit is the most "important basic element in most communities … and maternity is at the center of family and community life" (World Bank 2006a, 17). The high esteem put on motherhood results in enormous pressure put on women to bear children; women are expected to "give her husband children." Women who do not adhere to this expectation are rejected by society (World Bank 2006a, 17).

Since the 2001 DHS, the fertility rate has decreased in Mali from 6.8 to 6.1 children per woman, but it still remains high. Women with no formal education have, on average, 2.5 more children than women who have a secondary level of education or higher (CPS/SSDSPF et al. 2014, 74). The fertility rate in Mopti is higher than the national average at 6.5 children, which is identical to the ideal number of children women in Mopti reported that they would like to have. Thirty-eight percent of births are spaced by 24–35 months, thirteen percent by 18–23 months, and nine percent by 7–17 months. Only 40 percent of births are spaced 36 months or more as recommended (CPS/SSDSPF et al. 2014, 70). Among women in Mopti ages 20–49, the average age at first birth is 19.5; for women ages 25–49, it is 19.9 (CPS/SSDSPF et al. 2014, 74).

Decision making for Maternal, Newborn, and Child Health

Intra-household dynamics affects a woman's health-seeking behaviors for maternal and child health. For example, to seek care for a sick child, the mother must obtain authorization from the most senior male in the household, regardless of whether that man is the child's father. The senior-most woman in the household is responsible for identifying the illness, and then depending on who is present. The father, senior woman, or senior man (in that order) will decide if the child should be taken to a health center. Ultimately, the father's quick action (or lack thereof) and ability or willingness to pay will determine the health outcome for the sick child (Ellis et al. 2013). However, regarding payment of the health care for their children, if a mother cannot obtain money from the father of the children, she will often ask for credit from neighbors or sell some of her belongings (Ellis et al. 2013, 753).

Ellis et al. (2013) found that while the father does play a significant role in his children's health, "the decision to seek modern, institutional health care falls—at least in part—in the domain of the mother-in-law." Their research found that the mother-in-law influenced not only whether a woman gave birth in a health facility but whether she received postnatal care. A woman was more likely to give birth in a health facility and receive adequate postnatal care if the mother-in-law reported that her son held more decision making power than her daughter-in-law when it came to maternal health choices (White et al. 2013).

In addition, White et al. (2013) found that "the preferences and opinions of mothers-in-law were associated with the maternal health behaviors of their daughters-in-law." Furthermore, "women's own perceptions of their self-efficacy, the value of women in society and the quality of services at the local health facility were…independently associated with their preventive and health-seeking practices." They did not find an association between the husbands' preferences and opinions and any outcome (White et al. 2013). They concluded that even though men are supposed to make the maternal health decisions, the mother-in-law is the one who has the greatest influence over these decisions; in some societies, her influence "overshadows" that of the father (White et al. 2013, 66).

A woman's attitude about her local health center is another influential factor in seeking maternal health care (White et al. 2013, 65). In rural areas, 35 percent of women received 4 or more antenatal care visits, while 30 percent did not receive any antenatal care visits. Five percent of rural women made one visit, and twenty-nine percent of rural women made two or three visits (CPS/SSDSPF et al. 2014, 108). Sixty percent of women in Mopti ages 15–49 who had a live birth in the past five years received antenatal care from a trained health worker, the lowest average among all surveyed regions and well below the seventy-four percent national average. Of those 60 percent who received antenatal care from a trained professional, 36 percent saw a nurse or midwife; 19 percent saw a "Matrone,"or an auxiliary midwife; and 2 percent saw a doctor (CPS/SSDSPF et al. 2014, 106). As part of their antenatal care, 54 percent of women in Mopti reported taking iron pills or syrup during a pregnancy in the past five years (CPS/SSDSPF et al. 2014, 109).

Furthermore, in rural areas, women are more likely to follow traditional birth practices (World Bank 2006a, 26; CPS/SSDSPF et al. 2014), and 52 percent of women give birth at home (CPS/SSDSPF et al. 2014, 111–112). In Mopti, the majority of women give birth at home (71 percent), with others giving birth in a public health clinic/hospital (24 percent) or in a private health clinic/hospital (2 percent). Major disparities exist among socioeconomic status, as 86 percent of women in the highest wealth quintile give birth in a public sector clinic/hospital, whereas only 6 percent of women in the same quintile give birth at home (CPS/SSDSPF et al. 2014).

Postnatal care in Mali occurs less frequently than antenatal care. According to the DHS, in Mopti, 75 percent of women do not receive any postnatal care; 21 percent of women receive care within the recommended 48-hour period after giving birth, whereas 17 percent of women (out of 21 percent) receive care less than 4 hours after giving birth (CPS/SSDSPF et al. 2014, 115). The majority of women who receive postnatal care within the first 48 hours see a doctor, nurse, or midwife (12 percent out of 21 percent); 4 percent see a Matrone; and 4 percent see a traditional birth attendant (CPS/SSDSPF et al. 2014, 116).

In general, the weight of the newborn is only known in 30 percent of the cases, most of which occur in Bamako or in the highest wealth quintile (CPS/SSDSPF et al. 2014, 123). In Mopti, only 13 percent of women knew the weight of their newborn at birth. Of the 13 percent of women who knew the weight, 16 percent of the newborns were very small or smaller than average. Seventy-eight percent of newborns were average or above average (CPS/SSDSPF et al. 2014, 124).

Women's Nutrition

The 2025 Malian prospective study conducted by the President's Office found that 75 percent of Malians are not eating the recommended number of meals per day. Malnutrition impacts more women than men because of "taboos, dietary patterns, frequent pregnancies and too much work" (World Bank 2006a, 27). In Mopti, 14 percent of women have a Body Mass Index (BMI) below 18.5, and very few are obese (3 percent). Mopti is in line with the national averages, which are 12 percent for BMI under 18.5 and 5 percent for a BMI above 30, which is categorized as obese (CPS/SSDSPF et al. 2014, 185). "Underweight women were more prevalent in southern Mali, while obesity was more frequent in the northeast. Women in major urban areas were more likely to be obese than their rural counterparts" (Gewa, Leslie, and Pawloski 2013).

The nutritional status of women is strongly associated with wealth (Gewa, Leslie, and Pawloski 2013, 1581). At the national level, 9 percent of households reported not having enough to eat or at least 1 person going to bed hungry in the past 4 weeks. In Mopti, 10 percent of households reported not having enough to eat or at least one person going to bed hungry during the previous 4 weeks. Of those households that did not have enough to eat, the majority (58 percent) said this occurred rarely, while 29 percent said sometimes (3–10 times in 4 weeks), and 13 percent said often (11 times or more) (CPS/SSDSPF et al. 2014, 186).

Fifty-one percent of women in Mali are anemic, and sixty percent of pregnant women are anemic. Anemia is more prevalent among women in the lowest wealth quintile and for women who have no formal education. In Mopti, 57 percent of women are anemic (CPS/SSDSPF et al. 2014, 173).

Ayoya et al. (2007) investigated the high rates of anemia among pregnant women in Mali, and they found that infections and food accessibility were the two main contributing factors. Women did not necessarily have access to food because it was not available, but rather because women were avoiding these foods or at least rarely consuming them. These self-imposed food restrictions stemmed from beliefs such as eggs and milk cause malaria, or salt, bananas, meat, and eggs increase the size of the baby, making the baby larger and causing a difficult birth. (Ayoya et al. 2007).

The traditional Malian diet consists of a "starchy staple, mainly refined white rice, refined wheat flour or millet, accompanied by a sauce typically made from vegetables and beef or fish" (Kennedy et al. 2010, 3). Forty-five percent of women between the ages of 15 and 49 reported consuming grains and grain-based foods. Thirty-eight percent of women reported drinking milk, either fresh or powdered. In 36 percent of cases, women ate meat, poultry, or seafood. Least often consumed by women were foods made with palm oil (7 percent), eggs (5 percent), and cheeses or other dairy products (3 percent). No matter the food group, it was often the youngest (ages 15–19) and the oldest (45–49) women who consumed the smallest portions. Women in rural areas ate far fewer dairy products (3 percent), fruits and leafy green vegetables (10 percent), eggs (4 percent), or foods made with palm oil (6 percent). Women in the highest wealth quintile ate more eggs, dairy products, and foods made with palm oil than women in the lowest wealth quintile (CPS/SSDSPF et al. 2014, 189).

In Mopti, 41 percent of women reported drinking milk (either fresh or powdered), but only 2 percent ate other dairy products such as cheese or yogurt. In Mopti, 49 percent of women ate grains or grain-based foods; 10 percent ate fruits or vegetables rich in Vitamin A; 10 percent ate roots or tubers; 19 percent reported eating leafy green vegetables; 7 percent reported eating fruits or vegetables; 14 percent reported eating legumes or nuts; 38 percent reported eating meat, fish, seafood, or poultry; 3 percent ate eggs; 11 percent ate food made with oil, butter, or fat; 5 percent ate food cooked with palm oil; 6 percent ate sugary foods, such as cakes, chocolates, cookies, or pastries; and 27 percent reported eating insects, snails, worms, spicy foods, or fish powder (CPS/SSDSPF et al. 2014, 188).

At the national level, 50 percent of women received Vitamin A within 2 months of giving birth; in Mopti, it was 33 percent of women. Thirty-two percent of women did not take any iron supplements during their last pregnancy. In Mopti, 46 percent did not take any iron supplements during their last pregnancy. A woman's level of education and wealth quintile had a major influence on whether she took Vitamin A or iron supplements (CPS/SSDSPF et al. 2014, 177).

An analysis of the micronutrient intake of women of reproductive age (WRA) in urban Mali revealed a strong positive relationship between mean probability of adequacy (MPA) and the quantity consumed of nut, seeds, and dark leafy green vegetables. There was also a significant positive correlation between MPA and the consumption of foods in the milk and yogurt group and foods rich in vitamin C. The results showed that vulnerable populations in Mali could benefit from increased consumption of dark green leafy vegetables to help improve micronutrient intakes. In general, dietary diversification is an effective strategy to improve micronutrient intake of WRA in Mali, whether they are vulnerable or not (Kennedy et al. 2010).

Child Nutrition

In Mali, 25 to 30 percent of children under 5 are stunted, and 19 percent of these cases are severe (UNICEF/WHO/World Bank 2015; CPS/SSDSPF et al. 2014). Acute malnutrition affects 13 percent of children under 5, while 5 percent of children are severely malnourished. Twenty-six percent of children under five are underweight, and nine percent are severely underweight (CPS/SSDSPF et al. 2014, 161). Fifty percent of children born fewer than twenty-four months after the previous child suffer from malnutrition compared to thirty-three percent of children who were born forty-eight months or more after the previous child (CPS/SSDSPF et al. 2014). For cases of severe malnutrition, birth spacing is an influencing factor: 29 percent of children born 24 months or less after the last child are malnourished compared to 14 percent of children born more than 48 months apart. Rural children are more likely to be malnourished than children living in urban areas (42 percent compared to 23 percent).

A higher percentage of stunting exists in Mopti compared to the national average: 47 percent of children are stunted, with 26 percent severely stunted (CPS/SSDSPF et al. 2014, 182).

For children in Mopti under 5 with reported cases of diarrhea in the past 2 weeks, 14 percent were given more liquids, and the amount of food given was increased in only 6 percent of cases (CPS/SSDSPF et al. 2014, 137).

Researchers have put concerted effort into determining the underlying factors that lead to child malnutrition. As previously discussed, the mother-in-law has a strong influence over health care decisions in the household. Simon, Adams, and Madhavan (2002) found consistent data showing the negative impact a supportive mother-in-law has on a child's nutrition. These results are counterintuitive, but were "corroborated by Castle's work among Fulbe women in Mali, which identified mothers-in-law as important resource keepers of food and cash for illness management and treatment" (Castle 1993). If a woman was the only daughter-in-law living in the household with her mother-in-law, her children had higher rates of malnutrition. Simon, Adams, and Madhavan (2002, 208) postulate (along with Castle) that the reason for this relationship is that as physical and emotional proximity of the mother-in-law increases, fewer resources reach her grandchildren.

Other underlying factors influencing child nutrition is seasonality, in which child wasting increases during the rainy season compared to the dry season. For further investigation, Simon, Adams, and Madhavan found an association between a mother obtaining Koranic education (which 20 percent of the women in their sample had participated in) and her children being malnourished (p<0·01) (Simon, Adams, and Madhavan 2002; Ruel and Alderman 2013).

At the national level, 82 percent of children aged 6–59 months are anemic, with 9 percent being severely anemic. Lower wealth quintiles have a higher percentage of anemia compared to the higher wealth quintiles (CPS/SSDSPF et al. 2014, 171). In Mopti, anemia is higher than national averages and the highest compared to all other regions surveyed. Eighty-nine percent of children 6–59 months have low levels of anemia, and fifteen percent are severely anemic (CPS/SSDSPF et al. 2014).

Most babies are breastfed in Mali (97 percent), and bottle feeding is very rare (World Bank 2006a). Exclusive breastfeeding, however, is not as widespread (33 percent) (CPS/SSDSPF et al. 2014, 161), and less than half (42 percent) of children are not breastfed within 1 hour of being born nor are they given colostrum or fed on demand (CPS/SSDSPF et al. 2014, 163). By 12–15 months of age, 95 percent of babies are still breastfeeding, but on average, babies are breastfed until they are 23.1 months (World Bank 2006a, 27). In Mopti, 98 percent of children are breastfed; 62 percent of newborns are breastfed within 1 hour of birth, and 23 percent of babies are given something other than breastmilk during the first 3 days following birth (CPS/SSDSPF et al. 2014, 163).

In Mali, 33 percent of children aged 0 to 5 months are exclusively breastfed. The median duration of exclusive breastfeeding is 0.7 months. In Mopti, the median duration for exclusive breastfeeding is higher than the national average at 1.6 months (CPS/SSDSPF et al. 2014, 166).

In Mali, complementary foods are not adequate: fewer than half (45 percent) of children aged 6–9 months receive solid or semi-solid foods. Only 8 percent of children between the ages of 6 and 23 months are fed according to the three optimal feeding practices for infants and young children (Minimum Acceptable Diet).

In Mopti, 10 percent of children aged 6–23 months are fed from 4 or more different food groups; 28 percent are fed the minimum number of recommended meals, and less than 4 percent are being fed according to optimal infant and young child feeding practices (CPS/SSDSPF et al. 2014, 169; WHO 2010).

In Mali, more than half of children aged 6–23 months consume Vitamin A-rich foods (55 percent). The percentage increases with age: in Mali, 28 percent of children aged 6–8 months consume Vitamin A-rich foods, and 65 percent of children aged 12–17 months and 71 percent of children aged 18–23 months consume Vitamin A-rich foods. In Mopti, 50 percent of children aged 6–23 months consume Vitamin A-rich foods, the lowest of all the regions surveyed, and 48 percent of children in Mopti receive Vitamin A supplements (CPS/SSDSPF et al. 2014, 175).

Implementing a Vitamin A supplementation campaign during National Nutrition Week was found to be an extremely effective strategy for increased Vitamin A supplementation intake—reaching at least 80 percent of children. The most effective communication channels were those that were more "traditional," such as town criers, friends, and family members. More "modern" forms of communication, such as radio and television, were less effective in reaching the target groups. The most effective messaging targeted fathers (Ayoya et al. 2007).

Similar to Vitamin A-rich foods, iron consumption increases with the age of the child; 24 percent of children aged 6–8 months consume iron rich food along with 66 percent of children aged 18–23 months. With all age groups of children combined, 49 percent consume iron-rich foods. Children not being breastfed consume more iron-rich foods than children being breastfed (63 percent versus 47 percent). In Mopti, only 41 percent of children aged 6–23 months receive iron-rich foods, the lowest of all regions surveyed. Twenty percent of children in Mopti receive iron supplements (CPS/SSDSPF et al. 2014, 175).

Water and Sanitation

Women are the main users of water and the ones who fetch it and recruit other family members to help them fetch it (Gleitsmann, Kroma, and Steenhuis 2007, 146). In 2010, 76 percent of Malians had access to potable water, not taking into account broken water pumps, nonfunctioning water points, and pump equipment that is difficult to use, all of which make the chore of fetching water even more arduous for women and girls. Sixty-six percent of households have access to an improved water source; in rural areas, it is 59 percent (CPS/SSDSPF et al. 2014, 13). In Mali, only 22 percent of households have a modern latrine or a modern shared latrine. In rural areas, it is 17 percent (CPS/SSDSPF et al. 2014).

In the northern regions of Mali, waste is taken outside the village. In urban and rural areas, women are responsible for disposing waste, and they either do it themselves or pay someone else to do it (World Bank 2006a, 29).

In Mopti, 32 percent of households do not have water, soap, or any other cleaning product available to wash their hands. Twenty-two percent of households have an observed place for handwashing, while twenty-nine percent have soap and water available (CPS/SSDSPF et al. 2014, 21). One study in Mopti found that most households do not filter their water, and if they do, it is mainly to filter out large particles and debris (Halvorson et al. 2011, 453).

Women are often not included in decision making about the "siting, management and technical maintenance of water points" (World Bank 2006a, 29). Only 34 percent of committees that manage water points consist of women (République du Mali 2011; Groupe de la Banque Africaine de Developpement 2011). However, men must be included in decision making for water resources because they are responsible for obtaining water for their livestock (Gleitsmann, Kroma, and Steenhuis 2007, 147).

The West Africa Water Initiative (WAWI) implemented in Mali, Ghana, and Niger provided rural populations with access to "improved rural water supply, participatory natural resource management, and capacity building at community and organizational levels. It also focus[ed] on hygiene promotion and sanitation around established boreholes within the selected communities in the target regions." Gleitsmann, Kroma, and Steenhuis's 2007 assessment of WAWI revealed that while projects were taking positive steps in the right direction to improve rural water supplies, the projects were not responding to the needs of the communities and were unsustainable in the long run. All stakeholders must be involved in the decision making process to better inform the design and choice of technology (Gleitsmann, Kroma, and Steenhuis 2007).

Hygiene

Aboubakar Kone, SPRING/Mali

In places with water scarcity, the use of water for hygiene purposes is seen as less important, so when there is no water, people do not practice hygiene behaviors (Gleitsmann, Kroma, and Steenhuis 2007, 148). Many mothers do not understand the severity of diarrhea nor can they recognize the symptoms of dehydration and malnutrition caused by severe diarrhea (Halvorson et al. 2011, 454).

In Mopti, the peak of diarrheal disease occurrence is June and July at the beginning of the rainy season and the onset of flooding (Halvorson et al. 2011, 454; Findley et al. 2005). Thirty-three percent of households dispose of the feces of children under five in a hygienic manner (CPS/SSDSPF et al. 2014, 139). An additional behavior that leads to increased diarrhea in children is the customary practice for the mother to give newborn babies water as soon as two days after birth (Halvorson et al. 2011).

Halvorson et al. (2011) conducted WASH research in four villages along the Niger River in the Mopti region. They found that even when pit latrines are available in a community, they run the risk of flooding during the rainy season and contaminating water sources. Because the latrines were unavailable, people defecated in the river instead, "thereby adding to oral–fecal contamination present in the environment" (Halvorson et al. 2011, 453). In addition, they noted that recontamination was a major contributing factor to fecal contamination—the water source was uncontaminated, but unhygienic water handling practices led to recontamination. The women in the study sites did not associate diarrhea with unsafe drinking water and thought the water they used was safe, even though there were "observations of sources of fecal contamination in and around households" (Halvorson et al. 2011).

In these same villages in Mopti, mothers were ill-informed on how to recognize symptoms of dehydration caused by diarrhea (Sodemann et al. 1996; Halvorson et al. 2011). Mothers often tried to cure their children's diarrhea with medicinal plants or medicines purchased from street peddlers, with only 16 percent visiting a health facility. The most common drugs used to treat diarrhea were gandida (Sulfadimidine) and toopie (Amoxicillin). Unfortunately, only 15 percent of mothers mentioned using Oral Rehydration Solution (ORS)" (Halvorson et al. 2011).

Conclusion

The findings of the literature review help answer some of the study questions developed before the study began. A summary of the findings that answer the study questions are provided in the table below. Gaps and additional questions raised from the literature review are listed in the third column of the table.

Summary of Literature Review Findings

References for the Mali Snapshot Table