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

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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.