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CONTENTS

FOREWORD

KEY MESSAGES

ACKNOWLEDGEMENTS

ACRONYMS AND ABBREVIATIONS

INTRODUCTION

PART 1
OVERVIEW OF FOOD SECURITY AND NUTRITION IN EUROPE AND CENTRAL ASIA

1.1 The 2018 assessment of hunger and food insecurity in the ECA region

1.2 Triple burden of malnutrition: A concern in the ECA region

1.3 Understanding of who are at risk of being left behind

1.4 Socio-economic burden of diseases and malnutrition

PART 2
REGIONAL AND NATIONAL POLICY DRIVERS TO SUPPORT ACHIEVING SDG 2 TARGETS

2.1 General socio-economic characteristics of the ECA region

2.2 Regional and subregional policies and recent developments

2.3 National policies and main developments

PART 3
MIGRATION, GENDER AND YOUTH: LINKAGES WITH RURAL DEVELOPMENT AND FOOD SECURITY IN EUROPE AND CENTRAL ASIA

3.1 Migration in the ECA region: definitions, patterns, trends and drivers

3.2 Labour migration and linkages between migration and food security

3.3 The role of remittances in food security and nutrition

3.4 Gender, youth and migration

3.5 Recommendations

ANNEX

Glossary

REFERENCES

NOTES

TABLES, FIGURES AND BOXES

TABLES

1  SDG 2 targets and indicators covered in Part I

2  Prevalence of undernourishment (%) in the ECA region, 2004-2017

3  Prevalence of severe food insecurity based on FIES in the ECA region, 2015-2017

4  Number of severely foodinsecure adults (by sex and age) and total people, including children (millions), 2015–2017

5  Classification of the public health significance of malnutrition among children younger than five

6  Malnutrition among children younger than five in selected ECA countries: stunting, wasting and overweight, % of population, 2016

7  Prevalence of exclusive breastfeeding in selected countries of the ECA region, 2014-2016, % of population

8  Prevalence of obesity among adults in the ECA region, 2005-2016

9  Prevalence of anaemia among women aged 15-49 in selected countries of the ECA region, 2005-2017

10  Health expenditures per capita (current USD) for selected countries, 2005-2014, annual

11  GDP growth rates in ECA region and selected countries (annual %, const. 2005 prices, in the years 2005, 2010 and 2017)

12  Selected policy documents on agricultural production and rural development, 2016-2018

13  Overview of selected policy documents on improving access to food at the national levels of the ECA countries, 2017-2018

14  List of policy documents addressing food utilization and nutrition through agricultural and rural development, health and advocacy measures

15  Examples of recent food safety reforms in ECA region

16  Overview of policy measures on market intervention, trade and innovation in selected countries

17  Indicators of rural development in the ECA region, 2017

18  Opportunities and challenges for labour migration regarding economic and social perspectives in the countries of origin

19  Migration and the four dimensions of food security – main linkages

20  Unemployment rate among young women and men (15-24 years old), as % of total labour force (2017) in selected countries of the ECA region

21  The share of female migrants and their median age in the world and by region,2000-2017

22  Percentage of female migrants (%) and median age (years) in selected ECA countries, 2017

23  Positive and negative effects of migration on young women and men – on the migrants themselves and on their areas of origin

FIGURES

1  ECA countries and subregions – changes (percentage points) in the prevalence of undernourishment, 2005-2017

2  Prevalence of undernourishment and number of undernourished people (POU, SDG indicator 2.1.1) in Central Asia,2005-2017

3  FIES framework and levels of food insecurity: mild, moderate and severe food insecurity

4  Prevalence of severe food insecurity by sex (%), 2015-2017, based on FIES

5  Stunting, wasting and overweight among children younger than five in selected ECA countires: % of total, 2016

6  Prevalence of adult obesity in ECA by subregion, 2000-2016, as % of total population

7  Prevalence of anaemia among women of reproductive age (15-49), 2000-2016

8  Prevalence of stunting and overweight among children under the age of five, disaggregated by houshold wealth quintile

9  Prevalence of stunting among children younger than five on the subnational level of selected countries

10  Examples of classifications of provinces in Kyrgyzstan and Tajikistan based on their vulnerability and state of food security

11  Poverty at national poverty line in selected countries of the ECA region as a percent of the total population, 2005-2016

12  GDP growth rates, annual percent, const. 2005 prices

13  GDP per capita (current USD) by subregions and selected countries

14  Agricultural and food production index for 2005, 2010 & 2017

15  Food supply in the ECA region, by subregion, 2013 (kcal/person/day)

16  Average protein supply in the ECA region, 2011-2013 (g/capita/day, 3-year average)

17  Share of dietary energy supply derived from cereals, roots and tubers (%, 3-year average)

18  Inequality in selected ECA countries, measured by Gini Index (retrieved May 2017)

19  Food price trends (wheat flour) in selected countries

20  International migrants in the ECA region and selected countries, 2005-2017 (thousands of people)

21  Estimated numbers of labour migrants in the Russian Federation from Central Asia and Azerbaijan (mid-2017)

22  The growth rate of remittances in the world and by regions, 2010-2018, growth rate compared to 2000

23  Remittance inflows, millions USD, in selected ECA countries (2005-2016)

24  Remittances from Russian Federation to Central Asia and Azerbaijan, millions USD (2007-2016)

25  Remittances' contribution to GDP in ECA countries (%), 2017

BOXES

1  The definition and methodology of the prevalence of undernourishment calculation

2  Calculation of the severe and moderate prevalence of food insecurity, based on the Food Insecurity Experience Scale

3  Causes and consequences of obesity and overweight

4  WHO guidelines for a healthy diet for adults

5  Partnerships in Food and Livelihood Security

6  School Food and Nutrition Programmes linked to the Agricultural Sector

7  Main definitions related to migration

8  Migration key facts and figures in the ECA region

9  Migration in Kyrgyzstan, Republic of Moldova, Tajikistan and Uzbekistan

10  Case studies of programmes encouraging the flow of remittances towards agriculture and rural development in Republic of Moldova and Tajikistan

11  Changing drivers of female migration

FOREWORD

In adopting the 2030 Agenda for Sustainable Development and its ambitious goals for a more sustainable and equitable world, countries and their international partners also committed to regular monitoring and progress reporting.

A comprehensive framework of targets and indicators was developed for the 17 Sustainable Development Goals (SDGs), and FAO was designated custodian United Nations agency for 21 of those indicators. Of these, nine relate to Goal 2: End hunger, achieve food security and improved nutrition and promote sustainable agriculture, by 2030.

FAO’s Regional Overview of Food Security and Nutrition in Europe and Central Asia 2018 (Regional SOFI 2018 in ECA) describes the current situation vis-à-vis SDG 2 in countries of the Europe and Central Asia (ECA) region. It focuses in particular on the countries’ status in relation to SDG Target 2.1 (to ensure access to food for all) and Target 2.2 (to end all forms of malnutrition).

The Regional SOFI 2018 in ECA reports on the prevalence of severe food insecurity in ECA countries – based on food insecurity experience scale (FIES) surveys. The prevalence of severe food insecurity is an experienced-based metric that helps determine the severity with which people experience food insecurity in terms of their access to food. It complements the prevalence of undernourishment (PoU) indicator, traditionally used by FAO to analyse the extent of hunger.

Initial analysis of the data on severe food insecurity shows that adult women have a higher prevalence of severe food insecurity than men in the Caucasus, Central Asia, and European CIS subregions – pointing to gender inequalities in societies that are ref lected in access to food and food insecurity. To address this, coordinated measures are needed at all levels.

The emphasis on nutrition in the 2030 Agenda for Sustainable Development constitutes a major opportunity for the ECA region to address malnutrition and related issues, stepping up efforts as called for in the Rome Declaration on Nutrition and Framework for Action of the Second International Conference on Nutrition (2014) and the United Nations Decade of Action on Nutrition (2016–2025).

Interlinkages between these developmental challenges and actions taken to address them are examined in the Regional SOFI 2018 in ECA. The publication provides an in-depth situation analysis of SDG Targets 2.1 and 2.2, the state of micronutrient deficiencies in the ECA region, and the prevalence of severe food insecurity based on the FIES surveys. It also offers an overview of new and existing government policy initiatives to achieve the SDG 2 targets addressing all dimensions of food security, interlinkages with other Goals, and prevailing challenges such as poverty and inequality.

The publication’s focus this year is on migration, gender and youth and the linkages with rural development and food security in Europe and Central Asia. Migration processes that have characterized the region are changing. They need to be fully understood if we are to address the challenges of migration and harness the potential benefits – for sustainable development and revitalized rural areas.

The complexity of the sustainable development agenda and the multiple interlinkages among the SDGs demand coordinated national and international efforts, key policy decisions, joint endeavours, and a scaling up of successful efforts. This work needs to be supported by solid evidence and analysis, to which the Regional SOFI 2018 in ECA is a critical contribution.

VLADIMIR RAKHMANIN

Assistant Director-General and Regional
Representative for Europe and Central Asia

KEY MESSAGES

PART I: OVERVIEW OF FOOD SECURITY AND NUTRITION IN EUROPE AND CENTRAL ASIA

The Europe and Central Asia (ECA) region is heterogeneous in terms of the countries’ economic structure, rate of economic growth and transition, geographic position, climatic conditions, and various socio-demographic features.

The ECA countries are committed to achieving Sustainable Development Goal 2 (SDG 2), improving food security and nutrition, and indeed food security has improved substantially over the past two decades. However, new evidence points to a stagnation of the decreasing trend in food insecurity in recent years in some subregions, particularly in Central Asia.

While the overall malnutrition situation in the ECA region has improved, overweight among children and obesity among adults continue to rise and now constitute a significant issue. Meanwhile, stunting and wasting remain prevalent in some places, particularly in rural and remote areas.

In the three-year period from 2015 to 2017, about 19 million people (14.3 million adults and 4.7 million children) in the region suffered from severe food insecurity, according to the new Food Insecurity Experience Scale (FIES)-based indicator.

This means that about 2.1 percent of the region’s population are affected by a severe level of food insecurity, according to the FIES.

This prevalence is far lower than the world average of 9.2 percent, but still is of concern in some countries. Considerable efforts will be needed to ensure that we “leave no one behind” on the road to achieving SDG Target 2.1, ensuring access to food for all. It will mean addressing key underlying issues such as poverty, economic inequality, conflict and social tensions, and other factors.

Initial findings across the region show that inequality between women and men in the prevalence of severe food insecurity varies by subregion. Adult women were found with a higher rate of severe food insecurity than men in the Caucasus, Central Asia, and European CIS subregions in 2015–17. This signals more fundamental gender inequalities in societies, reflected in access to food as well as food utilization. To ensure that all people, regardless of gender, have adequate food and nutrition, immediate measures are needed at all levels and in different policy areas.

Malnutrition in one or more of its three main forms – undernutrition, overweight and obesity, and micronutrient deficiencies – is present to varying degrees in all countries of the region. Often all three forms coexist, creating what is called the “triple burden of malnutrition.”

Malnutrition problems are more prevalent in remote and rural areas. Based on recent nutrition surveys, stunting among children is more prevalent in the poorest groups in almost all countries. In some countries in Central Asia, stunting among the poorest groups in rural areas was nearly twice as high as in cities. This underlines the importance of addressing the underlying conditions in poor rural areas of poverty, long-term insufficient nutrient intake, poor diets, and frequent infections.

Millions still suffer from micronutrient deficiencies – in particular anaemia, which occurs at significant levels in many countries, including in high-income countries. Anaemia in women of child-bearing age is on the rise, constituting an important public health problem. Addressing it will require gender-sensitive policy approaches and careful monitoring of their implementation.

The growing levels of overweight and obesity in the region are cause for serious concern. A recent World Health Organization analysis covering the 2000– 2016 period show a continuous increase in the prevalence of obesity among adults in all subregions of the ECA region. In 2016, one-fourth of adults in Europe (EU-28 and European CIS), and more than 32 percent of adults in Turkey, were obese. These trends and related public health implications and costs underscore a need for adequate policy measures and more effective, longterm multi-sectoral nutrition programming. Efforts need to be well informed and underpinned by regular data collection and analysis – to track progress and address shortcomings.

PART II: REGIONAL AND NATIONAL POLICY DRIVERS TO SUPPORT ACHIEVING SDG 2 TARGETS

In order to implement the 2030 Agenda, a range of policy measures are being adopted at subregional and national levels. The SDGs offer a coherent framework for national implementation plans. To achieve Sustainable Development Goal 2, these policy frameworks and related programmes need to consider the food system as a whole. They need to address all four dimensions of food security – availability, access, utilization and stability – and nutrition.

Governments, public and private institutions, and other concerned parties need to collaborate to increase their impact. Various types of partnerships are forming in the region to strengthen food security and nutrition as well as agricultural and rural development.

Recent country policy measures targeting the agriculture sector include agricultural support instruments, price regulation, market stabilization and rural development for improving food availability and stability.

Poverty levels in most of the ECA countries have been declining in recent years as a result of regional economic growth. However, in low- and lower-middle-income countries, poverty coupled with inequality leads to increased vulnerability of disadvantaged groups and populations in rural and remote areas. In order to “leave no one behind”, policies and institutional systems should be carefully designed to assure social security, healthcare and education.

Alongside dedicated programmes on improving nutrition and promoting balanced and diversified diets, strategic policy documents and measures focus on food utilization. These aim to improve nutrition and address the region’s coexisting malnutrition challenges. Institutional reforms and other measures are also being undertaken in the area of food safety control and inspection to enhance food safety across the entire food system.

Different policy measures have been adopted recently in the ECA region to improve food access, including social protection and food assistance. Food assistance programmes include vouchers and food subsidies, food transfer programmes, cash transfers, and school feeding programmes. Food and livelihood assistance and support programmes play an important role in supporting populations affected by conflict or in post-conflict situations and in assisting refugees and their host communities.

Monitoring the implementation of policy measures adopted for food security and nutrition needs to be supported by data on all forms of malnutrition (in particular micronutrient deficiencies), disaggregated by gender, social groups, and at subnational level.

PART III: MIGRATION, GENDER AND YOUTH: LINKAGES WITH RURAL DEVELOPMENT AND FOOD SECURITY IN EUROPE AND CENTRAL ASIA

Among the development challenges and opportunities faced by the ECA region, migration requires greater attention due to its demographic and socioeconomic dimensions. Migration is linked in multiple ways to agricultural and rural development – both as a driver and as a possible source of development opportunities. Labour migration and remittances play a significant role.

The ECA region ranks second in the world for receiving migrants: 78 million international migrants of the total 258 million worldwide in 2017. Western Europe was the top destination for international migrants. The Russian Federation hosted over 11 million international migrants, with half coming from neighboring countries.

A large share of international migrants in the ECA region are labour migrants from rural areas. Low agricultural productivity and a poor rural economy were major drivers of migration. Economic drivers of migration are further exacerbated by the impacts of climate change and weather variability in the region.

Along with economic migration, the ECA region witnessed an increase in recent years in both internally displaced and refugee populations. At the end of 2017, internally displaced people numbered about 4 million in the ECA region, an estimated 1.8 million of them in Ukraine. Turkey hosted the largest number of refugees worldwide (3.9 million), mainly from Syria.

Remittance flows in 2017 were estimated at USD 44 billion within the ECA region. Remittances have become an important source of income, in particular for the population of Central Asia, lifting millions of families out of poverty in recent years. After a decline in remittances observed in certain areas of the ECA region during 2014–16, remittance growth rates rebounded in 2017 and are projected to continue increasing in 2018, remaining at the highest annual growth rate in the world. For the countries of Central Asia and Azerbaijan, the Russian Federation was the main source of remittances.

Remittances have made a significant contribution to national economies (more than 30 percent of the GDP in Kyrgyzstan and Tajikistan, for example) and have become an important and stable source of income for many households, reducing poverty and food insecurity.

In the ECA region, 52 percent of international migrants are women, compared to 48.4 percent globally. The feminization of migration, along with increasing youth migration, are emerging as clear trends in the countries of the region. This has important implications for social and family dynamics and for the vulnerability of children, the elderly, and disabled groups.

Unemployment, which is one of the main drivers of migration among people aged 15–24, is above the world average in many ECA countries. The average recorded unemployment rate for women is much higher than for men. For young women, migration is a contributing factor to their employment and empowerment, increasing their decision-making authority within families and communities. On the other hand, young women are particularly vulnerable to the risks associated with migration, which can outweigh the economic benefits. Rural women who stay behind face particular challenges. These risks for women can be mitigated by targeted programmes and services focused on women, particularly in rural areas.

Despite the many benefits migration might bring to communities of origin, there are concerns that rural areas have lost a significant share of their young and educated labour force, which will negatively affect agriculture and rural development if not adequately addressed and supported.

The impact of remittances on agriculture is mixed, and developing tailored support programmes can promote the positive effects of migration on agricultural and rural development. Case studies from Republic of Moldova and Tajikistan show that management of financial flows can turn remittances into investments, support agriculture, improve rural livelihoods, and even provide employment opportunities for youth in their home countries.

Food insecurity, poverty and unemployment, effects of climate change, and overuse of natural resources are all “push” factors for internal migration and urbanization. To better understand the drivers of migration, up-to-date information and monitoring of migration processes and their impact on rural livelihoods are needed.

Analysis of evidence and experience gained by countries of origin will inform measures aimed at mitigating the negative consequences of migration and harnessing its development potential. Support measures for migrants returning to their country of origin, and the potential for rural development to offer alternative livelihood options to the involuntary migration, are areas that deserve greater attention and investment.

ACKNOWLEDGEMENTS

The Regional Overview of Food Security and Nutrition in Europe and Central Asia 2018 has been prepared by Ariella Glinni, Senior Policy Officer of the FAO Regional Office for Europe and Central Asia (REU), in close collaboration with the FAO Statistics Division (ESS) and the FAO Agricultural Development Economics Division (ESA), under the overall supervision and guidance of Vladimir Rakhmanin, Assistant Director-General and Regional Representative for Europe and Central Asia.

The report was made possible by the contributions of an interdisciplinary team of experts, and in particular by Guljahan Kurbanova, Economist and Food security analyst consultant, who assisted in drafting the report, and Cheng Fang, Keigo Obara, Giorgi Kvinikadze, Dono Abdurazakova and Zoltan Hradszky from FAO REU. Thematic section III benefitted from technical contributions from Bakhodur Eshonov of the FAO Subregional Office for Central Asia (SEC). Peer review was provided by staff in the Regional Office for Europe and Central Asia and the Office of the Director-General, as well as by the Economic and Social Development Department teams in FAO headquarters. Important peer reviews were received from Cindy Holleman and Giovanni Carrasco Azzini in ESA; Carlo Cafiero, Klaus Grunberger, Sara Viviani, and Anne Kepple from ESS; Trudy Wijnhoven and Maria Antonia Tuazon from the Nutrition and Food Systems Division (ESN), Alejandro Grinspun, Ion Bulgac, Thu Hien Dao, and Ariane Genthon from the Social Policies and Rural Institutions Division (ESP), and Iryna Kobuta and Georgios Mermigkas from the Trade and Markets Division (EST), under the overall supervision of Kostas Stamoulis, Assistant Director-General for the FAO Economic and Social Development Department.

Special thanks to Amirhossein Yarparvar, of the UNICEF Europe and Central Asia Regional Office, for assisting with nutrition data and regional studies. Valuable input was provided by Dinara Abzhamilova, of the World Food Programme Kyrgyzstan Country Office, for subnational-level food security analysis for Kyrgyzstan.

Many thanks to Sharon Lee Cowan and Irina Tarakanova and their team, who coordinated the layout, translation and production of the document.

ACRONYMS AND ABBREVATIONS

ADB Asian Development Bank

BMI Body mass index

BIH Bosnia and Herzegovina

CA Central Asia

CAP Common agricultural policy

CIS Commonwealth of Independent States

DES Dietary energy supply

ECA Europe and Central Asia

EEU Eurasian Economic Union

EU European Union

FAO Food and Agriculture Organization of the United Nations

FIES Food Insecurity Experience Scale (based on Gallup World Poll)

FSN Food Security and Nutrition

GDP Gross domestic product

HLPE High Level Panel of Experts on Food Security and Nutrition

ICN2 Second International Conference on Nutrition

IMF International Monetary Fund

IOM International Organization for Migration

IDP Internally displaced person

IFAD International Fund for Agricultural Development

MDG Millennium Development Goals

NCD Non-communicable disease

PoU Prevalence of undernourishment

PPP Purchasing power parity

PoSFI Prevalence of Severe Food Insecurity using the Food Insecurity Experience Scale

SDG Sustainable Development Goal

SOFI The State of Food Security and Nutrition in the World

WFP World Food Programme

WHO World Health Organization

USD United States dollar(s)

UN DESA United Nations Department of Economic and Social Affairs

UNSD United Nations Statistics Division

INTRODUCTION

In a world facing multiple, complex challenges, the 2030 Agenda for Sustainable Development commits the international community to acting together to surmount those challenges – for the benefit of present and future generations.

The Sustainable Development Goals (SDGs) – adopted by all countries in 2015 – renewed and revitalized the commitment to ending hunger and malnutrition, with special attention to the vulnerable and to rural areas. Goal 2, to “end hunger, achieve food security and improved nutrition and promote sustainable agriculture” by 2030 (FAO, 2017e) also has close links to other SDGs, including SDGs 1, 5, 6, 12, 13, 15, and 17.[1]

Working in partnership with IFAD, WFP, WHO, and UNICEF, the Food and Agriculture Organization of the United Nations (FAO) is well equipped to fulfil its role as custodian agency for food security and nutrition indicators and related targets. Since 2017, FAO has aligned its monitoring functions at global, regional and country levels to measure progress towards achievement of the SDG 2 food security and nutrition targets. With little more than a decade left in which to achieve “zero hunger” and reach related targets, success is put at risk by the effects of climate change, weather variability, depleting natural resources, and increased armed conflicts.

New evidence confirms the increase in hunger worldwide recorded in recent years, after a prolonged period of decline. Approximately one in nine people in the world is undernourished. At the same time, a “triple burden” of malnutrition is evident in many countries. Through different pathways (FAO et al., 2018), food insecurity contributes to undernutrition, to overweight and obesity, and to micronutrient deficiencies.

The Regional Overview of Food Security and Nutrition in Europe and Central Asia 2018 complements FAO’s annual global report, The State of Food Security and Nutrition in the World. It provides a more in-depth analysis of how countries in the region are progressing towards food security and nutrition targets. It also offers an overview of recent policy decisions and drivers of food security and nutrition outcomes. Finally, it examines the linkages in the region among migration, gender, youth, rural development, and food security. With this last, the publication adds to our understanding of migration processes in the region, the challenges they present, and their potential to contribute to sustainable development.

PART 1
OVERVIEW OF FOOD SECURITY AND NUTRITION IN EUROPE AND CENTRAL ASIA

In the framework of the 2030 Agenda for Sustainable Development, Sustainable Development Goal 2 aims to end hunger, achieve food security, improve nutrition and promote sustainable agriculture. It is a comprehensive goal covering the four dimensions of food security (food availability, access, utilization and stability) and nutrition, and it requires the systematic monitoring of progress made towards the SDG 2 indicators to provide valuable and regular evidence to Member States, regional bodies and international organizations. FAO has committed to monitoring trends in food security and nutrition at global, regional and national levels, jointly with its partners, within the framework of the 2030 Agenda for Sustainable Development.

The Europe and Central Asia region is heterogeneous in terms of the composition of the countries[2] and their economic structures, rates of economic growth and transition, and other sociodemographic features and geographical and climatic conditions. It is composed of Western European countries, the transition economies in Central and Eastern Europe, and countries in the Caucasus and Central Asia. More than half of the region’s countries are members or candidates for membership in the European Union, and many of them are already extending technical or policy assistance to neighboring countries. The Eurasian Economic Union is also expanding its role in the region.

The countries of the region have committed to achieving SDG 2 to improve food security and nutrition. While the region as a whole has made major progress towards eradicating hunger, it has not yet overcome problems related to food security and nutrition for all, and concerns remain regarding the persistence of the triple burden of malnutrition – overweight and obesity in combination with undernourishment and micronutrient deficiencies.

Part I assesses the food security and nutrition situation based on data issued in 2018 and on updated estimates for countries in Europe and Central Asia. It describes the progress made in the region in two key areas: (i) food insecurity and hunger, based on the Prevalence of Undernourishment (PoU) indicator and level of severe food insecurity shown by the Food Insecurity Experience Scale (FIES); and (ii) malnutrition, based on SDG Indicator 2.2.1 on stunting and SDG Indicator 2.2.2 on wasting and overweight among children younger than five. It also considers the state of micronutrient deficiency, including anaemia and deficiencies in vitamin A, zinc and iodine, as well as possible undernutrition outcomes such as low birth weight.

1.1 THE 2018 ASSESSMENT OF HUNGER AND FOOD INSECURITY IN THE ECA REGION

Prevalence of Undernourishment (SDG Indicator 2.1.1)

The prevalence of undernourishment (PoU) is a measurement of hunger and food insecurity and one of two indicators under SDG Target 2.1. The PoU indicator is an estimate of the proportion of the population whose habitual food consumption is insufficient to provide the dietary energy levels that are required to maintain a normal active and healthy life.

The prevalence of undernourishment is based on the comparison of usual food consumption expressed in terms of dietary energy (kcal) against energy requirements. The part of the population with food consumption below the energy requirement norm is considered undernourished.

The ECA region has achieved Millennium Development Goal 1C to halve the proportion of undernourished people, with undernourishment decreasing to less than five percent in the region between 1990 and 2015. All countries in the region have made considerable progress in reducing the incidence of food insecurity. However, the pace of progress has slowed recently.

The analysis of the PoU across the ECA region during the period 2004–2017 shows the progress made – especially the progress registered in the countries of Central Asia, where the average PoU decreased from 11 percent in 2004–06 to six percent in 2015–17, and in the Caucasus, where a decrease from 6.4 percent to 3.3 percent was recorded during the same period (Table 2). At country level, a significant decrease of the PoU was observed in Armenia, Azerbaijan, Kazakhstan, Kyrgyzstan and Uzbekistan, while a slight increase was observed in Turkmenistan and Ukraine (Figure 1).

Nevertheless, despite such significant progress in fighting hunger across the subregions, several ECA countries still have a comparatively high prevalence of undernourishment (Table 2). The prevalence of undernourishment remains an issue of concern in Georgia (7.4 percent), Uzbekistan (7.4 percent), Kyrgyzstan (6.5 percent), Serbia (5.6 percent), Turkmenistan (5.5 percent) and Albania (5.5 percent). No PoU estimates for 2015–2017 were available for the Republic of Moldova or for Tajikistan at the time of this report’s preparation.

While the number of undernourished people in Central Asia decreased by 32 percent (from 6.5 million to 4.4 million) from 2005 to 2017, Central Asia still had the highest PoU in the ECA region (6.2 percent) in 2017.

The decreasing trend of the prevalence of undernourishment observed during recent decades, however, appears to be stagnating. It is estimated that the PoU in the Central Asia subregion increased to 6.2 percent in 2017 from 5.8 percent in 2015 (Figure 2). The number of undernourished people increased from 4 million in 2015 to 4.4 million in 2017 (Figure 2). A slight decrease was observed during 2015–2017 in the Caucasus subregion, where the PoU dropped from 3.3 percent in 2015 to 3.2 percent in 2017. PoU estimates for other subregions are not reported, because the prevalence is estimated to be lower than the 2.5-percent threshold used for measuring PoU.

Among the factors contributing to the stagnation observed in the decreasing trend in food insecurity in Central Asia are the changes in the situation for migrants, since most countries in Central Asia are reliant on remittances from labour migrants to the Russian Federation. The recent economic downturn in that country has led to higher unemployment and/or job insecurity, which raises concerns regarding the impacts on food security. Further details on the linkages between remittances and food security in the ECA region are examined in Section 3.

During the same period, the number of undernourished people is estimated to have further increased at the global level, after a long period of progress towards reduced food insecurity. According to 2018 estimates from The State of Food Security and Nutrition in the World, the number of undernourished people appears to have increased to 820.8 million in 2017 from 784.4 million in 2015, or to 10.9 percent of the population from 10.6 percent in 2015; this raises major concerns and calls for a scaling up of efforts to revert this detrimental trend.

Prevalence of severe food insecurity in the ECA region, based on the Food Insecurity Experience Scale (SDG Indicator 2.1.2)

In 2017, The State of Food Security and Nutrition in Europe and Central Asia presented, for the first time, estimates of the prevalence of severe food insecurity based on the Food Insecurity Experience Scale (FIES) (FAO, 2016a). The prevalence of severe food insecurity refers to a person’s capacity to access food (Box 2). The PoU and FIES indicators are complementar y in food security analysis. The PoU ref lects the level of undernourishment from the point of energy intake in calories for measuring regular food access, whereas the Prevalence of Severe Food Insecurity (PoSFI), as an experience-based measure, allows for the measurement of the severity of the food insecurity condition at household and individual levels.

The PoSFI implies a probability of people having been unable to access nutritious and diverse food that contributes to healthy diets and having been forced to reduce the quantities of food eaten as a result of lack of money or other resources (FAO, 2016a) (see Box 2). At severe level, an inability to regularly consume high-quality diets in adequate amounts can lead to varying degrees of undernutrition and micronutrient deficiencies.

According to the FIES framework (Figure 3), the borders between mild, moderate and severe food insecurity stages are flexible, meaning that the impacts of different factors (e.g. price shocks, extreme events, trade policy changes, effects of climate change, etc.) can affect vulnerable households or individuals at any time, moving them from one level of food insecurity to another (FAO, 2018f). Therefore, in addition to the PoU, indicators of prevalence of moderate to severe food insecurity (PoMSFI) are used and collected through surveys, as per FIES methodology. This allows for the timely capture of changes in the situations of population groups resulting from the consequences of such developments as welfare reduction (reduction of other essential expenses, psychological costs), malnutrition (obesity, micronutrient deficiencies, undernutrition) or starvation (FAO, 2017l).

The Regional Overview of Food Security and Nutrition in Europe and Central Asia 2018 uses the estimates for severe food insecurity based on FIES for the regional analysis in 2018. According to the latest estimates in 2015–2017, 2.1 percent of the total population in the ECA region has been exposed to food insecurity at a severe level (PoSFI). This prevalence in the ECA region is much lower than the world average, which was 9.2 percent during the same period. However, the year-on-year change in the PoSFI from 2015 to 2017 shows an increasing trend in the Central Asia subregion, from 1.7 percent in 2015 to 3.5 percent in 2017. This coincides with a gradual increase in the PoU (Figure 2). More in-depth studies will be needed to investigate the causes of the recent increase observed.

The regional breakdown of the share of severe (PoSFI) food insecurity among people differs significantly by country and subregion (Table 3). For example, in EU-28 subregion it is 1.6 percent, in Central Asia 2.6 percent and in the Western Balkans and Turkey 6.2 percent. At country level, the prevalence is a subject of concern in Albania (10.5 percent), Georgia (8.9 percent), and Tajikistan (7.8 percent).

The relatively high level of PoSFI in some countries in the region indicates that economic access to food is still an issue of concern. The overall availability of food is not a severe problem in the ECA region, as is shown by the high dietary energy supply, which exceeds population energy requirements in almost all countries in the region (FAO 2017p), including in the countries and subregions that have relatively high PoSFI. Household income and livelihoods largely affect economic access to food, but high market prices of basic food items also limit their economic access, particularly among lower-income groups who spend a large share of their income for purchasing food.

A better understanding of the underlying causes of food insecurity is important for developing effective and targeted policies and programmes.

People who are in a situation of food insecurity meet their dietary energy needs by consuming less-expensive, lower-quality, energy-dense foods, for example, or by cutting back on other basic needs, with potentially negative consequences for their nutritional status. Vulnerability is inf luenced by factors affecting one or more dimensions of food security – such as market shocks (prices and infrastructure), droughts or f loods, or instability and conf licts – combined with poverty, low incomes, lower access to adequate social protection, and inequality due to gender or age group.

In accordance with the FIES data collected by FAO (Table 4), 14.3 million adults in the ECA region suffered from severe food insecurity, on average, during 2015–2017. When including children in these estimates, there were 19 million people in the region who suffered from severe food insecurity during the same period.

As the FIES survey was administered to individual respondents, one important feature is that the results can be analysed at the individual level. This makes it possible to compare food insecurity levels among men and women. Table 4 provides the breakdown of adults suffering from severe food insecurity by sex and reveals different situations for each subregion. Out of a total of 14.3 million adults in the ECA region who were severely food insecure in 2015–2017, 7.3 million were women, and 7 million were men. In terms of prevalence, the FIES data when disaggregated by sex (Figure 4) demonstrates that the prevalence of severe food insecurity is equal among women and men (1.9 percent) at the regional level. However, there are subregional differences, with a higher percentage of women in the Caucasus, Central Asia, and European CIS affected by severe food insecurity. The percentage is higher for men in the Western Balkans and Turkey and EU-28 subregions.

Greater food insecurity is usually associated with deprivation and poverty. The high inequality of the prevalence of severe food insecurity between women and men may signal significant social and economic inequalities. Structural barriers and social practices that perpetuate gender inequalities, including ownership of, access to and control over livelihood assets, also negatively and disproportionately affect women – especially expectant and nursing mothers who need special or increased food intake. Experience gained in other parts of the world suggests that strategies to improve livelihoods and ensure that women and men have the same economic opportunities, access to land, and economic power, are important for achieving greater food security and nutrition.[3]

To arrive at more efficient interventions that will ensure food security for all, regardless of their sex, there is a need in further region-specific research and analysis to improve our understanding of the links between gender and food insecurity.

1.2 TRIPLE BURDEN OF MALNUTRITION: A CONCERN IN THE ECA REGION

The Rome Declaration on Nutrition, one of the outcomes of the Second International Conference on Nutrition (ICN2) in 2014 (FAO & WHO, 2014), reiterates that malnutrition has many forms and commits countries to increase their investments in food systems to prevent all forms of malnutrition, particularly undernutrition in women and children, and to reverse the trend of increasing overweight and obesity. As a follow-up to the ICN2, 2016–2025 was proclaimed in 2016 as the Decade of Action on Nutrition by the United Nations General Assembly, with the aim of accelerating the implementation of the ICN2 commitments, achieving global nutrition and diet-related noncommunicable diseases targets by 2025, and contributing to the realization of the SDGs by 2030 (United Nations, 2018a).

Specifically, SDG Target 2.2 refers to ending all forms of malnutrition – including undernourishment, micronutrient deficiencies, overweight and obesity – and other manifestations resulting from inadequate food intake and aggravating social, economic, cultural, environmental and health conditions. It requires measurement and analysis of stunting, wasting and overweight and obesity among children younger than five, as well as of micronutrient deficiencies.

In addition to limited or unequal food access reflected in the PoSFI indicator, malnutrition remains a concern for ECA countries. The effects of economic development in the region have contributed to important shifts in diets. Also called the “nutrition transition”, this refers to changes in dietary patterns alongside demographic and epidemiological changes. According to the concept, higher level of incomes, the availability of cheaper but lower-quality foods, and changing lifestyles contribute to dietary choices with higher intakes of saturated fats, sugars and refined foods and lower intakes of fiber-rich foods. All of this is driven by technological advances that have made energydense, nutrient-poor foods cheaply available. This consumption is often accompanied by an increasingly sedentary life, leading to an increasing prevalence of overweight and obesity and other dietrelated non-communicable diseases (FAO, 2017p).

The region is characterized by the coexistence of undernutrition and overweight and obesity, with countries that have relatively high prevalence of more than one form of malnutrition. ECA countries can be divided into four broad categories with regard to the prevalent types of malnutrition (undernourishment, overweight and obesity, and micronutrient deficiencies): (1) those primarily affected by undernourishment and micronutrient deficiencies but with a relatively low prevalence of overweight and obesity; (2) countries with the triple burden of malnutrition, characterized by residual undernourishment, persisting micronutrient deficiencies and rapidly growing rates of obesity and overweight; (3) countries primarily affected by overweight and obesity as well as micronutrient deficiencies; and (4) countries where food security concerns are relatively low (FAO, 2017p; Traill, et al., 2014).

Malnutrition in general is a major obstacle to socioeconomic development in many countries due to its impact on the health of the population (with high social and public costs), learning ability (with a vast loss of human potential), and productivity (with greatly reduced work capacity). These deficiencies contribute to a vicious cycle of malnutrition, reduced development prospects and poverty, affecting already-disadvantaged groups. Preventing malnutrition would eventually reduce costs incurred for curative healthcare and social welfare needs while potentially making resources available for needed development activities (FAO & International Life Sciences Institute, 1997; WHO, 2018a; Levin, 1986; Strauss, et al., 1986; Horton, et al., 1998). Thus, understanding and addressing malnutrition remain key factors for progressing on the Sustainable Development Goals.

Malnutrition in children

Stunting, wasting and overweight among children younger than five are internationally recognized as important indicators of nutritional status. They are also part of the SDG monitoring framework. The prevalence of stunting in children younger than five is the percentage with low height for age, ref lecting the cumulative effects of undernutrition since and even before birth. Wasting in children younger than five is the percentage with low weight for height, while overweight is an indicator of excessive weight for height and generally ref lects an imbalance between food intake and energy expenditure.

Thresholds have been suggested to provide a guide for classifying the prevalence of child malnutrition. Table 5 shows classifications proposed by the World Health Organization and the United Nations Children’s Fund for undernutrition and overweight among children. For example, the prevalence threshold that is considered high for child stunting is 20 percent or higher, and for child overweight and wasting, ten percent or more is considered to be high prevalence.

According to these classifications, based on recent data, four countries in the ECA region have a medium prevalence of stunting (Azerbaijan, Kyrgyzstan, Tajikistan and Turkmenistan), whereas only one country falls into this category in terms of wasting (Tajikistan). This indicates that the nature of child undernutrition in the ECA region is chronic malnutrition, which could increase the risk of impaired cognitive ability and performance at school and work in the long term. It is worth noting that all the countries with moderate child stunting rates are also experiencing moderate or severe rates of anaemia among women. The coexistence of chronic undernutrition and micronutrient deficiency may have significant consequences on human and economic development through reduced productivity. Further studies are necessary to identify the extent of the problem at country level, to better understand the underlying causes of chronic undernutrition and micronutrient deficiencies, and then to upscale actions to address these issues.

Table 6 presents the malnutrition (stunting, wasting, and overweight) situation among children younger than five in selected ECA countries. The results can be summarized as follows:

1. Stunting: While the prevalence of stunting, or low height for age, decreased in the ECA region during the past two decades, the prevalence remains at medium level in several countries (Table 6). There are still around two million children younger than five classified as stunting, mainly in the countries of Central Asia (FAO et al., 2017, p. 94). Stunting strongly correlates with wasting, along with the underlying conditions of poverty. It is caused by long-term insufficient nutrient intake, poor diets, and frequent infections, and it can result in delayed motoric development, impaired cognitive functioning, poor school performance, and immune system disorders (FAO et al., 2017).

2. Wasting: Wasting, or low weight for height, is a strong predictor of mortality among children younger than five. Wasting ref lects a reduction in or loss of body weight and is considered a relevant indicator of acute malnutrition. While wasting rates in the ECA region are considered low overall, according to the WHO classification ( Table 6), Tajikistan falls in the medium category. The estimated prevalence of wasting in ECA countries is well below the world average of 7.7 percent (FAO et al., 2017).

3. Overweight: The level of overweight among children younger than five is of high concern in the ECA region. The prevalence is at high or very high levels in almost all countries, except for the countries in Central Asia. While the world average of overweight among children younger than five is recorded at six percent, the prevalence is significantly higher in Montenegro, Serbia, Turkey and the countries of the Caucasus (FAO et al., 2017, pp. 79–84). Overall, the number of overweight children younger than five in the ECA region is on the increase.

The prevalence of child overweight is high or very high in almost all countries in the ECA region. Paradoxically, child overweight rates are also high in the countries that have high rates of undernutrition (Table 6). This suggests a need for attention to disaggregated analysis by potential underlying factors such as income levels, nutritional knowledge and practices, and dietary patterns. The identification of underlying factors would help the formulation of effective intervention strategies targeted for the groups susceptible to different types of malnutrition.

While malnutrition can manifest in multiple ways, the paths to the prevention of each are virtually identical: adequate maternal nutrition before and during pregnancy and lactation; optimal breastfeeding in the first two years of life, including exclusive breastfeeding up to 6 months of age; nutritious and safe foods in early childhood; and a healthy environment, including access to basic services and opportunities for physical activity. These key measures are achievable in the ECA region for making children free from malnutrition through effective and sustained multi-sectoral nutrition programming over the long term, tackling basic, underlying and immediate causes of malnutrition through an appropriate mix of nutrition-specific and nutrition-sensitive interventions, particularly in agriculture. The majority of ECA countries are taking relevant actions in the right direction (see Part II). At the same time, regular data collection for monitoring and analysing country, subregional and regional progress are required.

Exclusive breastfeeding of infants age 0–6 months. The prevalence of exclusive breastfeeding varies by country, and its prevalence at regional level (30 percent) is well below the world average of 43 percent, except in Turkmenistan (58.9 percent). In Kyrgyzstan and the Central Asia subregion, the averages are close to the world average, at 41 percent and 40 percent, respectively (Table 7 and Figure 4).

Prevalence of obesity in the ECA region

Obesit y is an increasingly widespread phenomenon in the region. Overweight and obesity are defined as abnormal or excessive fat accumulation that may impair health. The body mass index (BMI) is a simple index of weight for height that is commonly used to classify overweight and obesit y in adults. It is defined as a person’s weight in kilograms divided by the square of his/her height in meters (kg/m2). For adults, WHO defines overweight and obesity as follows:

•  overweight is a BMI greater than or equal to 25; and
• obesit y is a BMI greater than or equal to 30.

The BMI provides the most useful population-level measurement of overweight and obesity, as it is the same for both sexes and for all ages of adults. However, it should be considered only an indicative guideline, because it may not correspond to the same degree of overweight and obesity in different individuals.

Worldwide, the total number of obese people has become greater than the number of underweight people, based on a study of body mass index trends between 1975 and 2014 (NCD Risk Factor Collaboration, 2016). However, the respective public health burdens of overweight and undernourishment/ micronutrient deficiencies are not quantified only in terms of the number of people affected. Relative effects on morbidity, longevity, lifetime social costs and inter-generational aspects need to be fully examined.

WHO’s recent analysis indicates a constant increase in the prevalence of obesity among adults of all ECA subregions during the period between 2000 and 2016 (Figure 7). In decreasing order, the highest rates of increase are seen in Central Asia (42.1 percent), Caucasus (37.6 percent), Western Balkans and Turkey (31.6 percent), Europe (23.9 percent), EFTA (23.4 percent), EU 28 (23.0 percent), and European CIS (17.9 percent).

By 2016, there were significant differences in the rates of adult obesity by subregion. The Western Balkans and Turkey had the highest prevalence of obesity (30.1 percent), followed by European CIS (25.7 percent), EU 28 (25.4 percent), EFTA (22.6 percent), Caucasus (21.0 percent), and Central Asia (16.8 percent). In the ECA region in 2016, 24.6 percent of the total population were obese, a figure representing 200 million obese people.

Prevalence of micronutrient deficiency: anaemia

Micronutrient deficiency is a form of malnutrition caused by a dietary deficiency of vitamins or minerals. Vitamin A deficiency, iron deficiency anaemia and iodine deficiency disorders are the most common forms of micronutrient malnutrition. Iron deficiency anaemia is the most common and widespread nutritional disorder in the world. As well as affecting a large number of children and women, iron deficiency exacts its heaviest overall toll in terms of ill health, premature deliveries among pregnant women and the loss of earnings due to low productivity. Iron deficiency and anaemia reduce the work capacity of individuals and entire populations, bringing serious economic consequences and obstacles to national development. Overall, it is the most vulnerable, the poorest and the least educated who are disproportionately affected by iron deficiency and who would benefit most by its reduction (FAO & International Life Sciences Institute, 1997; WHO, 2018a).

The analysis of the prevalence of anaemia shows a dynamic pattern among women of reproductive age in ECA from 2000–2016 (Figure 8). In 2016, there were significant differences among subregions. The Caucasus subregion showed the highest prevalence of anaemia among women (34.4 percent), followed by Central Asia (33.8 percent), the Western Balkans and Turkey (30.2 percent), European CIS (23.4 percent), EU 28 (18.7 percent), and EFTA (17.2 percent).

From 2000 to 2016, two subregions in ECA had a reduction of the prevalence of anaemia among women of reproductive age: Central Asia saw a decrease of 7.0 percentage points from the previous rate, and the prevalence in the Western Balkans and Turkey dropped 0.7 percentage points. In contrast, the other three subregions showed increases: EU 28 (5.4 percentage points), EFTA (3.9 percentage points), Caucasus (2.1 percentage points), and European CIS (two percentage points).

The trend observed for all subregions since 2011 (Figure 7) shows a reversal in trends in the reduction of the prevalence of anaemia among women of reproductive age, including a stagnation in the long-term decreasing trend in Central Asia, reversal of the decreasing trend in the Western Balkans and Turkey, and a slowdown of progress in all other subregions.

By country (Table 9), there were three countries in which the prevalence of anaemia among women aged 15–49 in 2016 was higher than the world average of 32.8 percent (Azerbaijan, 38.5 percent; Kyrgyzstan, 36.2 percent; and Uzbekistan, 36.2 percent).

According to WHO (2016) estimates of the worldwide prevalence of anaemia by regions and population groups, women and young children are most vulnerable to anaemia. A ten percent increase in hemoglobin in a moderately anaemic person results in a 10-to-20-percent increase in work output (Levin, 1986). Eliminating anaemia would increase adult productivity by 5 to 17 percent and gross domestic product by two percent in countries where anaemia prevalence is high (Strauss, et al., 1986; Horton, et al., 1998). Making progress in preventing the consequences of anaemia requires an integrated package of interventions delivered at scale to address the causes of anaemia. Within the European Union, findings indicate that half of the low-income households in the Member States that have joined the EU more recently struggle with insufficient access to food (European Commission, 2018c). In addition to the rising prevalence of overweight (more than half of the adult EU population) and obesity, there is clinical evidence of rising micronutrient deficiencies in EU countries (Loopstra, et al., 2015).

According to studies conducted by UNICEF (UNICEF, 2016b) on the national average of the prevalence of anaemia among women in the 15–49 age group (Table 9), differences within a country have been observed at subnational levels, in urban vs. rural settings, and by age group. For example, in Tajikistan, the highest prevalence rates of anaemic women were found in Khatlon Region and in Gorno-Badakhshan Autonomous Region (34.3 percent and 31.8 percent, respectively), while those in Sughd and Dushanbe had a much lower prevalence of anaemia (19.4 percent and 20.0 percent, respectively). These regional variations were statistically significant. Significant differences also were observed in Tajikistan between women in rural areas (27.2 percent) and in urban areas (24.9 percent). The prevalence of anaemia was higher in older women (27.7 percent in women between 25 and 40 years of age and 27.6 percent in women between 41 and 49 years of age) than in women and girls aged 15 to 24 (20.4 percent). These significant differences point to the need for greater attention to women in different areas and in different age groups.

Inadequate intake levels of vitamin A, iron, vitamin D, folic acid, iodine and calcium are the primary causes of micronutrient deficiencies for all age groups in the ECA region (FAO, 2015b). For example, in Central Asia 32.2 percent of children and 33 percent of adults had a vitamin A deficiency. The highest levels of iodine deficiency among children were found in Belarus (81 percent) and Georgia (80 percent) (FAO, 2017p).

Low birth weight (LBW) is defined by the World Health Organization as an infant birth weight of less than 2500 g, regardless of gestational age. At the population level, the proportion of new-borns with a low birth weight is an indicator of a multifaceted public health problem. Causes include a host of factors, such as maternal nutritional status (particularly iron status), food intake, access to prenatal care and others. The average low birth weight rate for 2011–2016 is estimated at 10.5 percent worldwide and six percent in ECA (including six percent in Eastern Europe and Central Asia and seven percent in Western Europe).

The reduction of low birth weight rate is one of the targets of World Health Assembly Resolution 65.6 (WHO, 2012), which aims to reduce the LBW rate by 30 percent, or by three percent every year for 2012– 2025. World Health Organization data confirm that nutritional improvement (during intrauterine life and childhood) could result in increased lifetime growth potential. Interventions to prevent low birth weight include food-distribution systems, nutrition for adolescent girls, salt iodization, supplementation with iron and folic acid, clean and adequate water, sanitation and hygiene, and improvement in facility-based perinatal care. Mothers in deprived socio-economic conditions frequently have children with low birth weights as a result of poor nutrition over a long period of time, including pregnancy.

1.3 UNDERSTANDING WHO ARE AT RISK OF BEING LEFT BEHIND

With the 2030 Agenda for Sustainable Development, the world has committed to ending hunger and malnutrition in all its forms, with the principle of “leaving no one behind”. Disaggregated analysis of food security and nutrition indicators by sex, age, income, geography, occupation and other aspects of social identity is essential to determine if this core principle is likely to be achieved given the actual progress being made. The identification of disadvantaged subpopulation groups will better inform the formulation of intervention strategies for those vulnerable groups.

In this context, the introduction of the sexdisaggregated data based on FIES estimates for severe food insecurity constitutes a first step, and its further analysis is foreseen to provide evidence on progress made in the region towards SDG Target 2.1.2 and on related gender-equality aspects.

The reports of recent national nutrition surveys conducted in eight countries and territories of the ECA region[4] were examined to assess the main dimensions of inequalities. The findings are summarized below.

Disaggregated analysis by household wealth

Considering the characteristics of food security and nutrition problems, along with the availability of data in the region, the prevalence of stunting and overweight among children younger than five were selected for disaggregated analysis. The prevalence of stunted children was higher in the poorest groups in almost all countries in which recent nutrition survey data was available.[5] In some countries, the prevalence among the poorest group was nearly twice the national average (Figure 9).

The analysis of the prevalence of overweight among the same population group (children younger than five) shows that overweight is prevalent not only in higher income groups but also in lower income groups. While the prevalence of overweight children is greater in higher-income groups in most countries, the poorer groups had higher prevalence in Armenia and Serbia. Malnutrition – both undernutrition and overweight – are multicausal problems. For instance, physical inactivity and sedentary lifestyles also contribute to overweight. Social protection programmes that target lower-income groups would need to incorporate the raising of awareness about healthy diets and child feeding practices.

Disaggregated analysis at subnational level within countries

Spatial disparities among regions within countries exist in many transition countries in the ECA region, resulting in rural–urban migration trends and widening social and economic inequalities (Figure 10). Poverty indicators are often higher in rural areas, particularly in remote regions where access to resources and markets is limited. Disaggregated analysis of the prevalence of stunting among children younger than five shows significant geographical disparities, in particular between major cities and other provinces. In most countries, the prevalence is lower in capital cities and large cities and higher in the regions remote from major cities or in geographically disadvantaged areas. In the high-alpine Gorno- Badakhshan Autonomous Region (GBAO) of Tajikistan, the prevalence is nearly twice as high as in the country’s capital city, Dushanbe.

Monitoring food security at subnational level to inform targeted food security interventions

Different tools and methodologies are used for monitoring food security at subnational level to inform national stakeholders. For example, in Kyrgyzstan, World Food Programme (WFP) vulnerability analysis and mapping data identified vulnerabilities at the district level on six different dimensions, creating a composite vulnerability score that provides information to prioritize the most vulnerable areas for food security interventions among WFP partners. For instance, WFP selected 250 pilot schools from the most vulnerable areas of the country for the Optimizing Primary School Meals Programme, which introduced nutritious school meals for children in primary school. The result of the vulnerability analysis was published in the first National Food Security Atlas of the Kyrgyz Republic (WFP, 2016).

In Tajikistan (Figure 10), WFP and UNICEF regularly monitor food security, child feeding practices and nutrition in rural areas by analysing data from household surveys across livelihood zones. The analysis signals the incidence of critical food insecurity at subnational levels.

1.4 SOCIO-ECONOMIC BURDEN OF DISEASES AND MALNUTRITION

Poor dietary habits are the second-leading risk factor for global deaths and global disease burden (GBD 2016 Risk Factors Collaborators, 2017). The 2017 Global Nutrition Report (Development Initiatives, 2017) shows that 88 percent of countries worldwide face a serious burden from two or more forms of malnutrition. Thus, the world is off track to reach global targets on nutrition. In current food systems, nutritious foods that constitute a healthy diet are not available or affordable for many people. Overweight and obesity are risk factors for noncommunicable diseases such as diabetes, cardiovascular diseases, musculoskeletal disorders and some cancers (WHO, 2018b) (see Box 3), while childhood undernutrition, suboptimal breastfeeding and zinc deficiencies are among the risk factors for lower respiratory tract infections and low immunity (Levin, 1986; Strauss, et al., 1986; Horton, et al., 1998).

The public health expenditures do reflect these trends. Currently, health expenditures per capita vary to a large extent across the region and countries (Table 10), showing a rising overall trend of health expenditures in the world and in the ECA region. Average health expenditures per capita in 2014 in the ECA region (USD 2 421) were mainly buoyed by high-income countries, whereas this same indicator decreases substantially (to USD 575) if high-income countries are excluded. This latter figure is barely more than half of the world average level.

Health expenditures (Table 10) have been steadily increasing in the ECA region, though to varying degrees. The average expenditures on health in Europe and Central Asia have increased by 44 percent and are slightly below the rate of increase worldwide, with some countries – such as Azerbaijan, Republic of Moldova, the Russian Federation and Uzbekistan – showing a more significant increase, with health expenditures in 2014 three times higher than in 2005. To some extent, health expenditures reflect the burden of diseases, including diet-related non-communicable diseases. Different health expenditure patterns are projected across the region. For example, in the EU countries, the increasing numbers of older people and of those with lower incomes are a concern due to their particular risk of becoming food insecure. The proportion of people of working age in EU 28 countries is reducing, while the relative number of those retired is expanding (Eurostat, 2018a). The share of older persons in the total population is projected to increase significantly in the coming decades, with an increase of social expenditure required by the aging population for a range of related services (Eurostat, 2018a), including health services.

Further analysis is required for the findings that countries showing some forms of issues related to food security and nutrition – such as Armenia, Georgia, Kyrgyzstan, Republic of Moldova, Tajikistan, Turkmenistan, Ukraine, and Uzbekistan – show allocations for health per capita that are less than one-third of the world average.

PART 2
REGIONAL AND NATIONAL POLICY DRIVERS TO SUPPORT ACHIEVING SDG 2 TARGETS

The findings from Part I not only describe the current state of food security and nutrition in the ECA region but also point to a range of related problems (such as micronutrient deficiencies like iron-deficiency anaemia, increasing obesity, and reduced exclusive breastfeeding) that are of concern and require specific actions in the policies and strategies of governments, institutions and organizations at regional and national levels.

Part II of this report reviews relevant national, subregional and regional policies and programmes that have been adopted in recent years. It includes actions that have been planned and implemented by countries, subregions and the region as a whole towards achieving SDG 2 and related SDG targets. It also aims to capture and consolidate experiences gained, lessons learned and good practices developed by analysing policy issues and outcomes linked to the four pillars of food security (availability, access, utilization and stability) and nutrition.

2.1 GENERAL SOCIO-ECONOMIC CHARACTERISTICS OF THE ECA REGION

Current aspects of food security and nutrition problems in the ECA region reflect the diversity of countries facing different issues and economic situations. The region covers high-income countries in Western Europe, middle-income countries in Central Europe, and middle- and lower-middleincome countries in Eastern Europe, the Caucasus and Central Asia. Diverse socio-economic characteristics shape government priorities and constraints in addressing food security and nutrition and the type and range of policy tools adopted.

To complement the review of recent developments in policies and measures taken by countries in the ECA region towards achieving SDG 2 and related targets, selected indicators are considered – in particular, the levels of economic growth, income, poverty, and inequality as well as of agricultural and food production, food supply and dietary composition.

While significant progress was made in past decades in reducing the prevalence of undernourishment, especially in Central Asia and the Caucasus, poverty still impedes many households in accessing healthy and nutritious food. This is reflected in the malnutrition observed and the increase in obesity among children and adults.

In 2013, the average level of poverty in the region was estimated at 2.4 percent, based on the international poverty line (less than USD 1.90 per day, using 2011 purchasing power parity, or PPP); or 6.8 percent, based on the lower-middle-income poverty line (less than USD 3.20 PPP); or 14.9 percent, based on the upper-middle-income poverty line (USD 5.5 PPP).[6] Using any of the three poverty-line measurements, poverty is significantly lower than in 2005.

The analysis of the dynamics of changes in poverty levels over a ten-year period for the selected countries of the ECA region shows that the poverty level in different countries varies across a wide range measured at the national poverty line (Figure 12). Among the region’s 53 states are some countries with poverty levels below the national poverty line; in Armenia, Kyrgyzstan and Tajikistan, about one-third of the population is living below the national poverty line, while in Serbia and Romania, about one-fourth of the population is living below the national poverty line. In Bulgaria, Latvia, Lithuania, Estonia and the former Yugoslav Republic of Macedonia, around one-fifth of the population is living below the national povert y line.[7]

The decrease in the poverty levels in these countries is related to regional economic growth, which has rebounded since 2011, especially during 2017 and 2018. Gross domestic product (GDP) growth in Europe and Central Asia was estimated at 2.2 percent in 2017, which is the strongest growth in six years. Almost all parts of the region demonstrate stronger growth than earlier expected, reflecting a strengthening of industrial production and exports in 2017. Countries in Central Europe and the Western Balkans continue to register solid GDP growth after a decline in 2012–2014, although the extent of growth varies in Greece, Croatia, Bosnia and Herzegovina and Cyprus (Focus Economics, 2015). The Russian Federation and Belarus have come out of recession. Azerbaijan, the country that was hardest hit by the fall in oil prices and that responded with some delay, is expected to remain in recession in 2018 (World Bank, 2017a, p. 3).

However, in spite of this growth, the GDP per capita remains below the world average in three subregions (Central Asia, the Caucasus, and Eastern Europe) and in Turkey. In addition, widespread inequality can be observed among the countries in Europe and Central Asia, based on the subregional data on GDP per capita (Figure 14). Both poverty and income inequality are key factors for food security and nutrition.

The GDP per capita is lowest in Central Asia and the Caucasus, where it is below the world average. This means that many households have a limited budget available for food. A correlation is observed between GDP per capita and the prevalence of undernourishment (PoU) level (FAO, 2017p, p. 7). Among the countries of the ECA region, relatively high PoU levels have been recorded in Armenia, Georgia, Kyrgyzstan and Uzbekistan, all of which belong to the group of lower-middle-income countries, as classified by the World Bank, in 2017–2018 (World Bank, 2018c). In these countries, the PoU level ranges from 4.3 percent in Armenia to 7.5 percent in Uzbekistan (FAO, 2017c, p. 6).

This situation is compounded by multiple challenges faced by countries, such as effects of climate change and variability, migration processes and conflicts, all of which require attention and action from policymakers and decision makers (FAO, 2016b, 2017c). Some countries are also vulnerable to fluctuations in commodity prices (such as Azerbaijan to fluctuations in oil prices) and trade.

Agricultural production in the European Commonwealth of Independent States and Central Asia (a region that includes Kazakhstan, the Russian Federation and Ukraine as main agricultural producers) expanded rapidly over the previous decade as a result of an overall economic recovery and considerable investments into the modernization of agriculture. In the coming decade, agricultural and fish production are projected to expand by 14 percent. In terms of arable crops, the region is foreseen to maintain its position as the world’s second-largest wheat producer, increasing its share of global production to almost 22 percent by 2027. Additionally, other crops – such as maize, sunflowers and rapeseed – are also foreseen to expand rapidly (OECD/FAO, 2018).

Overall, trends in agricultural and food production are on the rise in most subregions during the period of 2005–2017 (Figure 15), with the highest increase of agricultural and food production observed in Turkey and the Central Asian countries. This sector is crucial for the region; it employs, on average, around ten percent of the population, while one-third of the population lives in rural areas.

2.2 REGIONAL AND SUBREGIONAL POLICIES AND RECENT DEVELOPMENTS

To complement the food security and nutrition analysis, an overview of policy measures taken at national, subregional and regional levels on economic, environmental and social issues is given, including factors related to production, trade and market regulation, infrastructure, and the environment. Policy measures and frameworks have been adopted in the ECA region to achieve SDG 2, ensuring food security and nutrition at the national level and through the development of joint policy measures (for example, the European Union common agricultural policy, the Eurasian Economic Union harmonized agricultural policy, and others).

The overview of main policy development includes recently adopted documents, grouped according to their contributions towards the four pillars of food security and nutrition. The four pillars are (1) availability (agricultural strategy, production and rural development); (2) access (social protection and food assistance); (3) utilization (food utilization and nutrition); and (4) stability (market regulation, price, stocks, environment protection).

International and regional developments

The regional, subregional and national policies on food security and nutrition are guided by key concepts and objectives set forth in the framework of the United Nations Decade of Action on Nutrition (2016–2025) (United Nations, 2017), the ICN2 Rome Declaration on Nutrition, and the ICN2 Framework for Action (FAO/WHO, 2014). In the ECA region, the Regional Symposium on Sustainable Food Systems for Healthy Diets (organized jointly by FAO, the World Health Organization and the World Food Programme) (FAO, 2017n)[8] of December 2017 provided a platform for policy dialogue and a renewed call for good governance and leadership on nutrition, enhancing policy coherence and multi-sectoral collaboration for healthy diets and good nutrition outcomes.

Between 2016 and 2018, various types of partnerships to strengthen measures related to food security and nutrition have been adopted and implemented in the region. This includes a range of steps undertaken by countries towards national SDG action plans, particularly towards achieving SDG 2, encompassing different national initiatives with new governance and coordination mechanisms.

To support the countries in implementing the 2030 Agenda for Sustainable Development, the United Nations System assists national counterparts to translate SDGs into their national agendas and to transform the global goals into concrete national plans. The regional United Nations Development Group conducted joint missions under the umbrella framework of the Mainstreaming, Acceleration and Policy Support approach (UNDG, 2015). In order to assess progress in implementation and achievements of the 2030 Agenda for Sustainable Development, countries report with Voluntary National Reviews at the UN High-level Political Forum on Sustainable Development,[9] which is organized annually. Many countries of the region have already reported on progress at the forums in 2016, 2017 and 2018. Particular emphasis on SDG 2 – Zero Hunger – was given in 2017.[10]

The Regional Symposium on Sustainable Food Systems for Healthy Diets in Europe and Central Asia in December 2017 (FAO, 2018g) highlighted the major regional challenges for food security and nutrition and the critical role of cooperation among all relevant governmental sectors – food and agriculture, health, education, and social protection – as well as of non-state actors, in improving diets and nutrition.

In addition, various forms of intraregional cooperation at the technical level have been established, with countries setting up national coordinating bodies to align the activities of authorities engaged across the food system. Cross-border cooperation, such as for monitoring animal and plant health, combating antimicrobial resistance and limiting the use of unsafe products, has proven essential. Cooperation can help avoid the contamination of food at every stage of the value chain and can contribute to multiple dimensions of food security through enhancing food safety, quality and availability; increasing market access for agrifood producers; and boosting income opportunities.

Countries are also taking steps on the national level to implement international and regional agendas on improving policy areas related to food security and nutrition via adopting various policy frameworks, strategies and resolutions. For instance, Georgia[11] and Ukraine[12] recently adopted a comprehensive agriculture and rural development strategy that addresses issues related to trade, institutional development, value chain development, food security and safety, and climate change. Other countries also adjusted their existing legislation between 2016 and 2018, covering specific areas of the four pillars of food security. Azerbaijan[13] and the Russian Federation[14] amended their existing legislation to improve state support and social assistance. Kyrgyzstan[15] and Tajikistan[16] adopted measures to improve food availability by supporting agricultural production. Kazakhstan took the approach of combating NCDs by adopting measures to promote healthy diets among the population.[17] Turkmenistan[18] and Uzbekistan[19] implemented measures to improve food security through improved coordination of agrifood value chains.

Subregional policy processes and recent developments

Regional and subregional integration among countries contribute to the creation of larger markets, both for producers and consumers, and to calls for policy coherence and the alignment of standards, such as for food quality and safety. Integration also offers platforms that aid in the enhanced sharing of knowledge and information to strengthen capacities for the sustainable use of natural resources and for addressing challenges posed by environmental degradation and climate change. At regional level, policy measures in this area are mostly undertaken in the framework of the European Union[20] and the Eurasian Economic Union,[21] which have developed strategic documents and policy action plans related to food security and nutrition. These policies cover various socioeconomic aspects such as rural development, agricultural production, social protection, market regulation, and sustainable natural resource management, in line with the SDGs integrating social, economic, and environmental sustainability.

European Union and common agricultural policy. In the framework of the European Union, issues related to food security and agriculture and rural development are based on the common agricultural policy (CAP). The recent reforms to the CAP, made in 2013 and applying to the period 2014–2020, aimed at enhancing policy coherence for food security. These reforms were backed by analysis of how developed countries’ agricultural policies, such as tariffs and market price support, impact trade and food security in developing countries. The CAP further underpins the policies spelled out in the 2030 climate and energy framework, which calls upon the farming sector to contribute to the economy-wide target of reducing emissions by 40 percent by 2030, and to the EU adaptation strategy. It aims to help the European farming sector contribute to the achievement of the Sustainable Development Goals and to meet the commitments made under the COP21 Paris Agreement, reflecting a higher level of environmental and climate ambition and addressing citizens’ concerns regarding sustainable agricultural production. Within the EU, the process for developing and negotiating the future of the common agricultural policy after 2020 started in 2017.

Eurasian Economic Union. The Eurasian Economic Union (EEU) was set up in 2015 and integrated Armenia, Belarus, Kazakhstan, Kyrgyzstan and the Russian Federation within a single market of 183 million people. With regard to agriculture, the harmonized state support rules of production and processing of agricultural products, with priorities given to the World Trade Organization rules and regulations, contribute to setting a common approach to regulation of the single agrarian market. All of these measures are based on the EEU concept of coordinated agroindustrial policy. In addition to facilitating trade and cooperation on food security, the EEU adopted a number of decisions on food safety and phytosanitary measures between 2016 and 2018.

The new transport corridors promoted under the Central Asia Regional Economic Cooperation Program, which comprises 11 member countries[22] and multilateral organizations, and the Belt and Road Initiative, which is aimed at enhancing connectivity and cooperation among European and Asian countries, particularly China, are projected to further facilitate the movement of goods and services and the related labour force in the region.

In Central Asia, countries are facing many similar challenges in food security and nutrition, and governments have adopted a range of public policies, from extensive development of agricultural production and promotion of food self-sufficiency to subsidy programmes designed to facilitate the import of staple products (Peyrouse, 2013).

As described in Part I, food security and nutritional issues remain of concern, especially in Central Asia, which shows the highest prevalence of undernourishment (6.4 percent) in the region in 2017, with around 4.4 million individuals undernourished. Due to supply constraints, Kyrgyzstan, Tajikistan, Turkmenistan and Uzbekistan heavily depend on the import of cereals, mainly wheat; the significant level of these imports makes these countries highly vulnerable to international food markets, which can severely affect the food security of their populations. Tajikistan is able to cover only onethird of its food consumption needs, while Kyrgyzstan and Uzbekistan cover around 47 and 22 percent of their needs, respectively (FAO, 2017b).[23] Earlier studies indicate that the share of household expenditure devoted to food remains very high: 80 percent in Uzbekistan and in Tajikistan, 58 percent in Kyrgyzstan, and as much as 42 percent in Kazakhstan (Peyrouse, 2013).

2.3 NATIONAL POLICIES AND MAIN DEVELOPMENTS

The overview of policies at national level is structured around their prevailing contribution to the four pillars of food security: addressing the supply and consumption of food (Section 3.1); access to food (Section 3.2); food utilization and nutrition (Section 3.3); and stability of access to food, including measures for stabilizing domestic food markets (Section 3.4).

Enhancing food availability and supporting agricultural programmes and strategies

Analysis of the policy measures adopted in 2016 and 2018 confirms that in the ECA region, countries are focusing on agricultural production and rural development as a basis for supporting food security and good nutrition. The trends of agricultural production for the period of 2005– 2017 show increasing rates throughout the region. In Europe,[24] the increase is recorded at eight percent. In Central Asia, it is 40 percent; in Turkey, it is 20 percent; in Armenia, it is 35 percent; and in Azerbaijan, it is 31 percent. At the same time, a negative trend is reported for the countries of Southern Europe (a decrease of five percent, mainly due to a decline in Greece, Croatia, Bosnia and Herzegovina, Montenegro and Italy) and in Georgia (a 13-percent decrease) (UNSD, 2018). The average food supply (kcal/ person/day) in the region is above the world average, except in the Central Asia subregion, where it is slightly lower; this indicates that the overall national food supply seems to be adequate to ensure sufficient energy consumption (Figure 16). In terms of composition, food supply data show that the share of dietary energy in the region’s countries is mainly supplied by cereals, roots and tubers (Figures 17 and 18).

The share of calories derived from cereals and roots and tubers in a number of countries in the region is above the world average level of 50 percent, as recorded for 2011–13, while the average level in Europe, including in EU countries, is 34 percent. In countries such as Azerbaijan, Bosnia and Herzegovina, Kyrgyzstan, Tajikistan, Turkmenistan and Uzbekistan, it is above 53 percent. With regard to the per-capita protein supply, in several countries (Georgia, Republic of Moldova, Tajikistan and the former Yugoslav Republic of Macedonia), this indicator is below the world average (80 g/person/ day) and the European average (128 g/person/ day) (Figure 16).

The differences in food consumption patterns among the countries in the region, mainly in Armenia, Georgia, Kyrgyzstan, Republic of Moldova, Tajikistan, the former Yugoslav Republic of Macedonia, and Uzbekistan (Figures 17 and 18), show that such dietary processes appear to follow a pattern involving two main stages (Kearney, 2010). The first stage, known as the “expansion” effect, is marked by an increase of energy supplies and of extra calories coming from cheaper foodstuffs of vegetable origin. The second stage, called the “substitution” effect, results in a shift in the consumption of foodstuffs with no significant change in the overall energy supply. The second stage is country-specific and is inf luenced by culture, beliefs and traditions. Low levels of protein supply and dietary energy supply are prevalent mainly in Armenia, Georgia, Kyrgyzstan, Republic of Moldova, Tajikistan, the former Yugoslav Republic of Macedonia, and Uzbekistan.

The review of recent policy measures taken for the agriculture sector and for rural development (Table 12) indicates the attention given by governments to different measures, such as agricultural support instruments (Kazakhstan and the Russian Federation), price regulation (Kazakhstan), and rural development (Albania and Bosnia and Herzegovina). However, limited information is available on the efficiency and results of such measures.

Improving access to food and nutrition through economic growth, social protection and food assistance

Economic growth is one of the basic indicators used for income generation and food access. The ECA region registered a stronger economic growth in 2017 than at any time since the global financial crisis of a decade ago (World Bank, 2018b), and favorable estimations exist for 2018. Economic recovery has been recorded in almost all ECA countries after the dramatic drop in energy prices during the period of 2014–2016 observed in Azerbaijan, Belarus, Kazakhstan, and the Russian Federation. Poverty is a major obstacle to people accessing adequate food in the ECA region, and it remains an issue at the national level in some countries in the Caucasus and the Central Asian subregion. Other obstacles include a lack of knowledge of nutritional aspects and dietary preferences and habits.

Multiple policy measures were adopted between 2017 and 2018 for improving food access, including for social protection and food assistance, in the ECA region (Table 13).

The main issue faced by most people in terms of food security is inadequate access to nutritious food, which is fundamentally an outcome of poverty. Poverty, combined with inequality, leads to increased vulnerability and fragility in food security and nutrition and the overall livelihood of the population. In the ECA region, while no countries are ranked as extremely poor countries,[25] the issue of inequality is of concern. Inequality, as measured by the Gini index,[26] varies from country to country: The highest Gini index was observed in Turkey (41.2), followed by Turkmenistan (40.8). Of 53 countries, roughly 60 percent have a Gini index of 30 or higher, which is considered average (CIA, 2018). The extent of inequality observed across the ECA region may explain the wide differences in the state of food security and nutrition among and within the countries. Further analysis is needed on the linkages between food security and levels of inequality. In high-income and middle-income countries, comprehensive social transfer programmes can contribute to achieving measurable reductions in poverty and income inequality and to helping people with lower incomes overcome social exclusion and access barriers (Roelen, Sabates-Wheeler and Devereux, 2016).

An analysis of inequality throughout the ECA region (Figure 19) indicates the extent of inequality and points to the associated vulnerability of specific population groups. The most vulnerable groups remain the unemployed and the working poor, women, youth, children, pensioners and the elderly, disabled people, single-parent households, migrants, and asylum seekers. Rural women are still vulnerable in terms of income since they are more concentrated in lower-paid jobs and face pressures in terms of legal rights to land and other property, especially in Central Asia. In addition, it has been observed that while, in general, women and children are improving their economic situations when opting to migrate, some women and children are becoming more vulnerable due to the type of migration processes observed in the region (FAO, 2014a, 2017p), described in more detail in Part III.

Food assistance and livelihood support programmes in the ECA region. Food access for vulnerable population groups is supported by food assistance programmes, including vouchers and food subsidies, as well as food transfer programmes, cash transfers and school feeding programmes implemented by non-governmental organizations, National Red Cross Societies (Matosek and Kletskovskyy, 2015) and governments. Almost 86 percent of the National Societies of the Red Cross have observed some deterioration in the humanitarian situation in their respective countries as a result of economic situations and conflicts in the region and in neighboring countries. For those groups, more than 70 percent of National Societies of the Red Cross conducted projects on food distribution in partnership with the corporate sector in the form of food parcels, food banks, soup kitchens and lunches for schoolchildren (Matosek and Kletskovskyy, 2015).

Schoolfood and nutrition programmes in the post-Soviet countries have been used to provide subsidized milk and meals to schoolchildren. For example, the Kyrgyz Ministry of Education and Science is expanding the Kyrgyz Republic’s school meals programme in the country’s poorest rural areas with financial and technical support from the Russian Federation and other donors (FAO/WFP, 2015). Since 2013, the Kyrgyz Government has worked to scale up and enhance school feeding programmes and now supports core school feeding programmes in many schools, as well as school vegetable and garden pilot projects (WFP, 2016). The programme is supported by the World Food Programme, and the local authorities – such as the Ministry of Health and Social Protection, the Ministry of Education and the Russian nongovernmental organization Social and Industrial Food Service Institute – cooperate with farmers and food producers on the provisions of food supply to schools. The programme promotes the local procurement of pulses from smallholders, which in the long run contributes to economic development.[27]

School feeding programmes are good examples of how child nutrition has been supported in ECA countries (FAO, 2017n). Such programmes are being implemented in Armenia, Kyrgyzstan and Tajikistan and are being supported by FAO, the World Food Programme, the World Health Organization and UNICEF. In European Union countries, the school fruit, vegetables and milk scheme was extended in 2017 to promote healthier diets (European Commission, 2018b). Improving school feeding programmes is an effective instrument for improving the state of food security and nutrition in countries. Multisectoral approaches are crucial to increasing the food security of children.

Provision of food assistance in emergency and recovery settings. In the ECA region, food assistance for vulnerable people is provided by national and international organizations as well as by governments. Various programmes are ongoing in the region at different scales. In Turkey, the Emergency Social Safety Net programme is run through a close cooperation among the World Food Programme, the European Union Civil Protection and Humanitarian Aid, the Turkish Red Crescent Society and the Turkish Government. The programme provides food assistance to the most vulnerable refugees, including monthly cash transfers for purchasing food, medicine and essential items (WFP, 2018b), supporting approximately one million refugees, most of whom are from Syria.

Food assistance and support programmes have an important role in conflict and post-conflict areas. In Eastern Ukraine, 4.4 million people are affected by the protracted conflict, and around 1.8 million were internally displaced by the end of 2017 (UNHCR, 2017). Some 3.4 million people urgently require humanitarian assistance and protection (OCHA, 2018). The security situation remains fragile and is affecting individuals and communities. An estimated 1.2 million people are moderately or severely food insecure, with many resorting to negative coping mechanisms (WFP, 2018a). Unemployment, reduced income and high inflation rates in conflict-affected eastern areas of the country have severely limited civilians’ ability to fend for themselves. Particularly vulnerable are the elderly living alone and femaleheaded households (FAO, 2018b).

Food assistance programmes are also needed in high-income or upper-middle-income countries because of economic inequalities.[28] For example, the Ministry of Finance and the Ministry of Industry and Trade of the Russian Federation are finalizing a programme of targeted social assistance for 2018, aiming at solving two problems at the same time: helping low-income people who are not able to buy fresh meat, fish or vegetables on their own, and helping domestic industry. It is the second programme on food aid for the food support provision to poor and vulnerable population groups in the country. The previous one is the concept on food aid development (3 July 2014, No. 12-15h). At the same time, some local territories, for example Sakhalin Oblast in the Russian Federation, have already adopted their own decisions on the provision of food aid to poor and vulnerable people.

Kyrgyzstan and the Russian Federation are examples of countries that have increased public funding for the implementation of social protection programmes since 2015. The Government of Kyrgyzstan adopted a national social protection programme that aims to shift spending towards its Monthly Benefit for Poor Families with Children programme to reach 45 percent of the total benefit budget. This means that a tested transfer initiative provides monthly cash benefits to increase the per-capita income of eligible households to the guaranteed minimum income. The Russian Federation provides funding for family grants in its maternity capital programme. Grants are issued in the form of vouchers to families with a second or subsequent child, whether born or adopted, regardless of the family’s income status (FAO, 2017p).

Policy actions for addressing concerns on food utilization, and malnutrition

Different policy measures were adopted from 2013 to 2016 covering nutritional aspects, including strategic policy documents, to improve nutrition and address multiple malnutrition challenges in the region (Table 14).

The food utilization dimension of food security plays a significant role in addressing malnutrition. In order to raise awareness on this aspect, relevant high-level advocacy events have been conducted, such as the FAO/WHO Regional Symposium on Sustainable Food Systems for Healthy Diets in Europe and Central Asia. Several informationsharing and capacity-development platforms have been developed, including by the United Nations Standing Committee on Nutrition, the Forum on Food Security and Nutrition in Europe and Central Asia[29] and others. Dedicated projects and programmes on improving nutrition and promoting diversified, balanced diets are being implemented with the support of FAO, WFP, WHO and UNICEF.

In addition, a number of programmes and projects on balanced nutrition are under implementation by the European Union, the United Kingdom, Slovenia (European Parliament, 2011)[30] and other countries in the region. FAO’s global programme on Strengthening Food Systems for Nutrition- Sensitive Social Protection and the regional project “Developing Capacity for Strengthening Food Security and Nutrition in Selected Countries of the Caucasus and Central Asia,” supported by the Russian Federation and FAO, aim at strengthening institutional capacities to reduce the prevalence of food insecurity and malnutrition in Armenia, Kyrgyzstan and Tajikistan while emphasizing the strengthening of social protection systems.

As described in Part I, the malnutrition problems persisting in the ECA region are also related to diets with low micronutrient contents, which can be addressed by diversification of diets (the foodbased approach), increasing micronutrient content of diets, and other measures, including fortification. The latter, however, is not implemented in many of the ECA countries, and recent analysis of nutrition data still show high a prevalence of anaemia.

Advocacy and education on nutrition. One factor contributing to nutrition-related issues is the lack of knowledge and understanding regarding healthy diets and the importance of breastfeeding. Therefore, advocacy and awarenessraising activities, building on nutrition-related information and action networks, are key. Nutrition education aims to inform people about what constitutes a healthy, balanced diet, as well as how to improve their diets and lifestyles. While interventions aimed at schoolchildren are widespread throughout the European Union, adults in the workplace are not currently the focus of awareness-raising campaigns. Although nutrition education is not compulsory in most ECA countries at present, several countries foresee targeting education or training on nutrition for children (FAO, 2013a), mothers of young children, and pregnant women.

Food safety policies and institutional reforms. Food security, nutrition and food safety are inextricably linked. When food is unsafe, the availability of adequate food may be reduced, potentially resulting in adverse health outcomes such as infectious and chronic diseases with potential knock-on adverse effects on nutritional status and well-being. The burden of foodborne disease due to the biological and chemical contamination of food is still significantly high in the ECA region, and it needs to be addressed by the continuous improvement of food safety control systems.

Countries in the region recognize the need to improve their food safety control systems and align their national regulations with international and regional standards and requirements, such as the Codex Alimentarius and standards from the European Union and Eurasian Economic Union. For example, harmonized food safety regulations have been introduced in Armenia, Belarus, Kazakhstan, Kyrgyzstan, and the Russian Federation through the Eurasian Economic Union. These reforms address domestic food production (including local and traditional food products), export/import control and the improvement of consumer health. FAO supports countries in building robust food safety control systems based on identified needs and priorities, including the use and adoption of international food safety standards. Common and recurring priorities in the ECA region include developing risk-based inspection systems, strengthening laboratory capacities, improving scientific and risk-assessment capacities as the basis for decision-making on food safety, improving food import and border control, and coordinating efforts to address issues such as antimicrobial resistance that require a multi-sectoral approach. FAO works with countries to adequately prepare for the FAO/WHO Coordinating Committee for Europe (CCEURO), which will meet in Kazakhstan in 2019, and to maximize engagement and results from the regional meeting and network provided by CCEURO.

The recent reforms related to food safety made by a number of countries in the region are notable. Institutional reforms have been undertaken to combine the official control and inspection for food safety control and animal and plant health, in order to improve the coordination among different actors (such as Armenia, Azerbaijan, Republic of Moldova and Tajikistan). Improved coordination can be effectively achieved through the creation of a multiagency food safety committee or through the establishment of a single agency. These reforms have been accompanied by relevant legal reforms, and work is ongoing (the food law in Azerbaijan, for example) and can be reinforced through the development of a comprehensive food safety strategy.

Supporting the stability of food security and nutrition through developing sustainable food systems: strengthening import capacity, stocks, markets and innovations

Sustainable food production and food systems play a crucial role in ensuring stable food prices and agricultural commodity markets and in assuring adequate diets for food security and nutrition for all in the ECA region. Within the 2030 Agenda for Sustainable Development, aspects of food security stability need to be addressed to assure positive interactions between SDG 2 and all other goals.

The main risks related to food security stability in the ECA region are: (i) heavy food import dependency (the Western Balkan countries, Caucasus, and Central Asia); (ii) vulnerability to the impacts of climate change and variability, including in the most vulnerable countries (such as Albania, Armenia, Georgia, Kyrgyzstan, Republic of Moldova, Serbia, Tajikistan, the former Yugoslav Republic of Macedonia, Turkey, Turkmenistan and Uzbekistan); (iii) limited and declining natural resources and their unsustainable use; (iv) increased variability of weather patterns; and (v) political instability and social unrest. External factors also influence the stability and sustainability of food production and provision, including energy and fertilizer prices, currency fluctuations, trade restrictions, stocks of staple products, etc. The depreciation of all the national currencies against the United States dollar and the euro in post-Soviet countries of the region, which began in 2014, continued in 2015 and 2016 and, in some cases, 2017, had negative effects. Due to weaker national currencies and falling consumer demand, the total value of imports of agrifood products in United States dollar terms decreased in many countries. Despite the depreciation of national currencies, the decline in demand for agrifood products in the region and lower international prices contributed to reductions in the value of agrifood exports from the region (FAO, 2017f).

Food prices and market volatilities may be caused by a number of other factors as well, including adverse weather patterns, climate change, natural disasters, trade restrictions, limited infrastructure facilities, and political and social instabilities. The impacts of food prices include increasing price volatility or depreciation and fluctuation of national currencies.

Various countries have taken decisions to regulate prices and support the markets (FAO, 2017o). Considering country priorities and the regulatory environment (EU or EEU membership, for example), the policy tools assuring price stability may vary in Europe and Central Asia. They can involve the adjustment or reform of the currency exchange regime, currency devaluation or appreciation by the Central Bank, market intervention and imposing import duties, tariffs and bans on certain commodities. In some countries – for instance in Kazakhstan – state-owned companies may manage the strategic grain reserves, assuring price stability via the procurement of crops to balance the interests of producers and consumers. In the European Union, market interventions have played a less important role since the 1990s, and price stability and regulation of food availability is achieved via the first pillar of the common agricultural policy (including direct payments), providing a basic payment for producers. This form of subsidy is not linked to the volume of production but is distributed to farmers who follow strict rules on human and animal health and welfare, plant health, and the environment. The EU also distributes green payments to farmers who may fulfill extraordinary requirements and apply methods that go beyond basic environmental protection (European Commission, 2018a).

Many post-Soviet countries have either adopted or are in the process of developing programmes and strategies on agrifood export promotion that become part of their national legislation. Many governments of these states have prioritized boosting export volumes as one of the stimuli for economic growth, while an effective foreign trade policy is instrumental in innovative development and sustainable growth in the agricultural sector. Overall, export promotion measures contributed significantly to the export policy implemented among the countries in the region in 2015–2017.

The assurance of safety for foods traded and the management and control of animal and plant diseases are essential for trade policies and the potential to increase market access (FAO, 2017m).

Overall, in the countries of Europe and Central Asia, the volatility of domestic food inflation remained calm – except for a seasonal rise in potato prices in Armenia, Belarus, Kazakhstan, Kyrgyzstan and the Russian Federation (FAO, 2018a).

Regarding national currency fluctuations, significant volatility and increases for 2016–2018 have been recorded in the Ukrainian hryvna: 12.4 percent in 2016 and 13.7 percent in 2017. Food price inflation in Ukraine was reported at around 18 percent in early 2018 (January–February) over the same period in 2017 (The State Statistics Service of Ukraine, 2018).

During 2017 and 2018, a slight volatility in food prices was observed in the countries of Europe and Central Asia, although a spike was recorded in potato prices in June 2017. A significant increase in potato prices was driven by production shortfalls, mainly in post-Soviet countries. However, in general, food price volatility is relatively low in the region (Figure 19).

The stability of food security is further linked to socio-economic processes, such as social unrest and its consequences, caused by poverty, unemployment and political instability. A review of rural development and employment and livelihoods in the region, along with their implications for the population, especially rural women and youth, and challenges and opportunities related to migration, is described in Part III of this report.

PART 3
MIGRATION, GENDER AND YOUTH: LINKAGES WITH RURAL DEVELOPMENT AND FOOD SECURITY IN EUROPE AND CENTRAL ASIA

The evidence of persisting food insecurity and the recent increase of various forms of undernourishment in Europe and Central Asia prompt the exploration of their relationship with other development issues such as rural poverty, migration and gender. An understanding of the integral links among these elements will be critical in progressing towards meeting the targets of the Sustainable Development Goals (SDGs) and in achieving Agenda 2030.

Successful monitoring of the progress towards achieving the food security and nutrition targets in SDG 2 – as well as SDG 2.3 on doubling by 2030 the productivity and income of small-scale food producers – will need to consider the nexus of migration, food security and nutrition, encompassing their main drivers and challenges. Migration and food security have multiple intersections and complex linkages that need to be analysed and addressed holistically (IFPRI, 2018). Advancing towards success on the SDGs – particularly SDGs 1, 2, 3, 4, 5, 8, 10, 16 and 17 – also will need to consider such key factors as gender, youth and the overall vulnerability of people.

While five of the top ten global migration destinations are located in Europe and Central Asia,[31] the region is also among the top three globally for outmigration, both intraregional and interregional (McKinsey & Company, 2016). Remittances to some countries in the ECA region account for important shares in national gross domestic products and in individual household incomes. How can food security in the countries of the region benefit from these dynamics, and what can be done to harness these growing phenomena as opportunities for growth?

This chapter focuses on the ECA countries, mainly in the Caucasus, Central Asia, European Commonwealth of Independent States (CIS), Western Balkan countries and Turkey, in which FAO supports interventions and programmes, exploring the regional linkages among rural labour outmigration, gender and food security, highlighting the potential of remittances to stimulate investment in the agricultural sector, improve the incomes of rural households, and help countries to work towards zero hunger. In particular, this chapter discusses migration-related issues in the ECA region and reviews migration trends, patterns and drivers. It explores the linkages between migration and food security, identifies the roles of remittances in food security and nutrition, and discusses the impact of migration on gender and youth. Furthermore, it recommends what the international community in general, and FAO in particular, could do to assist the countries of the region to address these challenges – by empowering rural communities and supporting the families (especially rural women and youth) who stay behind – in the achievement of sustainable development.

In the United Nations Secretary-General’s report to the General Assembly Making migration work for all (United Nations, 2018b), migration was considered an engine of economic growth, innovation and sustainable development, allowing millions of people to seek new opportunities each year and contributing to broader goals of eradicating poverty and fighting against inequality, including gender inequalities.

3.1 MIGRATION IN THE ECA REGIONS: DEFINITIONS, PATTERNS, TRENDS AND DRIVERS

Definition of Migration

FAO defines migration as a movement of people, either within a country or across international borders, irrespective of the drivers, duration or purpose of the movement. The term encompasses economic migrants, migrants in distress, internally displaced persons (IDPs), refugees and asylum seekers, returnees, and people moving for other purposes, including for education and for family reunification (FAO, 2018e). The overview of the main international definitions used for describing migration processes and their linkages is provided in Box 7.

Key Facts, Trends and Patterns of Migration in the ECA Region

In 2017, there were 258 million international migrants worldwide, a significant increase from 220 million in 2010 and 173 million in 2000 (UNDESA, 2017a). More than 90 percent of the world’s cross-border migrants move primarily for economic reasons, while the remaining ten percent are refugees and asylum seekers who have fled to another country to escape conflict and persecution (UNDESA, 2017a). The median age of all international migrants in 2017 was 39.2, compared with 38.0 in 2000, and women were slightly less than half of all international migrants worldwide (with the regional deviations proving women’s higher representation among migrants in Europe) (UNDESA, 2017a). The proportion varies considerably in the ECA region; in countries such as the Republic of Moldova and Ukraine, the majority of emigrants are female, while in other countries, such as Armenia, Tajikistan and Uzbekistan, the majority are men. Female migrants are seen as moving independently rather than as dependents and are more involved in sending remittances and supporting their families from abroad, which in turn is altering social and familial dynamics and decision-making. A large share of both internal and international migrants leave rural areas to move to places where they believe they will find jobs and opportunity, with around 40 percent of international remittances sent to rural communities (UNDESA, 2017a).

International Migration in Europe and Central Asia

As origin, transit and/or destination countries, all countries in Europe and Central Asia are experiencing some form of migration processes. The patterns and scales of migration in the region are diverse and include both internal (particularly from rural to urban areas), and international movements, primarily between countries in the region but also from other parts of the world.

The analysis of migration in the ECA region needs to be differentiated by countries of destination (hosting), transit, and origin. In 2015, Europe-to-Europe migration represented the second-largest regional migration corridor in the world, after the corridor of migration to North America from Latin America and the Caribbean. Each grew steadily in the 1990s and more rapidly during the 2000s before finally slowing thereafter (IOM, 2018a). Among European Union countries, Germany (12 million migrants), France (7.5 million), the United Kingdom (7.5 million), Spain (5.5 million) and Italy (5 million) accrued the largest foreign-born population in 2015, coming from North Africa, India, Poland, Turkey, Kazakhstan, the Russian Federation, Romania and other countries. From the 20 top migration countries in the region, Switzerland had the highest share of migrants in its population (29 percent), followed by Austria, Sweden and Ireland (IOM, 2018a).

Between 2005 and 2017, the number of international migrants increased worldwide, and in Europe it increased overall by 19 percent. The largest increases in the region were observed in the countries of Northern Europe (by 39 percent), Southern Europe (by 32 percent) and Turkey (by more than 50 percent) (Figure 20). The ECA region is the second in the world for receiving migrants, with a stock of 78 million international migrants in 2017.

Migration processes are governed by relevant international agreements.[32] Within the 2030 Agenda on Sustainable Development, addressing the root causes of these processes, efforts are combined with policies and programmes to combat extreme poverty through fostering rural development, to support access to education and employment, and to achieve food security and nutrition for all.

Within the ECA region, the Russian Federation is the second-largest destination country for migrants in Europe, after Germany. In Eastern Europe, the Caucasus and Central Asia, the Russian Federation remains the major destination country in the subregion (and is one of the most significant in the world). In 2017, the Russian Federation hosted more than 11.7 million international migrants (stock) (UNDESA, 2017a), with around half coming from neighboring countries – most notably, CIS members – although the economic slowdown between 2012 and 2015 and changes in immigration policies in the Russian Federation have seen the inflow of migrants and the outflow of remittances decreasing in 2014 from previous years. Immigration in 2017– 2018 is showing an upward trend.

Internally displaced persons and refugees in the ECA region

Along with international migration, the ECA region witnessed an increase in recent years in internal displacement and in the refugee population. According to the Global Report on Internal Displacement 2017, the total number of internally displaced persons (IDPs) recorded in the ECA region exceeded four million people (with Azerbaijan accounting for 562 000 people; Bosnia and Herzegovina 98 000 people; Cyprus 278 000 people; Georgia 208 000 people, and Turkey 1.1 million people) (IDMC, 2017, pp. 113–116). In addition, Turkey hosts the largest refugee population worldwide, with approximately 3.9 million refugees and asylum seekers, mostly from Syria but also from Iraq, Afghanistan and other countries (IDMC, 2017, pp. 113–116). In Ukraine, roughly 1.8 million IDPs were estimated at the end of 2017 (UNHCR, 2018b) as a result of the protracted conf lict in the eastern part of the country, which has also generated an outf low of migrants and refugees to neighboring states and to EU countries. A large number of Ukrainians have also applied for asylum in the Russian Federation, and an increasing number of Ukrainians have left the country as migrant workers, particularly to Poland and the Russian Federation. The impact of the situation in Eastern Ukraine on food security is critical, with increases in poor food consumption, applications of negative coping mechanisms and reductions in food expenditure. In the government-controlled area, 33 percent of surveyed IDP households had “only enough funds to cover food,” and 11 percent had to “limit expenses even for food” (IOM, 2018b).

Since 2011, the protracted conf lict in the Syrian Arab Republic has caused major movements of people to neighbouring countries. Some countries in the region – the Russian Federation, Greece, Serbia and some Balkan countries – were transit corridors for migrants from Western and Southern Europe. This form of migration increased in 2015 and early 2016, particularly from and through Turkey and the Western Balkans to northern European Union countries, primarily Austria, Germany and Sweden.

Based on the United Nations High Commissioner for Refugees’ 2017 global report, after the European refugee crisis in 2015 and 2016, 2017 was a year of transition and relative stability, though challenges did still exist for migrants. Unresolved conf licts in the region and ongoing violence in other parts of the world fueled largescale and protracted displacement. With increasing restrictions on access to territory and to international protection, along with difficult integration possibilities, a limited number of safe pathways and the often-lengthy processes required to access them, many f leeing persecution around the world were left with few choices. Refugees and migrants continued to undertake dangerous journeys, with a significant number known to have died or gone missing while crossing the Mediterranean Sea in 2017. While this situation remained a concern, the overall number of refugee and migrant arrivals in Europe fell in 2017 by 53 percent from 2016 figures, mainly as the result of fewer people travelling from Turkey to Greece and from North Africa to Italy, although arrivals into Spain increased (UNHCR, 2018b).

Turkey remains the country hosting the world’s largest number of refugees (UNHCR, 2018a), with a total of almost 3.9 million. The total refugee population hosted in Turkey comprises 3.52 million people from the Syrian Arab Republic, 169 000 from Afghanistan, 142 000 from Iraq, and 52 000 from other countries (UNHCR, 2018b). Migration processes in Europe continue to evolve. The number of first-time asylum seekers to the 28 European Union countries (EU-28) has fallen by nearly a third, from the peak reached in October 2015 to December 2016. Between mid-2015 and mid-2016, the number of refugees in the EU-28 increased by 273 000, to 1.6 million. During the same period, the number of refugees worldwide rose by 1.4 million, to 16.5 million.

European countries are currently engaged in identifying ways to regulate migration flows and adopt legislation. In 2016, the European Union and Turkey reached an agreement to stem irregular migrant crossings. The European Union adopted a new “Migration Partnership Framework” in June 2016, aiming at well-managed migration through coordination among its Member States, institutions, and third countries to reduce the number of people making dangerous journeys to Europe (European Commission, 2017). The implementing framework focuses on priority countries of origin, and transit Syrian refugees are supported in Turkey under the Refugee Facility.

The Russian Federation hosted more than 11 million international migrants (stock), with half from neighbouring countries

The region is experiencing regular and irregular labour migration flows. Labour migration from Armenia, the Republic of Moldova, Ukraine and Central Asian countries to the Russian Federation and other countries (and, for the Central Asian countries, to Kazakhstan) forms one of the largest and most stable migration corridors in Eurasia and the world (Ryazantsev, 2016). Analysis of migration by countries and trends shows (Figure 21) that Tajikistan has the highest share of migrants (over ten percent of the total population has emigrated elsewhere), although Uzbekistan has a higher number of outmigrants (two million), correlated to lack of employment opportunities and labour surplus in rural areas and constraints in accessing agricultural inputs. The lowest share of migrants is from Turkmenistan, related to the limited mobility of its population due to legislation in the country.

The migrant population is primarily composed of labour migrants; according to expert estimates, it includes between 2.7 million and 4.2 million people, or between 10 percent and 16 percent of the economically active population of Central Asia (Ryazantsev, 2016). In 2017, the Russian Federation hosted more than 11 million international migrants (UNDESA, 2017a), with around half of them coming from neighboring countries (2.5 million from Uzbekistan and 1.13 million from Tajikistan, followed by China and Ukraine) (IOM, 2018a, p. 259).

The key drivers of migration in the ECA region

The main drivers of migration are economic, social, demographic and political factors. Along with conflicts, violence and natural disasters, many migrants, especially from rural areas, move because of rural poverty and food insecurity. FAO categorizes the drivers of rural migration as (i) economic causes (rural poverty and food and nutrition insecurity in the absence of alternative opportunities to improve livelihood prospects and farming practices); (ii) political causes (inequality between rural and urban areas, conflicts and political instability, limited access to basic social services); and (iii) environmental causes (climate change and extreme weather events, the depletion of natural resources, environmental degradation). The decision to migrate is often not solely based on one category of causes but rather a mix of different factors.

Low agricultural productivity and poor rural economy are the major causes of rural migration in ECA

More than 75 percent of the world’s poor and food-insecure people live in rural areas, mostly depending on agricultural production for their subsistence. The agriculture sector remains a vital part of many economies of Europe and Central Asia, with an average of around 30 percent of the population living in rural areas, reliant and dependent on agricultural production for employment and food provision. There are considerable differences among the countries.

The consequences of climate change processes and the depletion of natural resources due to environmental degradation – and the related loss of livelihoods – are emerging as further reasons for migration, exacerbating the economic drivers of migration as well as the occurrence of forced displacement. Land degradation and desertification affect land used for agriculture, undermining farmers’ productivity and resilience. Droughts and the related volatility of food prices increase poverty, hunger, and the need to find viable options elsewhere. Smallholder family farmers, small-scale fishers, forest-dependent communities and pastoralists are hardest hit by weather-related disasters, which are increasing in frequency and intensity.

Changes in demographic patterns in the countries of origin and destination, the pace and quality of reforms in agriculture and rural development, rural poverty, lack of jobs, and poor infrastructure all have implications for the way people move and/ or migrate. In addition to intercountry differences, the region is characterized by a specific demographic profile, encompassing a wide range of natural, economic and social diversity.

Although the average level of agricultural contribution to gross domestic product in 2015 was 2.1 percent (and in the European Union, 1.6 percent) in the entire region, agriculture is for some economies a vital part. A level of 25 percent was observed in Tajikistan, followed by Albania at 23 percent (World Bank, 2018d). Despite the general trend of the share of agriculture in GDP falling (for example, in Central Asian states it has fallen to 18–25 percent in the past 25 years, and to below ten percent in the oil-rich countries of the subregion), the sector still employs 29–45 percent of the total workforce in Albania, Armenia, Azerbaijan, Georgia, Kyrgyzstan and Uzbekistan. In Tajikistan, 57 percent of the total workforce is employed in agriculture (Table 17) (FAO, 2018d, p. 31). Agriculture represents the most important source of income for rural women – farmers, unpaid workers on family farms, and women who work as paid or unpaid labourers on other farms and agricultural enterprises (FAO, 2018d, p. 31). At the same time, employment in the agricultural sector remains associated with low and unstable incomes, a high level of informality and, as a result, limited social protection. There is significant gender inequality in pay, with women having little or no access to social infrastructure; life opportunities such as access to quality education are limited in rural areas, which can be a further driver of migration.

A review of the dependency of rural development on agriculture (Table 17) shows wide differences among the countries and subregions, with countries where the share of rural population in total is over 50 percent (Bosnia and Herzegovina, Kyrgyzstan, Republic of Moldova, Tajikistan, and Uzbekistan), while the average is about 30 percent in Eastern Europe and Southern Europe and about 47 percent in Central Asia and the Caucasus countries. A further decline of this share is expected and indicates further urbanization and implications for employment and migration. This trend is expected based on the significant decline in agricultural employment from 2005 to 2017 reported throughout the region, from 11.7 percent to 8.7 percent for the entire ECA region and from 20.4 percent to 15.2 percent in the ECA region excluding high-income countries (World Bank, 2018e). The main sources of migrants in the region are the rural population and unemployed persons.

In the region, smallholders and family farms dominate the agricultural landscape as a result of the wave of privatization of community and stateowned farms during the 1990s. This process led to excess fragmentation of land, with small average farm sizes, which has limited the economic viability of the sector. In addition, the rural poor, and especially smallholder family farmers, face considerable difficulties in accessing credit, services, technologies and markets that would allow them to improve their productivity. This often constrains farmers’ ability to assure a decent livelihood from the agricultural and related sectors, pushing them to seek other employment options, leaving rural areas and often their home countries in search of better opportunities (FAO, 2013c, 2015c).

The economic drivers of migration are further exacerbated by the impacts of climate change

The economic drivers of migration are further exacerbated by the impacts of climate change, with changes in weather patterns, natural disasters and the depletion of natural resources due to environmental degradation emerging as further reasons for the related loss of livelihoods. In the ECA region alone, 577 natural disasters were recorded between 1990 and 2017, disrupting the stability of food systems and affecting around 35 million people, especially in rural areas (FAO, 2017c).

Thus, migration becomes an important strategy of rural households for improving their livelihoods. Lack of employment and income-generating opportunities, lack of social infrastructure and adequate social services (health, education and social protection), and difficulties in managing social, economic and environmental risks also contribute to decisions to migrate (FAO, 2017c). The consequences of climate change may gradually lead to decreased water availability and consequent reductions in agricultural productivity, especially in the countries with fragile agroecosystems that are vulnerable to shocks and changes in environmental conditions. Limited resilience and resources to mitigate the negative impacts or to recover from current and projected effects of climate change may further lead to a decreased subsistence base for rural households and to the depopulation of rural areas. Once these livelihood options have been exhausted, people may be forced to migrate to seek alternative livelihood options and to escape poverty and hunger.

Changes in weather patterns and extreme events such as prolonged droughts are further exacerbating and contributing to conflicts. The Syrian Arab Republic, for example, is affected by a protracted complex crisis with resulting IDPs and migration (FAO, 2017c).

Demographic and social factors for migration in ECA

Demographic and social trends and conditions vary considerably across the ECA region. With a total population of about 912 million people (Table 3), it can be roughly divided into two categories: countries with aging populations and declining birth rates, which is the case in a number of the EU and Eastern European countries, and countries marked by rapid population growth due to high childbirth rates and higher shares of young people (as in Azerbaijan, Turkey and most countries of Central Asia, where young people form nearly 60 percent of the population). Considering demographic trends, it is anticipated that in the first group of countries, potential shortages of labour and skills will challenge both employment and economic growth prospects in the medium term. In this context, migrants can make an important economic contribution if they are well-integrated in a timely manner into education and into the labour market.

The region is strongly urbanized, with the share of its total urban population projected to continue to increase, from some 71 percent at present to over 80 percent by 2050. Likewise, according to provisional projections, the region’s agricultural labour force could continue to decline from about 50 million at present to only 15.3 million in 2050. Urbanization and demographic trends across Europe and Central Asia (European Commission, 2014, p. 5) will continue to serve as pull factors for rural-to-urban migration, with implications for individual countries’ economies and social systems and also for food security and nutrition throughout the region (FAO, 2012a, 2012b).

3.2 LABOUR MIGRATION AND LINKAGES BETWEEN MIGRATION AND FOOD SECURITY

Impact of labour migration: social and economic perspectives

Movement by people has always been an essential part of economic, social and human development, contributing to the progress of communities and societies. As such, it impacts all aspects of livelihoods, food security and nutrition, and agricultural and rural development, and it is accompanied by challenges and opportunities.

Migration from rural to urban areas is an important component of both international and internal migration. While economic and environmental factors drive migration, rural-tourban migration can be considered part of the process of the structural transformation of economies, in which the relative role of agriculture in terms of income generation and employment gradually declines as labour is transferred to other sectors of the economy.

Migration can pose challenges and create opportunities. Primarily, migration represents a challenge for those who migrate, especially in terms of vulnerability at the various stages of the migration process, and in particular for families left behind. Additional negative consequences include the loss of family as a unit, parents not being able to care for young children while migrating, and the loss of cultural ties. Young women and men are particularly vulnerable to the risks associated with migration, whether internal or international. These risks can outweigh the economic benefits. Risks may be related to problems associated with accessing housing and services in destination cities. Women, but also young men, are at risk of trafficking and of sexual and labour exploitation. However, awareness of these issues, as well as services targeting migrants, are limited in both sending and receiving countries.

Remittances associated with labour migration can help overcome the lack of access to credit and insurance in rural communities and can foster investments in agriculture or other rural economic activities and in human resources. Remittances can also serve as social safeguard measures.

By receiving young migrants, destination countries also benefit by being able to fill jobs not accepted by locals, enhancing the efficiency of the labour market and contributing to economic growth. On the other hand, immigrants may reduce wage rates and compete for jobs with workers in the destination country, thus increasing domestic unemployment. However, the characteristics of the immigrant workforce may differ substantially from those of the local labour force in terms of education and work experience, and migration can provide a clear net benefit to the economy (De la Garza, 2010; Temin, et al., 2013; United Nations, 2004).

Even though outmigration can result in the loss of the most vital and dynamic share of the workforce in rural, migrant-sending areas, in some countries with persisting unemployment, especially in rural areas, outmigration may be a way to remove pressures on the labour market, land and other natural resources. Outmigration from rural areas can bring back benefits through the acquisition and transfer of new knowledge, which can contribute to greater skills and awareness, including on cultural norms such as general health and education issues or gender equality. Moreover, diaspora and return migrants can help rural areas through capital investments, the transfer of skills and technology, increased know-how and wider social networks.

Linkages between migration and food security

The relationships between migration and food security are multiple, as migration provides poor households, through remittances, with means for support in food consumption. Households’ strategies to effectively address food insecurity may involve the migration of a household member in search of better-paid jobs in other countries. With a focus on the Europe and Central Asia region, a complete understanding of the nexus of food security, nutrition and migration needs to take into account the impact of migration on rural areas and households in the country of origin, as well as on hosting communities in terms of livelihoods, rural development and food security and nutrition.[33]

The share of total household expenditures spent on food is an indicator of household food security. It is documented that the poorer and more vulnerable a household is, the larger percentage of household income is spent on food. In some countries in the region (Kazakhstan, Kyrgyzstan, Republic of Moldova, Tajikistan and Ukraine), more than 40 percent of households’ budgets is spent on food. The average is 23 percent throughout the ECA region (RIA Rating, 2016). In countries with a high incidence of poverty or that are affected by conflicts, the share of income spent on food is even higher. The challenges and opportunities related to migration impact the level and scope of food consumption and utilization. The main linkages among migration and the four pillars of food security are given in Table 19.

For the countries of origin, the primar y impact of labour migration on food security include: (i) the possibility of receiving remittances from the migrant members of the households, thus improving the food consumption level, and the probability of investment and diversification of patterns; (ii) the potential receipt of information, knowledge and skills from the migrant ’s new location, inf luencing their behavior; and (iii) fewer household members, resulting in lower consumption levels but also lower labour availability. These impacts can be seen along the four dimensions of food security – availability, access, utilization and stability.

Overall, two main trends in the region in relation to migration and food security can be generalized as follows: (i) households receiving remittances in areas of origin are generally more food-secure than the households not receiving remittances; and (ii) at destination, migrant households are generally less food-secure than non-migrant households (Zezza, et al., 2011). In addition, migrants – especially irregular migrants – are among the most vulnerable members of society and likely to experience human rights violations, loss of employment, lower pay, longer working hours in poor working conditions, and limited access to health and other social services. Overall, these trends highlight the importance of successful migration to households’ food security and well-being.

3.3 THE ROLE OF REMITTANCES IN FOOD SECURITY AND NUTRITION

Remittances to the ECA region

Remittances to ECA have increased significantly

Recent World Bank data confirm a steady increase of remittances worldwide (Figure 22), although differing from region to region. After three consecutive years of decline, remittances sent to Europe and Central Asia (ECA) are estimated to have risen by 20.9 percent in 2017 over 2016 (Box 9) (World Bank, 2018a). They are projected to continue increasing in 2018, remaining at the highest level in the world.

Remittance flows are estimated at USD 44 billion in Europe and Central Asia.[34] Remittances to Central Asian countries from the Russian Federation alone totaled USD 13.5 billion in 2013. According to the World Bank, Kyrgyzstan and Tajikistan placed first and third among all countries for remittances as a share of gross domestic product, at 35 percent and 31 percent, respectively.

Remittance flows into Central Asian countries largely ref lect labour migration routes (Figures 22 and 23) within and from the region. For more than a decade, remittances have remained an important source of income for the population of Central Asia, and it has been estimated that they have been reducing national poverty rates (in Kyrgyzstan, for example, by six to seven percent) (World Bank, 2017b). Some ECA countries and territories (e.g. Tajikistan, Kyrgyzstan and Kosovo[35]) are strongly dependent on remittances, which make up to 100 percent of international reserves (World Bank, 2018a). Remittances also play important roles in the economies of Albania, Armenia, Bosnia and Herzegovina, Georgia, and Republic of Moldova. The breakdown of the inf low of remittances for the region recorded by the World Bank shows higher relative increases for Kyrgyzstan, Tajikistan and Turkey (Figure 23).

Money transfers from migrants also have been a major source of liquidity for the banking sectors of the Central Asian countries,[36] for which – as well as for receiving families – remittances are a source of investment. Although in some cases, such as in Kyrgyzstan, the potential of investment in agriculture from remittances is not fully achieved, the money may go to the procurement of additional livestock (mainly sheep), and this may have positive results for the rural households’ well-being and food security. This may have also sustainability implications, however, as many countries lack adequate feed supply and pasture management, leading to overgrazing of pasture and range land.

Contribution of remittances from the Russian Federation to Central Asian countries and Azerbaijan

Developments between 2014 and 2016 exposed the underlying economic vulnerability for migrants; the volatility of economic growth, conflicts, political tensions and sanctions led to a worsening of living standards for households with family members working abroad. This issue has been further exacerbated by insufficient policy and legislative provisions to accommodate returned migrants’ needs and to harness their potential to contribute to development in their communities and countries of origin. Between 2007 and 2016, a twofold increase in remittances was observed from the Russian Federation to the Central Asian countries and Azerbaijan, even though there was a sharp decline in 2014 due to a significant depreciation of the Russian rouble and an economic slowdown (Figure 24).

Contribution of remittances to national economies and rural development in selected countries of the ECA region

In the countries with a high level of emigration, it is possible to trace correlations between remittances and levels of poverty and undernourishment (PoU). The countries with an assessed high PoU (over five percent) do have a higher share of poverty, which decreases when supported by remittances. For example, in Kyrgyzstan, Republic of Moldova, Tajikistan and Uzbekistan, a correlation is seen between increases in remittances and reductions of povert y levels and improvements in food security and nutrition, as measured in terms of PoU (FAO, 2017b, Annex 1.1 and 1.2).

Significant contribution to national economy (GDP) in many ECA countries

Remittances are an important and stable source of income for many households in the countries of origin, especially in rural areas; they help to reduce monetary restrictions and overcome difficulties. Remittances contribute significantly to the GDP in Kyrgyzstan (35 percent), Tajikistan (31 percent) and Republic of Moldova (21 percent), as well as in Armenia (14 percent), Bosnia and Herzegovina (12 percent) and Georgia (12 percent) (Figure 25).

Significant role of remittances in rural development and food security

Remittance flows to rural areas are important, as they do benefit both the migrants’ households and the non-recipient ones through the multiplier effects of spending (Katseli, Lucas and Xenogiani, 2006). Remittances can increase access to (purchased) food and may have a consumption smoothing effect, reducing households’ vulnerability and improved food security (Thow, Fanzo and Negin, 2016). Recent studies have demonstrated that migration and remittances act as insurance against risk situations for destitute, vulnerable households.[37]

While in general, remittances to rural areas in Europe are lower than in other regions of the world, in Eastern European countries, the ratio of remittances to per-capita income is 60 percent in those communities in which the population is more than 35-percent rural. Some countries – such as Albania, Republic of Moldova and Romania – see over 50 percent of remittance flows going to rural areas. In Georgia, 48 percent of all remittances go to rural areas, while rural areas receive over 60 percent of all remittances sent to Azerbaijan (IFAD and FAO, 2008).

The impacts of remittances on agriculture are mixed and contextual

According to the World Bank, 78 percent of the world’s poor live in rural areas. Agriculture is the main source of income for over 40 percent of the population (World Bank, 2013, 2018i). Therefore, agriculture and rural development are crucial for poverty relief, for the provision of food security and better nutrition, and for reducing inequities and migratory pressures.

The impacts of remittances on agriculture are mixed and contextual. Evidence generated in some countries of the region (Kyrgyzstan and Tajikistan, for example) demonstrates that in some cases, remittances can compensate for the negative impacts of outmigration by allowing hired labour to replace the agricultural labour force lost. Alternatively, women left behind try to replace the labour force that has left. In other countries, remittances may reduce agricultural labour and production, for example by increasing non-farm activities and limiting people’s willingness to take on low-paid agricultural activities. Households that receive remittances may choose to spend their additional income on increased consumption, on investing in housing, education, health, and on entrepreneurial nonfarm activities or agricultural production. The positive effects depend on the type of investment (whether farm or non-farm) and on consumption patterns. Additional resources being invested in agricultural and non-agricultural production have a positive effect on both agricultural production and rural employment by increasing efficiency and creating new jobs. The additional resources also can be an incentive to developing business (Zezza, et al., 2011).

Developing programmes to facilitate investments of remittances for agriculture and rural development

Evidence and research generated in the region indicate that a large proportion of remittances is spent on food, housing and education, while a smaller share is spent on agriculture and rural development (LaCroix, 2010). While policies that encourage remittances to invest in agriculture and rural development are limited in the ECA region, programmes in Republic of Moldova and Tajikistan provide examples of promising practices (Box 10) that have emerged recently in the region (FAO, 2018h).

Case studies from Republic of Moldova and Tajikistan show how the management of financial f lows resulting from remittances can turn into investments, supporting agriculture and improving the livelihoods of rural populations. These are essential for keeping rural communities alive, as they create employment in the agrifood sector and reduce the pressure to migrate. This can, in turn, decrease unemployment and the pressure on the labour market. In this context, remittances play an important role in poverty reduction, improving food security and nutrition and contributing to sustainable agriculture and rural development.

Cross-sectoral partnerships and cooperation among sectors also are important. There are good examples of cooperation among FAO, UN Women and GIZ in a regional project on land rights in the Balkans and among FAO, the International Fund for Agricultural Development, UN Women and the World Food Programme on a joint programme in Kyrgyzstan. This latter project, in the area of rural women’s economic empowerment, led to rural women opting to stay in their villages instead of migrating in search of jobs.[38]

3.4 GENDER, YOUTH AND MIGRATION

Migration has profound and gender-differentiated impacts on rural communities. While positive and negative consequences of migration are examined in the previous sections of this report, greater emphasis is needed on exploring the transformative effects of migration on social and gender norms in rural areas, on changing gender roles, and on creating opportunities for women’s empowerment.[39]

Drivers for female migration and the share of female migration in the ECA region

Drivers of migration affect women differently than men

Although the drivers of migration may be similar, they affect women and men in rather different ways and to different extents. Women, especially from rural areas, might be particularly vulnerable to human rights abuses, exploitation, discrimination, and specific health and nutrition risks, due to lower educational levels and awareness. There also are contributing factors in terms of age, power within the family, children’s age, and the household’s ability to cope without the migrant in the origin countr y in terms of the availability of others to take on their activities.[40] The mobility of men and women is deeply intertwined with their roles and positions in the household. However, when it comes to food security, nutrition and family welfare, the decision-making process on labour migration may be a function of changes in intergenerational and gender dynamics within the household.

In addition to the most common drivers of migration, such as rural poverty, lack of employment opportunities and lack of access to social services and infrastructure, gender inequalities are considered as contributing to women’s decisions regarding migration. Women, and especially rural women, have limited access to information, knowledge and education, as well as to productive assets such as agricultural resources and inputs. For example, women own less than two percent of all land and represent only five percent of the clients of extension services worldwide. In the ECA region, women’s access to land and to extension services varies greatly but are around ten percent on average. Insecure land rights and informal agriculture, with limited access to social protection and services, may have profound impacts on women’s decisions to migrate across the ECA region. Women’s participation in decisionmaking, be it at the household and/or community level, is also often limited, as is their power to exercise control over productive assets such as land, equipment, transport and other resources. Based on recent food security and nutrition analysis, as reported in Section 1.2 of Part I, women are shown as having higher levels of severe food insecurity in the Caucasus, Central Asia, and European CIS, which may also point to significant open and hidden gender-based inequalities and discrimination. Clearly, greater attention from the side of policymakers and decisionmakers is needed to explore these issues and their relationships with improving food security and nutrition, as well as with improving rural development and safe migration.

Higher unemployment among youth and women in some countries of the ECA region is one of the main drivers of migration

Unemployment is considered one of the main drivers of migration. Remarkably, unemployment in the ECA region among young people 15 to 24 years of age (19.4 percent unemployment for women and 18.3 percent for men) is above the world average (15.6 percent for women and 13.1 for men), with wide variations among countries (Table 20). High unemployment rates among women and youth in the ECA region is one of the push factors for their migration.

The phenomenon of feminization of migration is growing in the ECA region

The phenomenon of feminization of migration is growing in the region, meaning that more and more women are migrating independently, rather than as family dependents, and are getting involved in sending remittances and supporting their families from abroad. This, in turn, is altering social and family dynamics and decision-making. As described in earlier sections, women in ECA comprise almost half of the region’s migrant population, but the proportion varies considerably by subregion and by country. In the Republic of Moldova and Ukraine, the majority of outmigrants, both internally and internationally, are women (60 to 65 percent). In Albania, women represent the majority among rural-to-urban migrants. In Armenia, Kyrgyzstan, Tajikistan and Uzbekistan, the face of labour migration is predominantly male (up to 90 percent in Tajikistan), but the share of women as labour migrants is growing (having increased from 10 to 15 percent in Tajikistan, for example, and up to 40 percent in Kyrgyzstan).

A review of the proportion of female migrants shows that there was an increasing trend of the share of female migrants across all regions in the world from 2000 to 2017 (Table 21). At 52 percent, Europe had the highest share of female migration in 2017. In the ECA region, several countries had a share of female migrants of over 50 percent ( Table 22).

Impact of migration on women and youth

Migration may have positive impacts, such as strengthening the economic well-being of young people and providing them with opportunities for upward social mobility. For young women, it can be a contributing factor to their empowerment, increasing their decision-making authority within families and communities and reinforcing equitable gender norms. At the same time, young women and men are particularly vulnerable to the risks associated with migration, whether internal or international, which can outweigh the economic benefits. Risks may be related to problems associated with accessing housing and services in the destination cities or at-risk coping mechanisms. Women, but also young men, are at risk of trafficking and sexual and labour exploitation; awareness of these issues, in addition to the existence of services targeting migrants, are limited in both sending and receiving countries.

Rural women, elderly and children left behind face particular challenges

Migration affects also families left behind – women, children and the elderly in the countries marked by male outmigration from rural areas ( Table 23).

Rural women left behind face particular challenges due to the fact that they suffer from a triple burden of responsibilities; in addition to work in the household and the household plot, they need to engage more and carry responsibilities for the family farm that do not necessarily lead to greater economic empowerment. They may face difficulty in accessing credit and inputs for farming, as observed in some remote areas in Central Asia from which men have migrated.

On the other hand, a review of the effects of migration for countries of origin shows that remittances do not automatically solve the negative impacts of migration on vulnerable groups of the population in all situations. In some countries, such as in Kyrgyzstan, Tajikistan and Uzbekistan, women and children left behind are particularly vulnerable, and policies and programmes need to consider that migration can contribute to strengthening practices such as polygamy that violate women’s rights. Migration also can overload women left behind, causing them to spend much more time on household chores, child care and working in family plots. It also can affect women who work and live in degrading conditions, in both the countries of origin and of destination. Policies and programmes need to undertake preventive measures and thorough gendered analysis to address these problems.[41]

Women form the majority of internally displaced persons (IDPs) and refugees in the region. In Turkey, nearly 70 percent of the 3.9 million Syrian refugees are women and children. In Ukraine, according to the Ministry of Social Policy, up to 70 percent of all IDPs in 2017 were women, children and the elderly. As estimated by the World Food Programme, 620 000 people in the affected areas were food insecure in 2016, and an additional 500 000 had little or no livelihoods. The number of food-insecure people in January 2018 was estimated at 1.2 million, almost doubled from 2016 (FAO, WFP, 2018).

This brief overview of the gender aspects of migration demonstrates the complexities and the need for further gendered analysis of migration and food-securit y issues for the sake of informing policymaking and development interventions in the ECA region.

3.5 RECOMMENDATIONS

This review of the main challenges and opportunities related to migration indicates how agriculture and rural development can be instrumental in addressing some of the drivers of migration by creating an enabling environment to harness the development potential of migrants, especially for reducing rural poverty, food insecurity, gender inequality and unemployment and for increasing social protection.

The ECA countries still need to build and update systems for regulating migration in the complex internal and international environment, because migration processes are based on legislation generally developed during the past two decades. These regulatory frameworks need to take into account more recent trends, such as the globalization and feminization of migration, the involvement of youth, and social and economic dimensions.

Support agriculture and rural development

Agriculture and rural development can address and prevent environmental degradation processes through sustainable management of natural resources, such as water, soil and pasture land. At the same time, by adopting a food systems approach, sustainable food and agriculture are key for improving related social and economic aspects, such as employment and inclusive economic development. Agriculture and rural development can contribute in addressing challenges associated with migration, combined with other efforts, including:

•  investment in food securit y and agriculture through gender-sensitive policies and practices that involve interventions focusing on income diversification and investments in inclusive value chains linked to sustainable agriculture; support to small- and medium-scale entrepreneurship;

•  communit y development; rural education and vocational training that matches labour market needs;

•  enhancing rural capacities to use remittances for investments in agriculture and in natural resource management;

•  reintegration of returnees in rural areas through the promotion of employment and entrepreneurship opportunities and assistance with property and land tenure rights; and

•  enabling access to social protection measures for migrant household members.

Mitigate the risks of migration for the most vulnerable

For stakeholders involved in agricultural and rural development and food security, increased attention should be placed on experiences gained from new and promising approaches to mitigating the risks of migration, focusing on women and targeted programmes and services in rural areas. These include:

•  involving women – and youth, both female and male – in development interventions as the agents of change who bring new knowledge, information and practices in rural areas;

•  using their activism as a strateg y to increase the voice of local women in decision-making in rural areas (based on experiences in Kyrgyzstan and Serbia), including local planning and budgeting and ensuring that programmes are accountable to rural women on issues relevant to rural development;

•  including women and youth migration issues in the capacity development of institutions and civil society organizations;

•  strengthening the role of women – and youth, both female and male – in the management systems of local authorities, water user associations, and pasture unions; and

•  engaging village women and youth organizations with local administration and lobbying for rights and services for women – and youth, both female and male – in rural areas.[42]

In particular, the migration of women and youth raises the need for improving social protection systems and access to education and health in destination countries, while return migration raises the need for creating an enabling environment for productive socio-economic reintegration of returning migrants in their countries of origin. It is also important to link female migrants with host country nationals to build cohesion and positive social change (based on the FAO-generated evidence in Turkey).

Facilitate strategic partnerships with rural stakeholders

Effective partnerships with civil society organizations, governments and the private sector are critical for broad implementation of the above directions, including large-scale social protection and social services needed by migrants, and, particularly, refugees. In particular, there is a growing demand for targeted services for rural women left behind and for migrant women facing gender-based violence; these services, in the form of shelters, call centers and health care, could be possible with private-sector partnerships. Services targeting women need to be improved, particularly in rural areas, with “mobile” services and with services at the district level that have the biggest impact on women in rural areas.

Develop a programmatic approach

Reintegration programmes, as in the Republic of Moldova, are needed for returnees in rural areas, including through employment, entrepreneurship and assistance with property and land rights. Along the migration cycle, FAO works in all stages to address the drivers of migration and to enhance the positive impacts of migration on agriculture and rural development.

Promote resilience and support for women’s empowerment in agriculture and food systems

With the feminization of migration and the vulnerability of children, elderly and disabled groups emerging as clear trends in the countries of the ECA region, the development of a sustainable and resilient agricultural sector and the achievement of food security are acquiring paramount importance. To this end, improving women’s access to resources, markets and services is essential. This demands that governments, international organizations, the business sector and civil society organizations work in cooperation towards creating a wide network of services that support rural women’s empowerment and address their needs.

Generate and disseminate knowledge

In view of the major knowledge gaps and data needs regarding the determinants, dynamics and consequences of migration, it will be important to generate and disseminate knowledge and evidence on the patterns, drivers and impacts of migration, including strengthening data collection, impact evaluation and operational research to support policymaking.

ANNEX

GLOSSARY

Anaemia

A haemoglobin concentration below a specified cutoff point, which can change according to age, sex, physiological status, smoking habits and living altitude. When anaemia comes on slowly, the symptoms are often vague and may include tiredness, weakness, shortness of breath or a poor ability to exercise.

Body mass index (BMI)

The ratio of weight to height, measured as the weight in kilograms divided by the square of the height in meters.

Dietary energy supply

An estimation of the amount of energy (kcal) in food available for human consumption during the reference period (a three-year average period). Percapita dietary energy supply is expressed in kcal per capita per day. Per-capita supplies represent only the average supply available for each individual in the population as a whole and do not indicate what is actually consumed by individuals.

Food insecurity

A situation that exists when people lack secure access to sufficient amounts of safe and nutritious food for normal growth and development and for an active and healthy life. It may be caused by the unavailability of food, insufficient purchasing power, inappropriate distribution, or an inadequate use of food at the household level. Poor health and sanitation conditions and inappropriate care and feeding practices are the major causes of poor nutritional status. Food insecurity may be chronic, seasonal or transitory.

Food security

A situation that exists when all people, at all times, have physical, social and economic access to sufficient, safe and nutritious food that meets their dietary needs and food preferences for an active and healthy life. Based on this definition, four food security dimensions can be identified: food availability, economic and physical access to food, food utilization, and stability over time. Food security is a necessary condition for healthy diets, and food environments strongly affect whether diets are healthy.

Hunger

In this report, hunger is defined as being synonymous with chronic undernourishment.

Import dependency ratio (IDR)

The ratio of the domestic food supply that has been imported, calculated as: IDR = (imports / (production + imports - exports) * 100. IDR takes into account the supply (quantity) of food groups, whatever its utilization, and not only what is destined for human consumption.

Internally displaced persons (IDPs)

People who have fled their homes or places of residence in search of safety but who have not crossed an international border. Unlike refugees, IDPs stay within their own country and remain under the protection of that country’s government, even if that government is the reason for their displacement.

Malnutrition

An abnormal physiological condition caused by inadequate, unbalanced or excessive consumption of macronutrients and/or micronutrients. Malnutrition includes undernutrition and overnutrition as well as micronutrient deficiencies.

Micronutrients

Vitamins, minerals and certain other substances that are required by the body in small amounts for normal physiological functions. They are measured in milligrams or micrograms.

Migrant

The International Organization for Migration defines a migrant as any person who is moving or who has moved across an international border or within a state away from his or her habitual place of residence, regardless of (1) the person’s legal status; (2) whether the movement is voluntary or involuntary; (3) the causes for the movement; or (4) what the length of the stay is.

Migration

The movement of a person or a group of persons, either across an international border or within a state. It is a population movement, encompassing any kind of movement of people, whatever its length, composition and causes; it includes the migration of refugees, displaced persons, economic migrants, and persons moving for other purposes, including for family reunification. The movement of people from one place to another and the intentions of settling in the new location can be either permanent or temporary. Migration can be further categorized as internal migration, where persons move to a new home within the same state, country or continent, and external migration, where persons move to a new home in a different state, country or continent. Labour migration refers to the movement of persons for the purpose of employment from one state to another or within their own country of residence.

Non-communicable diseases (NCDs)

These are also known as chronic diseases. They are not passed from person to person. They are long in duration and generally slow in progression. The most common diet-related NCDs are diabetes, cardiovascular disease and certain cancers.

Overnutrition

A form of malnutrition that refers to a chronic condition in which the intake of food is in excess of dietary energy requirements.

Overweight and obesity

Body weight that is above normal for height as a result of an excessive accumulation of fat. In children younger than five, overweight is defined as weight for length/height above +2 standard deviation scores relative to the WHO Child Growth Standards median, and obesity is defined as a weight for height above +3 standard deviation scores relative to the WHO Child Growth Standards median. In adults, overweight is defined as a BMI equal to or greater than 25, and obesity is defined as a BMI equal to or greater than 30.

Prevalence of undernourishment

A proportion of the total population in a condition of undernourishment, in other words people whose dietary energy consumption is continuously below the minimum requirement for maintaining a healthy life and carrying out light physical activity. The average amount of food available for human consumption per person, the level of inequality in access to that food, and the minimum number of kcal required for an average person are taken into account to estimate the prevalence of undernourishment.

Remittance

A transfer of money by a foreign worker to an individual in his or her home country. Money sent home by migrants is, along with international aid, one of the largest financial inflows to developing countries.

Stunting

Low height for age, reflecting a past episode or episodes of sustained undernutrition. In children younger than five, stunting is defined as length/height for age below -2 standard deviation scores relative to the WHO Child Growth Standards median.

Undernourishment

A state lasting for at least one year of inability to acquire enough food, defined as a level of food intake insufficient to meet dietary energy requirements. For the purposes of this report, hunger is defined as being synonymous with chronic undernourishment.

Undernutrition

The outcome of poor nutritional intake in terms of quantity and/or quality, and/or poor absorption and/ or poor biological use of nutrients consumed as a result of repeated disease. It includes being underweight for one’s age, too short for one’s age (stunted), dangerously thin for one’s height (wasted) and deficient in vitamins and minerals (micronutrient malnutrition).

Underweight

Low weight for age, reflecting a current condition resulting from inadequate food intake, past episodes of undernutrition, or poor health conditions. In children younger than five, underweight is defined as weight for age below -2 standard deviation scores relative to the WHO Child Growth Standards median. In adults, it is defined as a BMI of less than 18.5.

Wasting

Low weight for height, generally the result of weight loss associated with a recent period of inadequate caloric intake and/or disease. In children younger than five, wasting is defined as weight for length/ height below -2 standard deviation scores relative to the WHO Child Growth Standards median.

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NOTES

1  SDG1 – no poverty; SDG 5 – gender equality; SDG 6 – clean water and sanitation; SDG 12 – responsible production and consumption; SDG 13 – climate actions; SDG 15 – life on land; SDG 17 – partnerships for goals.

2  The following subregions of the ECA region and their corresponding countries are included in the report: Caucasus (3) - Armenia, Azerbaijan, and Georgia; Central Asia (5) - Kazakhstan, Kyrgyzstan, Tajikistan, Turkmenistan, and Uzbekistan; European Commonwealth of Independent States (CIS) (4) - Belarus, Republic of Moldova, Russian Federation, and Ukraine; Western Balkan countries and Turkey (6) - Albania, Bosnia and Herzegovina, Montenegro, Serbia, the former Yugoslav Republic of Macedonia, and Turkey; EU countries (28) - Austria, Belgium, Bulgaria, Croatia, Cyprus, Czechia, Denmark, Estonia, Finland, France, Germany, Greece, Hungary, Ireland, Italy, Latvia, Lithuania, Luxembourg, Malta, Netherlands, Poland, Portugal, Romania, Slovakia, Slovenia, Spain, Sweden, and United Kingdom; and European Free Trade Association (EFTA) countries (4) – Iceland, Liechtenstein, Norway, and Switzerland.

3  For more information and details, the FAO publication The State of Food and Agriculture 2010–11, specifically dedicated to issues of women in agriculture and closing the gender gap for development, can be visited at http://www.fao.org/publications/sofa/2010-11/en/

4  The reports examined include the following: Kazakhstan Multiple Indicator Cluster Survey (MICS) 2015 Final Report; Kyrgyzstan MICS 2014 Final Report; Kosovo MICS 2013-14 Final Report; Montenegro MICS 2013 Final Report; Serbia MICS 2014 Final Report; Turkmenistan MICS 2015 Final Report; Tajikistan Demographic and Health Survey (DHS) 2016 Final Report; Armenia DHS 2015-16 Final Report.

5  Ibid.

6  According to The World Bank Development Research Group. Data are based on primary household survey data obtained from government statistical agencies and World Bank country departments. Data for high-income economies are from the Luxembourg Income Study database. For more information and methodology, please see PovcalNet (iresearch.worldbank.org/PovcalNet/index.htm).

7  According to The World Bank Global Poverty Working Group. Data are compiled from official government sources or are computed by World Bank staff using national (i.e. country-specific) poverty lines, accessed via https://data.worldbank.org/indicator/SI.POV.NAHC?locations=RU-AM

8  A joint FAO/WHO Regional Symposium and initiative in collaboration with UNICEF and WFP, held December 2017 in Budapest, Hungary.

9  https://sustainabledevelopment.un.org/hlpf

10  https://sustainabledevelopment.un.org/hlpf/2017

11  Ministry of Agriculture of Georgia. 2015. Strategy for Agricultural Development in Georgia 2015–2020.

12  Ministry of Agrarian Policy of Ukraine. 2015. Single and Comprehensive Strategy and Action Plan for Agriculture and Rural Development in Ukraine 2020.

13  Presidential Decree No. 1235 of 2017.

14  State support and social assistance (amendment, federal law, 28 December 2017).

15  Concept on coordinated agro-industrial policy (2014), amended 2016–2018.

16  Resolution about the revision of food safety committee, 2018.

17  The Ministry of Health and Social Development announced that Kazakhstan will introduce a disease management programme in 2018, as one of the main directions of the state health development programme for 2016–2019 is the introduction of disease management programmes to prevent arterial hypertension, chronic heart failure and diabetes.

18  Decree on the establishment of a state commission for ensuring food security, 2018.

19  Presidential Decree No. UP-5303 of 2018.

20  The European Union is a political and economic union of 28 Member States that are located primarily in Europe.

21  The Eurasian Economic Union (EEU) is a political and economic union of states located primarily in northern Eurasia.

22  Afghanistan, Azerbaijan, the People's Republic of China, Georgia, Kazakhstan, the Kyrgyz Republic, Mongolia, Pakistan, Tajikistan, Turkmenistan, and Uzbekistan.

23  FAOSTAT food security and nutrition indicators. http://www.fao.org/economic/ess/ess-fs/ess-fadata

24  By United Nations Statistics Division classification (https://unstats.un.org/unsd/methodology/m49/): Eastern Europe contains Belarus, Bulgaria, Czechia, Hungary, Poland, Republic of Moldova, Romania, Russian Federation, Slovakia, and Ukraine; Northern Europe contains Åland Islands, Channel Islands, Denmark, Estonia, Faroe Islands, Finland, Iceland, Ireland, Isle of Man, Latvia, Lithuania, Norway, Svalbard and Jan Mayen Islands, Sweden, and United Kingdom; Southern Europe contains Albania, Andorra, Bosnia and Herzegovina, Croatia, Gibraltar, Greece, Holy See, Italy, Malta, Montenegro, Portugal, San Marino, Serbia, Slovenia, Spain, and the former Yugoslav Republic of Macedonia; and Western Europe contains Austria, Belgium, France, Germany, Liechtenstein, Luxembourg, Monaco, Netherlands, and Switzerland. Based on the same classification, Cyprus and Turkey are included in the Western Asia geographic grouping.

25  Extreme poverty is defined by the international community as a person earning less than USD 1.25 per day, as measured in 2005 international prices. Originally, the international poverty line was set at earning USD 1 per day, when the Millennium Development Goals were first published. The World Bank defines “extreme poverty” as living on less than USD 1.90 per person per day, as measured in 2011 international prices.

26  The Gini index measures the extent to which the distribution of income (or in some cases consumption expenditure among individuals or households) within the economy deviates from perfectly equal distribution. A Gini index of 0 represents perfect equality, while an index of 1 (or 100 %) implies perfect inequality.

27  WFP programmes in Armenia, Kyrgyzstan and Tajikistan. School meals programmes in the ECA region (Armenia, Kyrgyzstan and Tajikistan) are funded mainly by the Russian Federation and the Earth Group.

28  According to the World Bank classification of countries by income level at https://blogs.worldbank.org/opendata/new-country-classifications-income-level-2017-2018

29  Policy documents covering Europe as per the WHO classification, which lists the following as countries of Europe: Albania, Andorra, Armenia, Austria, Azerbaijan, Belarus, Belgium, Bosnia and Herzegovina, Bulgaria, Croatia, Cyprus, Czechia, Denmark, Estonia, Finland, France, Georgia, Germany, Greece, Hungary, Iceland, Ireland, Israel, Italy, Kazakhstan, Kyrgyzstan, Latvia, Lithuania, Luxembourg, Malta, Monaco, Montenegro, Netherlands, Norway, Poland, Portugal, Republic of Moldova, Romania, Russian Federation, San Marino, Serbia, Slovakia, Slovenia, Spain, Sweden, Switzerland, Tajikistan, the former Yugoslav Republic of Macedonia, Turkey, Turkmenistan, Ukraine, United Kingdom, and Uzbekistan.

30  The National Programme for Nutrition and Health Enhancing Physical Activity (HEPA) 2015–2025 Slovenia. http://www.mz.gov.si/

31  Germany, Russia, United Kingdom, France and Spain. World Bank, 2018.

32  United Nations Convention on Migrants’ Rights: International Convention on the Protection of the Rights of All Migrant Workers and Members of Their Families, entered into force on 1 July 2003; Conventions No. 97 and No. 143 and their accompanying recommendations, and the ILO’s instruments on fundamental principles and rights as well as – in principle – all other ILO standards; etc. (International Labour Office Geneva).

33  Adopted and re-developed from FAO (2016b) and LaCroix (2010).

34  Globally, remittance flows are estimated at USD 616 billion (2018), of which around USD 451 billion was directed to developing countries, representing nearly three times the total amount of official development assistance (World Bank, KNOMAD, 2016 and 2017).

35  Kosovo as per the United Nations Security Council Resolution 1244 (1999) on the situation relating to Kosovo.

36  The costs of sending remittances from the Russian Federation to other CIS countries are among the lowest in the world, which has encouraged the use of formal channels (UNDESA, 2017).

37  Patterns of Migration in Central Asia and Azerbaijan. Background Paper. FAO Subregional Office for Europe and Central Asia. Ankara, 2018 (forthcoming); LaCroix, 2010; World Bank. 2016. Migration and Remittances: Recent Developments and Outlook. Migration and Development Brief No. 26. KNOMAD; World Bank. 2017. Migration and Remittances: Recent Developments and Outlook. Migration and Development Brief No. 27. KNOMAD.

38  FAO, Regional Office for Europe and Central Asia, 2018. Summary of the discussions held at the side event on rural women, migration and agriculture, Thirty-first Session of the FAO Regional Conference for Europe, 2018 (FAO, 2018g).

39  Limited evidence exists on the direct impact of male outmigration on women’s empowerment in the countries of the region. However, a case study of Tajikistan is coming up as a result of the World Bank/FAO collaboration.

40  Sources: KNOMAD, Understanding Women and Migration: A Literature Review; Working Paper #8, February 2016; Women on the move: Migration, gender equality and the 2030 Agenda for Sustainable Development, Tam O’Neil, Anjali Fleury and Marta Foresti, July 2016.

41  Significant literature is produced in the region documenting this phenomenon in the countries of the region. To mention a few: Bock, B. Gender and rural globalization: international perspectives on gender and rural development (2017), CAB International; FIDT, Kyrgyzstan. Women and children from Kyrgyzstan affected by migration. An exacerbated vulnerability, September 2016, N 675a., and many others.

42  FAO, Regional Office for Europe and Central Asia, 2018. Summary of the discussions held at the side event on rural women, migration and agriculture, Thirty-first Session of the FAO Regional Conference for Europe, 2018 (FAO, 2018g).