Nutrition-sensitive agriculture programme impacts women’s mental health via food security in rural Bangladesh

INTRODUCTION: Food insecurity and malnutrition, as well as poor mental health, negatively impact millions of people worldwide and can reinforce each other, compounded by gender inequity. Nutrition-sensitive agriculture interventions have the potential to improve these simultaneously. We analysed the impact of a homestead food production (HFP) programme on women's mental health, including pathways through food insecurity, women's empowerment and dietary diversity. METHODS: The Food and Agricultural Approaches to Malnutrition cluster-randomised trial allocated 96 settlements in northeastern Bangladesh 1:1 to a HFP programme, implemented 2015-2018, and control. Data were collected at baseline in 2015, at endline in 2019/20 and continuously through a surveillance system. Depressive symptoms were assessed using the Edinburgh Postpartum Depression Scale (EPDS). We quantified the intervention's impact on depressive symptoms at endline, analysing data from 2513 women using multilevel regression. We also examined whether that effect was mediated by household food security, women's empowerment and women's dietary diversity, using sequential mediation analysis with cluster-bootstrapped standard errors, adjusting for baseline covariates. RESULTS: At baseline, 39% of households were severely food insecure and 69% of women did not have minimally diverse diets. At endline, 38% of women in the control and 32% in the intervention arm screened positive for depressive symptoms (EPDS≥12). The intervention reduced the odds of depressive symptoms by 23% (OR 0.77, p=0.03). There was no evidence that the combined pathway reduced depression (OR 0.95, p=0.24). When decomposed, food security was responsible for one-third of the total effect (OR 0.92, p=0.01). Most of the intervention effect on depression was through other pathways (OR 0.81, p=0.08). CONCLUSIONS: On average, intervention participants had better mental health 1 year after the programme ended, with some of the effect mediated by increased food security. There are likely other pathways through which nutrition-sensitive agriculture can improve mental health, such as social protection and income, which may act synergistically. TRIAL REGISTRATION NUMBER: NCT02505711.