Chapter 04

Strategies to integrate gender into food and health systems actions

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Chapter 4 of 10
Contents
4.1 Share section

Key findings

  • Gender norms and power relations shape how climate change affects nutrition outcomes through food and health systems. Women’s roles in food production, food preparation, caregiving and healthcare‑seeking are central to household nutrition, yet persistent inequities in access to land, inputs, income, information and services constrain their ability to cope with climate stress and shocks.
  • Climate change acts as a vulnerability multiplier, intensifying existing gendered risks to nutrition and health. Economic losses, increased food insecurity, higher care burdens and disrupted access to essential health and nutrition services have disproportionately affected women, particularly during pregnancy and lactation, reinforcing cycles of malnutrition and intergenerational disadvantage.
  • Women’s agency in food systems and health systems has been closely linked to improved nutrition, health and resilience outcomes. Greater control over resources, income and decision‑making has supported more diverse diets, increased use of preventive and curative health services and stronger adaptive capacity, while collective action through groups and cooperatives has amplified these gains.
  • Integrated strategies that place gender equity at the centre of climate‑resilient nutrition action, such as gender‑responsive social protection, health system‑embedded nutrition interventions and equitable access to climate information and services, have been better positioned to deliver co‑benefits across food systems, health systems and nutrition. Approaches that address women’s agency across production, consumption and care pathways have strengthened both resilience and equity under climate stress.

If you would like to know more about any of the terms used in this chapter, you can visit the report glossary.

This chapter applies a gender lens to climate, food and health systems. It examines women’s roles as agents of change and discusses how climate change amplifies gendered nutrition and health risks. It also explores strategies for integrating gender equity into food and health systems actions.

4.2 Share section

Why gender matters for food and health systems within climate change

Equity is a foundational principle for fair and resilient food and health systems. Nutrition outcomes are influenced by multiple, intersecting dimensions of inequity, including income, gender, geography, age, ethnicity, disability, vulnerability and displacement status. [1] These factors affect who has access to nutritious foods, high-quality health services and social protection, as well as the capacity to cope with shocks. Within this broader equity landscape, gender plays a strategic role. Gender norms and power dynamics influence decision-making and control over resources in households, markets and public programmes.[2][3]

Women contribute to food and health systems through farming and livestock work, processing and preparation, dietary management, caregiving and healthcare-seeking.[4] Structural constraints limit women’s access to resources such as land, finance, inputs, information, technology and formal decision spaces, affecting their income, access to nutritious foods and ability to cope with climate shocks.[5][6] Climate change increases exposure to these barriers by raising time and labour burdens, elevating the danger of displacement, reducing and destabilising incomes, disrupting food availability and interrupting service delivery.[7][8] In this sense, climate change affects women through two pathways: production (production and earnings) and consumption and care (dietary quality, feeding practices and service use).

Placing gender equality at the heart of climate-resilient nutrition strategies offers an opportunity to achieve multiple goals at once. Yet, this requires explicit gender actions across sectors. Governments and implementation partners can adopt multiple strategies to achieve gender equity: secure women’s land and asset rights[9]; target extension and climate information to women farmers[10]; design credit and input support that women can easily access[11]; reduce unpaid care burdens through water, sanitation and hygiene, energy access and childcare[12]; ensure social protection transfers reach women and are usable during shocks (including digital and last-mile options);[13][14] and maintain access to nutrition and health services through outreach and community delivery when facilities become inaccessible.[15]

4.3 Share section

How climate change amplifies gendered nutrition and health risks

Climate change acts as a vulnerability multiplier, intensifying the structural and social inequities that women already face in agri-food and health systems. Women working in agriculture and food value chains experience discrimination and are often restricted to lower-paid, more precarious roles with limited access to productive resources.[16] These constraints reduce their ability to adopt climate-resilient practices and recover from climate-related shocks.[17] Evidence shows that climate shocks disproportionately affect women’s incomes, assets and food security, especially in female-headed households. Income losses from heat stress, floods and droughts tend to be larger and longer lasting for women, undermining their ability to maintain adequate diets and invest in health and nutrition. Women’s assets are often the first to be sold during crises, weakening long-term resilience and perpetuating cycles of vulnerability.

These economic impacts intersect with inequities in women’s nutritional status and access to health services. Women’s higher physiological needs during adolescence, pregnancy and lactation make them more sensitive to food shortages, heat stress and infectious diseases,[18] yet access to essential health and nutrition services remains uneven. In low- and middle-income countries, women from the poorest households are less likely to receive the recommended number of antenatal care visits. Additionally, out-of-pocket healthcare expenses make up a significant portion of maternal health spending, creating barriers to continuous care. Meanwhile, anaemia and micronutrient deficiencies are widespread: approximately two-thirds of women of reproductive age globally have at least one micronutrient deficiency,[19] and in several regions about half of women are anaemic.[20][21] Climate-related shocks increase demand for health and nutrition services while simultaneously disrupting service delivery, further widening access-to-care gaps for women. Malnutrition reduces women’s ability to cope with climate stressors and their work capacity, increasing risks for both maternal and child health and reinforcing intergenerational cycles of disadvantage.[22][23]

Unpaid care and domestic work further limit women’s adaptive capacity. Women bear most caregiving and household responsibilities, including childcare, food preparation and collection of water and fuel.[24] These tasks become more time consuming and labour intensive under climate stress.[25] Increased care burdens reduce women’s time for income-generating activities, participation in training or collective action and use of health and nutrition services, with direct consequences for well-being.[26] This creates a critical barrier: even when climate information, agricultural extension services or health services become available, women may be unable to access them.

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Women as agents of change

In this report, agency is defined as the ability of individuals to make choices and act on them, and to have a voice in social, economic and policy decisions.[27] The Food and Health Systems for Equitable Nutrition (FHEN) Framework presented in this report positions women as key agents of change, recognising that women’s agency operates differently across food systems and health systems, and that climate change compounds existing constraints on this agency.

In food systems, women’s agency involves their ability to make decisions across the production-to-consumption continuum, including deciding what to grow, which technologies and inputs to use, when and where to sell and how to control income from these choices. It also influences household decisions about food purchase, storage and allocation. Limitations in agency manifest as unpaid or poorly paid labour and reduced control over crops, technologies or sales.[28] Within climate change, these constraints deepen. Climate impacts on crops and livestock reduce yields and labour returns, increase post-harvest losses and disrupt local food markets, raising price volatility and limiting access to nutrient-rich foods.[29] Women’s unpaid work often increases during crises, particularly water and fuel collection and caregiving, further restricting their time for farming, market participation and decision-making.[30] At the household level, climate stress tends to push consumption towards less expensive staples and nutrient-dense foods are the first to be cut.

In health systems, women’s agency determines whether and when they use services and how well they can adhere to treatment recommendations. Within many contexts, patriarchal norms and gendered power dynamics restrict women’s mobility, control of cash and decision-making about seeking care.[31] These constraints often lead to delays in or forgoing of essential services, including antenatal and postnatal care, facility delivery, contraception, immunisation visits for children and screening and care for undernutrition and anaemia. Restrictions are enforced through everyday mechanisms: needing permission to leave home, lack of funds for transport or fees, limits on phone ownership and access to health information, fear of stigma and low bargaining power within households.[32] Under climate stress, these barriers intensify. Transport costs rise, time away from work or care becomes harder to manage and women have less control over spending and travel choices, resulting in delays in seeking care and weaker adherence to nutrition and health interventions.[33]

Critically, constraints on agency in food systems and health systems are interconnected. When women lack control over agricultural income or food purchases, they cannot prioritise nutritious foods for themselves and their families, increasing malnutrition risks that require health system intervention. Conversely, when women cannot access health services for family planning, antenatal care or treatment of illness, their capacity for productive work in food systems diminishes. Climate change exacerbates both dimensions simultaneously, creating compounding effects on nutrition outcomes.

4.5 Share section

Evidence of the benefits of women’s empowerment

Despite these constraints, strong evidence demonstrates that women’s empowerment generates substantial benefits for their well-being, as well as climate resilience, nutrition, health and food system performance. When women have greater agency over agricultural decisions and household resources, agri-food systems become more diverse, productive and resilient, with positive effects on diets and nutrition.[34] These gains also strengthen health system effectiveness, as improved food security and dietary quality increase the impact of nutrition and health interventions delivered through routine services.

Closing gender gaps in access to land, inputs, finance, information and markets has been shown to increase farm productivity, promote crop and livestock diversification and improve dietary diversity at the household level.[35][36][37] Women’s decision-making power is consistently linked to greater allocation of resources to nutritious foods, healthcare and education, leading to better nutrition outcomes throughout the life-course and increased demand for preventive and curative health and nutrition services. This creates a positive feedback loop: better-nourished women and children are more productive in food systems and make more effective use of health services, and stronger health systems can better support women’s participation in food systems through reproductive health services, nutrition counselling and treatment of illness that would otherwise impair work capacity.

Collective action is particularly important. Women’s participation in savings groups, cooperatives and producer organisations strengthens their empowerment and increases access to credit, social capital and information, enabling women to invest in climate-resilient practices and small enterprises.[38][39] These mechanisms also provide platforms for addressing structural barriers, including limited bargaining power and restricted access to markets and services, and for strengthening linkages between communities and local health systems through outreach, information sharing and service uptake. When women’s groups connect with health system community platforms, they can facilitate healthcare-seeking behaviour, support adherence to nutrition interventions and provide peer support for optimal feeding practices.

Empowering women as economic and social actors strengthens food systems and in turn supports health system performance by increasing effective uptake of preventive and curative services, improving continuity of care and adherence to nutrition interventions across the life-course and strengthening community-based delivery and referral systems.

4.6 Share section

Entry points for integrated gender, climate and nutrition action

Evidence from policies and programmes points to several practical entry points for integrating gender equality, climate action and nutrition, with shared benefits across food systems and health systems.

Gender-responsive social protection is a key mechanism. Cash transfers, food vouchers, school feeding and public works programmes designed to reach women and account for their specific constraints can protect healthy diets during climate shocks while supporting long-term resilience.[40] When linked to local food production and women farmers, these programmes strengthen agri-food systems and livelihoods.[41][42] They also improve access to essential health and nutrition services during stressful times by stabilising household resources and reducing financial barriers to care.

Nutrition interventions can support climate resilience when designed with a gender perspective and embedded within health systems. Access to micronutrient supplements for women and adolescent girls can improve nutritional status and decrease vulnerability to climate-related health stressors, particularly during pregnancy and lactation.[43] Integrating such interventions into regular healthcare services, including antenatal, postnatal and adolescent health programmes, reinforces the role of health systems as frontline providers of climate-resilient nutrition.

Access to climate information, early warning systems and risk management tools is another critical entry point. When these services are combined with fair access to land and sufficient agency, they improve decision-making and support quicker recovery from shocks among women farmers.[44][45] Early warning systems can also trigger social protection responses and help pre-position health commodities to safeguard nutrition and health during climate emergencies. Similarly, insurance products and financial services that consider women’s preferences and constraints can narrow gender gaps in uptake and impact, safeguarding incomes and reducing reliance on harmful coping strategies that hinder nutrition and health.[46] Value chain interventions that support women beyond primary production, including processing, storage and marketing, offer additional opportunities. By improving women’s access to technology and infrastructure, including markets, these initiatives can raise incomes, reduce post-harvest losses and increase the availability of nutritious foods, particularly in underserved areas, while alleviating pressure on health systems by reducing nutrition-related disease burdens.[47][48]

Integrating gender-responsive social protection interventions into regular healthcare services, including antenatal, postnatal and adolescent health programmes, reinforces the role of health systems as frontline providers of climate-resilient nutrition.

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Footnotes

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