Intended for healthcare professionals


Food security, gender, and sexual and reproductive health and rights: a fragile golden thread

BMJ 2022; 379 doi: (Published 28 October 2022) Cite this as: BMJ 2022;379:o2599
  1. Traci L Baird, president and chief executive officer1,
  2. Kent Buse, director2
  1. 1EngenderHealth, Washington, DC, USA
  2. 2Healthier Societies Programme, George Institute for Global Health UK, Imperial College London, London, UK

The global conversation about food security must incorporate a gender lens, argue Traci L Baird and Kent Buse

On 7 October 2022, it was reported that the UN Committee on World Food Security had been foiled in finalising a global consensus document by the representatives of a handful of governments (including China, Egypt, Indonesia, and Russia) who objected to its language about gender.1 The irony? The document in question is the CFS Voluntary Guidelines on Gender Equality and Women’s and Girls’ Empowerment in the Context of Food Security and Nutrition, and its purpose is “to advance gender equality, women’s and girls’ rights, and women’s empowerment as part of their efforts to eradicate hunger, food insecurity, and malnutrition.”2

Some of the language that the dissenting governments contested is already agreed in other UN documents, such as the UN General Assembly Political Declaration on HIV/AIDS (2016). Terms now deemed objectionable by this small number of governments include “sexual and gender based violence” and “sexual and reproductive health and reproductive rights.” This is not the first time some of these governments have objected to language around gender and sexual health and rights in global outcome documents—similar challenges were raised at the World Health Assembly in May 2022.3

Policy makers, researchers, and advocates working in global health and development know that every thematic area of human development, including food security, must acknowledge and tackle the current reality of gender inequality to be effective and equitable. The sustainable development goals (SDGs) recognise that SDG 5 (gender equality) connects to SDGs related to zero hunger, good health and wellbeing, quality education, climate action, and more.4

Gender dynamics and food insecurity

In the case of food security, women and girls are widely acknowledged to be more at risk of poor nutrition.5 Women whose nutritional status is compromised have greater risks in pregnancy, leading to poor infant health and ongoing health risks for the child into their adolescence and reproductive years. Without good nutritional health, girls struggle in school, limiting their education and future employment opportunities, which contribute to greater risks of unplanned pregnancy, gender based violence, and poorer reproductive health.6 When women’s nutrition suffers, we see increased infant and maternal mortality and worse health outcomes for the whole family. Gender disparities in healthcare access, nutritional status, educational attainment, and the ability to live free of violence connect to and compound each other, and the impact on women, girls, and gender minorities multiplies.

The growing crisis of food insecurity can only be solved with the full participation of women, at all levels. Women are often responsible for ensuring that the nutritional needs of their family are met, forcing them to navigate unequal transactions and fraught power relationships as they make decisions and try to access information and resources. They negotiate these relationships with men in their family and with suppliers and traders. They also navigate the health and social service systems designed to support nutrition—which are rarely designed to be responsive to gender dynamics. They contend with powerful social and economic forces in their response to the marketing and promotion of food and in relation to their sense of self-worth and agency in the face of patriarchal norms governing their varied roles in food systems, from farm to fork to clinic. When women lack the resources, power, and rights to access nutritional food or supplements for their families, they, their children, and societies more broadly bear the burden.

The interconnectedness of food security and nutrition, gender, sexual and reproductive health and rights, and education is not a new concept. Twenty years ago, Ruth Oniang’o and Edith Mukudi, in their brief on nutrition and gender, noted that “efforts to improve women’s nutrition status will be most powerful if undertaken in conjunction with public policies and programs that aim to improve the status of women and to address gender inequalities.”7 This should include the leadership of women in the agriculture and food systems—where women typically work locally and are under-represented in leadership positions.8

Accelerating progress

The lack of progress in two decades is unforgivable. Fortunately, there are beacons of hope. Initiatives such as the Gender-Transformative Framework for Nutrition, led by a coalition of Canadian agencies, provides the global health and development sector with a useful approach to follow. Its intersectional model takes more than gender into account, tackling areas such as disability, migration, race, and sexuality, and can be incorporated by governments, donors, implementing agencies, and communities.9 The US government’s global food security strategy includes “increased gender equality and female empowerment” as a combined goal and suggests specific activities that incorporate gender differentiated needs and norms to work towards progress.10 Africa’s Food Systems Forum has a thematic platform focusing on women in agriculture that seeks to resolve problems within nutrition and financing (

Other initiatives, such as Global Food 50/50, use greater transparency and accountability to accelerate progress on gender equality across food systems. Based on the Global Health 50/50 model, which has improved accountability in the health sector,11 the initiative’s 2022 report reviews the gender related policies and practices of 51 organisations working on food security.12 Released in October 2022, the report found that some advances have been made since 2021, but there has generally been limited progress among these organisations in becoming more diverse and equitable in their leadership, programme design, and governing boards. Until the organisations that are funding and implementing food security programmes are themselves gender equal and support the full participation and leadership of women, it is hard to believe that their programmes will be gender responsive or effective in solving food insecurity.

Equitable food systems that serve all of humanity demand a set of urgent, interlinked actions. We urge governments, organisations, and all parties supporting the transformation of food systems to commit to two key principles. Firstly, to recognise the universality of women and girls’ rights, including at the critical intersection of food security and gender, sexual, and reproductive health and rights. And, secondly, to support the existing terminology on gender, equality, and rights for women and girls that has been agreed in previous global declarations, covenants, and treaties.

Next, they should support the following actions:

  • For organisations and people holding power and privilege in systems of food security: confront systems and structures of inequitable power distributions, including who gets to the table and whose voice is heard at the table—in kitchens, executive rooms, and boardrooms. This includes implementing policies and interventions that support the career progression and leadership of women and under-represented groups. This should be combined with a multisectoral approach to decision making spaces that ensures the right to participation.

  • For civil society: promote an advocacy coalition that brings food security and sexual and reproductive rights groups together for integrated advocacy and action.

  • For programmes and academics: design programmes to be gender transformative and measure and report on their outcomes.13 Generate evidence of need, resource allocation, and impact. Collect, analyse, disseminate, and act on gender disaggregated data to inform gender responsive and intersectional programming and ensure progress and accountability.

  • For all parties involved in food security and sexual and reproductive health and rights: start with yourselves by prioritising and living principles around equality and inclusion. Query and evolve your own gender assumptions and biases through processes such as training in gender equality and social inclusion.14

Regardless of the challenges involved in finalising UN consensus agreements, we must advance gender equality and women’s and girls’ health and rights if we are to succeed in efforts to eradicate hunger, food insecurity, and malnutrition.


  • Competing interests: K Buse is co-director of Global Health 50/50, which co-publishes the Global Food 50/50 report.

  • Provenance and peer review: Not commissioned; not peer reviewed.