On The Choice and Impacts of Innovative International Food Assistance Instruments

The rise of new food assistance instruments, including local and regional procurement, cash, and vouchers, has surpassed increase in understanding of the tradeoffs among and impacts of these options relative to traditional food aid. Response choices rarely appear to result from systematic response analyses. Further, impacts along multiple dimensions-timeliness, cost-effectiveness, local market effects, recipient satisfaction, food quality, impact on smallholder suppliers, etc.-may be competing or synergistic. No single food assistance tool is always and everywhere preferable. A growing body of evidence, including the papers in this special section, nonetheless demonstrates the clear value-added of new food assistance instruments. (C) 2013 Elsevier Ltd. All rights reserved.

Dietary Intakes of Children From Food Insecure Households

The objective of this cross-sectional study is to compare the dietary behaviors of children from low food secure (LFS) households with children from very low food secure (VLFS) households over an entire day, and during meals specifically consumed at home —breakfast, snack, and dinner. Parents of the recruited children completed a demographic questionnaire, along with USDA's 6-item short form food security questionnaire. Children completed 24-hour dietary recalls in person. Complete data from 102 children 9 to 12 years old were used. Using ANOVA to assess the differences among groups in intakes over an entire day and during meals consumed at home, no significant differences were found, except for vitamin C intake during breakfast. Based on the definitions of LFS and VLFS, it was hypothesized that children from VLFS group would have lower dietary intakes compared to children from the LFS group. However, this study found little difference. Speculations have been made for these findings and implications for research have been presented.

Advancing Childhood Food Security through Organizing Strategies

This paper focuses on a project developed in Texas that utilizes community organizing strategies to advance childhood food security. With a dual focus on organizing policymakers and local communities, The Texas Hunger Initiative provides an example of an organizing project with the goal of ending childhood food insecurity in Texas.

Soda Consumption Among Food Insecure Households with Children: A Call to Restructure Food Assistance Policy

The nutritional problems of food insecurity and obesity co-exist among low-income children. As the reauthorization of SNAP approaches in 2012, it is time to consider the dietary intake of food insecure children and how the SNAP program can assist with improving the nutrition of low-income children, in addition to contributing to reducing the prevalence rates of childhood obesity among food insecure households with children.

Food crop diversification as a risk mitigating strategy during conflict : evidence from Cote d'Ivoire

This study examines the significance of food crop diversification as a household risk mitigating strategy to achieve "self-sufficiency" to ensure food security during the civil conflict in Cote d’Ivoire. The main motivation for seeking self-sufficiency stems from the fact that during the period of heightened tension due to conflict, the north–south divide set by the UN peacekeeping line disrupted the agricultural supply chain from the food surplus zone, Savane in the north. While we theoretically predict a positive effect on crop diversification because of interrupted food supply chain, we also consider a negative effect due to the covariate shocks. We find robust and statistically significant empirical outcomes supporting such claims. The baseline outcomes withstand a series of robustness checks. The net effect of conflict on crop diversification is positive but not statistically significant. In addition, we find that increasing vulnerability to poverty and food insecurity during conflict seems to be the underlying factors that motivate farm households to adopt such coping strategies.

Analysis of the impact of globalization and economic growth on food security in developing countries

A pesar de los importantes avances en la reducción del hambre, la seguridad alimentaria continúa siendo un reto de dimensión internacional. La seguridad alimentaria es un concepto amplio y multidimensional, cuyo análisis abarca distintas escalas y horizontes temporales. Dada su complejidad, la identificación de las causas de la inseguridad alimentaria y la priorización de las medias para abordarlas, son dos cuestiones que suscitan un intenso debate en la actualidad. El objetivo de esta tesis es evaluar el impacto de la globalización y el crecimiento económico en la seguridad alimentaria en los países en desarrollo, desde una perspectiva macro y un horizonte temporal a largo plazo. La influencia de la globalización se aborda de una manera secuencial. En primer lugar, se analiza la relación entre la inversión público-privada en infraestructuras y las exportaciones agrarias. A continuación, se estudia el impacto de las exportaciones agrarias en los indicadores de seguridad alimentaria. El estudio del impacto del crecimiento económico aborda los cambios paralelos en la distribución de la renta, y cómo la inequidad influye en el comportamiento de la seguridad alimentaria nacional. Además, se analiza en qué medida el crecimiento económico contribuye a acelerar el proceso de mejora de la seguridad alimentaria. Con el fin de conseguir los objetivos mencionados, se llevan a cabo varios análisis econométricos basados en datos de panel, en el que se combinan datos de corte transversal de 52 países y datos temporales comprendidos en el periodo 1991-2012. Se analizan tanto variables en niveles como variables en tasas de cambio anual. Se aplican los modelos de estimación de efectos variables y efectos fijos, ambos en niveles y en primeras diferencias. La tesis incluye cuatro tipos de modelos econométricos, cada uno de ellos con sus correspondientes pruebas de robustez y especificaciones. Los resultados matizan la importancia de la globalización y el crecimiento económico como mecanismos de mejora de la seguridad alimentaria en los países en desarrollo. Se obtienen dos conclusiones relativas a la globalización. En primer lugar, los resultados sugieren que la promoción de las inversiones privadas en infraestructuras contribuye a aumentar las exportaciones agrarias. En segundo lugar, se observa que las exportaciones agrarias pueden tener un impacto negativo en los indicadores de seguridad alimentaria. La combinación de estas dos conclusiones sugiere que la apertura comercial y financiera no contribuye por sí misma a la mejora de la seguridad alimentaria en los países en desarrollo. La apertura internacional de los países en desarrollo ha de ir acompañada de políticas e inversiones que desarrollen sectores productivos de alto valor añadido, que fortalezcan la economía nacional y reduzcan su dependencia exterior. En relación al crecimiento económico, a pesar del incuestionable hecho de que el crecimiento económico es una condición necesaria para reducir los niveles de subnutrición, no es una condición suficiente. Se han identificado tres estrategias adicionales que han de acompañar al crecimiento económico con el fin de intensificar su impacto positivo sobre la subnutrición. Primero, es necesario que el crecimiento económico sea acompañado de una distribución más equitativa de los ingresos. Segundo, el crecimiento económico ha de reflejarse en un aumento de inversiones en salud, agua y saneamiento y educación. Se observa que, incluso en ausencia de crecimiento económico, mejoras en el acceso a agua potable contribuyen a reducir los niveles de población subnutrida. Tercero, el crecimiento económico sostenible en el largo plazo parece tener un mayor impacto positivo sobre la seguridad alimentaria que el crecimiento económico más volátil o inestable en el corto plazo. La estabilidad macroeconómica se identifica como una condición necesaria para alcanzar una mayor mejora en la seguridad alimentaria, incluso habiéndose mejorado la equidad en la distribución de los ingresos. Por último, la tesis encuentra que los países en desarrollo analizados han experimentado diferentes trayectorias no lineales en su proceso de mejora de sus niveles de subnutrición. Los resultados sugieren que un mayor nivel inicial de subnutrición y el crecimiento económico son responsables de una respuesta más rápida al reto de la mejora de la seguridad alimentaria. ABSTRACT Despite the significant reductions of hunger, food security still remains a global challenge. Food security is a wide concept that embraces multiple dimensions, and has spatial-temporal scales. Because of its complexity, the identification of the drivers underpinning food insecurity and the prioritization of measures to address them are a subject of intensive debate. This thesis attempts to assess the impact of globalization and economic growth on food security in developing countries with a macro level scale (country) and using a long-term approach. The influence of globalization is addressed in a sequential way. First, the impact of public-private investment in infrastructure on agricultural exports in developing countries is analyzed. Secondly, an assessment is conducted to determine the impact of agricultural exports on food security indicators. The impact of economic growth focuses on the parallel changes in income inequality and how the income distribution influences countries' food security performance. Furthermore, the thesis analyzes to what extent economic growth helps accelerating food security improvements. To address the above mentioned goals, various econometric models are formulated. Models use panel data procedures combining cross-sectional data of 52 countries and time series data from 1991 to 2012. Yearly data are expressed both in levels and in changes. The estimation models applied are random effects estimation and fixed effects estimations, both in levels and in first differences. The thesis includes four families of econometric models, each with its own set of robustness checks and specifications. The results qualify the relevance of globalization and economic growth as enabling mechanisms for improving food security in developing countries. Concerning globalization, two main conclusions can be drawn. First, results showed that enhancing foreign private investment in infrastructures contributes to increase agricultural exports. Second, agricultural exports appear to have a negative impact on national food security indicators. These two conclusions suggest that trade and financial openness per se do not contribute directly to improve food security in development countries. Both measures should be accompanied by investments and policies to support the development of national high value productive sectors, to strengthen the domestic economy and reduce its external dependency. Referring to economic growth, despite the unquestionable fact that income growth is a pre-requisite for reducing undernourishment, results suggest that it is a necessary but not a sufficient condition. Three additional strategies should accompany economic growth to intensifying its impact on food security. Firstly, it is necessary that income growth should be accompanied by a better distribution of income. Secondly, income growth needs to be followed by investments and policies in health, sanitation and education to improve food security. Even if economic growth falters, sustained improvements in the access to drinking water may still give rise to reductions in the percentage of undernourished people. And thirdly, long-term economic growth appears to have a greater impact on reducing hunger than growth regimes that combine periods of growth peaks followed by troughs. Macroeconomic stability is a necessary condition for accelerating food security. Finally, the thesis finds that the developing countries analyzed have experienced different non-linear paths toward improving food security. Results also show that a higher initial level of undernourishment and economic growth result in a faster response for improving food security.

Evaluating sustainability and food security of peasant farming systems in Mesoamerican highlands

En las últimas décadas, la agricultura sostenible ha sido objeto de gran interés y debate académico, no sólo en términos conceptuales, sino también en términos metodológicos. La persistencia de la inseguridad alimentaria y el deterioro de los recursos naturales en muchas regiones del mundo, ha provocado el surgimiento de numerosas iniciativas centradas en revitalizar la agricultura campesina así como renovadas discusiones sobre el rol que juega la agricultura como motor de desarrollo y principal actividad para alivio de la pobreza. Por ello, cuando hablamos de evaluar sistemas campesinos de montaña, debemos considerar tanto la dimensión alimentaria como las especificidades propias de los sistemas montañosos como base fundamental de la sostenibilidad. Al evaluar la contribución que han hecho alternativas tecnológicas y de manejo en la mejora de la sostenibilidad y la seguridad alimentaria de los sistemas campesinos de montaña en Mesoamérica, surgen tres preguntas de investigación: • ¿Se está evaluando la sostenibilidad de los sistemas campesinos teniendo en cuenta la variabilidad climática, la participación de los agricultores y las dinámicas temporales? • ¿Podemos rescatar tendencias comunes en estos sistemas y extrapolar los resultados a otras zonas? • ¿Son inequívocamente positivas las alternativas propuestas que se han llevado a cabo? En este trabajo se presentan tres evaluaciones de sostenibilidad que tratan de poner de manifiesto cuáles son los retos y oportunidades que enfrentan actualmente los sistemas campesinos de montaña. En primer lugar, se evalúan tres sistemas de manejo agrícola bajo dos años meteorológicamente contrastantes. Se determinó que durante el año que experimentó lluvias abundantes y temperaturas moderadas, los sistemas de bajos insumos, basados en el uso de abonos orgánicos y rotación de cultivos, obtuvieron los mejores resultados en indicadores ecológicos y similares resultados en los económicos y sociales que el sistema de altos insumos químicos. En el segundo año, con heladas tempranas y sequía invernal, la productividad se redujo para todos los sistemas pero los sistemas más diversificados (en variedades de maíz y/o siembra de otros cultivos) pudieron resistir mejor los contratiempos climáticos. En segundo lugar, se evalúa el grado de conocimiento (percepción) campesino para determinar los factores claves que determinan la sostenibilidad de sus sistemas y su seguridad alimentaria. Se determinó que los principales puntos críticos identificados por los campesinos (tamaño de parcela y pendiente del terreno) afectan de forma significativa a cuestiones de índole económica, pero no son capaces de explicar los desequilibrios alimenticios existentes. Realizando un análisis comparativo entre comunidades que presentaban buenos y malos resultados en cuanto a aporte energético y proteico, se determinó que la seguridad alimentaria estaba relacionada con la sostenibilidad de los sistemas y que concretamente estaba ligada a los atributos de equidad y autonomía. Otro resultado destacable fue que las comunidades más marginales y con mayor dificultad de acceso mostraron mayores niveles de inseguridad alimentaria, pero la variabilidad intergrupal fue muy alta. Eso demuestra que la seguridad alimentaria y nutricional forma parte de un complejo sistema de estrategias de autoabastecimiento ligada a la idiosincrasia misma de cada uno de los hogares. En tercer lugar, se evaluó el desempeño de las escuelas de campo de agricultores (ECAs) en la mejora de la sostenibilidad y la seguridad alimentaria de un sistema campesino de montaña. Para ver el efecto del impacto de estas metodologías a largo plazo, se estudiaron tres comunidades donde se habían implementado ECAs hace 8, 5 y 3 años. Encontramos que el impacto fue progresivo ya que fue la comunidad más antigua la que mejores valores obtuvo. El impacto de las ECAs fue rápido y persistente en los indicadores relacionados con la participación, el acceso a servicios básicos y la conservación de los recursos naturales. El estudio demostró un claro potencial de las ECAs en la mejora general de la sostenibilidad y la seguridad alimentaria de estos sistemas, sin embargo se observó una relación directa entre el aumento de producción agrícola y el uso de insumos externos, lo que puede suponer un punto crítico para los ideales sostenibles. ABSTRACT During the last decades, sustainable agriculture has been the subject of considerable academic interest and debate, not only in conceptual terms, but also in methodological ones. The persistence of high levels of environmental degradation and food insecurity in many regions has led to new initiatives focused on revitalizing peasant agriculture and renewed discussions of the role of sustainable agriculture as an engine for development, environmental conservation and poverty alleviation. Therefore, to assess mountain farming systems, we must consider food dimension and taking into account the specificities of the mountain systems as the foundation of sustainability. When evaluating contribution of technological and management alternative proposals in achieving sustainability and food security for peasant farming systems in Mesoamerican highlands, three research questions arise: • Is sustainability of peasant-farming systems being evaluated taking into account climate variability, participation of farmers and temporal dynamics? • Can we rescue common trends in these systems and extrapolate the results to other areas? • What alternative proposals that have been conducted are unequivocally positives? In this document, we present three evaluations of sustainability that try to highlight the challenges and opportunities that currently face mountain farming systems in Mesoamerica. First, we evaluate the sustainability of three agricultural management systems in two contrasting weather years. We determined that during the first year that exposed heavy rains and moderate temperatures, low-input systems, which are based on the use of organic fertilizers and crop rotation, provided better results in terms of ecological indicators and equal results in terms of economic and social indicators than those achieved using a high chemical input system. In the second year, which featured early frosts and a winter drought, productivity declined in all systems; however, the most diversified systems (in terms of the maize varieties grown and the sowing of other crops) more successfully resisted these climatic adversities. Second, we evaluate the farmers’ perception to determine the key drivers for achieving their sustainability and food and nutritional security. We determined that the key factors identified by farmers (landholding size and slope of cropland) exerted significant impacts on economic disparities but did not explain the malnutrition levels. We compared two contrasting hamlets according to their energy and protein supply, one namely Limón Timoté (LT), which did not present food problems and Limón Peña Blanca (LP), which did exhibit food insecurity. The results showed that FNS is linked to sustainability, and it is primarily related to the sustainability attributes of self-reliance and equity. Although the more marginated and inaccessible community exhibited more food insecurity, food and nutritional security depend upon a complex array of self-sufficiency strategies that remain linked to individual household idiosyncrasies. Third, we evaluated the impact of farmer field schools for improving the sustainability and food security of peasant mountain systems. In order to appreciate the long-term impact, we studied three communities where FFSs were implemented eight, five and three years ago, respectively. We found that FFSs have a gradual impact, as the community that first implemented FFSs scores highest. The impact of FFSs was broad and long-lasting for indicators related to participation, access to basic services and conservation of natural resources. This study demonstrates the potential of FFSs, but more attention will have to be paid to critical indicators in order to scale up their potential in the future. We observed a direct relationship between the increase in agricultural production and the use of external inputs, which is a critical point for sustainable ideals.

World food and agriculture: Outlook for the medium and longer term

The world has been making progress in improving food security, as measured by the per person availability of food for direct human consumption. However, progress has been very uneven, and many developing countries have failed to participate in such progress. In some countries, the food security situation is today worse than 20 years ago. The persistence of food insecurity does not reflect so much a lack of capacity of the world as a whole to increase food production to whatever level would be required for everyone to have consumption levels assuring satisfactory nutrition. The world already produces sufficient food. The undernourished and the food-insecure persons are in these conditions because they are poor in terms of income with which to purchase food or in terms of access to agricultural resources, education, technology, infrastructure, credit, etc., to produce their own food. Economic development failures account for the persistence of poverty and food insecurity. In the majority of countries with severe food-security problems, the greatest part of the poor and food-insecure population depend greatly on local agriculture for a living. In such cases, development failures are often tantamount to failures of agricultural development. Development of agriculture is seen as the first crucial step toward broader development, reduction of poverty and food insecurity, and eventually freedom from excessive economic dependence on poor agricultural resources. Projections indicate that progress would continue, but at a pace and pattern that would be insufficient for the incidence of undernutrition to be reduced significantly in the medium-term future. As in the past, world agricultural production is likely to keep up with, and perhaps tend to exceed, the growth of the effective demand for food. The problem will continue to be one of persistence of poverty, leading to growth of the effective demand for food on the part of the poor that would fall short of that required for them to attain levels of consumption compatible with freedom from undernutrition.

Using Quantitative Methods to Explore Political Leverage, Trade Policy, and Food Security: A Case Study of the Middle East

This dissertation explores why some states consistently secure food imports at prices higher than the world market price, thereby exacerbating food insecurity domestically. I challenge the idea that free market economics alone can explain these trade behaviors, and instead argue that states take into account political considerations when engaging in food trade that results in inefficient trade. In particular, states that are dependent on imports of staple food products, like cereals, are wary of the potential strategic value of these goods to exporters. I argue that this consideration, combined with the importing state’s ability to mitigate that risk through its own forms of political or economic leverage, will shape the behavior of the importing state and contribute to its potential for food security. In addition to cross-national analyses, I use case studies of the Gulf Cooperation Council states and Jordan to demonstrate how the political tools available to these importers affect their food security. The results of my analyses suggest that when import dependent states have access to forms of political leverage, they are more likely to trade efficiently, thereby increasing their potential for food security.

Food rescue: investigating directions for the future

This research helps explain how organisations can be structured to best respond to the needs of people experiencing food insecurity; an integrated person-centred approach must be employed. There is capacity for food charities to advocate and collaborate to promote long-term solutions and also, deliver acute support for people’s health.

“Come and live in my Shoes”: Food Access and social isolation for People living in poverty IN GANANOQUE, Ontario

This community-based research project, in collaboration with the Gananoque and Area Food Access Network (GAFAN), gathered data from self-reported food insecure residents of Gananoque and area to determine how to improve their access to healthy, personally acceptable food. In March 2016, I recruited 14 participants for three focus groups and one personal interview with those struggling to put food on the table for themselves and others in the household. Participants were single parents, adults over the age of 50, and adults who could benefit from improved access to healthy food but do not currently use existing services. Health issues, social isolation, scraping by, and lack of income were four themes that underscored the impact of poverty on the lives of participants. Lack of income, transportation, cost of food, lack of affordable or accessible childcare, and inadequate access to support services proved to be major barriers to food security: strongly influenced by the impact of rurality. The results of this research have the potential to help GAFAN improve food access for those living in this community. It may also have implications for enhancing food security in other rural Canadian communities.

Kitchens and pantries—helping or hindering? The perspectives of emergency food users in Victoria, Australia

In high-income countries, people affected by food insecurity may seek out free/subsidized food from charities. Their perceptions of the food programs provided and preferences for alternative strategies are underresearched. The aim of this study was to develop an understanding of the users’ experiences of food insecurity and gain evidence for effective responses in the future. Twelve semistructured interviews with a sample of users, who were also charity volunteers, were conducted in Victoria, Australia. A thematic analysis of the interview transcripts was undertaken. The results show that users have complex needs. Charities have both the capacity to hinder and help people maintain dignity, social inclusion, and health. Alternative community and policy food security strategies were proposed by interviewees. In the future, perspectives of affected community members must inform strategies that seek to improve people’s access to safe, nutritious, and affordable food. A human right to food framework is discussed as a mechanism to help realize food security in Australia.

Homegardening as a panacea : a case study of South Tarawa

The Republic of Kiribati is a small, highly infertile Pacific Island nation and is one of the most challenging locations to attempt to support dense urban populations. Kiribati, like other nations in the Pacific, faces an urban future where food insecurity, unemployment, waste management and malnutrition will become increasing issues. Homegardening is suggested as one way to address many of these problems. However, the most recent study on agriculture production in urban centres in Kiribati shows that, in general, intensive cultivation of homegardens is not a common practice. This disparity between theory and practice creates an opportunity to re-examine homegardening in Kiribati and, more broadly, in the Pacific. This paper examines the practice of homegardening in urban centres in Kiribati and explores reasons why change has or has not occurred through interviews with homegardeners and government/donor representives. Results show that homegardening has increased significantly in the past five years, largely because of the promotion of homegardens and organic composting systems by donor organisations. While findings further endorse homegardening as an excellent theoretical solution to many of the problems that confront urban settlements in Kiribati and the Pacific, it raises additional questions regarding the continuation of homegarden schemes beyond donor support programmes.

Low vitamin B12 levels among newly-arrived refugees from Bhutan, Iran and Afghanistan : a multicentre Australian study

Background: Vitamin B12 deficiency is prevalent in many countries of origin of refugees. Using a threshold of 5% above which a prevalence of low Vitamin B12 is indicative of a population health problem, we hypothesised that Vitamin B12 deficiency exceeds this threshold among newly-arrived refugees resettling in Australia, and is higher among women due to their increased risk of food insecurity. This paper reports Vitamin B12 levels in a large cohort of newly arrived refugees in five Australian states and territories. Methods: In a cross-sectional descriptive study, we collected Vitamin B12, folate and haematological indices on all refugees(n = 916; response rate 94% of eligible population) who had been in Australia for less than one year, and attended one of the collaborating health services between July 2010 and July 2011. Results: 16.5% of participants had Vitamin B12 deficiency (,150 pmol/L). One-third of participants from Iran and Bhutan, and one-quarter of participants from Afghanistan had Vitamin B12 deficiency. Contrary to our hypothesis, low Vitamin B12 levels were more prevalent in males than females. A higher prevalence of low Vitamin B12 was also reported in older age groups in some countries. The sensitivity of macrocytosis in detecting Vitamin B12 deficiency was only 4.6%. Conclusion: Vitamin B12 deficiency is an important population health issue in newly-arrived refugees from many countries. All newly-arrived refugees should be tested for Vitamin B12 deficiency. Ongoing research should investigate causes,treatment, and ways to mitigate food insecurity, and the contribution of such measures to enhancing the health of the refugee communities.

Postnatal depression in Central Vietnam

Postnatal depression (PND) is a significant global health issue, which not only impacts maternal wellbeing, but also infant development and family structures. Mental health disorders represent approximately 14% of global burden of disease and disability, including low and middle-income countries (LMIC), and PND has direct relevance to the Millennium Development Goals of reducing child mortality, improving maternal health, and creating global partnerships (United Nations, 2012; Guiseppe, Becker & Farmer, 2011). Emerging evidence suggests that PND in LMIC is similar to, or higher than in high-income countries (HIC), however, less than 10% of LMIC have prevalence data available (Fisher, Cabral de Mello, & Izutsu 2009; Lund et al., 2011). Whilst a small number of studies on maternal mental disorders have been published in Vietnam, only one specifically focuses on PND in a hospital-based sample. Also, community based mental health studies and information on mental health in rural areas of Vietnam is still scarce. The purpose of this study was to determine the prevalence of PND, and its associated social determinants in postnatal women in Thua Thien Hue Province, Central Vietnam. In order to identify social determinants relevant to the Central Vietnamese context, two qualitative studies and one community survey were undertaken. Associations between maternal mental health and infant health outcomes were also explored. The study was comprised of three phases. Firstly, iterative, qualitative interviews with Vietnamese health professionals (n = 17) and postpartum women (n = 15) were conducted and analysed using Kleinman's theory of explanatory models to identify narratives surrounding PND in the Vietnamese context (Kleinman, 1978). Secondly, a participatory concept mapping exercise was undertaken with two groups of health professionals (n = 12) to explore perceived risk and protective factors for postnatal mental health. Qualitative phases of the research elucidated narratives surrounding maternal mental health in the Vietnamese context such as son preference, use of traditional medicines, and the popularity of confinement practices such as having one to three months of complete rest. The qualitative research also revealed the construct of depression was not widely recognised. Rather, postpartum changes in mood were conceptualised as a loss of 'vital strength' following childbirth or 'disappointment'. Most women managed postpartum changes in mood within the family although some sought help from traditional medicine practitioners or biomedical doctors. Thirdly, a cross-sectional study of twelve randomly selected communes (six urban, six rural) in Thua Thien Hue Province was then conducted. Overall, 465 women with infants between 4 weeks and six months old participated, and 431 questionnaires were analysed. Women from urban (n = 216) and rural (n = 215) areas participated. All eligible women completed a structured interview about their health, basic demographics, and social circumstances. Maternal depression was measured using the Edinburgh Postnatal Depression Scale (EPDS) as a continuous variable. Multivariate generalised linear regression was conducted using PASW Statistics version 18.0 (2009). When using the conventional EPDS threshold for probable depression (EPDS score ~ 13) 18.1% (n = 78) of women were depressed (Gibson, McKenzie-McHarg, Shakespeare, Price & Gray, 2009). Interestingly, 20.4% of urban women (n = 44) had EPDS scores~ 13, which was a higher proportion than rural women, where 15.8% (n = 34) had EPDS scores ~ 13, although this difference was not statistically significant: t(429) = -0.689, p = 0.491. Whilst qualitative narratives identified infant gender and family composition, and traditional confinement practices as relevant to postnatal mood, these were not statistically significant in multivariate analysis. Rather, poverty, food security, being frightened of your husband or family members, experiences of intimate partner violence and breastfeeding difficulties had strong statistical associations. PND was also associated with having an infant with diarrhoea in the past two weeks, but not infant malnutrition or acute respiratory infections. This study is the first to explore maternal mental health in Central Vietnam, and provides further evidence that PND is a universally experienced phenomenon. The independent social risk factors of depressive symptoms identified such as poverty, food insecurity, experiences of violence and powerlessness, and relationship adversity points to women in a context of social suffering which is relevant throughout the world (Kleinman, Das & Lock, 1997). The culturally specific risk factors explored such as infant gender were not statistically significant when included in a multivariable model. However, they feature prominently in qualitative narratives surrounding PND in Vietnam, both in this study and previous literature. It appears that whilst infant gender may not be associated with PND per se, the reactions of close relatives to the gender of the baby can adversely affect maternal wellbeing. This study used a community based participatory research approach (CBPR) (Israel.2005). This approach encourages the knowledge produced to be used for public health interventions and workforce training in the community in which the research was conducted, and such work has commenced. These results suggest that packages of interventions for LMIC devised to address maternal mental health and infant wellbeing could be applied in Central Vietnam. Such interventions could include training lay workers to follow up postpartum women, and incorporating mental health screening and referral into primary maternal and child health care (Pate! et al., 2011; Rahman, Malik, Sikander & Roberts, 2008). Addressing the underlying social determinants of PND through poverty reduction and violence elimination programs is also recommended.