Background Healthy diets can help reduce undernutrition, morbidity, and mortality. However, evidence on the accessibility and affordability of recommended diets is limited, particularly in poor-resource settings including India. Objectives This study examined: 1) the minimum cost of different types of household diets; 2) how economic constraints may prevent households from accessing a nutritious diet; and 3) how home production and social protection may improve access to nutritious diets. Methods We conducted 24 market and 125 household surveys in Uttar Pradesh, India to obtain food prices and consumption patterns. Cost of Diet, a linear programming software, was used to assess the minimum cost of different diets, estimate affordability of nutritious diets, and model scenarios of home production and social protection interventions to improve affordability. Results The minimum cost nutritious diet that met all recommended nutrient requirements (US${\$}$904/year) was over twice as expensive compared to the diet which only met energy requirements (US${\$}$393/year). The nutritious diet was unaffordable for 75% of households given current income levels, consumption patterns, and food prices. Household income and dietary preferences were the key barriers to obtain nutritious diets rather than food availability. Home production had potential to reduce cost of nutritious diets by 35%, subsidized grains by 19%, and supplementary food by 10%. The poorest households could only afford recommended nutritious diets with access to multiple interventions. Conclusions Practical, habitual diet-related behavior change communication to middle and high-income households and additional social protection for poorer households could enable individuals to achieve optimal nutrient intakes.

Objectives Uttar Pradesh (UP) is the most populous state with the highest burden of undernutrition in India. Alive & Thrive is working to strengthen behavior change communication (BCC) on diet diversity and quantity, using health systems platforms to deliver maternal nutrition intervention. However, evidence on the accessibility and affordability associated with recommended diets is limited. This study aims to: 1) examine the costs of nutritious foods in local markets, 2) identify inexpensive sources of essential micronutrients which could be promoted through BCC interventions. Methods Data collection included 24 market surveys and 125 household interviews to obtain food prices and consumption patterns. Cost of Diet (CotD), a linear programing software, was used to estimate the lowest cost for meeting nutrient requirements of 4 types of diet: 1) energy only diet (EO), 2) energy and macronutrient diets (MAC); 3) nutritious diet (NUT-meets recommended intakes for energy and nutrients), and 4) a food habits diet (FHAB-meet energy and nutrient requirements based upon local dietary habits). The diets were compared to identify relative costs and nutrient requirements met. Results The FHAB diet (USD 90/month for a household of 6 people) was over twice as expensive compared to the energy only diet. EO and MAC diets were affordable for all households, but they indicated inadequate nutrient intakes for vitamins A, C, B-12, folic acid, calcium, and iron. NUT and FHAB diets met all nutrient requirements but were not affordable for the lowest quartile of households. Recommended intakes of Vitamins A, C, B12, and calcium were most difficult to meet. Key foods identified which provided majority of essential macro and micronutrients included wheat flour, buffalo milk, soybean, and spinach. Multiple sources of iron and calcium were identified as affordable and accessible in local markets. Conclusions Foods available in local market are sufficient for households to obtain recommended intakes of macro- and micronutrients. Economic constraints and dietary habits are key barriers to achieve a nutritious diet. Practical, habitual diet-related behavior change communication to middle and high-income households and additional social protection for poorer households could improve optimal nutrient intakes. Funding Sources Bill & Melinda Gates Foundation through POSHAN, led by International Food Policy Research Institute.

This session will survey global evidence and examples of best practice on mitigation solutions and enabling conditions for mitigation.