Maternal nutrition practices and perceptions in Bihar, India Público
Piasecki, Alexandra Marie (2013)
Abstract
Background
Malnourishment is a serious public health
issue in India with more than half of India's children suffering
from undernutrition. Improving maternal nutrition is one means of
addressing this issue. Bihar, India is the poorest and least
developed state and according to the United Nations Children's Fund
(UNICEF). More than half the children are underweight in Bihar, a
proportion which is higher than the overall Indian average.[1] And
approximately one in two women aged 15-49 years in underweight with
a body mass index (BMI) less than 18.5 kg/m2, where a BMI between
18.6 and 24.9 is considered normal. [2]
Objective
This study aims to describe the
perceptions of mothers, mothers-in-law and frontline workers
surrounding maternal malnutrition in Bihar, India and make
recommendations for improvements.
Methods
A qualitative study was conducted between
June-August 2012. Data collection included twenty-two focus group
discussions with mothers, mothers-in-law, and frontline workers in
Bihar, India. A systematic analysis of verbatim transcripts
identified major themes, comparing and contrasting patterns within
the three population groups of the focus group discussion.
Results
The data revealed strong cultural practices
and food taboos associated with maternal nutrition. All study
groups mentioned specific foods with beneficial and/or adverse
effects on either the mother or her child. Strong cultural
practices preventing pregnant women from eating adequately were
described, especially among women living in large
multi-generational homes. All women mentioned a form of restrictive
diet following delivery in order for the woman's body to recover
and prevent post-delivery complications.
Discussion
Maternal nutrition needs to be
prioritized at the community level among all family members and
frontline workers. Cultural traditions prioritizing pregnant women
need to be encouraged in order to improve their access to adequate
food intake. Educational interventions to address specific food
taboos and the harmful effects of a restrictive diet could improve
nutritional knowledge. However further research surrounding the
origins of these taboos is necessary in order to rebuff them and
change behaviors and beliefs. With this information future programs
can target the identified barriers and capitalize on the
opportunities for improving mother's nutritional status and
reducing maternal and infant mortality.
Table of Contents
Chapter 1: Introduction. 1 Introduction and rationale. 1 Malnutrition in India. 1 Bihar, India. 2 Problem statement2 Purpose statement and research aims. 3 Significance statement3 Chapter 2: Literature Review.. 5 Introduction. 5 Maternal malnutrition. 5 Causes of Malnutrition. 7 Consequences of Malnutrition. 9 Strategies for Improving Maternal Nutrition. 11 Balanced Energy Protein Supplementation. 11 Iron and Folic Acid Supplementation. 12 Micronutrient Supplementation. 12 Nutritional Education and Counseling. 12 Background on Bihar13 Maternal Nutrition in Bihar13 Bihar's Maternal Nutrition Programs. 14 Conclusion. 16 Chapter 3: Methods. 18 Study location. 18 Study population. 19 Recruitment20 Focus group discussions with mothers and mothers in law.. 21 Focus group discussions with ASHAs and AWWs. 21 Table 1. Summary of focus group discussions. 22 Ethical consideration. 22 Data analysis. 23 Limitations. 24 Chapter 4: Results. 26 Description of the Study Population. 26 Table 2. Demographic characteristics of all focus group respondents by target group.27 Role of Family Members. 30 Knowledge of nutrition. 33 Impact of nutrition on infant34 Barriers. 35 Food Practices during Pregnancy. 36 Food Practices Immediately Post-Partum.. 38 Food Practices for Lactating Women. 41 Table 3. Key concepts summarized in the results section.42 Chapter 5: Discussion. 45 Study findings in perspective. 45 Women's status. 45 Dietary Taboos. 46 Affordability. 49 Post-partum Food Taboos. 50 Government Advocacy. 53 Global Recommendations. 54 Limitations. 54 Appendix A: Tables. 56 Table 4. Foods mentioned during pregnancy. 56 Table 5. Foods mentioned post-partum.. 58 Table 6. Foods mentioned during lactation. 59 Appendix B: Focus Group Guides. 61 Focus Group Discussion Guide (FGD) for Mothers-in-law.. 61 Focus Group Discussion Guide (FGD) for Mothers. 64 Focus Group Discussion Guide (FGD) for Frontline Workers. 68 References. 72
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