Maternal nutrition practices and perceptions in Bihar, India Público

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

About this Master's Thesis

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School	Rollins School of Public Health
Department	Hubert Department of Global Health
Degree	MPH
Submission	Master's Thesis
Language	English
Research Field	Health Sciences, Public Health
Palavra-chave	pregnancy food practices maternal nutrition maternal health Bihar, India
Committee Chair / Thesis Advisor	Ramakrishnan, Usha, Emory University
Committee Members	Girard, Amy Webb, Emory University Young, Melissa, Emory University
Partnering Agencies	Emory University schools, faculty or affiliated programs International Non-governmental organization (e.g., CARE, Inc.)

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