Exploring Presence of and Access to India's Food and Nutrition Entitlements: Realization of the Right to Food by Women in Bihar 公开

Abstract

Background: Maternal malnutrition is critically important in Bihar, India due to the high prevalence of malnutrition and intergenerational impacts of maternal undernutrition. Since its independence, India has regarded support of the right to food as a responsibility of the government and has developed entitlement programs to improve food and nutrition security. In 2013, the government passed the National Food Security Act (NFSA) to expand food and nutrition support. It is crucial to understand the experiences of entitlement providers and beneficiaries to inform future implementation of maternal and child nutrition programs.

Objective: This study provides formative research on the implementation of the NFSA in Bihar, barriers and facilitators of widespread implementation of the NFSA, and actions to better support the demand and uptake of food and nutrition entitlements and consequential realization of the right to food by women in Bihar.

Methods: Qualitative research was carried out from May-July 2014 in two comparative panchayats. In-depth interviews with pregnant or lactating women (n=8), Anganwadi Workers (n=4), Public Distribution Shopkeepers (n=4) and focus group discussions with husbands (n=4) and mothers-in-law (n=3) explored the supply, distribution, access, and utilization of entitlements available to women of reproductive age. Systematic coding and analysis of transcripts was conducted to describe data trends within and across each participant group.

Results: Strong cultural beliefs exist with regards to women's responsibilities, the power of household "guardians," and prioritization of maternal health. All participants recognized Anganwadi Center services, but specifics about eligibility were unknown and services were not widely accessed. Interviewees were aware of Public Distribution System services, but the majority of participants were dissatisfied with the reduction in provisions in the 6 months prior to this study. Entitlement providers indicated challenges associated with the supply of resources they are given relative to demand.

Discussion: Women's restricted autonomy, the minimal awareness of entitlement eligibility, and limited quantity and quality of provisions limit the realization of the right to food. In order to support the realization of the right to food in India, particularly for women, these challenges must be mitigated through a combination of citizen empowerment and improved entitlement accountability systems.

Table of Contents

CHAPTER 1. INTRODUCTION. 1

Context of Problem. 1

Problem Statement. 2

Bihar, India. 2

Purpose of Project. 5

CHAPTER 2: LITERATURE REVIEW. 7

Burden of Maternal Malnutrition. 7

Role of Food Security in Malnutrition. 8

Contribution of Food Security to Health Beyond Nutrition. 9

Global Right to Food Movement. 10

Indian Context. 14

CHAPTER 3: METHODS. 24

Study Location. 25

Study Population. 25

Study Team. 27

Recruitment. 28

Development of Data Collection Tools. 29

In-Depth Interviews and Focus Group Discussions. 29

Ethical Considerations. 31

Data Analysis. 32

Limitation. 33

CHAPTER 4. RESULTS. 35

General Status of Community Food and Nutrition Security. 35

Food-related Household Roles and Responsibilities. 38

Prioritization of Women's Nutrition and Health. 39

Perceptions of Food and Nutrition Entitlement Programs. 42

Community Engagement in Demand and Advocacy for Change. 53

CHAPTER 5. DISCUSSION. 56

Women's Autonomy and Status in the Household. 56

Minimal Awareness of Entitlement Eligibility. 58

Limited Quantity and Quality of Entitlement Provisions. 59

Programmatic Recommendations. 61

Policy Recommendations. 62

Need for Future Research. 63

Strengths and Limitations of Research. 63

Conclusion. 64

REFERENCES. 67

APPENDICES. 71

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, Nutrition Health Sciences, Public Health
关键词	Nutrition security Food security Maternal nutrition Right to food National Food Security Act Bihar India Public Distribution System Integrated Child Development Services
Committee Chair / Thesis Advisor	Girard, Amy Webb, Emory University
Partnering Agencies	Emory University schools, faculty or affiliated programs International Non-governmental organization (e.g., CARE, Inc.)

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