Understanding the impact of the UN Oil for Food program on later Iraqi Kurdish population health Restricted; Files Only

Tribble, Anna Grace (Fall 2022)

Permanent URL: https://etd.library.emory.edu/concern/etds/t435gf48c?locale=en


Objectives: This study examines the relationship between intrauterine exposures to food insecurity, subsequent food aid introduction, and later young adult health outcomes among Iraqi Kurdish agrarian families who experienced the economic sanctions of the 1990s. Young adults born after the introduction of the UN Oil for Food program (OfF) to mothers who were consuming that food aid during pregnancy were hypothesized to have “better” health outcomes (i.e., lower rates of overweight/obesity, lower blood pressure, lower mental illness burden).


Methods: Iterative rounds of field work were conducted between 2016 and 2019 in Chamchamal district of northeastern Iraqi Kurdistan. In this mixed methods study, early formal and informal data collection (2016 [N=27], 2017 [N = 43], 2018 [N=28]) provided insight into food system functionality, livelihood strategies, and local governance in the 1990s. In 2019, household data collection included an in-depth survey of the household (N= 50) and individual young adults (N = 87). Informal interviews were collected with the father and the mother (N = 50). Ethnographic data were analyzed in MaxQDA, and thick descriptions of key themes were composed. Quantitative data were analyzed in R studio using a “difference-in-differences” model to isolate the treatment effect of consuming food aid from the Oil for Food program during pregnancy.


Results: Qualitative and quantitative data verified two key assumptions in the main quantitative model used to evaluate the hypothesis: (1) households were experiencing severe food insecurity in the early 1990s before the introduction of the OfF program, and (2) the OfF program did successfully roll out in 1997 and did distribute food to the households participating in the study. Young adults born after the OfF-program’s introduction to mothers consuming food aid were 52.3% more likely to have high systolic blood pressure relative to their siblings born before the program.


Conclusion: Contrary to the hypothesis of this study, young adults born after the OfF program to mothers consuming food aid had higher rather than lower blood pressure. Future research will explore the potential roles of catch-up growth, dietary quality of food aid, and maternal buffering. 

Table of Contents

Chapter 1: Introduction.. 1

1.1: Contributions to Gaps in Key Literatures. 2

1.1.1: Gaps in and Contributions to Interdisciplinary Literature on the Developmental Origins of Health and Disease. 2

1.1.2: Gaps in and Contributions to Nutritional Anthropology and Food Insecurity Literature. 3

1.1.3: Gaps in and Contributions to Kurdish Studies on Iraqi Kurdistan. 5

1.2: Methodological Overview.. 7

1.2.1: Note about “The Household”. 8

1.2.2: Note about “Saddam”. 9

1.2.3: Note about the use of the term “Anfal” in reference to the Kurdish genocide. 9

1.2.4: Note about “Kurdish Region of Iraq”. 10

1.2.5: Use of pseudonyms in naming conventions. 10

1.3: Orientation of this Dissertation: The Biocultural Approach. 10

1.4: Community Point of Entry. 12

1.5: Mapping This Dissertation: Chapter Summaries. 15

Chapter 2: The Developmental Origins of Health and (adult) Disease and its Mediators. 18

2.1: The Basics of Early Development. 19

2.1.2: Fetal Development 19

2.1.3: Health Outcomes Linked to Poor In-Utero Environments. 20

2.2: Tracing the Hypotheses that Contribute to the DOHAD Framework. 21

2.2.1: Thrifty Genotype Hypothesis (1962) 22

2.2.2: Thrifty Phenotype Hypothesis (1992) 22

2.2.3: Weather Forecasting Model (1999) 23

2.2.4: Predicative Adaptive Response Hypothesis (2005) 24

2.2.5: Intergenerational Phenotypic Inertia Hypothesis (2005) 26

2.2.6: The Capacity-Load Model: Maternal Metabolic Ghetto Hypothesis (2009) 27

2.3: Retrospective Cohort Studies Used in Evaluation of DOHAD Hypothesis. 29

2.3.1: Proxying the Fetal Environment 31

2.3.2: Case Studies in DOHAD Naturalistic Experiments. 36

2.4: Household Food Insecurity as a Key Mediator. 41

2.4.1: Defining Household Food Insecurity. 42

2.4.2: Measuring Food Insecurity. 43

2.4.3: Coping and Adaptive Strategies among Food Insecure Agrarian Households. 46

2.4.4: Deploying Food Aid: A Problematic Solution to Food Insecurity. 47

2.4.5: Pathways from Food Insecurity to Poor Health and Wellbeing. 49

2.4.6: Intergenerational Implications. 52

2.5: Operationalizing the DOHAD Framework for This Dissertation. 53

Chapter 3: Conducting Research on DOHAD in Iraqi Kurdistan.. 56

3.1: Criteria for DOHAD Research in Communities Met by Iraqi Kurdish Population. 56

3.1.1: Increasing Regional Chronic Disease Mortality. 57

3.1.2: A Clearly Timed Exposure to Maternal Food Insecurity In Utero. 61

3.1.3: A Clearly Timed Exposure to Maternal Food Aid Consumption In Utero. 68

3.1.4: Other Key Events to Ensure Retrospective Recall 71

Chapter 4: Methods for Data Collection and Analysis. 78

4.1: Ethnographic Setting and Population. 79

4.1.1: History on and Anthropological Insights from Chamchamal Area. 81

4.2: Integrated Qualitative and Quantitative Data Collection: A Mixed Methods Approach. 85

4.2.1: Fieldwork in 2016. 86

4.2.2: Fieldwork in 2017. 87

4.2.3: Fieldwork in 2018. 89

4.2.4: Fieldwork in 2019. 94

4.3: Qualitative Data Analysis. 102

4.3.1: Transcription and Translation. 102

4.3.2: Codebook Development 103

4.3.3: Description, Comparison, Categorization. 104

4.3.4: Rigor and Validity in Qualitative Data Analysis. 105

4.4: Quantitative Data Analysis. 107

4.4.1: Variable Creation for All Models. 107

4.4.2: Description of Model Selection. 112

Chapter 5: Verifying Severe Food Insecurity in the Early 1990s. 118

5.1: Food Insecurity Status of Iraqi Kurdish Households in Chamchamal Area. 119

5.1.1: Ethnographically Derived Kurdish Phrases Related to Food Insecurity in the 1990s. 119

5.1.2: Quantitative Results of Food Insecurity in Chamchamal Area (HFIAS) 123

5.2: Iraqi Kurdish Rural Agrarian Households and their Strategies. 124

5.2.1: Adaptive Strategies in Iraqi Kurdistan: Crop and Herd Sharing. 125

5.2.2: Novel, Household Coping Strategy in Iraqi Kurdistan: Gleaning after Wheat Harvests. 128

5.2.3: Assignment of In-Utero Exposure to Malnutrition Based on Event Timing. 135

Chapter 6: Verifying Exposure to the UN Oil For Food Program: In Utero Event Timing.. 137

6.1: The Functioning of the UN Oil for Food Program.. 138

6.2: Food Aid Distribution Timing for In-Utero Exposure Assignment. 144

6.2.1: Evidence from Household Surveys. 145

6.2.2: Evidence from World Food Program Emergency Reports. 146

6.2.3: Evidence from Newspaper Debates about the UN Oil for Food Program.. 150

6.2.3: Assignment of In-Utero Food Aid Consumption Exposure Based on Event Timing. 153

Chapter 7: Evaluation of Hypothesis Regarding Impact of Oil for Food Program... 155

7.1: Demographics for Iraqi Kurdish Households. 156

7.2: Demographics for Iraqi Kurdish Young Adults. 157

7.3: Descriptive Statistics of Health Outcomes by Sub-Group. 158

7.4: Anthropometrics. 160

7.4.1: Descriptive Statistics for Anthropometric Outcomes by Sub-Group. 160

7.4.2: Average Predicted Value or Predicted Likelihood Bar Charts for Anthropometric Outcomes. 161

7.4.3: Regression Results for Anthropometric Outcomes. 164

7.5: Blood Pressure. 165

7.5.1: Descriptive Statistics for Blood Pressure Outcome by Sub-Group. 165

7.5.2: Average Predicted Value or Predicted Likelihood Bar Charts for Blood Pressure Outcomes. 166

7.5.3: Regression Results for Blood Pressure Outcomes. 168

7.6: Mental Health Measures. 169

7.6.1: Descriptive Statistics for Mental Health Outcomes. 169

7.6.2: Average Predicted Value or Predicted Likelihood Bar Charts for Mental Health Outcomes. 170

7.6.3: Regression Results for Mental Health Outcomes. 172

Chapter 8: Conclusion.. 174

8.1: Summarizing This Dissertation’s Findings. 174

8.2: Reflections on This Study: Strengths and Limitations. 179

8.2.1: The Strengths. 179

8.2.2: The Limitations. 182

8.3: Literature Contributions. 185

8.3.1: Contributions to the Developmental Origins of Health and Disease Hypothesis. 185

8.3.2: Contributions to Literature on Nutritional Anthropology and Food Insecurity. 186

8.3.3: Contributions to Kurdish Studies and to Iraqi Studies. 188

8.4: Future Research Directions. 189

Acknowledgements. 194

Appendix A: Codebook.. 197

Appendix B: Pseudonyms. 235

References 238

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