Maternal diets in rural Tanzania: An exploration of culture, lived experiences, and social shifts affecting women’s intake during pregnancy and lactation Open Access

Dickson, Lyndsey (Spring 2020)

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Introduction: Each year approximately 15.5% of infants are born with low birthweight, defined as underweight for gestational age, a common cause being maternal undernutrition. Maternal diets are crucial for the health of pregnant and lactating women and their children, yet women under-consume for reasons including food insecurity, insufficient knowledge of adequate nutrient consumption, and cultural beliefs and practices that restrict intake. Poor nutrition during a child’s first 1000 days, conception through two years of life, is associated with impaired cognitive ability and can lead to stunting. This paper examines cultural beliefs and practices related to PLW’s diets and influences of shifting norms on maternal intake in rural Tanzania.

Methods: Qualitative data were collected from thirty villages in two districts of Eastern Tanzania with varying levels of pastoralism and sedentarization. Data were collected in one of two local languages, Kiswahili or Maasai. Collection methods included household in-depth interviews, focus group discussions and key informant interviews. Verbatim transcripts were analyzed in MAXQDA 2020 via coding, constant comparison, conceptualization, categorization, theme development and thick descriptions.

Results: The effects of societal shifts in relation to maternal diets were explored. Changes were largely due to increased education and interethnic exchange, facilitated by changes in livelihoods, modernization, and globalization. Despite shifts in some norms, others remain unchanging. While public health efforts to improve maternal diets is praised and widely accepted, implementation has been hindered by persistence of cultural habits such as food allocation practices at mealtime, gender norms and PLW-related food taboos. Pastoral communities were less influenced than sedentary communities, yet participants from all villages discussed normalization of previously tabooed foods, saw changes in food availability, increased mutual decision-making among partners, ate more balanced meals, and prioritized children’s diets.

Discussion: Cultural and societal influencers play a major role in maternal diet. Despite recent advances in livelihoods, education and intercultural exchange, tradition persists, and women face challenges to implementing new knowledge. This study has implications for nutrition education programs to improve maternal and child nutrition through improved diet. Findings provide insight for development of culturally appropriate nutrition interventions and program improvement programs in rural Tanzania.

Table of Contents

Chapter 1: Introduction                                                                                                    1

           Introduction & Significance                                                                                  1

           Problem Statement                                                                                                  2

           Purpose                                                                                                                      3

           Summary of Implications                                                                                       3

           Definition of Terms                                                                                                 4

Chapter 2: Literature Review                                                                                           5

           2.1. Importance of Sufficient Maternal Nutrition                                             5

2.2. Current Recommendations                                                                                 6

2.3. Drivers of Maternal Food Intake                                                                        12

2.4. Current Knowledge Gaps                                                                                   17

Chapter 3: Manuscript                                                                                                      20

           3.1. Introduction                                                                                                     20

                       Introduction & Significance                                                                     20

                       Problem Statement                                                                                    20

                       Purpose                                                                                                         21

                       Definition of Terms                                                                                    22

           3.2. Methods                                                                                                            22

                       Introduction                                                                                                22

                       Study Population                                                                                        23

                       Ethical Considerations                                                                              24

                       Data Collection                                                                                           24

                       Data Analysis                                                                                              26

           3.3. Results                                                                                                              28

                       Community Diet Changes                                                                         29

                       Drivers of Changing Diets                                                                         31

                       Social Shifts                                                                                                 32

                       Inability to Act                                                                                            33

                       Taboos – Decreasing Yet Persistent                                                       34

           3.4. Discussion                                                                                                        36

                       Persistent Beliefs                                                                                        36

                       Gender Norms                                                                                             36

                       Interethnic Exchange                                                                                38

                       Strengths & Limitations                                                                           38

                       Public Health Implications                                                                       39

           References                                                                                                                40

           Tables                                                                                                                       43

Chapter 4: Discussion & Implications                                                                          48

Persistent Beliefs                                                                                                       49

Gender Norms                                                                                                           49

Interethnic Exchange                                                                                                 51

Strengths & Limitations                                                                                            52

Recommendations for Future Research                                                                    52

Public Health Implications                                                                                        53

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