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)
Abstract
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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