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ABSTRACT
From research in central Chhattisgarh, this paper interprets the bearing that healthcare beliefs and practices may have in shaping maternal and child nutrition both in the light of biomedical recommendations and within the context and constraints of a rural village setting. It contends that health beliefs and practices that are at variance from biomedical recommendations appear to have few consequences for gestational nutrition and for child health in relation to pregnancy. In the postpartum however, health ideas at variance from biomedical recommendations appear to have an important bearing on maternal nutrition and infant feeding, and may put mothers and children at risk of nutritional deficiency. Maternal ‘eating down’ following a surgical procedure such as a caesarean delivery or tubectomy is especially noteworthy, since food intake quantity is reduced over an extended time frame. While caring practices are influenced by cultural formulations, they also reflect, perhaps, adaptations to health risks.
Ethical approval
Ethical approval for this paper was obtained from the University of East Anglia International Development Research Ethics Committee.
Acknowledgments
The author thanks Richard Palmer-Jones, Cecile Jackson and the anonymous reviewers of this paper for their comments on previous versions of this work. The author is grateful to the Commonwealth Scholarship Commission, the Foundation for Urban and Regional Studies and the Parkes Foundation for their financial awards towards this research. The author thanks the University of East Anglia for institutional support.
Disclosure statement
No potential conflict of interest was reported by the author.
Notes
1. See, for instance, Pelto and Pelto (Citation1997) and Good (Citation1993).
2. They contend that India's flagship Integrated Child Development Services is hijacked to become a ‘feeding’ programme, and that it should emphasise instead health education. Alternative positions view key nutrition impediments as economic, stemming from deprivation and food insecurity (Chastre et al. Citation2007). India's Right to Food Campaign is also forceful in emphasising food provisioning. Unequal gender relations and the poor health environment are further viewed as key barriers.
3. Based on new evidence that extending breastfeeding met nutrient needs and additionally offered greater protection against gastrointestinal infections.
4. The author has a background in policy-engaged health research.
5. Most intensive engagement was between November 2011 and May 2012.
6. Under the Criminal Tribes Act (1924). As the act was repealed in 1952 the tribes were ‘de-notified’.
7. The research site was identified in September 2010 and scoping fieldwork was carried out in November 2010. Research was resumed from September 2011. The author has returned to Nariar every year since.
8. Nag's review finds that the overall pattern is to avoid hot foods in pregnancy, although he notes in summary that for some communities, food avoidance by ‘hot’ or ‘cold’ criteria are believed to vary in different stages of pregnancy and by individual physical constitution (Nag Citation1994, 2427).
9. The climate from the fifth month of Rekha's pregnancy was hot, and the temperatures in the months of April, May and June can be severe (touching 45 degrees Celsius).
10. Literature on the nature/extent of eating down is scant. Recent research from Nepal indicates that eating down with a view to prevent difficult deliveries was uncommon (Christian et al. Citation2006).
11. Mirroring conclusions of other anthropological work on perceptions of baby size (Messer Citation1989).
12. Between 2010 and 2012, 40% births in Nariar were institutional while 60% were home-based (N = 40).
13. Trials have shown small birth weight increases from antenatal multiple micronutrient supplementation (Bhutta et al. Citation2013; Fall et al. Citation2009), and their wider programmatic incorporation is recommended (Bhutta et. al Citation2013). Existing biomedical evidence is small however. It is argued that longer-term impacts of micronutrient supplementation are unclear and effects not unidirectional (Devakumar et al. Citation2014). A meta-analysis of trials on antenatal multi-micronutrient pill supplementation found supplementation linked with increased birth weights but with no effects on stillbirths or early neonatal mortality. In fact, on excluding results of one study the meta-analysis showed an increase in neonatal mortality despite an increase in birth weights (Ronsmans et al. Citation2009). Biomedical evidence is more conclusive on benefits of iron supplementation (for prevention of anaemia) and periconceptual folic acid supplementation (prevention of neural tube defects). See Bhutta et al (Citation2013) and De-Regil et al. (Citation2015).
14. This is reflected in Chhattisgarh's near neutral adult sex ratio (991:1000) and feminine child sex ratio (964:100). Census of India (2011).
15. Colostrum is frequently viewed as impure and sugar water, honey or animal milk are common first foods (Jeffery et al. Citation1989).
16. Anthropological work in other parts of India also shows that postpartum diet is significantly modified (see, for instance, Jeffery et al. Citation1989; Van Hollen Citation2003)
17. Informants did not articulate clear reasons why rice consumption may prevent the mothers body from healing/drying. Van Hollen (Citation2003) suggests that the viscous character of cooked rice might be a factor in Tamil Nadu.
18. Energy requirements for children (8–10 months): 702–731 kcal per day for boys and 652–676 kcal per day for girls (Butte Citation2008, 33).
19. See, for instance, Engles (Citation2002) and papers in Dibley and Senarath, eds. (Citation2012).
20. See, for instance, Pelto, Levitt, and Thairu (Citation2003).