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Understanding Maternal Dietary Behaviour and Perceived Attributes of Foods in the Context of Food Insecurity in Rural Bangladesh: a Qualitative Study

Wajiha Khatun*
The University of Sydney School of Public Health, The University of Sydney, NSW, Australia

Sabrina Rasheed
International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh

Michael J Dibley
The University of Sydney School of Public Health, The University of Sydney, NSW, Australia

Ashraful Alam*
The University of Sydney School of Public Health, The University of Sydney, NSW, Australia

Abstract/ Executive Summary:

Background Evidence shows inadequate dietary diversity among women in resource poor settings in developing countries. We explored women’s perceived attributes related to food choices to understand their eating habits during pregnancy and lactation, in rural Bangladesh. Methods We conducted a qualitative study in two villages in Jamalpur District in northern Bangladesh. These villages experience high levels of poverty according to the 2010 Bangladesh Poverty Map. We undertook in-depth interviews (n=36) with pregnant and lactating women and conducted focus group discussions (n=2) with their husbands. We used the ProPAN (Process for the Promotion of Child Feeding - a tool to improve infant and young child feeding) methodology to develop a key food list to conduct the food attribute exercise. Data was audio-recorded, transcribed in Bangla, and translated into English. The transcripts were manually coded and analyzed using the inductive thematic approach. Results We found that: (i) animal-source foods and fruits were the least consumed in the women’s diet resulting in low dietary diversity; (ii) Consumption of diversified foods was influenced by access to food at home, while accessibility depended on affordability and availability in the local market or homestead gardens; and (iii) even though food was available and accessible at the household level, individual food choice and consumption were subject to personal preference, cultural norms and lack of knowledge about nutritious foods and subsequent health benefits during pregnancy and lactation. Conclusions The findings will assist in planning appropriate interventions to improve dietary diversity of pregnant and lactating women. Insights from this study will be useful for designing appropriate nutrition behaviour change communication in Bangladesh and other low-resource settings.

Keywords: Bangladesh, Qualitative methods, Pregnant and lactating women, Food attributes, Perceptions

Location: In two villages of Melandah upazila (sub-district) of Jamalpur districts in northern Bangladesh

Start Date: 00-01-2015

End Date: 00-06-2015

Program Area: Food Safety and Security

Commodity: Dietary intake

Objectives:

Our aim is to explore pregnant and lactating women’s perceived food attributes to characterize personal, behavioural and environmental factors related to dietary behaviour.

Methodology:

STUDY SITE AND POPULATION We conducted a qualitative study in two villages of Melandah upazila (sub-district) of Jamalpur districts in northern Bangladesh. Melandaha upazila was selected as more than 60% of the population are considered poor, with nearly half of the population (47%) extremely poor according to the 2010 Bangladesh Poverty Map.21 In this impoverished rural region less than one in ten household heads had completed primary education. The feasibility of recruiting an adequate number of pregnant and lactating women was carefully considered. We visited the local BRAC office, the largest NGO in Bangladesh, to seek assistance in selecting and accessing the communities. We visited the community clinics, as advised by BRAC staff, to obtain a list of the pregnant and lactating women in selected villages. We collected data in two phases –from January to February 2015, and from May to June 2015. PARTICIPANTS A total of 36 pregnant and lactating women were purposively selected for in-depth interviews (IDI) using sampling techniques adopted from ProPAN (Process for the Promotion of Child Feeding - a tool to improve infant and young child feeding) methodology. 22 The field research team consulted the community health workers to obtain a list of eligible pregnant and lactating women currently receiving antenatal care and postnatal care services. We selected women who were pregnant at the time of data collection, had delivered a live baby in the past two years, or had a child 0-23 months of age. A total of 36 IDIs were conducted in two phases (16 pregnant, 18 lactating women, and 2 pregnant and lactating women). ETHICAL APPROVAL We obtained ethical approval from the Human Research Ethics Committee, University of Sydney (Ref.: 2014/874). In Bangladesh, the study was approved by the Ethical Review Committee of the International Centre for Diarrhoeal Disease Research, Bangladesh (Ref.: PR-14101/2014). Informed written and oral consents were obtained from respondents at each stage of the study. DATA COLLECTION METHODS We recruited two experienced qualitative researchers, who were then trained in data collection tools by an investigator (WK) (a nutritionist and skilled qualitative investigator). Data was collected using in-depth interviews, focus group discussion, market surveys, and food attribute exercises using methods and tools adapted from ProPAN – an approach to capture infant feeding practices through the development of a key food list and food attribute exercises

Source of Information: Journal of Global Health Reports Vol. 4, 202

Article Link (Online Journal): https://doi.org/10.29392/001c.12326

Funding Source:

Budget:

Total Budget (Tk.) :

Achievement/Findings:

Our study showed that household food security is necessary but not enough to ensure dietary diversity of pregnant and lactating women. In food-insecure households, homestead food production and free or low-cost access to essential foods is an important consideration for programming. For maximum benefit, context-specific behaviour change communication that considers social norms and personal preferences as well as appropriate local food production for potentially nutritious foods should be provided to women. The findings of the study will benefit programme and policy makers to design behaviour change communication that aims to improve the dietary diversity among pregnant and lactating women in Bangladesh and other low resource settings.

Knowledge Management: Journal