Lessons in Nutrition

Most of summer of 2015 was spent in villages of Jhalawar, a district in Rajasthan. It was only a month that our flagship program, Akshada, was launched. The main objective of the program is to improve the maternal health, child health and nutrition indicators. Hence it was important to speak to the mothers to understand practices around health and nutrition.

Every day we would meet groups of women. Younger women with babies in their arms were eager to interact. The older women would typically trickle in later and make statements – often complaining about ideas like ‘rest during pregnancy’ by the doctors. They thought such advice had ‘spoilt’ the younger women. They would often say that now-a-days young women do not have the kind of strength that they possessed in their youth.

I would ignore such statements because they were not responses to our questions- what do young mothers feed their children, what do they have during their pregnancy, are there any foods that they avoid during pregnancy, etc. However, similar responses from the older women, village after village got me thinking. I added a few questions and things to observe in my discussion guide from week two.
During the focus group discussions, I started noticing the difference. Most of the younger women in their colourful attire looked frail, tired and weak. They lacked that energy which is often synonymous with youth and being pregnant. The older women despite their slow and assisted movement, appeared well-nourished and not over-weight. Their wrists were broader and they seemed to have substantial muscle mass, as compared to the younger lot.
We started probing and comparing food habits during pregnancy of younger and older women. There was a significant change in diet over the years. The older women ate what they grew- whole grains and greens. Their diet comprised of curd and buttermilk in good quantities. On the other hand, the younger women bought cereals from the market, which was more than often not grown in their villages. In a couple of decades or so maize, millets, barley were replaced by wheat and rice. Today’s diet included more of processed food, especially in case of children in the weaning age-group.
Some basic ways of life had changed drastically. Majority of farmers are growing cash crops. Therefore, their daily diet had changed. With better access to cities, processed food has made its way into the lives of families in rural areas. And how! When a young mother was asked what does she feed her 8- month old child, besides breastmilk, she said “One packet of Takatak and a few Parle-G biscuits. He eats all of it. Does not want to have roti”. Takatak is the Kurkure equivalent in rural Jhalawar. This is what we heard in almost 75% of the villages that we visited. The older women told us that they ate maize rotis and maize porridge during pregnancy and when weaning a child, they would give them small and diluted portions of the same diet. Locally grown grains and vegetables were the main ingredients.
A lot had changed in two and a half decades- agricultural practices, food habits, perception of nutritious food, etc. It was also clear that providing interventions during the 1,000 days is just not enough. A comprehensive strategy needs to be deployed to tackle undernutrition. Policies related to agricultural practices are as important as pricing/taxing policies of junk food to create an environment, where healthier options are available. For example- farmers to compulsorily retain a fraction of their land to grow traditional food crops, fruits and vegetables. Only then can the remaining land be used for commercial production. Fast foods that have no or very little nutritious value should be taxed at a higher rate to discourage intake.

Lesson learnt: Do not ignore statements or comments made by onlookers during a focus group discussion as they may provide cue to rich data. When we began, I was clearly not listening!

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