Mother preparing ragi-koozh. Credits: Mira Kudva Driskell, NFLC 2017

Adequate nutrition in the first two years of life is vital for healthy brain development, growth, and illness prevention. However, millions of babies worldwide do not get the nutrition they need due to lack of household resources, inadequate or ineffective policies, and lack of support for caregivers. In India, Adivasi (indigenous) children suffer disproportionately from under-nutrition, resulting in elevated levels of stunting (NFHS 4). Not only is child nutrition an important issue in itself, it must be addressed in order to successfully meet the United Nation’s Sustainable Development Goals, which include good health and well-being, quality education, gender equality, and sustainable communities.

To combat the problem of child under-nutrition in India, the government of India initiated the Integrated Child Development Services (ICDS) Scheme in 1975. This program created village-level Anganwadi centers to improve education, health, and nutrition among children and mothers. Two of the main objectives of Anganwadi centers are (1) to improve the nutritional status of young children and pre- and post-natal mothers, and (2) to increase maternal education and the mother’s capacity to oversee the nutrition of her family (Sachdev and Dasgupta 2001:139). Some villages also have a community health worker who is formally trained in health care. Mothers may receive support from the Anganwadi worker and community health worker, but there are others who influence a mother’s choices about what, when, and how to feed children. A mother’s decisions on childcare may be influenced by family members and other community members, especially for decisions related to breastfeeding, supplementing breast milk with complementary foods, and eventually weaning infants off breast milk. Family members help with acquiring food, preparing meals, caring for children, and giving advice about what and how to feed infants and young children.

There is a wide body of knowledge about how the economic condition of a family and the educational status of the mother affect a child’s nutrition. These factors shape food choices, food acquisition, and intra-household food allocation. However, there is significantly less analysis of the influence of social support for mothers on infant and young child feeding practices and nutrition. Social support is defined as resources provided by other persons and can include informational, practical, or emotional support (Stansfield 2006). Through our research, we sought to answer the question: “In what ways does social support for mothers (informational, material, and emotional) influence infant and young child feeding practices?”

Our study took place in the Nilgiri Biosphere Reserve, which was established in 1986 in recognition of the exceptional diversity and interdependence of sociocultural and ecological diversity. We conducted our research in three Irula villages within forty-kilometers of Kotagiri, Tamil Nadu in March and April of 2017. We gained access to our research villages with the help of the Keystone Foundation, an NGO focused on eco-development based in Kotagiri. Keystone has longstanding relationships with these villages, and our research supports ongoing dialogue in the region about capacity building and policy advocacy for sustainable development. We used mixed methods of observation, including mapping and interviews to obtain our data. Our interview subjects were twelve mothers of children less than three-years-old and four key informants—two Anganwadi workers and two community health workers. Participants were invited for interviews by a liaison between the research team and the community. Prior to the interview, B. Mahanathi (co-author) read a script describing the work, its purpose, the respondents’ rights to terminate the interview at any point, and guarantee of anonymity. A signature was obtained from respondents who could write, and verbal consent was obtained otherwise. The research project was reviewed by Cornell University Institutional review board to assess risks to participants and ethics of the work.

Jackfruit tree in one of our research villages. Credits: B. Mahanathi, 2017

Interviews consisted of three modules. Module 1 utilized the “free listing” method to generate lists of foods fed to infants/young children in different age categories, foods considered bad for infants/young children, and differences in how girl babies and boy babies are fed. Module 2 used narrative discussion based on structured open-ended questions to obtain information about the challenges caregivers face around caregiving and feeding infants and young children. Module 3 had two parts— a social support scale based on 10 yes/no questions borrowed from Martin et al. 2017 and a series of open-ended questions related to social support. During our time in the field, we had 24/7 translation assistance to allow communication between Irula, Tamil, and English speakers. 

We used the social support scale data to determine each mother’s level of social support: high, medium, and low. We examined social support levels in relation to all other data obtained from our interviews. We noticed that mothers with lower levels of social support reported feeding babies fruits, biscuits (Marie Biscuits, for instance), and gravies more than mothers with higher levels of social support. Many mothers expressed beliefs about the dangers of fruits for young children. For example, jackfruit can give babies a fever or a cold, bananas can give babies a cold or diarrhea, and guava can give babies a cough. Despite the prevalence of these beliefs, mothers with low levels of social support were more likely to feed fruits to their babies. One mother categorized as having low social support said, “They say not to give jackfruit [to the baby], but I give it anyway. I don’t worry.” Another mother with low social support said, “No foods are bad [to give to the baby].”Mothers with high levels of social support were more likely to feed their babies vegetables. While fresh fruits are seasonally available in the villages, fresh vegetables are not. Vegetables are not grown in kitchen gardens in the villages, we were told because people thought monkeys would steal their produce before they were able to harvest. The more isolated a village, the farther people must travel to access fresh vegetables. Mothers with lower levels of social support struggle to access fresh vegetables as there are fewer people to watch their children or attend the market on their behalf. Mothers with less support have more constraints on their time and more difficulty travelling, which may lead them to choose easily accessible and readily available foods for their babies.

We found that social support, in the context of these three villages, is sought almost exclusively from family members. During the interviews, we asked each mother to identify who she goes to for advice regarding feeding her children. Not one mother identified an Anganwadi worker or a community health worker as a source of advice or information. In fact, all mothers but one reported going to elders in the family—primarily their own mothers, mothers-in-law, or paattis (grandmothers)—for advice on what and how to feed their infants and young children. One mother said, “I get advice from both paattis. If a paatti is not there, I will ask other elders in the village. If you go to elders, they give good advice. Mothers my own age don’t give good advice.” Many mothers (7/12) mentioned traditional medicines that paattis make for the babies. They told us of plant-based medicines to cure fevers, colds, and stomach pain, with ingredients including camphor, turmeric, the stem of a “vethalai” leaf, tamarind, and bark of the “itti” tree.  Mothers expressed great trust in the traditional knowledge of their female elders, who possess special knowledge of local ecologies. A few mothers told us of a tradition where the paatti keeps all of her traditional medicine secrets until she is on her deathbed. Before she dies, she writes down everything she knows about plant medicine and hands the paper to her daughter.

Because mothers turn to female family members primarily for help and advice, the level of family support may influence how strictly a mother adheres to traditional feeding practices. Some of the traditional practices include feeding girls and boys differently, avoiding giving certain fruits to babies, feeding a millet porridge called “ragikoozh” to babies at 3 months old, and making a nutritious broth called “rasam” to increase the mother’s breastmilk supply.

Mothers and key informants differed in their reports on how babies are fed. Key informants argued that mothers start feeding their children vegetables at six months. Only four of the twelve mothers reported feeding vegetables at this age. Key informants also reported no difference in how girl and boy babies are fed. However, a slight majority of mothers (7 of 12) told us that girl babies are fed differently than boys. These differences are further evidence that mothers do not look to Anganwadi teachers or community health workers for advice about what to feed their babies, but rather rely on family members. In general, mothers in our study do not utilize the Anganwadi centers’ services that are intended for them. Very few mothers reported feeding their children nutrition powder from the Anganwadi centers—a significant piece of the child nutrition initiative of the ICDS Scheme.

Bag of nutrition powder at the Anganwadi Center. Credits: Bridget Conlon, 2017

Our study raised many questions. Why do mothers in our study choose not to utilize free nutrition supplementation? Why do mothers look only to their family for advice, rather than seek advice from women formally trained in nutrition and health care? How does a mother’s level of family support impact whether she adheres to traditional feeding practices? How does indigenous knowledge of foods and medicines depend on the dynamic landscapes of the Nigiri Biosphere Reserve? How do infants and young children in our study villages compare to general statistics on tribal infants and young children in regards to nutrient deficiencies, stunting, wasting, and underweight?

In the Nilgiri Biosphere Reserve, people and communities are essential elements of the integrated conception of conservation. Indigenous knowledge, feeding practices, and nutrition outcomes are inextricably linked to environmental conservation as they are essential to sustaining human interactions with dynamic landscapes. In our study villages, familial support networks and traditional knowledge prevail over government interventions in nutrition. By gaining a better understanding of the social support systems available for Adivasi mothers and the sources of support they seek, researchers, community development practitioners, and policymakers could better assist tribal communities in creating nutrition programs that are relevant to local needs and sensitive to cultural preferences.

 

Acknowledgements: We would like to thank our mentors Rebecca Stoltzfus, Sharanya Das, and Shubh Swain, the faculty and staff of the Nilgiris Field Learning Center, the Keystone Foundation, our translator Sujithra Velkumar, our village guides, and the 16 women who shared their time with us for enriching our experiences and making our research possible. We would also like to thank our reviewers at Current Conservation for raising important questions in regards to our study and giving us the opportunity to share our research.

 

Bridget Conlon’17 majored in the International Agriculture and Rural Development Program at the College of Agriculture and Life Sciences at Cornell University. She can be reached at bcc48@cornell.edu.

Mahanadhi lives in the Sigur plateau, Nilgiri Biosphere Reserve. She has passed her 12th grade and  is a graduate of the NFLC class of 2017. She is currently working as a field assistant for the Keystone Foundation co-ordinating agricultural work and women’s health programs.

Email: kf@keystone-foundation.org

 

References:

National Family Health Survey-4. 2009. International Institute for Population Sciences, Deonar, Mumbai. http://rchiips.org/NFHS/nfhs4.shtml. Accessed on June 9, 2018.

Stansfeld, S.A. 2006. Social support and social cohesion. In Social Determinants of Health. (eds. Marmot, M. and R. Wilkinson). Pp. 148–171. New York: Oxford University Press.

Sachdev, L.T.Y and Dasgupta, J. 2001. Integrated Child Development Services (ICDS) Scheme. Medical Journal Armed Forces India 57: 139-143.

 

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