Addressing cultural barriers to nutrition in Nepal

[Individual articles from the Winter 2017 issue of Intersections will be posted on this blog each week. The full issue can be found on MCC’s website.]

In the Nepali context, household access to sufficient food does not ensure that all household members are well-nourished. Cultural beliefs about food consumption can lead to low nutritional status, particularly for highly-sensitive groups such as pregnant and lactating women and young children. Deep-rooted beliefs about food can present barriers that inhibit adoption of new, more nutritious food consumption practices. These barriers are in turn compounded by low levels of formal education in rural areas of Nepal and by strong hierarchies in families in which older, more traditionally-minded family members make decisions about food consumption in the household. This article explores the importance of engaging multiple stakeholders within the household in order to change cultural perspectives on nutrition.

One example of a common cultural practice that affects nutrition in Nepal is the categorization of foods into ‘hot’ or ‘cold’. These categorizations, unrelated to the physical temperature of food, reflect perceptions of how foods will affect the body after consumption. During critical periods such as pregnancy, lactation and illness, it is common practice to avoid eating foods classified as ‘cold’ in order to protect the body in its vulnerable state. For example, pregnant women may be warned to avoid eating certain vitamin-rich fruits and vegetables like papaya or spinach because these foods are considered cold.

Other cultural practices that affect nutrition may affect various household members differently. Baby boys are commonly exclusively breastfed until six months of age, while baby girls are generally offered their first solid food earlier, at five months of age. In some cultural groups, women family members eat meals last, after everyone else in the family has had their fill. Ultimately, these practices can contribute to poorer health status, including anemia and malnutrition for children under three and for women during pregnancy and lactation.

Lack of nutrition knowledge is the main reason for the persistence of traditions that negatively influence nutrition status in the community. In order to address this situation, the Rural Institution for Community Development (RICOD) has been disseminating appropriate nutrition knowledge and skills in rural communities of the southern Lalitpur district. In these trainings RICOD raised awareness about effective nutrition practices aimed not only at mothers of young children and pregnant women but also at those who traditionally hold decision-making power in their households, namely, the women’s in-laws and husbands. In order to ensure that such trainings, which aimed to change traditional practice, were also  culturally sensitive, RICOD’s staff focused on providing general nutritional advice, such as counseling pregnant women to consume diets rich in vitamins, rather than targeting and criticizing specific cultural practices, like avoiding green leafy vegetables (a ‘cold’ yet vitamin-rich food) during pregnancy.

Trainings generally targeted women with young children by teaching an in-depth nutrition curriculum in mothers’ groups and then reviewing and doing refresher trainings on that curriculum. Mothers-in-law were also often part of these groups, so these workshops included more powerful players in household decision-making. Additionally, RICOD organized workshops for men in the targeted households, because decisions in Nepal about buying food and about agricultural plans are traditionally made by male heads-of-household, including fathers-in-law and husbands of women with young children. Therefore, men’s understanding was crucial for households to start acting on new nutrition knowledge. RICOD also promoted learning and sharing opportunities between women and men on the importance of nutrition for women and children during vital periods. These meetings aimed to lower cultural barriers to acting on good nutrition knowledge.

More recently, RICOD organized nutrition awareness trainings for school-aged adolescents (men and women) to provide knowledge to younger generations. Not only are the nutrition facts important for these adolescents to know as future parents, these young men and women also tend to be well-placed to disseminate the information to their parents and neighbors.

In addition to teaching new information, RICOD recognized the importance of peer education in changing traditional practice. To promote learning and sharing opportunities among women, RICOD worked with existing mothers’ groups linked to local health posts to strengthen their functioning. Through these meetings, participants exchanged ideas and shared knowledge about nutrition and health. Participants then also shared the new knowledge they gained from the groups with their neighbors and relatives. RICOD also promoted kitchen gardening and empowered women by providing access to capital via revolving loans administered by these women’s groups. Kitchen gardens increased women’s access to homegrown vegetables while revolving loans stimulated small enterprises that in turn generated additional income for households to buy nutritious food.

Besides promoting peer education through women’s groups, RICOD provided in-depth training to volunteer peer educators on good nutrition practices. Peer educators are youth residing in the local community who regularly visit targeted households to encourage them to practice good eating habits. Additionally, some peer educators attend the monthly mothers’ group meetings, where they lead discussions on nutrition-related topics.

RICOD’s work has led to important learnings for future nutrition programs. In particular, understanding traditional beliefs and eating habits is essential for knowing how to promote improved nutrition practices. Broad dissemination of nutrition information should take place in order to teach many people within a community. RICOD also found that working with more than just one household member was a key to healthy changes in traditional practices. By training both men and women and both younger and older generations on the importance of nutrition and good nutrition practice, RICOD was more effective in creating change within households. Not all of this change came easily. Changing older generations’ traditional beliefs was a challenge, since it takes a long time to change traditional practice and behavior. Even now, not everyone has changed their traditional practices. RICOD’s work and encouraging results demonstrate, though, that exposure to better eating habits and continuous follow-up can lead to changed knowledge, skills and practice.

Additionally, peer education and coordination by non-governmental organizations like RICOD with other health providers, like Nepal’s Female Community Health Volunteers, are important so that people regularly hear the same message about good nutrition practice from multiple sources. Mobilization of local community members to disseminate nutrition knowledge can help lower cultural barriers through peer education and regular follow up. That regularity is key to changing long-held practices. Changing tradition is a slow process, but new knowledge and understanding can over time lead to positive changes in nutritional practice and health.

Honey Gurung is field coordinator and Ram Hari Ghimire is executive director for the Rural Institution for Community Development (RICOD).

Learn more

Adhikari, Ramesh Kant. Food Utilization Practices, Beliefs and Taboos in Nepal: An Overview. United States Agency for International Development, Global Health Technical Assistance Project (May 2010). Available at pdf.usaid.gov/pdf_docs/pnaeb772.pdf.

Alonso, Elena Briones. The Impact of Culture, Religion and Traditional Knowledge on Food and Nutrition Security in Developing Countries. FOODSECURE Working Paper No. 30 (March 2015). Available at www3.lei.wur.nl/FoodSecurePublications/30_briones.pdf.

Khatry, Subarna K., Steven C. LeClerq and Sharada Ram Shrestha. “Eating Down in Pregnancy: Exploring Food-Related Beliefs and Practices of Pregnancy in Rural Nepal.” Ecology of Food and Nutrition 45 (2006): 253-278. Available at www.k4health.org/sites/default/files/Eating%20down%20Nepal%20article_Caroline%20sent.pdf.

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