[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.]
Nutrition programs often target groups most visibly linked to desired nutrition outcomes. For example, since nutrition is key to children’s development during their ‘1000 golden days’, mothers with young children or women of childbearing age tend to be targeted to promote good nutrition for infants. As other articles in this issue contend, though, a narrow participant focus may limit the impact of nutrition programs and ignore the role that other family members play. At the same time, looking only at broad, household-level indicators of nutrition may miss different household members’ unique vulnerabilities. Nutrition programs are more effective and relevant when they are sensitive to family power dynamics, local practices and culture. This article offers ideas for integrating gender and cultural context into planning, monitoring and evaluating nutrition programs. While these ideas are not exhaustive, they offer a starting point for thinking through gender and cultural issues that affect nutrition.
Look within the household
Sufficient, nutritious food available at the household level does not ensure that all members will have access to enough food to meet their dietary needs. Intra-household distribution of food, family decision-making systems and cultural practices and taboos mean that the nutritional status of family members within one household may be widely different. As Gurung and Ghimire observe in their article, women in some households in Nepal eat after other family members have had their fill, which can limit their access to preferred foods like meat or vegetables. Looking simply at whether the household unit has enough food would miss this kind of variation in access to nutritious food within the household.
Collecting gender- and age-disaggregated data on diets for each member of the household using tools such as the Household Dietary Diversity Score provides insight into the unique nutrition status of different family members. Alternatively, Lee and Hembroom in their article describe a project in Nepal that has started to collect data on the number of times women in participant households skip meals. Since women eat last in this cultural context, the number of meals skipped by this population will be a more sensitive indicator than the number of times the entire household skips meals.
Disaggregated data may also reveal needs among populations who are not always targeted in nutrition interventions. While pregnant and lactating women and young children are generally known to be vulnerable to malnutrition, other household members, like elderly members or adolescent girls, might also be receiving insufficient food or nutrients for their needs. For example, after the April 2015 earthquake in Nepal, MCC worked with partner organization Shanti Nepal to distribute rations of ready-to-eat food that included nutritious and locally-sourced chiura (beaten rice flakes) and roasted lentils. However, while distributing these rations to highly-affected rural households in Dhading district, Shanti Nepal staff realized that young children and elderly people may lack the teeth necessary to eat such hard and crunchy food. They adapted the ration to include easier to eat instant noodles. For subsequent disaster responses, MCC and partners in Nepal have included a nutritious porridge flour mix in the emergency rations intended for young children and elderly people.
Identify decision-makers and agents of change
When planning projects, analyzing family systems and power dynamics within a household can help identify gatekeepers and potential agents of change. Nutrition programs often focus on health and agriculture activities, but addressing household power dynamics within family relationships and organizing anti-domestic violence activities can also lead to better nutrition outcomes. In Nepal, newly married women traditionally move into their husband’s family home and often take on a large portion of household duties. Mothers-in-law make decisions about their daughters-in-law’s work and also often have strong ideas about food taboos in pregnancy or for young children.
An MCC-supported project run through partner organization Sansthagat Bikas Sanjal and implemented by Interdependent Society in Surkhet district facilitates discussions between mothers-in-law and daughters-in-law and between husbands and wives. These discussions encourage shared understandings about good nutrition practices and provide opportunities to discuss family relationships. By encouraging shared knowledge about nutrition and by improving communication, the family members who make household decisions about money, household duties and food can work together toward improving nutrition for all family members. This project has reported that after these discussions mothers-in-law and husbands have started providing support to pregnant and lactating women by recognizing their specific nutrition needs, encouraging health check-ups and reducing their household workload. As noted in the article by Gurung and Ghimire, other projects in Nepal have also successfully engaged male family members to encourage better household nutrition practices.
Some family members may be better able to promote changed household practices than others. As Rahaman and Rahman point out in their article, identifying agents of change within a household, like students in Bangladesh, smoothes the process of change. In this case, project implementers found that parents who were reluctant to try new agricultural techniques themselves were willing to support and learn from their children, which led to diversified livelihoods and diets for participant households. Similarly, Climenhage notes that in Labrador, Canada, the Community Food Hub’s children’s garden is one of its most successful programs, working through students to promote healthy eating at home. Meanwhile Sarker and Rahman examine in their article how women’s heavy investment in the long-term good of the household led the monga mitigation project to select women as primary participants in asset transfers and project trainings.
Decide what to accept
Identifying cultural practices that affect nutrition also requires analysis of when to encourage different practices and when to simply offer alternatives that achieve the same nutrition outcomes. It may be a slow process to change the cultural perception in Nepal that pregnant women should not eat Vitamin A-rich papaya because of fears that it will cause miscarriage. Ultimately it may be more effective to promote carrots or eggs as alternate sources of Vitamin A that do not come with cultural taboos attached. Perhaps a comparable example is the idea that North Americans could consume less red meat if they started eating insects as a healthier and more sustainable protein option. In many cultures, insects are commonly eaten as snack foods. However, because of many North Americans’ revulsion at the thought of eating insects, a nutrition project that promotes beans and legumes as a substitute for red meat is likely to be more successful. Similarly, Wade and Yameogo observe in their article that the success of integrating moringa into diets in rural Burkina Faso links with the traditional practice of consuming moringa as a healthful medicinal plant and with the project’s demonstrations of how it can be adapted into traditional foods.
Gender- and culture-sensitive nutrition programing requires intensive analysis of family systems, intra-household power dynamics and awareness of taboos and cultural practices related to food consumption. Food insecurity affects communities, households and family members in diverse ways, requiring project approaches that recognize and build on the local context in order to address malnutrition successfully. Deep knowledge of the local community’s culture, traditions, eating habits and practices is essential and requires careful attention at all stages of a project. Such knowledge is often most accessible to those with close community ties. A community-driven approach that builds on the existing knowledge of local organizations and their relationships with community members can help navigate societal and cultural complexities and ultimately lead to better nutrition outcomes for all people in a community.
Martha Kimmel is MCC Nepal food security advisor. Leah Reesor-Keller is MCC Nepal co-representative.
Madjdian, Dónya S. and Hilde A.J. Bras. “Family, Gender, and Women’s Nutritional Status: A Comparison between Two Himalayan Communities in Nepal.” Economic History of Developing Regions 31/1 (2016): 198-223.