Dietary Practices Among Pregnant Women in Rural Amhara, Ethiopia

Abstract

Objectives Malnutrition affects 25% of women in Ethiopia. We are conducting a study to determine the impact of a prenatal nutrition intervention on maternal and infant health in Ethiopia. The objective of this formative study was to better describe dietary practices among pregnant women and community members in rural Ethiopia prior to initiation the parent study. Methods This formative study was conducted from October-November 2018 among pregnant women and community members in the rural Amhara region of Ethiopia, prior to the “Enhancing Nutrition and Antenatal Infection Treatment (ENAT)” study [ISRCTN15116516]. 28 in-depth interviews (IDIs) were conducted among 16 pregnant women and 12 community members. IDIs were recorded, transcribed, and translated. We used a grounded theory approach and inductive reasoning for content analysis of interview transcripts. Results Fasting norms in the Ethiopian Orthodox religion had a significant impact on dietary behaviors which occurs for more than 200 days annually. Community members indicated that fasting during pregnancy is common and is also supported and encouraged by religious leaders and community members. Accordingly, women adhered to fasting restrictions during pregnancy, and many women maintained a vegan diet under direction of local religious leaders. Furthermore, many women reported restricting dietary intake in pregnancy to prevent growth of the fetus because of the concern for obstructed labor. A women's diet depended on her husbands’/family earnings and household food preferences. Sharing of meals is a cultural norm; the husband is served first, with the remaining portions to the pregnant women/children. Pregnant women in the area also reported regular consumption of a locally brewed alcohol (“tella”), as it is believed to have lower alcohol levels. These findings demonstrate the impact of traditional and cultural beliefs on dietary decisions amongst pregnant women in this population. Conclusions Reduced food intake in pregnancy is common in this population, due to fasting, reduced appetite, and food restriction to avoid pregnancy complications. Context-specific interventions are needed, and this formative work will inform the future delivery and education regarding nutrition interventions in rural Ethiopia. Funding Sources Bill & Melinda Gates Foundation (OPP1184363).

Anemia in Pregnant Women as a Cultural Phenomenon: A Literature Review

“…as well as the role of family, religious figures, mothers, and in-laws. The article was explained by Workneh et al (2023), Asim et al (2022); Amare et al (2022); Maykondo et al (2022); Dalaba et al (2021), Ramulondi et al (2021), and Alehegn et al (2019). Some articles examine the opinions of traditional leaders, mothers’ perspectives, and husbands’ perceptions of anemia which are explained by 2 articles by Darmawati et al (2020) and 1 article by Darmawati et al (2022).…”

“…Dietary restrictions on animal protein include meat, milk, eggs, and certain fish in Ethiopia and their effects on the mother and future baby (Amare et al, 2022; Workneh et al, 2023). Dark green vegetables such as kale, spinach, broccoli, and lettuce are the foods that are most avoided, as are green chilies, and offal (Mohammed et al, 2019).…”

“…All the research results above are about field facts about pregnant women’s compliance with the culture of abstinence from food and are strengthened by information from traditional leaders and supervision from fathers, mothers, mothers-in- law, and husbands as well as fears of the dangers that will be experienced by mothers and babies who will be born. Belief in culture cannot be easily eliminated, so interventions related to food taboos can be carried out with religious-based health counseling (Darmawati et al, 2020) because religious beliefs that fasting for pregnant women is a spiritual practice so as not to harm pregnancy (Workneh et al, 2023). Providing information about local food that contains iron (Darmawati et al, 2020) as well as health education based on local wisdom (Darmawati et al, 2022).…”

Enhancing Nutrition and Antenatal Infection Treatment (ENAT) study: protocol of a pragmatic clinical effectiveness study to improve birth outcomes in Ethiopia

“…Prior to the study, formative work was conducted with a range of community members (mothers, families, community and religious leaders, health providers). 32 This feedback directly informed the design of the study interventions, packages and their implementation. Community sensitisation was performed prior to initiating the study.…”

“…Routine ANC nutrition counselling includes increasing intake and dietary diversity, however, can vary depending on patient load. For ENP centres, supplementary, locally contextualised, counselling material was developed based on our formative work, 32 and is delivered by midwives. Content includes BMI-based recommended weight gain, dietary diversity and educational messages developed to address local cultural beliefs related to dietary intake during pregnancy as well as side effects of IFA.…”