Dietary Practices among Deviant Pregnant and Locating Women (PLW) in Productive Safety Net Settings of Ethiopia - Abstract
Background: In Ethiopia, the dietary diversity score, minimum dietary diversity, and dietary practices of Pregnant and Lactating Women (PLW) were found suboptimal. Food insecurity and socio-economic factors are the common barriers to maternal feeding practices. This study was designed to identify dietary barriers and explore how positive deviant PLW could overcome those barriers while negative deviants are struggling with malnutrition both sharing similar settings which can help in showing a different perspective on nutrition programming. Methods: A qualitative study was conducted in two purposely selected productive safety net program-supported districts in Oromia and Amhara regions. Sixteen positive deviant PLWs (not acutely malnourished and living in food-insecure households (HHs); and sixteen negative deviant PLWs (acutely malnourished
and living in food-secured HHs) were interviewed, observed their HHs and identified feeding barriers at demand and supply sides. We also conducted an in-depth interview with health service providers, traditional healers, and district nutrition program managers. Additionally, seven focus group discussions (FGD) were made with community leaders, grandmothers and mothers-in-laws, and religious leaders. The findings were organized and coded using Atlas.ti qualitative software and thematically analyzed. Result: Positive deviants have increased awareness and value of the importance of nutrition to themselves and their kids, practice preventative medical
services for themselves and their child (ANC, Delivery, PNC, and vaccination), supported by their family culture and members on a balanced diet, motivated for the translation of nutritional knowledge into practice, they tend to have no or less influence by food taboos, understand better the effect of fasting on themselves and their kids and have a flexible attitude toward fasting, tend to consume more locally cheaper but more nutritious food items and take part in diversified small business income-generating activities to be a food subsistent household. Negative deviants are unhappy with the health service experiences they received from health centers and health posts, tend to have poor feeding routines, are not flexible in fasting practices, not have a good understanding of the frequency of feeding practices and type of food for pregnant and lactating mothers recommended to eat, less visited by agriculture and health service government sectors at the household level. Conclusion: Pregnant and lactating mothers’ nutrition program design and implementation needs to consider understanding the deviant mothers’ dietary unique behaviors. Particularly, it is important to capture and customize the positive deviants’ unique behaviors that helped them to overcome local barriers to their feeding practices and nutritional behaviors while negative deviant mothers’ specific dietary barriers also need to be explored and addressed.