Why nutrition programmes for women & girls must strengthen gender responsiveness, now!

Author : Neha Abraham, Centre of Women Collectives Led Social Action

Date : 27/06/2020

Bastar, Chhattisgarh. 18-year-old Lalita nervously watched over her four-month-old son Anand*, as her husband prepared a concoction of horse dung and warm water one afternoon in September 2003 at their village Alwahi in the Eastern Indian state of Chhattisgarh. Horse dung was believed to have properties that could reverse the ill-effects of the kathal sabzi or jackfruit that Lalita had absent-mindedly eaten at a neighbour’s house. They had heard that if breastfeeding mothers ate kathal, it could make the baby gravely ill. So her husband, Ramesh*, had travelled for an hour to villages on the outskirts of their district in search of horses and dung.

Jackfruit, which is rich in vitamin C, fibre and minerals, available abundantly across Bastar’s barren landscape is one of several nutritious foods including bananas, custard apples, pumpkin, colocasia and red meat that are forbidden to pregnant women and young mothers. Emic explanations reveal various beliefs on the negative effects of these foods on the child, and that eating too much could make giving birth harder. That 57% of Bastar’s pregnant women are anemic and 37% have low BMI (NFHS-4) is then unsurprising.

Anand who is now 17, was diagnosed with sickle cell anemia which is a hereditary condition. But for Lalita's in-laws and husband, this has always been linked to the jackfruit she had eaten while breastfeeding him. The repulsive ordeal of consuming horse dung proved inadequate for the family. Every time he is sick and there are hospital bills to be paid, she is blamed with a taunt - “Tu kathal khayi, isliye hua” (you ate the jackfruit, which is why he is like this). 

 

Gender dynamics affect women’s nutrition, health and dignity

Various studies have advocated the need for nutrition literacy and have acknowledged the pervasiveness of such food taboos that leave young mothers nutritionally deprived during the first 1000 days. Culturally in South Asia, women are also usually the last to eat in the family and often end up with the least. In fact in Bastar, a dish is considered ‘jootha’ or desecrated if the woman eats it first. The onset of the COVID-19 pandemic then has worsened existing nutritional issues resulting from gender inequalities in the family. Rumours of contracting the Corona Virus by eating eggs and chicken, for instance, have further reduced rural women's protein intake. Programme implementers must reflect on these realities and seek to address their underlying causes.

Norm abidance however, is one part of the problem. Evidence from South Asia as well as our own research in Bastar show how alcohol use and intimate partner violence affect women’s food security and lead to differential nutritional outcomes within a household. Post-lockdown, several reports have documented the global increase in cases of violence against women.  Rising food prices and food shortages are likely to exacerbate this.

Acute poverty is a contributing factor for malnutrition in general. But while poverty may account for the reduced quantity or variety of food on the plate, it does not explain the skewed sacrifice made by women. Deep-rooted patriarchy in addition to a lack of access to health services thus adversely affect women’s health, nutrition and self-efficacy. The ongoing pandemic has also made this more obvious

 

Why anti-poverty and nutrition programmes must work towards becoming gender-transformative now

Women’s self-help groups, primarily envisaged as community-based credit institutions, have emerged as promising catalysts to lead behaviour change interventions on health and nutrition, given their vast networks, organisational readiness to manage grants for livelihoods as well as community development activities. In the current scenario, self-help group members are also actively involved in awareness generation, relief measures, and supporting continuity of essential maternal and child nutrition services. It is important that they are also capacitated to address norms and gender dynamics at the household that impact women's nutrition.

 Anti-poverty and nutrition programmes around women’s groups must take cognizance of how the relation between women’s economic empowerment and improved nutrition levels is complex, as this study highlights. Better economic decision making as a result of improved access to income or livelihood opportunities for women needn’t translate into equal division of food at the table or equal priority for accessing quality healthcare, for instance. Key messages used in community- based nutrition interventions must thus be re-worked with a gender lens targeting not just women, but families; particularly mothers-in-law, who are keepers of food traditions and husbands and sons who are often prime decision-makers in the family.

 

Building on prior initiatives to address gender discrimination

In India, the National Rural Livelihoods mission recognises gender as a cross-cutting socio-cultural variable and has sought to address various gendered forms of discrimination by building capacities of its cadre. To this end, the Chhattisgarh Rural Livelihoods Mission (CG-SRLM) or Bihan which anchors the poverty alleviation programme in the state, had conducted a series of gender sensitisation training to develop community-based gender resource persons or (GRPs) to address gender discrimination in the community. Lalita whose story we shared in the beginning, is now aged 31 and is one of Bihan's gender resource persons (GRP). Amongst a range of issues, she is also trained to counsel families on gendered beliefs and practices that leave women eating last and the least. This is part of an ongoing pilot where gender has been layered into Bihan's maternal and adolescent nutrition called Swabhimaan

The intervention was designed based on a formative study conducted to understand the socio-cultural context of Bastar, as well as men and women’s perceptions around diets, marriage and pregnancy, to assess the programmatic implications of these.

Bihan’s strategy to enhance the adequacy of food intake and diet diversity among adolescent girls, pregnant women and mothers now also focuses specifically on engaging husbands of these target groups. This was also reflected in the IEC material circulated for awareness generation on maternal nutrition practices during COVID -19.

 

Food; an effective trigger for conversations around gender

Conversations about food are effective triggers for behaviour change as they resonate with everyone. Talking about food, is also less contentious than talking about property rights and entitlements, for instance.When we ask how a family divides a fish, most women will say the fleshy centre goes to the children, the head, which is considered most nutritious goes to the men because men need strength and the tail with all the bones to the women. In fact, women often make do with only rassa or gravy. Both men and women understand this example,” explains Lalita 

The GRPs thus use food to segue into larger questions of gender, enabling families to become increasingly receptive to the power dynamics within their homes. This is key, as it has also helps avoid backlash from the larger community which is a challenge for implementers of gender-transformative interventions.

For Lalita, having insight on gendered power relations in her family and discussing these with other self-help groups members has been empowering as she feels she is now better positioned to navigate these. 

It is now crucial to resume work initiated earlier. Building capacities of more community leaders like Lalita, investing in their social capital and the collective strength of women’s groups to engage men, boys and families, could thus prove to be a sustainable and effective pathway to safeguard women’s nutrition.

*Names changed in this article