Background Characteristics of the study participants
A total of seventy nine (79) respondents participated in the eight FGDs and Twelve KIIs. The participants comprise of twenty-six pregnant women, twenty-four men (husbands of pregnant women), four health professionals, four health extension workers four elderly (mothers-in-law). The participants represented a wide age range (20–63 years) and educational status of the respondents ranged from no formal education to secondary school and above. (Table 2)
Table 2 Socio-demographic characteristics of the participants in rural Illu Aba Bor Zone, Southwest Ethiopia, 2019
Characteristics of respondents
|
Categories
|
Frequency(n)
|
Percent (%)
|
Age range
|
20 - 63 years
|
-
|
-
|
Sex
|
Male
Female
|
35
44
|
44.3
55.7
|
Educational status
|
No formal education
Primary
Secondary & above
|
41
20
18
|
51.9
25.3
22.8
|
Occupational status
|
Employee
Housewife/Farmer
Daily laborer
|
21
51
7
|
26.6
64.6
8.8
|
From a thorough review and readings of the scripts, the following three themes were identified:
- Beliefs and practice of food taboos in the community.
- Food items held as taboos and reasons attached to it
- Model summarizing the Reasons for adherence of the food taboos and misconceptions
Beliefs and Practice of food taboos in the community
The respondents were asked whether they were aware of any foods that are culturally prohibited during pregnancy. Differing opinions were noted regarding to the practice of food taboos.
Some pregnant women, their husbands and mothers- in- law believed that some foods should be avoided during pregnancy to protect and support maternal health.
A mother-in-law, 51 years, KII participant stated,
“…When they have morning sickness they cannot eat oily foods. Restriction of oily foods is Practiced early in pregnancy to reduce the likelihood and severity of morning sickness...”
Similarly, one mother-in-law, 60 years explained the following corroborating what was said earlier,
“… Intake of oily foods may be limited throughout pregnancy and that, in general, pregnant women don’t eat as much oily food...”
A Pregnant woman, 34 years, FGD participant also stated,
“…pregnant women should be careful and avoid certain foods, particularly towards the last trimester. Our community strongly believes that what a woman eats in the last months of her pregnancy goes directly to the womb to feed the baby. Thus, some foods can hurt the Fetus…”
In contrast, the health workers and health extension workers believed that food taboos are becoming an old story.
A midwife Nurse, female, 30 years, working in the area stated,
“….. Except for a few women that live in remote areas, I do not think that many still believe that some foods need to be avoided during pregnancy…”
Similarly, a 26 years old HEW, KII participant stated,
“… ihhhhh, though in the former times there was restriction of foods like egg, milk and milk products, due to the belief that it makes the fetus big and gets attached to the fetal body,… now a days there is no such practice in our community…”
40 years old, district health office head and KII participants stated,
“…most of our community members are now questioning the reason behind these taboos and the need for adherence, so the practice is not widely observed in the district ...”
Another 35 years old health worker stated the following substantiating the same opinion,
“... Educated people are not strongly upholding the taboo and beliefs…”
Foods held as taboos and reasons attached to it.
FGDs across participant groups pointed to restriction of high carbohydrate foods particularly sugarcane. The consumption of this food was perceived to be associated with having bigger babies, which is believed to lead to a difficult labor and delivery.
FGD participant and husband of pregnant 34 years old stated,
“…Our community strongly believes that if a pregnant woman eats sugarcane, she may have a big baby which endangers her life by making labor difficult, but I doubt the effect …”
Similarly, 27 years old pregnant women stated,
“…if you eat these kinds of foods or meals you will have difficulty during birth. Consumption of “a lot of sugar” during pregnancy leads to increase in weight and a risky delivery due to the increase in wight during pregnancy makes the baby very big…”
Similarly, the discussants' reported that foods like fruits specifically banana and avocado and some types of vegetables like cabbage, pumpkin and taro (Colocacia esulenta) are considered as taboo for pregnant women particularly as the gestational age advances. The reason attached to the taboo of these foods as stated by the discussants is that cabbage may cause abdominal cramps to the baby when born, whereas pumpkin, banana, Avocado and Taro (Colocacia esculenta) locally named “Godare” are believed to pass to the fetus in the womb and get plastered to the head of the fetus.
In explaining this situation a mother in law, 60 years old, KII participant stated,
“….if a pregnant woman consumes banana, avocado and taro (locally known as Godare) particularly as the gestational age advances; it can pass to the womb and get attached to the baby’s body while cabbage causes abdominal cramp to the fetus after birth. …”
Likewise, 28 year old FGD participant husband of a pregnant woman uttered,
"… I heard some people saying that pregnant women should not consume pumpkin... But I do not know the reason…”
By the same token, the consumption of dairy products (milk, yogurt, cheese) and eggs during pregnancy is considered harmful to the fetus and the mother.
FGD participant pregnant woman of 25 years old stated,
“….it is believed that pregnant women should avoid consuming dairy products like yogurt and cheese, particularly in the last weeks of her gestation. This is because dairy products can pass to the womb and attach to the baby’s body…”
One of the respondents had the following to say, which reaffirms the assertions of the other discussants stated above:
“…A pregnant woman shouldn't eat some foods such as eggs. This is because the fetus will become very big and the mother will have difficult labor and delivery...”
Table 3. Summary of the taboo food and reasons mentioned by the participants, Illu Aba Bor Zone, Southwest Ethiopia, 2019.
Taboo foods
|
Reasons behind the taboo
|
Discussants who mentioned the reason
|
Oily foods
|
To reduce the likelihood and severity of morning sickness
|
Few of the KII and FGD participants
|
Banana
|
Plastered onto fetal head
|
Most of the FGD and KII participants
|
Avocado
|
Plastered onto fetal head
|
Nearly half
|
Taro
|
Plastered onto fetal head
|
Few participants
|
Milk and milk products
|
Makes the baby big / Plastered onto fetal head and body
|
Most of the FGD and KII participants
|
Egg
|
Makes the baby big/Difficult delivery
|
Most of the FGD and KII participants
|
Sugarcane
|
Excessive weight gain to the mother/ Makes the baby big / cause difficult delivery
|
Most of the FGD and KII participants
|
Cabbage
|
Causes abdominal cramp to the fetus after birth
|
Most of the KII and FGD participants
|
Pumpkin
|
Plastered onto fetal head and body
|
Few participants
|
Reasons underlying the adherence to the food taboos.
The underlying reasons for adherence to the food taboos from explanations provided by study participants were grouped into three broad categories: cultural influence, social context and beliefs of the pregnant women themselves.
Cultural influences
Majority of the study participants viewed the existence of traditional practices and beliefs about foods held as taboos are inherent in the community. They stated the reasons for their practice of food taboos stems from cultural influences.
FGD participant husband 38 years of pregnant women stated the following to elaborate the matter,
“… Our community strongly believes that if a pregnant woman consumes foods that are held as taboo, she may have a big baby which makes labor difficult and endanger her life …”
Social Context
The pressure from important others surrounding the pregnant women is a critical driver of the adherence to the food taboos. The discussant expressed that husbands and mothers-in-law impose cultural and traditional beliefs on pregnant women. One FGD discussant also mentioned about peer influence.
To substantiate this state affair, a KII participant Mother-in-law, stated,
“….pregnant women should avoid foods like banana, avocado and taro (locally known as Godare) …if she consumes particularly as the gestational age advances; it can pass to the fetus in the womb and gets attached to the baby’s body …”
Similarly, pregnant woman 32, years stated,
“… It is believed that some foods can pass to the fetus in the womb and plastered on the fetal body…and women laugh at each other if a woman gives birth to a baby with full of the white substance on the body…that is why we follow the food restrictions…”
Attitudes and beliefs of the individual pregnant women
This study revealed that recipients of the cultural practices, pregnant women, were without an understanding of why they do what they do. However some of the discussant believed that consumption of the foods held as taboo may hurt the fetus.
Pregnant woman 27 years, stated,
“…“if you eat certain kinds of foods or meals you will have difficulty during birth. …”
Similarly, 30 years pregnant woman, FGD participant stated,
“… it is believed that consumption of the tabooed food may cause damage to the fetus, and … I do not want my baby hurt, that is why I avoid the foods held as taboo…”
In general, the reasons for the food taboos are deeply embedded in the personal believes and attitudes of the pregnant women, who are nested within the influence of the social environment surrounding her (important others) and the traditional beliefs and values of the society in general. The interrelationships between drivers at the different levels are illustrated in Figure 1.