Dietary Adequacies of Maternal-Child Pairs in León, Nicaragua in Relation to Food Insecurity

87 Pages·2014·1.54 MB·English

Dietary Adequacies of
Maternal-Child Pairs in
León, Nicaragua in
Relation to Food Insecurity
Honors Thesis
Presented in Partial Fulfillment of the Requirements for graduation “with Honors
Research Distinction in Anthropological Sciences” in the undergraduate colleges of
The Ohio State University
By Thara Nagarajan
The Ohio State University
May 2014
Project Advisor: Professor Barbara Piperata, Ph.D, Department of Anthropology

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Introduction
Food insecurity is defined as, “a state when people lack physical, economic or social
access to sufficient amounts of food to meet their dietary intakes and food preferences for a
healthy lifestyle” (FAO, 2012). With approximately 1 billion people (1 in 7) world-wide
suffering from lack of adequate access to food, food insecurity and accompanying maternal-child
malnutrition remain critical health issues in communities around the world in both developed and
developing settings.
The causes, or pillars, of food insecurity include: inadequate availability due to low
productivity, limited access to available food, usually due to poverty, reduced utilization which
includes compromised food safety, poor food choices, and the limited ability to extract nutrients
from food sources due to poor health and instability (Hadley and Crooks, 2012). Globally,
limited access, due to poverty, is one of the most critical predictors of food insecurity. Chronic
exposure to food insecurity is associated with many ill effects on adults and children, such as
poor fetal growth and neurological development, low birth weight, increased risk of infection,
and poor growth and cognitive development in childhood. Food insecurity also has an effect on
mental health. Mental health is a relatively unexplored realm of study in relation to food
insecurity, but it has been hypothesized that factors such as uncertainty in the household
regarding food, lack of micronutrients in the diet, and sensitivities to inequalities in diets may
have correlations to anxiety and depression amongst individuals and families suffering from food
insecurity (Chilton et al., 2007; Weaver and Hadley, 2009). Together, these consequences of
food insecurity undermine individual well-being, societies’ productivity, and the ability to break
the intergenerational cycle of poverty (Chilton et al., 2007; Cole and Tembo, 2011; Merchant
and Kurz, 1993; Walker et al., 2007; Weaver and Hadley, 2009). Thus, by improving nutrition
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worldwide, people will be better able to experience a higher quality of life in terms of overall
physical health and mental well-being.
In response to the global epidemic of poverty, the United Nations (2011) implemented
the Millennium Development Goals (MDG) in 2000 in an attempt to methodically eradicate
major global public health and economic issues. The goals drafted by the United Nations aim to
improve overall human health and well-being. The first Millennium Development Goal is to
eradicate extreme poverty and hunger. However it could be said that other goals, such as
reducing child mortality, improving maternal health, and improving environmental sustainability,
also relate to food insecurity because food insecurity is a precursor for these problems (UN,
2000).
Food insecurity has long been an issue tackled by nutritionists and economists. These
studies have examined the types and quantities of foods consumed, and the economic perspective
illustrates the larger impact of policy on food insecurity (Gittelsohn, 1997; Gittelsohn, 1991;
Horner et al., 1981; Kaiser and Dewey, 1991; Haddad et al., 1997). However, the
anthropological perspective utilizes ethnographic methods to not only understand the dietary and
economic landscape, but to also understand the personal and community experiences with food
scarcity. The important topics anthropology focuses on in regards to food insecurity are 1) the
cultural value of food 2) how food insecurity debilitates the agency and productivity of women
and children, 3) intrahousehold effects on food insecurity 4) gender and power structure/roles in
the home and 5) the value placed on children and strategies designed to value children (such as
preferential feeding). Food insecurity not only affects women and children detrimentally in a
biological sense, but it also contributes to the cultural undermining of their status in society.
Gender discrimination is an integral part of Nicaragua in aspects of the machismo culture.
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Machismo is the idea that men are the stronger, more favored gender, and their authority trumps
that of the woman in almost all social contexts. William Harvey states in his paper about women
and their roles in Nicaragua:
“Although machismo is often viewed as primarily sexual in origin and outward
manifestation (Liebman 1975), many see it as being far more pervasive. It is recognized
not only in the traditional sexual dominance of the male, and in the corresponding
passivity of the female, but also in a wide variety of economic, social, and political
contexts” (Williams, 1986).
It is believed beyond the sexual aspect of machismo, that men are superior to females in almost
every manner, including intellectual prowess. Men are viewed also as more responsible and more
capable of sociopolitical ideals. Men are also viewed as morally superior. These ideals are not
only ingrained in social roles (younger men for example, are given authority over older females
in the household), but are also supported by larger social institutions. The Catholic Church
defends these gender differences, and even women support these assumptions.
Because of these cultural constraints, when food insecurity affects women and children,
women resort to coping strategies to fend off hunger. Research has demonstrated that in response
to food insecurity, households adopt a series of coping strategies which include: reducing food
variety, limiting portion sizes, meal skipping and the preferential feeding of some household
members over others. Coping strategies are defined as a “short-term response to an immediate
and inhabitual decline in access to food (Davis, 1996; Hadley and Crooks, 2012)”. While coping
strategies often start out as short term fixes, it has been shown that because there are limited
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additional options to deal with food insecurity, households have to apply these short-term coping
mechanisms for long-term food scarcity issues (Hadley and Crooks, 2012).
The preferential feeding of some household members over others has been reported in a
number of studies (see Haddad, 1996 for a review). In some cases, more economically active
members of the household, such as adult men, are given greater access to nutrient-dense foods
such as meats, vegetable and fruits (Engle and Nieves, 1993; Gittelsohn, 1991). In other cases,
members perceived as being more vulnerable, such as children, are prioritized at mealtimes. In
one study examining the Nuñoan population of the Peruvian highlands, it was found that
children, as a group, were subject to far less seasonal food stress than adults, and that adults
protected children from hunger by preferentially allocating food to children (Leonard, 1991).
However, in general, women and children are viewed as being the most vulnerable to suffering
food insecurity due to their lower social status in the home and their greater biological needs
(Gittelsohn, 1991; Pelto, 1987; Torun et al., 1996). This is important, as mothers are often the
first to report reducing their own intakes in an effort to allocate scarce food resources to their
children due to their primary roles in food production, preparation and distribution in the home
(Handa, 1996; Kennedy and Peters, 1992). This phenomenon has been referred to as “maternal
nutritional buffering”. In practicing nutritional buffering, mothers can reduce their portion sizes
during meals, skip meals, or consume different kinds of foods than their children (Radimer et al.,
1992; Fitchen, 1987; Piperata et.al., 2013; Kaiser and Dewey, 1991; Graham, 1997). For
example, in Mexico, Kaiser and Dewey, (1991) identified household distribution patterns that
tended to favor children over their mothers, and that seasonally, children received a more varied
diet than mothers. In rural highland Peru, the quantitative caloric intakes for children were
compared to ethnographic data examining local concepts of health and wellness, and it was
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found that because children were considered to be especially vulnerable to disease if hungry,
parents would buffer children to make sure the child avoided hunger and the potential for illness
(Graham, 1997). Finally, a recent study was conducted amongst rural Amazonian mothers and
children, where dietary data were collected over three days using the weighed-inventory method.
The authors found that household food availability predicted the degree to which mothers were
able to buffer their children from food shortages (Piperata et al. 2013). Beyond the few studies
reviewed above, there is very limited data on the actual dietary intakes of mothers and children
living in food insecure conditions, making it difficult to determine the degree to which maternal
nutritional buffering occurs and its effectiveness in improving intakes among children in
different contexts of food insecurity.
This thesis builds on the above cited literature by examining the dietary intakes of
mothers and children living in a sample of poor urban and rural households in León, Nicaragua,
As not all poor households are food insecure, the goal of this thesis is 1) to examine the energy
and protein adequacies of the diets of matched-pairs of mothers and children 2) to identify
differences in dietary adequacies between women and children by environmental context (urban
versus rural) and food security statuses (food insecure versus food secure) and 3) to identify
evidence of maternal nutritional buffering and how this is affected by the cultural context of
Nicaragua.
Specific hypotheses this thesis examines are:
1) What are the dietary adequacies of mothers and children in León, Nicaragua?
a. Are the dietary intakes of mothers and children in poor urban households
more adequate than of those in rural contexts? Considering that access to
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resources is greater in urban contexts and poverty rates were higher in rural
zones, I hypothesize that dietary adequacies will be greater among mothers
and their children in urban households.
b. Are the dietary intakes of mothers and children living in poor, food secure
households more adequate than those of mothers and children living in poor
food insecure homes? If perceived food insecurity is related to actual food
availability in the household, then I hypothesize that energy and protein
adequacies of mothers and children would be higher in food secure versus
food insecure households.
2) Is there evidence of maternal nutritional buffering?
a. Is there greater evidence of maternal nutritional buffering in food insecure
households compared to food secure households? Since maternal buffering is
a recognized coping mechanism for dealing with food insecurity, I hypothesize
that maternal buffering (i.e. the diets of children will be more adequate than
maternal diets) will be greater in food insecure compared to food secure
households.

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Background
Site Location and Description
Nicaragua, located in Central America (Figures 1 and 2) has a population of
approximately five million people, (WHO, 2012) and contains many varied environments,
including tropical rainforests, dry costal zones and arid mountain ranges (CIA World Factbook,
2014). It is also rich in natural resources. Nicaragua exports many different products, including
cacao, coffee, and peanuts (CIA World Factbook, 2014). Despite being rich in natural resources
and exporting food crops, Nicaragua is considered the second poorest country in the Western
Hemisphere. Approximately 45% of the population lives on less than US $1.00 per day (USAID,
2005). Half of the population identifies as being poor and 17% consider themselves extremely
poor (Peña et al., 2008). Even with a dramatic 50% increase in grain production between 1994-
2002 and a significant amount of rich, arable land, high rates of food insecurity persist,
indicating that access to and utilization of food, rather than low food production, are driving food
insecurity in the country. USAID (2005) estimates that 29% of the Nicaraguan population is
under-nourished and that access to micro-nutrient rich foods is limited (Contreras and Ekström,
2008).
Rural areas in Nicaragua experience greater poverty than urban areas. The estimated
rate of poverty in rural areas is 70% while 30% of the urban population is considered poor.
Women and children suffer disproportionally from poverty. Twenty percent of children under the
age of five show severe nutritional deficiencies related to inadequate consumption of protein
(kwashiorkor) and inadequate consumption of carbohydrates and other macronutrients
(marasmus) (Peña et al. 2008). Women face many reproductive health issues because of
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malnutrition such as poor pelvic bone growth, vitamin deficiencies, and increased risk of anemia
(Merchant and Kurz, 1993). Malnutrition also negatively impacts children and is the primary
underlying cause of child deaths each year in Nicaragua (PCIGlobal, 2014. These two
populations therefore are directly affected by nutritional issues and food security in Nicaragua.
The site of the study is León (Figure 3), located in the central Pacific region,
approximately 90 kilometers from Managua, the national capital. León is the second largest city
in Nicaragua, with a physical area of about 820 km2, and a population of 176,915 residents (Peña
et al. 2008). León is home to the original campus of the Universidad Nacional Autonomidad de
Nicaragua (UNAN), and currently houses the medical campus of UNAN. León is divided into
three zones, Perla, Mantica, and Sutiava. All three zones include both rural (Figure 4) and urban
(Figure 5) areas.

Figure 1. Map of Nicaragua in relation to North America
http://www.cbnicaragua.com/where_is_nicaragua.php
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Figure 2. Map of Nicaragua in Central America
http://www.lonelyplanet.com/maps/central-america/nicaragua/

Figure 3. Municipality map of León, Nicaragua http://www.armadillo-
nicaragua.com/Maps.php
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