The study explored community perceptions of optimal nutrition for maternal and child health as well as barriers or cultural beliefs about foods and eating habits of women in the Kassena-Nankana districts of rural northern Ghana.
All study participants recognised the importance of optimal nutrition to the health of the mother and child. The participants recognised that the lack of nutritious food can lead to anaemia, underweight as well as the general well-being of women who are pregnant, in labour and lactating. Different foods were perceived to be healthy and non-heathy depending on the woman’s reproductive period. For example, the study findings revealed that eating nutritious, more balanced diets including meat and eggs was believed to be very good for women particularly in promoting recovery and post-delivery health, including breast-milk production and its quality, but not believed to be good during pregnancy. These findings are in agreement of findings from previous study that reported that eating meat and eggs is recommended for women who have given birth [6].
Also, those who do not support the eating of fresh meat and eggs by pregnant women said it is a taboo that has been inherited from their ancestors. It is believed that when pregnant women eat fresh meat and eggs, they would gain weight and also make the unborn baby large which could lead to difficult labour. This is corroborated with other studies conducted in Africa that reported that pregnant women try to cut the intake of food such as meat and eggs to avoid labour difficulties [26,27,28]. In addition, it was mentioned that when a pregnant woman eats eggs and gives birth, the child will develop bad habit of stealing which is also reported in previous studies [25, 27, 29]. Though, it is important for pregnant women to have a balanced diet for themselves and the unborn baby [6], how much of weight gained or balanced diet considered to be “normal” in pregnancy needs further research. The vulnerable group (pregenant women, lactating mothers, and their childen) are therefore being deprived a valuable source of protein if they are prevented by taboos not to eat eggs and meat.
The main sources of nutrients in our study communities, particularly in rural areas and in poorer households, are from plant sources. However, one source of protein, consumed in the majority of household, is a low cost dried fish (locally called “amani”), which is usually obtained from the southern part of the country.
Generally, knowledge on the use of various plant and animal products forms a critical base for household dietary diversity for mother and child. Combinations of food can improve consumption and uptake of nutrients for a mother and child [26, 30]. However, food taboos and household economic resources restrict the intake of nutritious foods by pregnant, lactating mothers and children [11, 12].
It has been reported that food taboos can be found in virtually all human societies [27, 31]. Food taboos are set of rules or instructions from the forefathers/ancestors (God) that is being passed down from generations to protect community members from diseases [27]. Food taboos or cultural beliefs are generally meant to protect humans and promote good health. However, the fact is that these taboos mostly target the vulnerable group such as women, pregnant women and children. These food taboos spill out foods that are not to be eaten because it is perceived to have health consequences. These food taboos are usually based on casual explanation which can be supernatural, logical or sometimes hard to explain [31]. Community member’s belief noncompliance to taboos upsets the ancestors (gods) and this may result in harmful consequences from the ancestors. In the case of pregnant women, disobedience of taboos or ancestral laws may be associated to adverse pregnancy and delivery outcomes including death [27]. Therefore, women usually adhere to food taboos in the study area and it is also reported that, food taboos are respected and observed in all African countries [31, 32].
Food taboos can have positive or negative effects on humans [31]. With regards to nutrition, the positive effect is when the food taboo prevents people form eating harmful foods and the negative part is when the taboo prevents people from taking nutritious foods [27].
The baked solid white clay (Kaolin) [24] locally called ferinkasa/Ayilo, is a taboo for pregnant women in the study area which can be considered a positive effect of taboo. This “ferinkasa” that is mined in the depths of the earth contains chemicals such as Lead, Nickel and Arsenic as well as microorganisms such as Bacillus, Pseudomonas, Mucor and Aspergillus spp [24] which has negative effect on the human body and can lead to pregnancy complications and cancer [24]. Despite these few positive effects of food taboos, the negative effects of food taboos far outweigh the positive effects.
Some food taboos do not have scientific bases and can prevent people from eating healthy foods. Strategic education and discussion based on communities’s cultural beliefs from health workers with women, men and elders is needed to dispel some cultural beliefs on food taboos. Some of these foods such as eggs, bambara beans, meat that have been mentioned to be culturally unsuitable to eat by pregnant women are the common affordable foods with considerable amount of protein in th study community. Improvement in income generating activities would also help to ease the financial contraints to access to healthy food and general well being.
Although the government of Ghana has introduced a number of policies to improve nutrition in the country such as NNP, not much has been achieved over the period [25]. Infact, the goal of the NNP is to improve the nutritional status of the people, especially disadvantaged groups, including mothers, adolescent girls and children; to prevent and control malnutrition; and to accelerate national development through raising the standard of living [3].
There are however major implementation gaps in these policies due to multiple factors, resulting in suboptimal benefits to the target population in Ghana particularly northern Ghana [33]. The study district is located in one of the poorest regions (Upper East region) in northern Ghana [5, 34] and getting optimal nutrition is a challenge particularly in the rural poor households. The poverty situation in the study area is one of the main reasons for high undernutrition among pregnant women, breast feeding mothers and children in the area [3].
Generally, in Ghana most of the policies are progressive but the problem is usually in the implementation. Therefore, there is the need for engagements between health workers, community members and policy makers to strategize on the implementation of the NNP and other interventions in order to improve livelihood and nutrition in the country. Though health workers provide nutrition education and counselling to pregnant women during antenatal care visits, the effect is not much, given that some women still abide by their traditional beliefs or food taboos. This therefore suggests that health workers need refresher trainings on nutrition and communication that will incorporate some of these beliefs or food taboos in the education. Also, community elders should also be engaged in the nutrition education since they are the custodians of the land and taboos and therefore have influence. Furthermore, health workers should be resourced both financially and with adequate knowledge and logistics to enable them to provide nutrition education to community members.
Strengths and limitations of the study
Interviews were conducted in the local languages of the study area and translated into English for analysis. It is possible that the real meaning of some statements made in the local languages may have been lost in the English translation. Nevertheless, the interviews were translated and transcribed by experienced research officers who are natives of the area and hence, the misinterpretation of the statements or words made in the interviews would be minimal and may not affect the results of the study.
Even though the interviewers tried to obtain the monthly income of households, about half of FGD participants were unable to provide an estimate of their household monthly income. We cannot be sure that this did not impact the results of the findings of this study, but as all participants were drawn from similar communities, it is unlikely to intrinsically change the findings.
Responses of study participants could also influence the study findings particularly on the traditional/cultural barriers of some foods, given that they know that the study team are from the health sector and are usually against taboos. However, the study team were well trained to allay the fears of participants to provide accurate responses that reflect what patterns in the community.