While there are many drivers of food choice, there are relatively few quantitative analyses on the importance of food avoidance taboos. Food avoidance beliefs are not measured in Demographic Health Surveys (DHS), Multiple Indicator Cluster Surveys (MICS), or even in more country-specific nutrition surveillance systems, despite many smaller-scale studies suggesting that these taboos may be widespread in low- and middle-income countries (LMICs), including in South East Asia where there are many traditional beliefs related to the notion that mothers should avoid consuming certain foods during breastfeeding, postpartum (the first six weeks after birth) or during pregnancy. In Myanmar, one qualitative previous study had documented food avoidance beliefs during the postpartum period among 196 women in western Yangon (Sein 2013), and systematic reviews have uncovered a number of smaller-scale studies on food avoidance taboos in a wide range of South-East Asian countries. These beliefs have their origins in traditional Indian and Chinese medicine, which began to spread throughout South-East Asia several thousand years ago. However, despite piecemeal evidence that these beliefs are widespread in South-East Asia, no previous research has documented how prevalent such beliefs are with nationally representative surveys, nor what impacts such beliefs have on maternal dietary quality.
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Key Findings
- This study designed and analyzed two new surveys in Myanmar. The first one is the fifth Myanmar Household Welfare Survey (MHWS) round conducted from April to June 2023, in which 12,953 respondents were surveyed, including 5,512 women of reproductive age (15-49). The second is the Rural Urban Food Security Survey conducted in 2020, in which respondents were women who were pregnant in round 1 (June-July 2020) in Yangon and participated in at least five of those six rounds.
- Forty percent of all Myanmar women aged 15-49 believe that breastfeeding mothers should avoid at least one healthy food, with vegetables the most widely cited food to be avoided, followed by fruits, fish, meat and beans/nuts.
- Beliefs were prevalent throughout Myanmar’s diverse regions and across both genders, but more common in majority Buddhist regions (and less common in majority Christian regions).
- Beliefs in food avoidance during breastfeeding were less prevalent among women with more formal education and nutritional knowledge, and with exposure to nutrition counselling from community health workers.
- Mothers in the Yangon panel saw minimum dietary diversity of women (MDD-W) fall by 46 percentage points from pregnancy to the first month after birth, stemming from significant declines in eight of the ten MDD-W food groups.
- MDD-W recovered somewhat over the second to fifth months after birth but was still significantly lower up to the sixth month after birth.
Recommendations
- The massive impact of food avoidance behaviors on maternal dietary diversity warrants more research on the nutritional impacts of these practices, as well as programmatic interventions that redress these harmful food avoidance traditions.
- Maternal nutrient requirements are high during breastfeeding, and micronutrient deficiencies among mothers can also be passed on to breastfeeding infants, particularly deficiencies in B vitamins (except folate), vitamin A, selenium and iodine. Further research studies documenting dietary intake and micronutrient deficiencies should be conducted to assess the severity of this public health concern.
- National and subnational surveys such as the DHS, MICS and other nutrition surveys should include questions on food avoidance beliefs in South-East Asian countries where there is evidence that they are prevalent. Such studies should also monitor maternal dietary diversity.
- Social behavioral change communications (SBCC) interventions should be used to redress harmful food avoidance practices during the postpartum and breastfeeding periods and should be prioritized in nutritional messaging from medical practitioners, community health workers, ICT-based messaging and mass media campaigns.
