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Jakarta Post

Nutrition of pregnant women: Interplay of sociocultural, access barriers

  • Sri Kusyuniati

    -

Jakarta   /   Wed, September 16, 2020   /   10:15 am
Nutrition of pregnant women: Interplay of sociocultural, access barriers Illustration of pregnancy. (Shutterstock/Natalia Deriabina)

In her 1949 book The Second Sex, Simone de Beauvoir states: “She [woman] is defined and differentiated with reference to man and not he with reference to her; she is the incidental, the inessential as opposed to the essential. He is the Subject, he is the Absolute — she is the Other.”

Though the book was released seven decades ago, its theory of women as “others” is practiced even today in many parts of the world.

Women have frequently been excluded from decision-making, including from discussions about their own health. In resource-poor settings, girls often suffer from poor nutrition during childhood and adolescence, which is further exacerbated during pregnancy.

Women are often responsible for preparing the meals, yet they eat last and least, with no special consideration for their nutrition if they become pregnant. A malnourished mother is more likely to give birth to low birthweight and malnourished babies.

Prenatal nutrition and poor nutrition in infancy and early childhood are linked to stunting and the development of noncommunicable diseases in adulthood, including obesity, hypertension, heart disease and diabetes.

In Indonesia, nearly half of pregnant women are anemic, according to the 2018 Basic Health Survey (Riskesdas). Anemia among pregnant women adversely affects the development of the fetus and increases the risk of mortality and morbidity for the mother and newborn. This has contributed to 27.67 percent of children suffering from stunted growth in the country (Riskedas 2018).

The government has been working to reduce stunting rates, including the launch of its national strategic Integrated Nutrition Interventions for Stunting Reduction and Prevention program in August 2017. Despite this, most communities have limited awareness about nutrition and its role in pregnancy and birth outcomes. For reduction efforts to be successful, a multistakeholder approach that addresses gender norms and involves families and communities is necessary.

The number of public healthcare facilities and medical professionals in Indonesia has increased over the past few years, yet many women still deliver their babies in their homes. Women who deliver at home may not have access to skilled birth attendants or emergency care, increasing the risks of maternal and newborn mortality and morbidity.

Additionally, women belonging to lower socioeconomic families, in high-risk groups, including those who are too young or old, anemic or have poor nutritional status and with less access to health care are at a greater risk of maternal and infant morbidity and mortality.

In a number of Indonesian communities, superstitious beliefs and customs present additional barriers for women to access antenatal care. Some ethnicities restrict women from accessing health services without the presence of a male or elderly female relative, further delaying medical attention.

In many marginalized communities, health information is mostly shared via community health centers (Puskesmas). Given the current pandemic, most Puskesmas are shut to prevent disease transmission and critical health information is instead being disseminated online, through webinars, conference calls, or WhatsApp or text messages.

While 39 percent of women now own a smartphone as Pew Research Center found in February 2019, they are not necessarily the user of the device and mobile phone and technology usage remains low among women. For those that do have access to a device, many have seen their household responsibilities increase and have limited free time to read these messages. As a result, women are not receiving information critical for their own health.

In a society where women and girls often struggle to access basic needs, such as a healthy diet, education, clean water, and sexual and reproductive health services, these needs are being pushed further out of reach due to the restrictions imposed by COVID -19.

Studies have shown that due to direct and indirect effects of COVID -19, an increase in maternal and newborn and infant mortality is expected in lowand middle-income countries. Women are at the frontline of the pandemic at home as well as in the healthcare sector and are feeling the consequences most acutely.

Many activists have been fighting for equal representation of women in decision-making. Including women in household discussions about their own health and nutrition is a crucial first step to bring about change.

Information must also be made more accessible by leveraging common media like radio and television, as well as influencers like religious leaders and health workers to disseminate key health messages. Building the capacities of women’s self-help groups in municipalities and engaging adolescent girls who possess mobile phones to pass on nutrition messages to pregnant women are also important measures.

While it is necessary to increase awareness of maternal and child health issues for all women, it is equally important to educate and engage men about women’s health concerns. Ensuring male participation during integrated health services post (Posyandu) sessions is an effective strategy to explain the special needs of women during and post pregnancy.

Behavior change communication tools, which rely on graphic and illustrative messaging, have proven to be effective in reaching large populations, particularly those with low levels of literacy. Designing these tools not just for healthcare staff at Puskesmas but also for the beneficiaries to take home can help critical health messages and essential nutrition actions resonate.

An example of this is Nutrition International’s Iron & Folic Acid (IFA) Compliance Card, which was introduced to record daily IFA supplementation for pregnant women. Not only did it help women keep a record of the IFA supplements, it also acted as a reminder for them and their family members to ensure they were taken.

In addition, the card became a useful monitoring tool for the health workers at the facility and community level and was adopted by the Health Ministry for national use in the Maternal and Child Health Handbook.

As attention and resources are devoted to stemming the damage of COVID-19, the world cannot overlook the impact on women who already face steep barriers to access basic services, which are exacerbated by the coronavirus response.

The number of public healthcare facilities and medical professionals in Indonesia has increased over the past few years, yet many women still deliver their babies in their homes.

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Country director of Nutrition International

Disclaimer: The opinions expressed in this article are those of the author and do not reflect the official stance of The Jakarta Post.