Khin Mar Linn

Food avoidance taboos during breastfeeding are widespread and associated with large declines in maternal dietary diversity in Myanmar

Background Maternal food avoidance practices during pregnancy and breastfeeding have been documented in several Asian countries, but their prevalence and impacts on dietary diversity are not well quantified. Objectives This study: (1) assessed the prevalence of beliefs around maternal food avoidance during breastfeeding in Myanmar; (2) explored the correlates of women’s food avoidance beliefs as well as mother’s stated rationales for avoiding specific foods; and (3) assessed how minimum dietary diversity (MDD-W) of mothers changed from pregnancy to postpartum/breastfeeding. Methods We added a novel nutrition module to a nationally representative survey (N=12,353) in Myanmar to estimate the prevalence of beliefs around maternal food avoidance during breastfeeding and re-surveyed a subsample of mothers (N=155) to understand avoidance of specific foods. We then used a high-frequency panel of mothers in Yangon (N=3,541) to assess how MDD-W changed from pregnancy to postpartum/breastfeeding using mother fixed effects regressions. Results 40 percent of adult women in Myanmar believe breastfeeding mothers should avoid at least one food group that nutritionists would typically define as a healthy (e.g. vegetables, fruits). Regression analysis indicated these beliefs were less prevalent among women with more education and nutritional knowledge, and with exposure to nutrition counselling from community health workers. Mothers rationalized food avoidance by referring to a variety of perceived maternal and child health risks. MDD-W of mothers in the Yangon panel fell by 43 percentage points from pregnancy to the first month after birth, including significant declines in eight of the ten MDD-W food groups. MDD-W remained significantly lower up to six months after birth than during pregnancy. Conclusions Food avoidance taboos during breastfeeding pose a potentially serious risk of micronutrient deficiencies for mothers and infants and warrant more extensive monitoring in nutrition surveys and more research on how to redress these nutritionally harmful beliefs and practices.