Food Avoidance Taboos During Breastfeeding Are Widespread and Associated With Large Declines in Maternal Dietary Diversity in Myanmar.

Abstract

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 of women (MDD-W) pertaining to 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 resurveyed a subsample of mothers (N = 155) to understand avoidance of specific foods. We then used a high-frequency panel of mothers in Yangon (N = 3541) to assess how MDD-W changed from pregnancy to postpartum/breastfeeding, employing mother fixed-effects regressions.

Results: Forty percent of adult women in Myanmar believe that breastfeeding mothers should avoid at least one food group that nutritionists would typically define as a healthy (e.g., vegetables and fruits). Regression analysis indicated these beliefs were less prevalent among women with more education and nutritional knowledge and with exposure to nutrition counseling from community health workers. Mothers rationalized food avoidance by referring to a variety of perceived maternal and child health risks. MDD-W pertaining to mothers in the Yangon panel fell by 43 percentage points from pregnancy to the first month after birth, including significant declines in 8 of the 10 MDD-W food groups. MDD-W remained significantly lower ≤6 mo 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.