“When I Breastfeed, It Feels as if my Soul Leaves the Body”: Maternal Capabilities for Healthy Child Growth in Rural Southeastern Tanzania
Abstract
:1. Introduction
2. Capabilities Approach: A Theoretical Framework
3. Methods
3.1. Study Design
3.2. Study Setting
3.3. Recruitment of Participants
3.4. Data Collection
3.5. Data Analysis
3.6. Positionality
3.7. Ethical Issues
4. Results
5. The Capability to Feed
5.1. Personal Conversion Factors and the Mother’s Capability to Feed
When a mother is pregnant there are particular nutritious foods that she is supposed to use [eat] so that she promotes the health of the baby in her womb. You see, when a mother gives birth, you will find that the baby is in good health. When the baby is born in good health you will hear people say, ‘Someone has given birth to a big baby, the baby is bigger than her mother.’ The baby is big to the extent that when s/he is taken to be weighed you find that it has three or four kilos, you see! That means that a father took a good care of his wife when pregnant. (FGD-#03-Father)
I told him (partner) that the child has been found with UTI and malaria, and that the cost is 3000 shillings. He said, ‘I do not have that 3000 shillings.’ I then decided to report him to the sub-village leader. The leader helped me to make him provide that money. I then paid the lady (nurse). (IDI-#05-Mother)
When returning from the farm work, you are tired, but the household chores await you (majukumu yanakusubiri). You are supposed to fetch water, cook, feed children, wash children, wash clothes, and clean the house. Ideally, a child is supposed to eat three times a day, in the morning, in the afternoon, and in the evening. That is the mother’s good care. But now, I return from farm work at 3 pm, it takes a lot of time to prepare mboga (leafy greens) and cook ugali. Eventually, my children eat late. In most cases, they end up eating twice a day. (IDI-#01-Mother)
At times, I overstay there [in the field] and return home late. I start cooking, but find that by the time I finish cooking, it is already late evening. They (children) end up eating just a single meal per day, as you cannot return early from the farm. (IDI-#02-Mother)
We usually go to farms early in the morning and return home at 2.00 p.m. At times, we even lack a chance to eat lunch. You only come to get ugali (stiff porridge) in the evening, around 4:00 p.m. That is when you return from the farm, you start cooking, and you finish around 6:00 p.m. That is the only meal you have for the day. While working in the farm, you are starving, but the baby breastfeeds on you the whole day. Thus, both you and the baby starve. When I breastfeed, it feels as if my soul leaves the body. So, you say, aah, it is better to stop breastfeeding her/him so that we can both eat ugali. Or you say, it is better to introduce food to him/her early so that s/he does not heavily breastfeed on you. (KII-#03-TBA)
Working with the babies in the farm is not pleasant at all. The farm environment is for work, not for resting. [...]. You find that a child cries so much, s/he becomes exhausted as most of the time s/he is tied on her/his mother’s back. S/he must be tired. A child needs to relax, play a little bit, and sleep. But in the farms, s/he lacks that. (IDI-#03-Father)
Most of men in our village are patriarchal (wana mfumo dume). They leave the burden [of child care] to mothers. You find that a mother has a lot of activities to do, and is still supposed to look after children. [...] With that situation, instead of preparing food that has nutrients proper for healthy growth of her child, a mother decides to feed her child kiporo (dinner left-overs) so that s/he does not bother her with his/her hunger. That’s why you find that a child becomes malnourished as s/he is not being provided with food suitable for her/his age. (IDI-#07-Father)
I have best friends (maswahiba) with whom my child is comfortable. They like to stay with my child. One of the neighbors, who is with my son as we speak… I used to leave my child at her place, go to the farm and return late in the evening, say at 3 pm. I even do not leave behind any food for him (child), because what they will eat, my child also eats. She (friend) is so helpful. (IDI-#03-Mother)
5.2. Socio-Cultural Conversion Factors and Mother’s Capability to Feed
When a woman becomes pregnant prematurely, she can’t continue to breastfeed while knowing that she has a baby in her womb. She has to stop breastfeeding, short of that, the baby will contract excessive diarrhea, which will weaken her and make her growth falter. […] It is important to immediately stop breastfeeding completely when you notice that you are pregnant, even if the baby is three or five months old. (KII-#02-TBA)
People in our community have come to know over the years that when an infant cries much, it means that s/he is born with hunger. Thus, when a baby reaches three weeks, one month or two months, you find that s/he [caregiver] starts feeding her/him some ‘uji’ (porridge). (KII-#01-CHW)
Other children are denied breastfeeding by the evil spirits. When a mother has an evil spirit in her body, the child is being threatened by that evil spirit that you have. So, when a child is scared s/he avoids coming closer to you. […] when that happens, a mother decides to give the baby porridge or cow’s milk. (FGD-#03-Mother)
5.3. Capability to Control and make Decisions on Farm Produce and Income
In our context, men control farm income. Thus, a woman decides to cultivate her own farm, and her man cultivates his own farm. When you harvest, you have your own income, and the man will have his own income (IDI-#04-Mother).
You work in the farm from the first month of pregnancy till when you are almost due. In the ninth month if you feel that you are so tired, you may rest for one month, and then give birth. When you give birth, you continue working. […] If you refuse to go to the farm, when he harvests, he will not involve you with the products. He could even decide to sell all the crops in the farm. You will just hear that your partner has sold the crops and has married another wife. Women are now conscious! She goes to work in the farm even when she has a little infant. This way, men hardly find a good reason to misappropriate the crops. (KII-#03-Traditional birth attendant)
5.4. Capability to Assure Access to and Utilization of Medical Care
Usually, when a child is sick, a mother is the first person who will notice. She will then inform you (a father) that this little one is sick. Even if a child cannot speak, the mother has the capacity to recognize an ill condition in her child. By being close to a child, she can just tell if something is wrong in his/her (baby’s) health” (FGD-FOU-#03)
Men in our context do not take children to the clinic. They feel shy (laughs). He will be laughed at by his colleagues. They will ask him, ‘Why do you take the child to the clinic? Are you controlled by your wife? (umetawaliwa na mkeo?).’ That is what most of them (men) fear. (IDI-#01-Mother)
Many men lack confidence. People talk about being charmed by a wife. That’s why one may ask himself, ‘Should I take the child to the (CGM) clinic? No way, this is my wife’s role.’ So, he leaves it up to his wife. (IDI-#05-father)
The lack of a dispensary (health facility) in this village is a big challenge towards our efforts to ensure that our children get better health care. We are greatly affected. Geographically, our area is troublesome during rainy season. We also lack good roads which could enable someone to rush someone to the nearby hospital in times of health emergencies. If we could have a dispensary in our village, it would be much better. […] So, if a child falls sick, and if you are not careful, you may be surprised that the child dies at home. (IDI-#04-Father).
You find that the child is ill and needs immediate treatment, but the father is not around or he tells you that he does not have money. What will you do? You must use your brain. If you have a friend, you go and ask her for a help or a loan so as you take your child to the hospital, with the agreement of refunding her later. (IDI-#04-Mother)
One day my son was feverish, I could not sleep. I was alone as his father does not sleep here. When the morning came, I informed his father about the child’s condition. He told me to go to the drug shop for medication. I decided to take the child to the hospital for diagnosis. I only had 1000 shillings, while the diagnosis costs 3000 shillings. So I asked the nurse to help me (give medication on loan), she trusted me and told me to bring the remaining 2000 shillings later. When I returned home, I told him (partner) that the child has been diagnosed with UTI and malaria, and that the cost is 3000 shillings. He said, ‘I do not have that 3000 shillings’. I then decided to report him to the sub-village leader. The leader helped me to make him provide that money. I then paid the lady (nurse). (IDI-#05-Mother)
6. Discussion
6.1. Being Able to Feed
6.2. Being Able to Control and Make Decisions on Farm Produce and Income
6.3. Being Able to Ensure Access to Medical Care
7. Conclusions
Author Contributions
Funding
Acknowledgments
Conflicts of Interest
References
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Mchome, Z.; Yousefzadeh, S.; Bailey, A.; Haisma, H. “When I Breastfeed, It Feels as if my Soul Leaves the Body”: Maternal Capabilities for Healthy Child Growth in Rural Southeastern Tanzania. Int. J. Environ. Res. Public Health 2020, 17, 6215. https://doi.org/10.3390/ijerph17176215
Mchome Z, Yousefzadeh S, Bailey A, Haisma H. “When I Breastfeed, It Feels as if my Soul Leaves the Body”: Maternal Capabilities for Healthy Child Growth in Rural Southeastern Tanzania. International Journal of Environmental Research and Public Health. 2020; 17(17):6215. https://doi.org/10.3390/ijerph17176215
Chicago/Turabian StyleMchome, Zaina, Sepideh Yousefzadeh, Ajay Bailey, and Hinke Haisma. 2020. "“When I Breastfeed, It Feels as if my Soul Leaves the Body”: Maternal Capabilities for Healthy Child Growth in Rural Southeastern Tanzania" International Journal of Environmental Research and Public Health 17, no. 17: 6215. https://doi.org/10.3390/ijerph17176215