Gender based perceptions of food, dietary behavior and practices in tribal regions of Telangana: a qualitative assessment of vulnerable population
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This presentation was given by Padmaja Ravula (International Crops Research Institute for the Semi-Arid Tropics / ICRISAT), as part of the Annual Scientific Conference hosted by the University of Canberra and co-sponsored by the University of Canberra, the Australian Centre for International Agricultural Research (ACIAR) and CGIAR Collaborative Platform for Gender Research. The event took place on April 2-4, 2019 in Canberra, Australia. Read more: https://www.canberra.edu.au/research/faculty-research-centres/aisc/seeds-of-change and https://gender.cgiar.org/annual-conference-2019/
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Gender based perceptions of food, dietary behavior and practices in tribal regions of Telangana: a qualitative assessment of vulnerable population
- 1. Gender Based Perceptions of Food, Dietary Behavior and Practices in Tribal Regions of Telangana: A Qualitative Assessment of Vulnerable Population Padmaja Ravula, Kavitha Kasala and Soumitra Pramanik 2-4 April, 2019 Seeds of Change Conference University of Canberra AUSTRALIA
- 2. Background ๏ง A growing nutritional crisis in India ๏ง Diet related malnutrition ๏ง Diet quality depends on a number of factors ๏ง Tribal population more at risk of malnutrition ๏ง Need for adopting a multi- sector, holistic, system perspective
- 3. Location of study ๏ง Komaram-Bheem district, Telangana; Tiryani mandal 19.2% Toilet fac 21.1% Drinking water 11.1% 4.9%
- 4. Data and Methods โข Qualitative Analysis using Focus Group Discussion (FGD) โข Group 1 - Adolescent girls between the ages of 11 to 18 years old who were non-pregnant or non-lactating. โข Group 2 -Pregnant and/or Lactating Women (within 12 months postpartum) aged 20-49 years
- 5. Nutritional Status of adolescent girls in terms of anthropometric indicators: Indicator Early Adolescent (11 to 14 years) Late Adolescent (15 to 18 years) Overall Height (cm) 142.35 (7.99) 151.36* (4.80) 146.99 (7.76) Weight (kg) 33.57 (6.58) 42.48* (5.23) 38.16 (7.06) BMI (Kg/M2) 16.38 (2.27) 18.54* (3.81) 17.49 (2.35) BMI Status Under weight 81.97 54.32 67.74 Normal 17.46 42.90 30.55 Over weight 0.56 2.79 1.71 Note: i) Values in the parenthesis represent standard deviation (SD) ii) * indicate the values of late adolescent groups are significantly different from early adolescent group of respondent Source: Baseline survey, Nutri-food Basket project, ICRISAT, 2017 Z score for BMI Stunting + Thinness 12.25 4.78 8.41 Only Stunting 20.14 26.96 23.65 Only Thinness 12.96 13.81 13.40 Normal/stable 54.65 54.45 54.55
- 6. Dietary Diversity: low to medium Women Dietary Diversity Scores (WDDS): Percentage of individuals Mandal Name Members Status Dietary diversity (Normal day) Low Medium High (Upto 3 food groups) (4 to 5 food groups) (More than 5 food groups) Kasipet Adolescent girls (N=586) 35.96 63.36 0.68 Pregnant and lactating women (N=526) 40.15 58.69 1.16 Tiryani Adolescent girls (N=441) 46.8 52.28 0.91 Pregnant and lactating women (N=420) 51.21 48.06 0.73 Utnoor Adolescent girls (N=428) 39.57 59.24 1.18 Pregnant and lactating women (N=774) 33.77 63.34 2.89 Dietary diversity (Market day) Kasipet Adolescent girls (N=586) 31.4 66.72 1.88 Pregnant and lactating women (N=526) 32.89 65.02 2.09 Tiryani Adolescent girls (N=441) 39.46 56.92 3.63 Pregnant and lactating women (N=420) 43.57 54.52 1.9 Utnoor Adolescent girls (N=428) 27.8 64.49 7.71 Pregnant and lactating women (N=774) 27 66.02 6.98
- 7. 1:DescriptionofCommon DietaryPractices The typical diet consists of cereal dominated/based two meals in a day Perceptions on awareness of nutrition recorded moderate responses Seasonal variation in the diets is observed Key Findings
- 8. 2:Communityperceptionsand culturetowardsfood Prevalence of the concept of special foods and food restrictions Myths and food taboos influence the diets Fasting is common among women and adolescent girls Consumption of packaged foods prevalent among young children and adolescents Key Findings
- 9. 3:Perceivedbarrierstomanaging gooddietaryandsanitarypractices Access to weekly markets affects the dietary patterns Order of food consumption affects the food intake within a household Change in diets from millets to cereals Key Findings
- 11. Conclusion and recommendations โข Role of social and cultural norms and traditional beliefs about food โข Nutrition literacy โข Role of government led programs and effectiveness of functionaries โข Catalyze behaviour change โข Moving forward: Nutrition messaging
- 12. gender.cgiar.org We would like to acknowledge all CGIAR Research Programs and Centers for supporting the participation of their gender scientists to the Seeds of Change conference. Photo: Neil Palmer/IWMI
Editor's Notes
- Undernutrition is higher in these areas due to socioeconomic disadvantages The National Family Health Survey reported that ST children have the poorest nutritional status in the nation
- The number of undernourished people is largest in Asia and Africa. Vulnerable groups: the poor, women, infants, children and adolescents Vicious cycle of poverty > malnutrition > illness > decreased productivity, slows economic growth > more poverty Malnutrition in the Tribal Villages of India Scheduled tribes (STs) comprise 8.2% of Indiaโs population High undernutrition due to socioeconomic disadvantages National Family Health Survey โ ST children have poorest nutritional status (2006) The National Family Health Survey reported that ST children have the poorest nutritional status in the nation
- The present study focused on the common dietary practices as well as availability, access and absorption of foods among pregnant women, lactating mothers, children (3-5 years) and adolescent girls (11-18 years) in Tiryani mandal of Komaram Bheem district of newly formed Telangana state, India. The study villages include Kannepalli, Goyagaon and Morriguda villages of Kannepalli Gram Panchayat and Chinnaredipalli village from Gambiraopet Gram Panchayat of the selected mandal.
- The purpose of the qualitative survey was to gather information concerning the typical dietary patterns and nutritional status of the vulnerable tribal population and the degree of their awareness about the food security related public policies and programs and to gain a better understanding of their conditions for effective implementation of food based interventions. Qualitative method-Focus Group Discussions were used to collect the data. Focus groups also tap into subjective experiences and are an efficient way to collect large amounts of data that describes, compares, or explains a social phenomenon (Fink, 2006) because they allow participants to interact with one another and build on one anotherโs comments, and they allow the facilitators to probe for details. Using an open-ended interview protocol to guide discussion, moderator facilitated the focus groups with the assistance of note taker. Interview questions were developed and were designed to cover a range of nutrition, health and gender issues and address specific questions and issues raised in initial baseline survey. All focus group discussions were tape-recorded with the permission of the participants. The anonymity of participants in the focus groups is protected in this report, and in some instances the use of โtheyโ or โtheirโ as the first person singular pronoun has been chosen to further protect the identity of participants and to illustrate how their statements are representative of many focus group participants. A total of four focus groups were conducted. Groups ranged in size from eight to eleven participants each and lasted from 30 to 55 minutes. A total of 32 adolescents, pregnant and lactating mothers participated in focus groups. Each focus group was homogenous in that it represented either adolescents or pregnant women and lactating mothersโ type. Sample was selected randomly across the selected villages. The adolescent girls were mostly illiterate and school dropouts. They go for farm and non-farm work or assist the family in managing the household chores. The pregnant women who participated in the focus group discussions mostly belonged to Scheduled Tribes (Gond tribes) and the scheduled caste minority section (Madiga and Nethakani). Data Analysis Focus group interview tape-recordings were transcribed and went through several phases of analysis. A preliminary analysis was conducted in order to get a general sense of the data and reflect on its meaning. Next, a more detailed analysis was performed and data was divided into segments or units that reflected specific thoughts, attitudes, and experiences of participants. At the conclusion of this process of analysis a list of topics was generated, and the topics were compiled into categories that were labeled as key findings.
- Key Finding 1 Focus groups participants were asked to first talk about their favorite food and what it meant to eat their favorite food, how often they used to eat their favorite foods, and the extent to which they were balancing their food intake between work and home responsibilities. Nearly all the participants, adolescents and the PL (Pregnant and Lactating Group) confirmed that they consume 2 to 3 meals every day and the diet is usually dominated by rice with some vegetable or pulses as accompanying dish. Roti made up of sorghum, pearl millet is a part of the meal across the selected villages except Chinnareddipalli village. As per the perceptions of the participants, they provided percent of foods important for health of an individual (Table 1). The data was obtained after the participants placed twenty seeds (assuming each seed is equivalent to five percent) in different blocks representing nine food groups. The data reveals that they perceive meat, fish, and organ meat and eggs to be healthy foods while the vitamin-A rich fruits and vegetables are not perceived to be the most important foods across three groups. The adolescent groups seems to have fair idea about significance of food groups such as dark green leafy vegetables, carrot, meat and eggs being nutrient rich but could not specify the nutrients nor its functions. This may be due to lack of awareness on nutrition. Majority of the participants (Figure 3) of both the groups described that there are changes in the diets according to the seasons. Mostly vegetables are consumed during the rainy and winter season while pulses are consumed during the summer season. This is due to less or no production of vegetables in their own farms and high prices of the vegetables in the markets (even though available). Pulses were produced in their own farm and mutual exchange of different kinds of pulses is widely practiced among the communities. One of the adolescent focus group explained that they consume easily digestible and fermented food preparations like idly during rainy season and we tend to eat fried foods in winter. Summer is marked with the consumption of traditional porridges like Ambali, Java, Rottelu (Sorghum Roti) and Chaaru (Tamarind water preparation with little seasoning). Key finding 2 In Tiriyani mandal, major religion was Hindu and includes Backward Castes, Scheduled Castes and Scheduled Tribes only. Kannepalli Gram Panchayat and Gambiraopet Gram Panchayat is dominated by Hindus. All the social groups consume non vegetarian foods across all the study regions. The discourse of the participants regarding the special foods provided to the adolescents, young children and especially PL women acknowledged that personal circumstances and economic levels do affect the food they eat. One participant, in response to being asked about the special food, explained that based on their taste, they cook the food and have it- thatโs all-- Similar comments were expressed by the other participants as well when they spoke about the special foods being provided to the vulnerable groups. The participants also listed down foods for young children as Uggu (weaning mix made up of with pulses and rice) and softly cooked rice and boiled dal (Figure 4). The PL women were given mostly milk and bread, goat meat (mutton), fruits and green leafy vegetables. Specific vegetables like ladyโs finger, bitter gourd and carrot. The adolescent girls were not given any special foods and consumed the same food prepared for the entire family. Figure 4: Illustration of flip chart used in FGD When talking about the food restrictions, there are food restrictions for the PL women and adolescent girls. Many participants noted that papaya was restricted especially during menstrual cycle for adolescent, throughout the pregnancy and lactation period and also to young children as it is considered as a โhotโ food which increases heat in the body. Apart from papaya, dry coconut, chicken and eggs were also restricted during pregnancy. During lactation periods, green gram dal, chickpea dal, brinjal and potato were also restricted from the diets. In case of adolescents, menstruating girls diet was restricted from the inclusion of any kind of sweet preparations including tea (because tea contains sugar) and sour preparations like Chaaru. Adolescent girls were kept separately in the house during 3- 5 days of menstruation and were not allowed to enter the kitchen. They were also not allowed to touch the food and other members in the family. They also mentioned that they were not allowed to work during these days so that they have enough rest. Fasting was practiced among PL and adolescent girls. Majority of the fasted on Monday and Saturdays. The participants explained that they skip one meal and substitute it with fruits, milk, tea or sometimes. Upma (Refined broken wheat preparation). The participants feel that their devotion is complete by fasting and it protects them and their family from any evil. In the month of July- August (Shravana Maasam), women especially fast for one month. They consume upma with milk in the morning and consume a complete meal at the dinner time. Participants routinely listed the various food items prepared during different festivals. Major festivals cited by them are Sankranthi (harvest festival), Dussera, Deepawali and Polala Amavasya (Festival dedicated to bullocks and cow, significance that cows and bulls are the part of agriculture). Muruku, Garelu, Bakshalu, Sakinalu and Sattulu are the common food preparations mostly with rice or maize flour, oil, jaggery and spices. Majority of the participants confirmed that they eat home cooked food and outside food is not preferred. However, they explained that they do consume packaged food like chips, biscuits and chocolates in case of young children and adolescents and the PL women consume whatever is left over by their children. Eating outside or eating packaged food is rare among these communities and often happens whenever they are visiting weekly market or moving out of the village or habitation.
- Key Finding 1 Focus groups participants were asked to first talk about their favorite food and what it meant to eat their favorite food, how often they used to eat their favorite foods, and the extent to which they were balancing their food intake between work and home responsibilities. Nearly all the participants, adolescents and the PL (Pregnant and Lactating Group) confirmed that they consume 2 to 3 meals every day and the diet is usually dominated by rice with some vegetable or pulses as accompanying dish. Roti made up of sorghum, pearl millet is a part of the meal across the selected villages except Chinnareddipalli village. As per the perceptions of the participants, they provided percent of foods important for health of an individual (Table 1). The data was obtained after the participants placed twenty seeds (assuming each seed is equivalent to five percent) in different blocks representing nine food groups. The data reveals that they perceive meat, fish, and organ meat and eggs to be healthy foods while the vitamin-A rich fruits and vegetables are not perceived to be the most important foods across three groups. The adolescent groups seems to have fair idea about significance of food groups such as dark green leafy vegetables, carrot, meat and eggs being nutrient rich but could not specify the nutrients nor its functions. This may be due to lack of awareness on nutrition. Majority of the participants (Figure 3) of both the groups described that there are changes in the diets according to the seasons. Mostly vegetables are consumed during the rainy and winter season while pulses are consumed during the summer season. This is due to less or no production of vegetables in their own farms and high prices of the vegetables in the markets (even though available). Pulses were produced in their own farm and mutual exchange of different kinds of pulses is widely practiced among the communities. One of the adolescent focus group explained that they consume easily digestible and fermented food preparations like idly during rainy season and we tend to eat fried foods in winter. Summer is marked with the consumption of traditional porridges like Ambali, Java, Rottelu (Sorghum Roti) and Chaaru (Tamarind water preparation with little seasoning). Key finding 2 In Tiriyani mandal, major religion was Hindu and includes Backward Castes, Scheduled Castes and Scheduled Tribes only. Kannepalli Gram Panchayat and Gambiraopet Gram Panchayat is dominated by Hindus. All the social groups consume non vegetarian foods across all the study regions. The discourse of the participants regarding the special foods provided to the adolescents, young children and especially PL women acknowledged that personal circumstances and economic levels do affect the food they eat. One participant, in response to being asked about the special food, explained that based on their taste, they cook the food and have it- thatโs all-- Similar comments were expressed by the other participants as well when they spoke about the special foods being provided to the vulnerable groups. The participants also listed down foods for young children as Uggu (weaning mix made up of with pulses and rice) and softly cooked rice and boiled dal (Figure 4). The PL women were given mostly milk and bread, goat meat (mutton), fruits and green leafy vegetables. Specific vegetables like ladyโs finger, bitter gourd and carrot. The adolescent girls were not given any special foods and consumed the same food prepared for the entire family. Figure 4: Illustration of flip chart used in FGD When talking about the food restrictions, there are food restrictions for the PL women and adolescent girls. Many participants noted that papaya was restricted especially during menstrual cycle for adolescent, throughout the pregnancy and lactation period and also to young children as it is considered as a โhotโ food which increases heat in the body. Apart from papaya, dry coconut, chicken and eggs were also restricted during pregnancy. During lactation periods, green gram dal, chickpea dal, brinjal and potato were also restricted from the diets. In case of adolescents, menstruating girls diet was restricted from the inclusion of any kind of sweet preparations including tea (because tea contains sugar) and sour preparations like Chaaru. Adolescent girls were kept separately in the house during 3- 5 days of menstruation and were not allowed to enter the kitchen. They were also not allowed to touch the food and other members in the family. They also mentioned that they were not allowed to work during these days so that they have enough rest. Fasting was practiced among PL and adolescent girls. Majority of the fasted on Monday and Saturdays. The participants explained that they skip one meal and substitute it with fruits, milk, tea or sometimes. Upma (Refined broken wheat preparation). The participants feel that their devotion is complete by fasting and it protects them and their family from any evil. In the month of July- August (Shravana Maasam), women especially fast for one month. They consume upma with milk in the morning and consume a complete meal at the dinner time. Participants routinely listed the various food items prepared during different festivals. Major festivals cited by them are Sankranthi (harvest festival), Dussera, Deepawali and Polala Amavasya (Festival dedicated to bullocks and cow, significance that cows and bulls are the part of agriculture). Muruku, Garelu, Bakshalu, Sakinalu and Sattulu are the common food preparations mostly with rice or maize flour, oil, jaggery and spices. Majority of the participants confirmed that they eat home cooked food and outside food is not preferred. However, they explained that they do consume packaged food like chips, biscuits and chocolates in case of young children and adolescents and the PL women consume whatever is left over by their children. Eating outside or eating packaged food is rare among these communities and often happens whenever they are visiting weekly market or moving out of the village or habitation.
- Key finding 3: Participants in every group confirmed that they need to drive to IB Tandur or Bellampally as it was the nearest market (Figure 5). While for the three villages/ habitations in Kannepalli Gram Panchayat the market is just 15 kilometers away which is IB Tandur while it is 25 kilometers away for the Gambiraopet Gram Panchayat. Participants emphasized that the increased distance from the habitation to market leads to decreased mobility of women and adolescent girls to the market. The weekly market days are held on Wednesday and Saturday. Usually most of them prefer to go to market on Saturdays as it is full-fledged market with wares from different villages. Many participants explained that they visit market mostly to procure vegetables, oil and some fried snacks for the household. Also they do shop for new clothes, imitation jewelry and so on. Many participants routinely explained that the quality of goods in the market were good and prices were low and accessible to everyone. While all participants unanimously agreed that it is the women who decide on what to cook in a household. In case of joint families, mother-in-law or the elderly women decided on the menu while in nuclear families, the women who cooks decided on the menu based on the availability of the food resources. Cooking practices are being followed as per their traditional methods handed over to them by word of mouth by their families. Many participants completely agreed that they eat in last after feeding the head of the household first followed by children. The main reason explained was, available food is limited for a household whereby women generally compromise on quantity of food. They also mentioned that that most of the male members of poor household are either laborers or doing a job which requires a lot of physical strength. Therefore, being the only bearing member of poor households, his health and nutrition is important for survival of the family. Another reason was that women would complete the household chores and then leisurely complete their meal. Food habits of tribal people living in the Agency areas of the Adilabad district have undergone a sea change because of supply of subsidized rice through ration depots of the Civil Supplies Corporation. Availability of rice at such a cheap price has induced the tribal communities to shift gradually from the highly nutritious millets to rice consumption. The reasons for declining health conditions among women and men among the tribal communities is the shift in their eating habits from foods that include sorghum, finger millet, pearl millet, foxtail millet, barnyard millet, and little millet (The Hindu, 19Sep, 2012). A number of other factors such as hardship in hand processing of millets, coupled with the absence of millet processors, and psychological factors such as pride in consuming rice over millets led to the decrease in diverse food base. During the past one decade, tribal people got accustomed to consumption of rice and, in the process, brought down consumption of millets as well as their cultivation. In line with the discussion, many participants did cite that there is a change in their diets at present when compared with a decade ago. The major change is their shift from sorghum or millet roti to rice. This change is majorly due to shift from millet production to rice production and partly cab be attributed to Targeted Public Distribution System(PDS) of Government which provides rice of 4kg per each member in the household per every month. Earlier diets (decade ago) did not include much of outside or packaged food, but now it frequently consumed by the young children. Many participants throughout the focus groups discussed that itโs good to have toilets especially in the rainy season when it becomes extremely difficult for the women and adolescents to defecate in open air. However, there were very few households with toilet facility within the premises. Participants do believe that better toilet facilities have a positive impact on their health but could not cite proper reasons for the same. In rural India, especially in the tribal belt, menstruation is a taboo induced with stigma not permitting discussion or information seeking. Because of shame and superstitions associated with this monthly biological occurrence, the women are impacted by poor menstrual hygiene. Good menstrual hygiene is crucial for the health, education and dignity of the girls and women. This is an important sanitation issue. Sanitation and hygiene are key issues for adolescent girls and women, consistent with their need for privacy, dignity, safety and self- respect. It was also observed that majority of the adolescent girls and women use cloth during periods. Most of the women and adolescent girls, around, clean the cloth and reuse it for the next month. After two months of use, it is usually disposed of by burning. Participants from the adolescent group recalled that they were given training on use and disposal of menstrual pads and were also given menstrual pads for use. Availability and accessibility of the sanitary pads is the major barrier for good menstrual hygiene among the adolescent girls and women. After years of work on the ambitious Komaram Bheem Drinking Water Project, there is potable drinking water in the tribal hamlets in the agency areas of Adilabad getting purified drinking water. In line with the development, majority of the participants confirmed that they have access to drinking water, however no household processing like boiling the water, addition of purifiers is practiced in the community. The water for the domestic purposes is drawn from the wells or bore wells located in each vaada or block of the village or habitation. Straining water through a piece of clean cloth is an extremely simple, low- resource method and widely used for household water treatment among the community while filling the pots. Upon enquiry about the purification of water, one among the participants mentioned that the water tastes good as isโ โDirect ee baaga taagutaamโ โWe drink a lot of water directlyโ Key finding 4 Nutritional food is being provided to pregnant and lactating women under the limits of ICDS project- Anganwadi under Indiramma Amrutha Hastham scheme and nutritional food called โBalamruthamโ is given to children below 3 years. Focus group participants expressed that they do send their young children to Anganwadi (Figure 6) so that they child gets habituated to the formal school and as well gets nutrition supplements and diets. The centres provide, rice, dal and eggs as part of the mid-day meal while Balamrutham powder (complementary powdered nutrient dense food) is given to the child. It was also note that the children who could not attend the Anganwadi, their share of dry food rationing is provided to that child. Adolescent girls were provided mid-day meal in the school and no additional food or referral services are provided by the ICDS workers. In collaboration with the ASHA worker, regular IFA supplementation continues to be provided to pregnant and lactating mothers. Dry food rationing to the target beneficiaries is commonly practiced in the study area.
- Key finding 3: Participants in every group confirmed that they need to drive to IB Tandur or Bellampally as it was the nearest market (Figure 5). While for the three villages/ habitations in Kannepalli Gram Panchayat the market is just 15 kilometers away which is IB Tandur while it is 25 kilometers away for the Gambiraopet Gram Panchayat. Participants emphasized that the increased distance from the habitation to market leads to decreased mobility of women and adolescent girls to the market. The weekly market days are held on Wednesday and Saturday. Usually most of them prefer to go to market on Saturdays as it is full-fledged market with wares from different villages. Many participants explained that they visit market mostly to procure vegetables, oil and some fried snacks for the household. Also they do shop for new clothes, imitation jewelry and so on. Many participants routinely explained that the quality of goods in the market were good and prices were low and accessible to everyone. While all participants unanimously agreed that it is the women who decide on what to cook in a household. In case of joint families, mother-in-law or the elderly women decided on the menu while in nuclear families, the women who cooks decided on the menu based on the availability of the food resources. Cooking practices are being followed as per their traditional methods handed over to them by word of mouth by their families. Many participants completely agreed that they eat in last after feeding the head of the household first followed by children. The main reason explained was, available food is limited for a household whereby women generally compromise on quantity of food. They also mentioned that that most of the male members of poor household are either laborers or doing a job which requires a lot of physical strength. Therefore, being the only bearing member of poor households, his health and nutrition is important for survival of the family. Another reason was that women would complete the household chores and then leisurely complete their meal. Food habits of tribal people living in the Agency areas of the Adilabad district have undergone a sea change because of supply of subsidized rice through ration depots of the Civil Supplies Corporation. Availability of rice at such a cheap price has induced the tribal communities to shift gradually from the highly nutritious millets to rice consumption. The reasons for declining health conditions among women and men among the tribal communities is the shift in their eating habits from foods that include sorghum, finger millet, pearl millet, foxtail millet, barnyard millet, and little millet (The Hindu, 19Sep, 2012). A number of other factors such as hardship in hand processing of millets, coupled with the absence of millet processors, and psychological factors such as pride in consuming rice over millets led to the decrease in diverse food base. During the past one decade, tribal people got accustomed to consumption of rice and, in the process, brought down consumption of millets as well as their cultivation. In line with the discussion, many participants did cite that there is a change in their diets at present when compared with a decade ago. The major change is their shift from sorghum or millet roti to rice. This change is majorly due to shift from millet production to rice production and partly cab be attributed to Targeted Public Distribution System(PDS) of Government which provides rice of 4kg per each member in the household per every month. Earlier diets (decade ago) did not include much of outside or packaged food, but now it frequently consumed by the young children. Many participants throughout the focus groups discussed that itโs good to have toilets especially in the rainy season when it becomes extremely difficult for the women and adolescents to defecate in open air. However, there were very few households with toilet facility within the premises. Participants do believe that better toilet facilities have a positive impact on their health but could not cite proper reasons for the same. In rural India, especially in the tribal belt, menstruation is a taboo induced with stigma not permitting discussion or information seeking. Because of shame and superstitions associated with this monthly biological occurrence, the women are impacted by poor menstrual hygiene. Good menstrual hygiene is crucial for the health, education and dignity of the girls and women. This is an important sanitation issue. Sanitation and hygiene are key issues for adolescent girls and women, consistent with their need for privacy, dignity, safety and self- respect. It was also observed that majority of the adolescent girls and women use cloth during periods. Most of the women and adolescent girls, around, clean the cloth and reuse it for the next month. After two months of use, it is usually disposed of by burning. Participants from the adolescent group recalled that they were given training on use and disposal of menstrual pads and were also given menstrual pads for use. Availability and accessibility of the sanitary pads is the major barrier for good menstrual hygiene among the adolescent girls and women. After years of work on the ambitious Komaram Bheem Drinking Water Project, there is potable drinking water in the tribal hamlets in the agency areas of Adilabad getting purified drinking water. In line with the development, majority of the participants confirmed that they have access to drinking water, however no household processing like boiling the water, addition of purifiers is practiced in the community. The water for the domestic purposes is drawn from the wells or bore wells located in each vaada or block of the village or habitation. Straining water through a piece of clean cloth is an extremely simple, low- resource method and widely used for household water treatment among the community while filling the pots. Upon enquiry about the purification of water, one among the participants mentioned that the water tastes good as isโ โDirect ee baaga taagutaamโ โWe drink a lot of water directlyโ Key finding 4 Nutritional food is being provided to pregnant and lactating women under the limits of ICDS project- Anganwadi under Indiramma Amrutha Hastham scheme and nutritional food called โBalamruthamโ is given to children below 3 years. Focus group participants expressed that they do send their young children to Anganwadi (Figure 6) so that they child gets habituated to the formal school and as well gets nutrition supplements and diets. The centres provide, rice, dal and eggs as part of the mid-day meal while Balamrutham powder (complementary powdered nutrient dense food) is given to the child. It was also note that the children who could not attend the Anganwadi, their share of dry food rationing is provided to that child. Adolescent girls were provided mid-day meal in the school and no additional food or referral services are provided by the ICDS workers. In collaboration with the ASHA worker, regular IFA supplementation continues to be provided to pregnant and lactating mothers. Dry food rationing to the target beneficiaries is commonly practiced in the study area.
- Dominant socio-cultural beliefs and related social norms including dietary taboos and, in some communities, young marriage (from 16-17 years old) and childbearing ages for girls, widely impact adversely on the health, well-being and nutritional status of communities studied. Consuming adequate fruit and vegetables remains rare across all livelihood/ caste/tribe groups due to availability and accessibility. Diets are majorly cereal and legume based which is usually cultivated by the community. Sanitation and hygiene facilities and practices are still dormant in the selected communities especially for the adolescent, pregnant and lactating women and it needs to be emphasized for improved hygiene and sanitation behavior. Long-term social and behavioral change programs are needed to raise awareness and catalyze change on some dominant socio-cultural beliefs and practices that negatively affect the health and nutritional status of girls, women, infants and children in particular. Availing the facilities provided by the Government programs by the target beneficiaries will yield better results.