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Food habits, dietary intake and nutritional status during economic crisis among pregnant women in Central Java, Indonesia
Umeå University, Faculty of Medicine, Public Health and Clinical Medicine, Epidemiology and Public Health Sciences.
2004 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

FOOD HABITS, DIETARY INTAKE AND NUTRITIONAL STATUS DURING ECONOMIC CRISIS AMONG PREGNANT WOMEN IN CENTRAL JAVA, INDONESIA

Th. Ninuk Sri Hartini, Epidemiology and Public Health Sciences, Dept. of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden; Community Health and Nutrition Research Laboratories, Gadjah Mada University, Jogjakarta, Indonesia; Nutrition Academy, Ministry of Health, Jogjakarta, Indonesia

ABSTRACT

Objectives: The overall objective of this thesis was to study the effect of the economic crisis on food habits, dietary intake and nutritional status among pregnant women in Purworejo District, Central Java, Indonesia.

Subjects and methods: Since 1994, the Community Health and Nutrition Research Laboratories (CHN-RL), Gadjah Mada University, Jogjakarta, Indonesia have operated a surveillance system in Purworejo District, Central Java, Indonesia. Between 1996 and 1998, a monthly monitoring of new pregnancies took place within the surveillance system. This project included a detailed evaluation of dietary intake during pregnancy. Each trimester six repeated 24-hour recalls were conducted on 450 pregnant women. Weight and mid-upper arm circumference (MUAC) were measured monthly, height and serum ferritin concentration was measured once. Here, the dietary intake and nutritional status of the women during the second trimester are evaluated in relation to the emergence of the economic crisis, that started in 1997. Women were classified into four socio-economic groups. A computer program (Inafood) was developed to calculate nutrient intake. To support the quantitative results, a qualitative study was carried out between January and June 1999. Focus group discussions were held with four groups of women, in-depth interviews with 16 women, three traditional birth attendants and four midwives, and observations were carried out with four women. Here, food habits and coping strategies in relation to the economic crisis were explored.

Results: Before the crisis, more than 80% of the pregnant women had inadequate energy and 40% had inadequate protein and vitamin A intake. All women had inadequate calcium and iron intake. The food intake consisted of rice, nuts and pulses and vegetables, meaning that it was mainly plant-based food. Rice behaved as a strongly inferior good in economic term, meaning that its consumption increased in spite of its price increase. Rice remained an important supplier of energy, protein and carbohydrates also during the crisis. Especially, rural, poor women with access to rice fields increased their rice intake and decreased their intake of non-rice staple foods. Reasons for the continued rice intake included the women had been accustomed to eating rice since they were born and that cooking methods for non-rice staple foods were difficult. The intake of animal food was low initially and decreased further during the economic crisis. Rich women decreased their intake of fat. The intake of nuts and pulses and vegetables increased for most groups. Nuts and pulses were an important supplier of calcium and iron, and vegetables were an important supplier of vitamin A. The rural, poor women with access to rice fields kept their food taboos also during the crisis. Rich women were able to maintain a good nutrient intake during the crisis, although fat intake decreased. Also, urban poor and rural, poor, landless women had an increased intake “during crisis” because relatives and neighbour provided some foods and perhaps also because of the government support programme.

Conclusion: Before the crisis, energy and nutrient intake of pregnant women were inadequate. The food pattern of the women was predominately plant-based. Rich women were able to maintain a good nutrient intake during the crisis, although fat intake decreased. Rural poor women with access to rice fields had a higher rice intake than other groups throughout the crisis. Urban poor and rural poor, landless women experienced a decreased intake of most nutrients in the transition period but an increased intake during the crisis, reflecting government intervention and support from relatives and neighbours. The latter, however, is not sustainable. Thus, vulnerable groups are at risk of developing nutritional deficiencies without food support programmes.

Key words: Food intake, nutrient intake, nutritional status, food pattern, pregnancy, food habits, coping strategies, economic crisis, Indonesia.

Place, publisher, year, edition, pages
2004. , 80 p.
Series
Umeå University medical dissertations, ISSN 0346-6612 ; 885
Keyword [en]
Public health
Keyword [sv]
Folkhälsomedicin
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Research subject
Epidemiology
Identifiers
URN: urn:nbn:se:umu:diva-212ISBN: 91-7305-590-5 (print)OAI: oai:DiVA.org:umu-212DiVA: diva2:142668
Public defence
2004-03-26, D, Tandläkarhögskolan, Norrlands Universitetssjukhus, Umeå, 09:00 (English)
Opponent
Supervisors
Available from: 2004-03-15 Created: 2004-03-15 Last updated: 2010-01-22Bibliographically approved
List of papers
1. Energy intake during economic crisis depends on initial wealth and access to rice fields: the case of pregnant Indonesian women
Open this publication in new window or tab >>Energy intake during economic crisis depends on initial wealth and access to rice fields: the case of pregnant Indonesian women
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2002 (English)In: Health Policy, ISSN 0168-8510, E-ISSN 1872-6054, Vol. 61, no 1, 57-71 p.Article in journal (Refereed) Published
Abstract [en]

Starting in August 1997, Indonesia experienced a radical and rapid deterioration in its economy. Between 1996 and 1998, dietary intake during the second trimester was measured in 450 pregnant women in Purworejo, Central Java, Indonesia. Using six 24 h recalls we describe the consequences of the economic crisis on the energy intake of pregnant Indonesian women. Depending on the date of data collection, women were grouped into 'before crisis', 'transition' and 'during crisis'. Mean energy intake among groups was compared using ANOVA and Student's t-test. All groups of pregnant women already had a mean energy intake before the emerging crisis that was lower than the Indonesian recommended dietary allowances (RDA). Nevertheless, energy intake differed significantly among women with different education levels (P = 0.00) and from different socio-economic groups (P = 0.00). 'During transition', a significant decrease in energy intake was experienced by urban poor women (P = 0.01). Poor women with access to rice fields had a higher rice consumption than other groups throughout the period. Our results most likely reflect the effect of higher rice price on income and welfare. 'During crisis', energy intake improved among vulnerable groups, perhaps reflecting government intervention.

Keyword
Energy intake, Economic crisis, Initial wealth, Pregnancy, Indonesia
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:umu:diva-3790 (URN)10.1016/S0168-8510(01)00210-X (DOI)12173497 (PubMedID)
Available from: 2004-03-15 Created: 2004-03-15 Last updated: 2017-12-14Bibliographically approved
2. Nutrient intake and iron status of urban and rural poor without access to rice fields are affected by the emerging economic crisis: the case of pregnant Indonesian women
Open this publication in new window or tab >>Nutrient intake and iron status of urban and rural poor without access to rice fields are affected by the emerging economic crisis: the case of pregnant Indonesian women
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2003 (English)In: European Journal of Clinical Nutrition, ISSN 0954-3007, E-ISSN 1476-5640, Vol. 57, no 5, 654-666 p.Article in journal (Refereed) Published
Abstract [en]

OBJECTIVE: We evaluated the adequacy of nutrient intake in comparison with the Indonesian Estimated Average Requirement (EARs) among pregnant Indonesian women and explain the short-term effect of economic crisis on nutrient intake and iron status. DESIGN: Cross-sectional study. SETTING: Purworejo District, Central Java, located 60 km west of Yogyakarta Province, Indonesia. SUBJECTS: During the period from 1996 to 1998, up to six 24 h recalls were performed during the second trimester of pregnancy among 450 women. Nutrient intake and iron status was evaluated in relation to date of data collection relative to the economic crisis that emerged in August 1997. A computer program (Inafood) was developed to calculate nutrient intake. RESULTS:: Forty percent of the pregnant women were at risk of inadequate intake of energy and protein, and 70% were at risk of inadequate intake of vitamin A, calcium and iron even before the crisis. Our results also demonstrate an effect of short-term economic crisis on nutrient intake and iron status. When the crisis emerged, urban poor experienced a decrease in intake of most nutrients. During the crisis, rich women experienced a significant decrease in fat (P<0.05). Negative changes in fat density during crisis were experienced by the rich and the rural, poor, and access to rice field subgroups (P<0.01). A significant increase in carbohydrate densities was seen for the rich and rural, poor, and access to rice fields groups (P<0.05). Urban poor experienced decreased serum ferritin concentration (P<0.05), whereas rich women experienced a significant increase (P<0.05). CONCLUSIONS: Urban poor and rural poor landless women were most directly affected by the emerging economic crisis.

Keyword
nutrient intake, iron status, pregnancy, economic crisis, Indonesia
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:umu:diva-3791 (URN)10.1038/sj.ejcn.1601595 (DOI)12771966 (PubMedID)
Available from: 2004-03-15 Created: 2004-03-15 Last updated: 2017-12-14Bibliographically approved
3. Food pattern during economic crisis among pregnant women in Purworejo District, Central Java, Indonesia.
Open this publication in new window or tab >>Food pattern during economic crisis among pregnant women in Purworejo District, Central Java, Indonesia.
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2003 (English)In: Food and Nutrition Bulletin, ISSN 0379-5721, E-ISSN 1564-8265, Vol. 24, no 3, 256-267 p.Article in journal (Refereed) Published
Abstract [en]

A cross-sectional study was conducted between 1996 and 1998. Six 24-hour recalls were performed during the second trimester of pregnancy among 450 women in Purworejo District, Central Java, Indonesia. The objectives of the study were to assess the food intake and food pattern among pregnant women before and during the economic crisis. Before the crisis, rich women had the highest intakes of animal foods, fats and oils, and sugar. Food intake among the urban poor and the rural landless poor subgroups was influenced by the emerging economic crisis. Although the price of rice increased, the intake of rice also increased among all subgroups. Rural poor women with access to rice fields increased their intake of rice and decreased their intake of nonrice staple foods (p < .05). There were significant decreases in the consumption of chicken by rich women and rural poor women with access to rice fields (p < .05). Rice was a strongly inferior good and remained an important supplier of energy, protein, and carbohydrate. Nuts and pulses were important suppliers of calcium and iron, and vegetables were an important supplier of vitamin A. Rich women increased their intake of nuts and pulses, vegetables, fats and oils, and sugar when their intake of rice increased (p < .05). The food patterns were based on rice, nuts and pulses, and vegetables, i.e., plant food. All but the rich women decreased their intake of nutritious foods such as meat, chicken, and fruits. The intake of nuts and pulses and of vegetables increased, whereas the intake of cooking oil and sugar remained constant.

National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:umu:diva-3792 (URN)14564930 (PubMedID)
Available from: 2004-03-15 Created: 2004-03-15 Last updated: 2017-12-14Bibliographically approved
4. The importance of eating rice: changing food habits among pregnant Indonesian women during the economic crisis
Open this publication in new window or tab >>The importance of eating rice: changing food habits among pregnant Indonesian women during the economic crisis
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2005 (English)In: Social Science and Medicine, ISSN 0277-9536, E-ISSN 1873-5347, Vol. 61, no 1, 199-210 p.Article in journal (Refereed) Published
Abstract [en]

This article presents qualitative and quantitative research findings on food habits of pregnant Indonesian women in relation to the economic crisis that arose in 1997. Between 1996 and 1998, dietary intakes were estimated for 450 pregnant women in Central Java. Between January and June 1999, four focus group discussions, 16 in-depth interviews and four non-participant observations were held with women, two in-depth interviews were held with traditional birth attendants, and four with midwives. Women were categorized as urban or rural, rich or poor, and according to rice field ownership. The women reported that before the crisis they bought more foods and cooked more meals and snacks. During the crisis, cooking methods became simpler and cooking tasty foods was more important than cooking nutritious foods. This involved using plenty of spices and cooking oil, but reducing the use of expensive nutritious foods. The herbal drink jamu was drunk by 15% of pregnant women; its consumption was lower during than before the economic crisis. Twenty-six percent of the women avoided certain foods due to food taboos, and most of these women avoided beneficial foods; this phenomenon decreased during the crisis among the rich and the rural, poor, landless women. In spite of increased prices for rice, women did not decrease their rice consumption during the crisis because rice was believed to have the highest value for survival, to provide strength during pregnancy and delivery, and to be easier to store and cook. Finally, children and husbands had highest priority in being served food, and women were the last to eat.

Keyword
Eating, Economics, Female, Food Habits, Humans, Indonesia, Interviews, Oryza sativa, Pregnancy, Social Class
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:umu:diva-13847 (URN)10.1016/j.socscimed.2004.11.043 (DOI)15847972 (PubMedID)
Available from: 2007-05-16 Created: 2007-05-16 Last updated: 2017-12-14Bibliographically approved
5. The coping strategies of pregnant women during the economic crisis in Central Java, Indonesia
Open this publication in new window or tab >>The coping strategies of pregnant women during the economic crisis in Central Java, Indonesia
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Article in journal (Refereed) Submitted
Identifiers
urn:nbn:se:umu:diva-3794 (URN)
Available from: 2004-03-15 Created: 2004-03-15Bibliographically approved

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