research on food taboo

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• Published: 15 July 2023

Food taboos and animal conservation: a systematic review on how cultural expressions influence interaction with wildlife species

• André Santos Landim 1 ,
• Jeferson de Menezes Souza 2 ,
• Lucrécia Braz dos Santos 1 ,
• Ernani Machado de Freitas Lins-Neto 1 , 3 , 4 ,
• Daniel Tenório da Silva 1 &
• Felipe Silva Ferreira 1 , 3 , 5  

Journal of Ethnobiology and Ethnomedicine volume  19 , Article number:  31 ( 2023 ) Cite this article

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Human societies have food taboos as social rules that restrict access to a particular animal. Taboos are pointed out as tools for the conservation of animals, considering that the presence of this social rule prevents the consumption of animals. This work consists of a systematic review that aimed to verify how food taboos vary between different animal species, and how this relationship has influenced their conservation.

For this systematic review, the search for articles by keywords took place in the databases “Science Direct,” Scopus,” “SciELo” and “Web of Science,” associating the term “taboo” with the taxa “amphibians,” “birds,” “mammals,” “fish” and “reptiles.” From this search, 3959 titles were found related to the key terms of the research. After the entire screening process carried out by paired reviewers, only 25 articles were included in the search.

It was identified that 100 species of animals are related to some type of taboo, and segmental taboos and specific taboos were predominant, with 93 and 31 citations, respectively. In addition, the taxon with the most taboos recorded was fish, followed by mammals. Our findings indicate that the taboo protects 99% of the animal species mentioned, being a crucial tool for the conservation of these species.

Conclusions

The present study covered the status of current knowledge about food taboos associated with wildlife in the world. It is noticeable that taboos have a considerable effect on animal conservation, as the social restrictions imposed by taboos effectively contribute to the local conservation of species.

The process of eating is influenced by social, cultural and biological factors, leading human populations to select certain foods and avoid others. People recognize and classify foods for their nutrition, considering preferences that determine the intensity and frequency with which certain resources are consumed [ 1 , 2 , 3 ].

About dietary restrictions, taboos stand out as an important cultural element in several societies [ 4 , 5 , 6 , 7 ]. Food taboos are cultural elements that represent unwritten rules regulating human behavior toward certain resources, appearing in two forms: general taboos, which are imposed on an entire ethnic group making them never eat certain foods, and specific taboos, which are understood as temporary and interfere with a period of the individual's life, such as dietary restrictions at certain ages, in the face of illnesses and at certain times of life [ 8 , 9 ].

Food taboos act by preventing access to a particular food resource, and several characteristics are related to define a species as taboo. Animals may be avoided as food due to the presence of toxicity, parasites, fat content, position in the food chain they occupy, microhabitat and their conservation status [ 10 ]. In a case study in Brazil, it was found that the existing dietary restrictions among fishermen populations in the southeast region were related to the shape of the fish, its appearance, odor, behavior, conspicuous teeth, absence of scales, strong or heavy meat (called in Brazil “reimosa”), habit of eating slime and presence of blood [ 11 ].

Additionally, aspects related to the local availability of fauna (considering the richness and abundance of species) and access to other proteins are pointed out as motivators for the absence or presence of food taboos. The literature shows cases in which the food resource decreases, there is a tendency to make food taboos more flexible [ 4 , 9 ].

The presence of a food taboo in a human society brings a debate associated with fauna conservation. The defended hypothesis is that dietary restrictions result in adaptive strategies that contribute to the conservation and management of natural resources, above all, protecting some species of animals [ 12 ]. In this sense, the literature suggests that the presence of taboos directly contributes to the conservation of animal species [ 4 , 13 , 14 ]. However, there is a lack of studies that show whether in fact food taboos act as cultural elements that contribute to the conservation of fauna. Furthermore, there are gaps in knowledge about how food taboos behave in relation to taxonomic groups (birds, mammals, reptiles and amphibians), and how they appear in different regions of the planet.

Thus, the present study aimed to carry out a systematic review based on the following motivating questions: (1) Do food taboos influence fauna conservation? and (2) is there variation in the types of taboos between taxonomic groups and continents?

Material and methods

Research strategy and selection of studies.

The systematic review was performed based on the Cochrane Handbook for Systematic Reviews of Interventions guideline and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) tool. Potentially relevant studies were identified through a search of Scopus, SciELO, Web of Science and Science Direct databases. The following research questions were used for this research: Do food taboos influence the conservation of wild species? and Do taboos influence fauna protection attitudes vary between taxonomic groups and continents?

As a search strategy, the standardized term “Taboo” was used, combined with terms related to animal taxa “Mammals,” “Reptiles,” “Amphibians,” “Birds” and “Fish,” linked by the Boolean operator “ and .” These terms are considered standardized because they were selected from consultations in the encyclopedia of controlled vocabularies in the “National Library of Medicines” through the “Medical Subject Headings” (MeSH) and in the VHL through the “Descriptors in Health Sciences” (DeCS). The search was performed using terms in English, Portuguese and Spanish. No time limit was used in the database search.

Inclusion and exclusion criteria for studies

Studies that met the following eligibility criteria were included in the review: (1) publication in English, Spanish or Portuguese; (2) object of study refers to animals with associated food taboo and (3) study points out whether the taboo associated with the animal leads to death or not of the species. Works were excluded: (1) unavailable in full; (2) abstracts published in conference proceedings; (3) letter to the editor; (4) literature review; (5) integrative review; (6) scoping review; (7) systematic review with or without meta-analysis; (8) systematic review overview with or without meta-analysis; (9) book chapter; (10) dissertations; (11) theses; (12) studies with imprecise results in reaction to taboos associated with species and (13) articles without the scientific name of the animal.

According to the eligibility criteria, the articles were selected according to the evaluation of the titles, followed by readings of the abstracts. If the article was appropriate, it was read in full. The selection was carried out by two researchers (paired review), called Reviewer 1 and Reviewer 2. In situations of disagreement between the reviewers, a third reviewer performed the tiebreaker.

The initial screening of articles found in the databases was performed using the EndNote software. x9 to exclude duplicate titles. Both the paired selection of titles and abstracts were performed using the Rayyan a software [ 15 ]. To verify the degree of agreement between the reviewers, the Kappa test was applied. The Kappa coefficient can be defined as a measure of association used to test the degree of agreement (reliability and precision) between evaluators [ 16 ]. The interpretation of the magnitude of the concordance estimators is agreed as: 0 (absent), 0–0.19 (poor/insignificant), 0.21–0.39 (fair), 0.40–0.59 (moderate), 0.60–0.79 (substantial) and ≥ 0.80 (almost perfect) [ 17 ]. Kappa test calculations were performed using the IBM SPSS Statistics 20 software.

The tabulation of the data was performed in Microsoft® Excel®, registering the information of the articles such as author; year of publication; country; study design; duration of study; species name; gender; family; order and class and endemisms, and if food taboo leads to death or not.

Data analysis

Data were analyzed qualitatively, taking into account the quality of the study, number of cited species, classification of taboos and classification of the species in relation to the threat of extinction according to the International Union for Conservation of Nature's (IUCN). The evaluation of the quality of the study was carried out through the analysis of the risk of bias in relation to: (1) sample size of the study, (2) indication of the area and population of the study, (3) species identification strategy, (4) data analysis and (5) exposure of food taboos (Table 1 ). Methodological quality assessment and risk of bias were performed using Review Manager (RevMan) 5.4. [ 18 ].

The number of animals cited was recorded by simple counting, considering the number of times an animal is mentioned in different works. The number of species consists of the frequency in which a species appears, without considering repetitions. For example, if a species is cited by two works in different countries or not, we compute that the “Number of animals” is equal to two and the “Number of species” is one. For the classification of food taboos, the classification by Colding and Folke [ 19 , 47 ] was adopted, classifying them into “specific taboos,” “segmental taboos,” “method taboos,” “life history taboos,” “habitat taboos” and “time taboos.” It was also recorded whether the type of taboo was related to the death of the animal.

The search for articles in the databases returned a total of 46,117 titles related to the descriptors. A total of 12,705 articles were excluded for being duplicated, with 33,412 being included for title analysis. After reading the titles, a total of 29,453 articles were excluded because they did not meet the eligibility criteria. Of the 3959 remaining titles, 1362 studies were excluded, 448 because they dealt with taboos related to insects and 914 because they were not the object of study of this research.

Before selection by reading the abstracts, a third reviewer was asked to analyze the 2597 titles that passed the initial screening, 1817 articles being excluded. A total of 780 articles were included for reading the abstracts, 377 studies being excluded at this stage. A total of 403 articles were read in full, and 25 studies were included in this review (Fig.  1 , see Additional file 1 ).

Studies identified by searching the databases, based on Page et al. [ 49 ]

The Kappa test indicated a reasonable agreement in the analysis of the titles ( k  = 0.309) and moderate agreement ( k  = 0.438) in the selection by reading the abstracts. Regarding the risk of bias, it was identified that 16% of the studies showed low risk of bias, 44% moderate risk and 40% high risk of bias in relation to the sample size. Regarding the identification of species, 52% of the works used photographs of the animals, collected parts or whole animals, presenting a low risk of bias. A total of 96% presented a good characterization of the study area and population, with maps of the area, geographic coordinates and cultural context. For the discussion of taboos, 64% showed low risk of bias, and 24% of the studies showed high risk of bias or moderate risk of bias for data analysis (Fig.  2 ).

Authors' assessment of each risk of bias item for each scientific article included

A total of 130 animals distributed in 100 species were identified with some associated taboo. The species Pseudoplatystoma fasciatum , Hoplias malabaricus and Chelonoidis denticulatus presented the highest citation frequency, with four citations. It was registered that the taboo protects 99% of the registered species, avoiding the death of the animal. The only exception was the Pteropus tonganus present in Niue (Oceania), where a habitat taboo is associated with the death of the species. Regarding the taxonomic groups, fish had the greatest diversity of taboo species (44 species, average of five animals cited per study), followed by mammals ( n  = 35); reptiles ( n  = 16) and birds (five species) (Table 2 ).

Considering the types of taboos, specific taboos ( n  = 74) and segmental taboos ( n  = 50) showed the highest frequency of animals; the habitat taboo had only one related mammal, and no animals related to the other types of food taboos were recorded (Fig.  3 ). All the specific and segmental taboos found did not cause the death of the animals. It was also found that the taxonomic category of fish had the highest frequency of segmental taboos, while the class of mammals had a predominance of specific taboos.

Number of food taboos by animal category

It was found that several motivations are pointed out for a species to be considered a food taboo; in this context, the registered species are avoided as food due to the characteristics of the meat (considered sweet, bad taste, unpleasant smell, high protein and fat), cultural beliefs (animals are totemic symbols, sacred, bring bad luck, they are gods), because they aggravate inflammation and cause irritation and for religious reasons.

Analyzing by continent, South America was the continent with the highest number of animals ( n  = 106) (birds: n  = 3; mammals: n  = 26; fish: n  = 59 and reptiles: n  = 18) mentioned with some type of taboo. None of the described taboos caused the death of animals in this continent. In Africa, only six animals were found, being distributed in the taxa of reptiles ( n  = 5), mammals ( n  = 1). Regarding the types of taboos in the African continent, only specific taboos were found for all animals. Asia recorded 16 taboo animals (birds = 3; mammals = 10 and reptiles = 3). In Europe and Oceania, only two species of animals were described in the studies, one species of fish (with segmental taboo) in the European continent and a mammal in Oceania, respectively (Fig.  4 ).

Distribution of taboo species by continent

The registered animals showed a low rate of endemism, with a total of eight species considered endemic, distributed among six fish ( Pinirampus pirinampu , Hoplias malabaricus and Cichla ocellaris , which are threatened with extinction, and Zungaro zungaro , Semaprochilodus brama and Hoplias brasiliensis which are least concern conservation status) and a bird ( Psophia viridis , vulnerable conservation status), recurrent in Brazil. Only one mammal is considered endemic ( Nycticebus javanicus , endangered), recurrent in Indonesia. The other species are of continental or cosmopolitan distribution.

As for the type of taboo, the South American continent presented the following types: specific taboo ( n  = 17), segmental taboo ( n  = 88) and habitat taboo ( n  = 1). The class of fish and mammals has the highest number of animals listed by type of taboo, being predominant in the segmental taboo with 54 and 25 animals, respectively. In Asia, specific taboos predominated over the other types of taboos found with eight species in total, followed by segmental taboo ( n  = 4) and habitat taboo ( n  = 4). With respect to the conservation status of the species listed here, it was identified that one species ( Eretmochelys imbricata ) is critically endangered (CR) in terms of conservation status, and 21 are in a state of vulnerability (VU).

Our data indicate that 100 species of vertebrates are related to some type of taboo. Although the patterns of the taboo/species relationship are not clear, it is possible to identify that some animals are rejected as food due to characteristics of the meat, and it is pointed out that consuming some species can aggravate inflammatory processes. At this point, it is necessary to consider that taboos consist of unwritten or defined social rules, generally symbolizing something forbidden and untouchable, without necessarily having a rational explanation [ 20 ].

Observing the ecological aspect, the taboos behave like restrictions or rejections that govern attitudes and actions regarding a natural resource, constructed based on the human perception of a certain species. Consequently, species can be avoided because of their behavioral patterns, morphological characteristics, toxicity or simply because they are involved in myths and represent religious symbols, which are part of the cosmology of a population [ 8 , 21 ]. Examples of species such as Nycticebus javanicus , Funambulus pennantii , Pardofelis marmorata and Catopuma temminckii are related in Asia to ancestral relationships, totemic symbols and religious beliefs that protect these species against hunting [ 28 , 29 , 46 ].

It is important to understand how humans seek, obtain and choose food, as food choices can be influenced by individual preferences, ecological, economic, social and cultural factors, as well as dislikes [ 22 ]. In this situation, food taboos often limit the use of natural resources and, therefore, have important implications for biodiversity conservation [ 19 , 23 , 24 ].

It is noticeable that taboos are heterogeneously distributed among animal classes, this perspective is possibly related to selective pressures, which led human beings to interact differently with fish, birds and reptiles. About fish, the literature points out many species with an inflammatory potential for humans. It is possible that human populations have developed fish-related taboos to reduce the risks associated with potentially inflammatory foods [ 4 , 25 ]. Another point is that the rejection for consumption of certain species of fish happens due to the animal's eating conditions, as well as its morphology. For example, species such as poraquê ( Electrophorus electricus ) and the sarapo ( Sternarchorhynchus mormyrus ) are avoided by Brazilian communities because they are like snakes, so in the local perception, they may contain some toxicity [ 1 ].

About mammals, the ancestry between humans and other animals of this taxon may be a factor that influences behaviors that originate taboos. As humans recognize characters in common with other mammals, this may lead to dietary restrictions for animals with anthropomorphic characteristics. Traditional peoples of China tend to avoid the Gibbon ( Hoolock tianxing ) as food, due to the belief that the species is “ancestors of people” [ 26 ]; it is also found that indigenous peoples of India do not hunt or consume any primates, due to the belief that primates were their ancestors and, therefore, are religious symbols [ 27 ]. In this way, shared ancestry, religious symbols and the belief that the species causes or intensifies inflammation can make a species taboo [ 4 , 14 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 ].

The taboos associated with reptiles and birds report situations of restriction to the meat of these animals due to sacred contexts or potential inflammation. Regarding reptiles, the emergence of taboos associated with these animals may be related to the feeling of fear. Most likely, humans' fear of reptiles is related to genes that arose in ancient lineages of mammals that were preyed on by snakes. Thus, the human feeling of fear is associated with these genes, possibly favoring the survival capacity of Homo sapiens against animals with some risk potential, such as snakes [ 50 , 51 , 52 ].

About the taboos related to birds, the human feeling about birds is directly associated with the beauty of these animals. Birds are seen by humans as beautiful animals due to their coloration [ 53 ]. Colors such as blue and yellow are seen, especially in birds, as elements that enhance beauty [ 54 ]. Possibly, this feeling influences a low number of birds used for food and, consequently, fewer food taboos. Additionally, the taboos assigned to birds that have been listed here are related to restrictions constructed by local sacred aspects. It is also necessary to consider that this taxon is directly linked to smuggling, in which several birds are sold in Brazil and in the world, causing birds to be incorporated into pet and trade categories [ 55 , 56 ].

Taboos can be classified in a utilitarian way, such as temporary (segmental) taboos that are restricted to certain periods of life, regulating the use of a resource according to age, gender, social condition and other specific conditions; and permanent (specific) that extend throughout life [ 19 ]. As for the variation in the types of taboos, the segmental taboos predominated in relation to the other types of taboos observed in the studies. Many of these segmental taboos are associated with the inflammatory potential of meat. These animals are known as “reimosos” in South America. The word “reima” comes from the Greek “rheum” which means “viscous fluid” and aims to classify the degree of safety of wild and domestic animals for consumption [ 1 ].

Creamy or “heavy” foods, for traditional populations, tend to provoke or aggravate inflammatory processes, tending to be avoided by people in physical states of liminality, initiated in some ritual, people with illnesses, menstrual period and postpartum [ 12 , 33 ]. In our study, we found 50 cases of taboos referring to “heavy animals,” many of which were described as “heavy meat” animals capable of causing infections, being foods to be avoided mainly by women during pregnancy, puerperium or menstruation. This perspective is recurrent in riverside communities in the Amazon (Basil), where some reptiles such as the Jabutis ( Peltocephalus dumerilianus ), ( Mesoclemmys raniceps ) and the jabuti-tinga ( Chelonoidis denticulatus ) are not eaten because they are oily, because they are “offensive to anyone eats,” causing “allergic reactions” [ 14 ]. Several other cases of segmental taboos are cited in this review [ 1 , 4 , 11 , 14 , 31 , 34 , 35 , 36 , 37 , 38 ]. These examples of segmental taboos point out how cultural factors and the phases of a person's natural life cycle can interfere in the dynamics of animal consumption in a community, and this instrument ends up being an important factor for the conservation of animal species.

Specific taboos are mostly related to religious factors and folk beliefs. In a case study, it is seen that the capture and consumption of primacy Nycticebus javanicus is prohibited because, according to villagers, taking and keeping this species in homes can bring unhappiness and bad luck [ 28 ]. On the other hand, in India, felines such as Capped Langur ( Trachypithecus pileatus ) , Asian golden cat (Catopuma temminckii ) , cat- marbled (Pardofelis marmorata ) and the tiger ( Panthera tigris ) are seen as animals that bring luck, because they are related to sacred institutions and cannot be hunted [ 27 ].

Habitat taboos are also considered a type of permanent taboo. This type of taboo was characterized by restrictions on hunting in places considered sacred. These places, because they are surrounded by symbology and spirituality, serve as a sanctuary for animals, thus being an important conservation factor. According to local beliefs, people who hunt in sacred places can suffer both divine and popular punishments [ 39 ]. Janaki et al. [ 27 ] point out that habitat taboos can help in the conservation of wild animals by providing refuges. Habitat taboos are recurrent in continents such as South America, Asia and Oceania, and these sacred reserves help government institutions to institutionalize places as biodiversity conservation areas, making them heritage protected by law.

The studies found are mostly from South America, reinforcing the perspective that this continent is one of the main scientific productions related to Ethnobiology [ 40 ]. It can be noticed that regarding taboo game species in South America, the vast majority of studies are focused on the fish group, with case studies being carried out with indigenous and riverside peoples, mainly in the Brazilian Amazon, in addition to caiçaras (mixture ethnocultural heritage of indigenous, European and African peoples) from the coastal portion of Brazil [ 1 , 2 , 4 , 11 , 25 , 30 , 38 ]. On the other hand, no studies were found that portrayed taboos associated with fish in Asia, Oceania and Africa. And only one study was found in Europe [ 41 ].

The greatest restriction for fish consumption in South America was due to the potential to cause inflammation, the feeding habits of these animals, in addition to the morphological similarities with snakes for some species [ 4 , 25 , 32 ]. In Asia, Africa, Oceania and Europe, it is noticeable that the taboos are similar, since most food restrictions are based on spirituality, where species, mainly mammals and reptiles, are prohibited so that the hunter/consumer does not suffer “punishments,” divine powers or punishments in their village/tribe [ 27 , 28 , 39 , 42 , 43 ].

By observing the behavior of taboos within the socioecological systems present in this review, it was found that food taboos have a positive effect on fauna conservation. This is because, even if unintentionally, the people involved end up acting in favor of the conservation of the species, either by restricting the consumption of “loaded” meat that can cause illness or by situations associated with the sacred place that can result in punishments for those who consume [ 14 , 27 , 43 ].

The literature directly discusses the effect of taboo on fauna conservation [ 13 , 21 ]. The compilation of data on taboos across the planet corroborates this perspective, as the data collected here show that food taboos have a positive effect on animal conservation, as of the 100 species listed under the effects of food taboos, 99 have taboos with positive effects for these species. These results show how taboos play a fundamental role in conservation and are often neglected by representations of formal institutions.

Analyzing the conservation status of the species listed here, we observe that the species classified as critically endangered (CR) in the IUCN list, as is the case of the hawksbill turtle ( Eretmochelys imbricata ) and the small primate the slow loris ( Nycticebus javanicus ) have taboos that reduce access by humans. We can presume that these species, without local taboos, could be susceptible to a decrease in population density in several regions of their occurrence [ 28 , 31 , 44 ].

However, it is important to consider the limitations of the effect of food taboos within a conservationist perspective [ 21 , 57 ]. Some species may present local taboos and have their consumption avoided, but form part of the diet of other human populations. For example, the present study shows that Tayassu pecari, Pecari tajacu and Nasua nasua have a record of food taboos in Brazil; however, it is used in food in different parts of northeastern Brazil [ 58 , 59 ]. Additionally, species such as Mazama americana, Mazama gouazoubira, Dasypus novemcinctus and Cuniculus paca have food taboos in Argentina but are preferred items in food in some locations in Brazil [ 55 , 59 ].

Considering that habitat loss (because of urbanization and agribusiness) [ 60 , 61 ] directly impacts wildlife, the existence of food taboos, even at the local level, plays an important role in conservation. If we consider that the food taboo has a local effect, the absence of these social rules could trigger greater pressure on certain species of animals, as their consumption would be widely spread. In this way, a species of animal avoided by a certain social group tends to have a higher population density at the local level, thus contributing to conservation. For example, in a study on sacred groves, it is demonstrated that the taboo of habitat serves to regulate the use of natural resources, being recognized by traditional communities as more efficient than areas of environmental protection [ 57 ]. Segmental taboos have also been identified as important wildlife managers, since they reduce the number of people who consume the resource [ 30 ].

The data collected here show that there are still few studies on food taboos and their consequences for preserving fauna. Thus, any strong conclusion about the role of taboos in conservation is still premature. However, it is possible to use these data and incorporate them into strategies to support fauna conservation. Taboos associated with the sacred are efficient mechanisms in the conservation of fauna. In a case study in Ghana (Africa), it is pointed out that among a community of turtles such as E. imbricata , Dermochelys coriacea, Lepidochelys olivaceae and Chelonia mydas are not hunted, due to local belief that these turtles were sighted saving ancestors of the population during a war against the Ashanti empire (an important ethnic group in Ghana). Therefore, residents of this village are prevented from consuming meat from these reptiles [ 44 ]. In the Brazilian Amazon, the taboo exerts a positive force (conservation) on species such as Tapirus terrestres , Tayassu fishermen , Fishermen steal and Ateles chamek which are avoided by indigenous peoples of the lower Madeira River, as they are considered to aggravate inflammation [ 7 ].

The consensus among studies is that animals considered taboo tend to be preserved, and this can positively impact the population dynamics of these species. It is estimated that the existence of taboos can reduce the pressure exerted on some species by up to 80%, since taboos reduce the number of people sharing the resource [ 4 , 13 , 14 ]. At this point, it was identified that only one work points to a negative relationship of taboos associated with wild species; it was found that in Oceania, flying fox hunting ( Tongan priest ) is intensified, due to the belief that the population of this species is infinite within a sacred area, so hunting the species in other areas does not impact the population of the animal [ 43 ].

Considering the types of taboos, it is observed that the specific and habitat taboos, as they are permanent, contribute to the formulation of laws and other regulations to prevent the hunting of different species of animals [ 57 ], showing the importance of the taboo even for formal institutions as technical and legal mechanisms for the conservation of species, corroborating the study by Nijman and Nekaris [ 28 ], which points out that species-specific taboos may have important ecological ramifications for the protection of threatened populations.

Final considerations

The present study covered the status of current knowledge about food taboos associated with wildlife in the world. It is noticeable that taboos have a considerable effect on animal conservation, as the social restrictions imposed by taboos effectively contribute to the local conservation of species. Even considering the importance of taboos for socio-biodiversity, there are still crucial gaps on this topic, showing that the topic “food taboo” is often neglected or little explored within socio-ecological systems.

From this study, it is evident the need to develop research to elucidate the mechanisms that favored the emergence of taboos. Undoubtedly, investigating human evolutionary history and foraging in the environment is an interesting way to identify what favored the emergence of taboos. Additionally, food taboos are important for maintaining the population of species on different continents. It is also important to emphasize that due to the inclusion and exclusion criteria of this research, data on other species and types of food taboos have been subtracted, so the number of species under the effects of food taboos may be even greater.

In this way, we point out that new studies should be designed to include objectives and metrics to analyze food taboos, seeking to understand how taboos arise and remain qualitatively and quantitatively within human populations. We also indicate that considering food taboos in environmental management plans can contribute significantly to the conservation of certain species.

Availability of data and materials

All data generated or analyzed during this study are included in this published article.

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This study was financed in part by the Coordenação de Aperfeiçoamento de Pessoal de Nível Superior—Brasil (CAPES)—Finance Code 001.

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André Santos Landim, Lucrécia Braz dos Santos, Ernani Machado de Freitas Lins-Neto, Daniel Tenório da Silva & Felipe Silva Ferreira

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ASL designed the study, performed the database searches, screened the studies and wrote the main text. JdMS carried out the selection of studies and carried out the review of the main text. LBdS carried out the selection of studies and organized the main results. EMdFLN performed the data and main text review. DTdS guided the construction of the protocol for searching the databases, and FSF guided all phases of the study. All authors have read and approved the current manuscript.

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Landim, A.S., de Menezes Souza, J., dos Santos, L.B. et al. Food taboos and animal conservation: a systematic review on how cultural expressions influence interaction with wildlife species. J Ethnobiology Ethnomedicine 19 , 31 (2023). https://doi.org/10.1186/s13002-023-00600-9

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Food taboos, health beliefs, and gender: understanding household food choice and nutrition in rural Tajikistan

• Katharine McNamara   ORCID: orcid.org/0000-0001-7951-5119 1 &
• Elizabeth Wood 1  

Journal of Health, Population and Nutrition volume  38 , Article number:  17 ( 2019 ) Cite this article

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Household nutrition is influenced by interactions between food security and local knowledge negotiated along multiple axes of power. Such processes are situated within political and economic systems from which structural inequalities are reproduced at local, national, and global scales. Health beliefs and food taboos are two manifestations that emerge within these processes that may contribute beneficial, benign, or detrimental health outcomes. This study explores the social dimensions of food taboos and health beliefs in rural Khatlon province, Tajikistan and their potential impact on household-level nutrition. Our analysis considers the current and historical and political context of Tajikistan, with particular attention directed towards evolving gender roles in the wake of mass out-migration of men from 1990 to the present. Considering the patrilieneal, patrilocal social system typical to Khatlon, focus group discussions were conducted with the primary decision-making groups of the household: in-married women, mothers-in-law, and men. During focus groups, participants discussed age- and gender-differentiated taboos that call for avoidance of several foods central to the Tajik diet during sensitive periods in the life cycle when micronutrient and energy requirements peak: infancy and early childhood (under 2 years of age), pregnancy, and lactation. Participants described dynamic and complex processes of knowledge sharing and food practices that challenge essentialist depictions of local knowledges. Our findings are useful for exploring entaglements of gender and health that play out across multiple spatial and temporal scales. While this study is situated in the context of nutrition and agriculture extension, we hope researchers and practitioners of diverse epistemologies will draw connections to diverse areas of inquiry and applications.

The recognition of good nutrition as a fundamental driver for sustained social, economic, and political development has led to global efforts to eradicate malnutrition [ 1 ]. These efforts have aided in reducing the prevalence of malnutrition worldwide; however, accessing safe, nutritious food in adequate quantities continues to be a struggle for approximately 815 million people across a variety of contexts, regardless of the GDP of their nation [ 2 ]. Spatial and temporal patterns of food distribution are heterogeneous, causing disproportionate levels of malnutrition among some groups of people [ 3 ]. Intersectional approaches to malnutrition can aid in considering the combined, complex interactions between health and the mutually constituting subjectivities that contribute to vulnerability: gender, age, ethnicity, and caste, among others [ 4 ]. In this article, we consider vulnerable groups those whose intersecting subjectivities convey greater susceptibility to malnutrition and severity of its effects (e.g., diarrhea, stunting, wasting), and face the greatest risk of long-term health consequences due to poor nutrition. We simultaneously explore the overlap of vulnerability and privilege as critical for engaging diverse agents of change who reflect a multitude of health experiences [ 5 ].

Malnutrition takes a variety of forms and is often expressed comorbidly alongside other health conditions. According to Soeters et al., malnutrition is “a subacute or chronic state of nutrition in which a combination of varying degrees of over- or undernutrition and inflammatory activity have led to a change in body composition and diminished function” ([ 6 ], p. 708). While the definition proposed by Soeters et al. guides our conceptualization of malnutrition, this article places particular emphasis on the implications of undernutrtion due to its pervasiveness within the study site: Khatlon Province, Tajikistan.

Tajikistan faces the highest rate of undernutrition in Central Asia with approximately 5% of children under the age of 5 years suffering from acute undernutrition (wasting), 30% from chronic undernutrition (stunting), and 11% from underweight [ 7 ]. Accessibility and availability of food is most concerning in rural areas of the country, where food insecurity is concentrated [ 7 ]. Khatlon province, a largely rural region located in southwest Tajikistan, is highly vulnerable to malnutrition due to the interaction of poverty, tough agroecological conditions, and high rates of male migration for work (38%) [ 8 ]. These factors are complicated by gender hegemonies, wherein gender expectations are performed, intertwine with, and are perpetuated within the broader socioecological system that dominate subaltern masculinities and femininities [ 4 , 9 ]. Ultimately, the dynamic between power, social systems, and complex food landscapes influences how much of what kind of food is consumed and by who .

Since the 1970s, development practice has largely targeted the immediate drivers of malnutrition through nutrition-specific interventions like micro- and macronutrient supplementation [ 10 ]. However, a growing body of research demonstrates that nutrition-specific programs are not sufficient to reach global targets as they fail to address the complex socioecological determinants of malnutrition relevant at multiple scales of intervention [ 11 , 12 ]. In response, nutrition research and practice increasingly emphasize the importance of the underlying determinants of malnutrition through nutrition-sensitive interventions [ 13 ]. Within the agriculture sector, such programs seek to influence the availability, accessibility, and diversity of food [ 12 ]. The agriculture extension system (AES) is considered particularly well-positioned to execute nutrition-sensitive efforts because of its close engagement with communities and families and potential to bridge multiple pathways to improved nutrition through local agro-food systems [ 11 , 14 ].

Tajikistan faces the challenge of developing effective strategies for nutrition-sensitive agriculture amidst a dearth of literature relevant to its geographic and cultural context. However, in combination with cases from Uzbekistan, a neighboring country that shares some sociocultural similarities and shared history with Tajikistan as a former Soviet state, this small body of work can help scholars and practitioners glean relevant points of entry into more comprehensive nutrition interventions. For example, in both Uzbekistan and Tajikistan, it is common for elderly parents to live in the home of their youngest son and his family in a multigenerational household [ 15 , 16 ]. Complex relations emerge within in this familial arrangement that are central to the decisions made around food production, food preparation, and diet. While the power dynamics in this context are diverse, the interaction of age and gender often situate young women and children at the low-end of intrahousehold hierarchies [ 17 ]. Relations between senior and junior women (e.g., between mother-in-law and daughter-in-law), widowed mother and son, husband and wife, and junior and senior men (e.g., between father and son) fluidly maintain a matrix of interacting hierarchal structures [ 15 ]. Relationships between mothers-in-law and daughters-in-law are particularly important to decision-making around food and strongly influence household nutrition [ 17 ].

Tajikistan has experienced continual demographic changes  since the late 1990s, spurred by growing rates of male out-migration. Today, approximately 40% of the working-age population leave the country to pursue work abroad; The majority of migrating workers are men from rural areas [ 16 ]. Naturally, demographic transformations are accompanied by changes in gender relations and expectations at multiple levels of society. While gender in any context is multifaceted, encompassing a range of discursive and performative processes by which masculinities and femininities are (re)constructed (for example through labor and specialized knowledge) [ 18 ], rapid and ongoing changes to national and local demographics contribute additional complexity to local gender relations. Despite the need for flexible research methods to capture these interwoven interactions, categorical gender analysis—which interprets men and women as static groups—remains widespread in the health literature. Nowhere is this more apparent than in work that equates gender with women and the fundamental linkages between men’s and women’s health are overlooked (see [ 19 ]). Ultimately, such approaches risk framing health and gender as “women’s issues” and essentializing men and women as either the perpetrators or victims of hierarchical dynamics, respectively, despite variation within these fluid subjectivities [ 4 ]. A gender relations approach that is responsive to complex and changing interactions “not only within but across identities and analytic categories” ([ 4 ], p. 1676), is therefore crucial for understanding gender and health in the context of Tajikistan.

The research presented in this article builds on the findings of a previous investigation that explored how Tajik intrahousehold dynamics affect the allocation of food resources and, ultimately, nutrition (see [ 17 ]. At the request of local agriculture extensionists, we framed our “initial dive” into food-related decision-making practices with the purpose of identifying recommendations to target malnutrition through AES. Entering this investigation, we expected to observe similar patterns to those documented in other contexts with prominent malnutrition and similar intrahousehold hierarchies. However, we found that food taboos and health beliefs shaped intrahousehold dietary practices in unexpected ways—a pattern not reflected by other studies in Central Asia.

In the early-to-mid 1900s, early Anthropological endeavors on the subject of taboos conceptualized such practices as irrational, pseudo-science avoidances "which, in their simplest forms, are almost as instinctive as those of the lower animals" ([ 20 ], p. 14). Later, taboos were reinterpreted as instrumental, rational practices that regulate complex social systems [ 21 ]. Over the last decade, the trajectory of scholarly approaches has evolved towards complex, integrated visions wherein the socio-ecological functions of taboos are entangled with symbolism and spirituality, history and politics, and economic and environmental conditions [ 22 ]. In this article, we apply insights from contemporary inquiry into taboos (see Meyer-Rochow 2009, Golden and Comaroff 2015) in tandem with theoretical contributions from anthropology, geography, and masculinity studies to call attention to the specific ways that Tajik food taboos shape and are shaped by  gendered experiences and knowledges around health.

According to Meyer-Rochow (2009), the word food taboo is used to describe the deliberate avoidance of a specific food item "for reasons other than simple dislike from food preferences" ([ 23 ], p. 2). In some cases, food taboos protect from health hazards [ 24 ], in others they facilitate environmental conservation or safeguard limited resources [ 22 , 25 ]. Thus, intimate connections between food taboos and social-ecological systems punctuate cultural practice [ 17 ]. Food taboos can indicate specialized knowledge of specific household members and the responsibilities and roles attached to certain subjectivities. In this way, both awareness and practice of taboos may be most aparent within sub-groups most involved in their preservation [ 18 ]. While food taboos are embedded within community health beliefs, the later reflects values associated with a given activity or practice. More specficially, health beliefs encompass a breadth of attitudes, perceptions, and values stemming from various sources of health-related knowledge. Another distinction lies in how health beliefs emerge and are preserved within a community. Taboos involve the co-evolution of practices within the fabric of social power structures. Health beliefs, in contrast, reflect diverse renderings of health concepts that may be important at both individual and group (e.g. household, community) levels; Thus, health beliefs are not necessarily tied to multigenerational knowledge-sharing. Health beliefs and food taboos are interconnected, however, within the unique social-ecological system of the context from which they emerge; For example, health beliefs may inform adaptive food restrictions. Finally, both concepts are flexible and respond to changes in environmental, political, and economic configurations [ 23 ].

As seen in other contexts, food taboos in Khatlon Province may reflect intrahousehold power dynamics along the axes of age and gender as social expectations performed through food practices. Building on the findings of our earlier work, we aim to explore how food security in Khatlon Province is mediated by taboos and health beliefs that govern dietary practices during critical points in the human life and along gendered subjectivities [ 25 ]. For example, young mothers and children experience increased nutrient and energy demands during pregnancy and lactation, and during the first 2 years of life, respectively. Thus, food restriction at these phases life can magnify the health impact of seasonal scarcity, crop failure, and other disturbances to the agro-food system on women and young children due to the interaction of social status and increased dietary requirements during “nutrient-expensive” stages of life [ 3 ]. Experiences of both women and men are crucial to understanding the determinants of household nutrition status. However, no regional study of household health has considered the position of men—much less their nutrition knowledge and practices—beyond their role as “head of household” or as the standard next to which women's health status is evaluted. In light of recent gendered demographic transformations and their role as a destabilizing force in the Tajik household [ 26 ], such considerations are necessary to capture the sociocultural nuances associated with diet and nutrition and the multiplicity of health effects incurred by all household members.

This article explores and characterizes the social dimmensions of food taboos and health beliefs in Khatlon Province and their potential impact on household nutrition by analyzing a subset of the data collected from the household decision-making study described above. We apply a gender relations approach by recognizing “gender dynamics and the circumstances under which they interact to influence health opportunities and constraints” ([ 9 ], p. 2); Analysis across gender categories is necessary to capture nuance within health and nutrition experiences. Our ultimate goal is to draw linkages between local knowledge and the evolving political, economic, and environmental context of Khatlon Province that came forward in the data as central to local adaptive strategies around health. We do this by presenting taboos as dynamic, flexible, and in a constant state of emergence in response to ongoing socioecological changes; the topics of shifting demographics, agricultural labor, and unspecific taboos are most salient in this respect. To our knowledge, no other studies have documented the critical role of food taboos and health beliefs in household nutrition and dietary practices in the Central Asian Region. By filling the void of locally relevant research on connections between gender dynamics and health, this study holds implications for nutrition-sensitive programs seeking to address the underlying causes of undernutrition.

A team from the University of Florida (UF) conducted this study in February 2017 in collaboration with partners from the Tajikistan Agrarian University (TAU) and the Feed the Future Tajikistan Agriculture and Water Activity (TAWA) project. Prior to data collection and participant recruitment, permission to conduct this research was granted by the Institutional Review Board II (IRB II) at the University of Florida. UF principal investigators (PIs) were experienced in qualitative methods and had extensive background in global public health and nutrition. Research assistants from UF and TAU were invaluable members of the research team and worked alongside PIs from data collection to analysis. All research assistants from UF were in the master’s in public health (MPH) program and were recruited based on their previous involvement in public health research alongside the PIs and interest in conducting nutrition-related research abroad. TAU research assistants were recommended by TAU faculty based on the focus of their graduate studies in agriculture extension and communication and their familiarity with the rural, agrarian context of Khatlon province. UF PIs provided training in qualitative research methods to research assistants from both universities before fieldwork was conducted. UF research assistants received training on focus group discussion (FGD) and interview methods, effective probing questions, and real-time note-taking strategies. TAU research assistants were trained in the same competencies with the addition of real-time oral and written translation and word-for-word translation and transcription of recorded data. Together, PIs and trained research assistants met with agriculture extension agents from TAWA—this organization refers to extension agents as “Extension Home Economists” (EHEs), we will use this terminology from this point on—to deliver training on FGD facilitation and to develop a data collection strategy to implement during FGDs that would involve collaboration between EHEs, research assistants, and PIs. Due to the EHEs’ familiarity with participants through their extension work, it was decided that EHEs would lead the FGDs with community members while support roles were filled by TAU research assistants (responsible for translating in real-time to UF researchers and asking probing questions) and UF research assistants and PIs (responsible for managing recordings, note taking, and posing probing questions for translation to TAU research assistants).

Content analysis forms the theoretical approach of this study and was chosen deliberately for two reasons: (1) the dearth of existing literature and theories within the context of interest and (2) our ultimate goal of describing and characterizing a phenomenon, in this case the intrahousehold dynamics that govern food-choice and practices in Khatlon Province. The use of content analysis was crucial to our inductive approach to data analysis through which codes, categories, and themes were directly drawn from the data [ 27 ].

Prior to conducting FGDs with community members, four key informant interviews (KIIs) were conducted with nutrition and maternal and child health specialists from the World Health Organization, UNICEF, German Corporation for International Cooperation, and a local health clinic in Khatlon Province to provide researchers with information on household food and nutrition-related practices within the region. KIIs also allowed researchers to gain insight into best practices for nutrition-related field work in Tajikistan, specifically Khatlon Province. Participants were purposively selected based on the in-country partners’ knowledge of organizations working on nutrition in the region. Following KIIs, the FGD instrument was tested in Yavon, a village within Khatlon province, among mothers with children under 10 years of age. The instrument was revised and adjusted for cultural competency.

FGDs took place in 12 villages across five districts in Khatlon Province (Shahrtuz, Jomi, Khuroson, Sarband, and Vakhsh), which were selected due to their location within USAID’s Feed the Future Zone of Influence and connection to ongoing extension work with EHEs. In 2014, TAWA EHEs established women’s groups in collaboration with the Women Entrepreneurship for Empowerment Project (WEEP), which seeks to provide leadership and skill-building activities related to agriculture and nutrition to women of reproductive age. Through their work with the WEEP women’s groups, EHEs have built strong working relationships and trust within those communities, making EHEs ideal facilitators of these discussions. FGDs were conducted among three target populations: in-married women, mothers-in-law, and men. These participant groups were chosen based on the patrilineal and patrilocal social organization of Tajik households. We defined the participant groups according to their relationship with the in-married women due to her central role in diet-related decisions. “Men” refers to the husbands of the in-married women or males in the same age cohort as men of marrying age. “Mothers-in-law” refers to mothers of the in-married women’s husband, or mothers of men of marrying age. Due to household hierarchies, key informants strongly recommended separating these three groups during FGDs for honest responses and to ensure full participation of each group member in the discussion. Based on this recommendation, data from two FGDs was excluded from our analysis because the groups included both in-married women and mothers-in-law. In these two cases, EHEs were unable to separate the in-married women from their mothers-in-law without risking household conflict. Thirteen homogenous FGDs were analyzed for the purposes of this study: seven FGDs with in-married women, four with mothers-in-law, and two with men. FGDs varied in size (from 5 to 12 participants), with fewer total male participants as compared to women due to the high rate of male migration for work and their subsequent absence in many villages. Both the number of FGDs conducted with men and the number of male participants in each FGD clearly reflect these trends.

Each FGD was conducted by an EHE of matching gender to the participants with a TAU and UF research assistant present. During the discussion, a TAU research assistant translated the discussion in real-time while one UF research assistant transcribed verbatim using a laptop and a second UF research assistant took notes and asked probing questions via the facilitator. All FGDs were recorded to capture any lost data and were later reviewed and compared to the transcripts by a TAU research assistant to ensure data quality. Due to the stigma of illiteracy, oral consent was collected in the participants’ native language: Tajik, Uzbek, or Russian. Before initiating the discussion, TAU students or EHEs read the consent agreement aloud in the local language. The theoretical approach of this study was reflected in the structure and style of the focus groups, which were framed with open-ended questions relating to dietary practices and household decision-making around food. Targeted probing questions based on respondents’ comments allowed for a participant-directed discussion. When discussions surrounding specific infant and young child feeding (IYCF) practices arose in the FGDs, participants were asked to define the age at which those practices were exercised.

Transcripts from the 13 homogenous FGDs form the empirical basis of this study. Researchers and research assistants from UF carried out data analysis using the constant comparative method where coding and analysis take place simultaneously [ 28 ]. Intercoder reliability was strengthened by building consensus between coders through intensive group discussion to develop a coding framework. Analysis was organized using Excel, in which each code was defined concisely. Follow-up discussions between coders were continual throughout the data analysis process to continually check interpretive convergence. Once all data were coded using QSR International’s NVivo 11 software, segments of the transcripts were retrieved and consolidated into an Excel matrix organized by theme, subtheme, participant group, and interpretation. From this, researchers defined recurrent themes and patterns. Food taboos and misconceptions emerged as sub-categories nested within determinants of food choice . Following analysis, we recoded misconceptions as health beliefs to convey the legitimacy of local knowledge in shaping health practices. Due to the rich discussions by participants, researchers conducted an additional analysis of the data subset that related specifically to food taboos and health beliefs . This allowed researchers to develop a more nuanced understanding of food taboos and health beliefs as they relate to nutrition in Khatlon Province.

The findings presented here build on our previous work on the intersections of household decision-making and nutrition. Our analysis targets a subset of that data relating specifically to food taboos and health beliefs, two themes that arose as critical determinants of household decision-making around food in the preceding work. Discussions around food taboos and health beliefs arose organically from an open-ended question: “Are there foods you avoid eating? Why?” This question was intentionally gender-neutral and probing questions, similarly, did not use gendered pronouns. Several themes and subthemes emerged that characterize food taboos in Khatlon Province according to who the taboo affects and when. There were also several health beliefs that followed similar patterns, affecting certain individuals during specific phases of the life cycle. Finally, a small portion of food taboos were found to be unspecific (uninfluenced by gender or age). The themes developed during analysis are presented according to a life-cycle approach: (1) food taboos during pregnancy, (2) health beliefs around breast-feeding, (3) food taboos during infancy and childhood, and (4) food taboos unspecific to gender or stage in life.

Food taboos during pregnancy

Antenatal food taboos were pervasive across participant groups and villages. However, while men were aware of restrictive antenatal taboos, women (in-married women and mothers-in-law) provided reasoning to detail why those practices were necessary. From the perspective of in-married women and mothers-in-law, exclusion of certain foods was intended to protect and support maternal health. For example, a mother-in-law stated, “When they have morning sickness they cannot eat oily foods.” Restriction of oily foods is practiced early in pregnancy to reduce the likelihood and severity of morning sickness. However, one mother-in-law explained that intake of oily foods may be limited throughout pregnancy and that, in general, “ pregnant women don’t eat as much oily food.”

FGDs across participant groups pointed to a general restriction of carbohydrate consumption during pregnancy. Men voiced their awareness of this practice by noting specific high-carbohydrate staple foods that are not consumed by pregnant women. The foods mentioned by men included osh (a rice dish) and mantou (dumplings). Women noted a more comprehensive list of avoided foods, adding noodles, bread, other baked goods. One mother-in-law summarized this list as “foods with carbohydrates”. When asked why carbohydrates are restricted, women explained that “if you eat these kinds of foods or meals you will have difficulty during birth” (In-married woman). Participants from women’s FGDs explained that consumption of carbohydrates during pregnancy leads to excessive weight-gain and a risky delivery because high gestational weight gain (GWG) “makes [the] baby very big” (mother-in law). Pistachios and nuts, a high-fat food item, were also restricted from the diet for the same reason.

These food taboos may have emerged recently in Khatlon Province due to their reported connection to recommendations from local physicians. Mothers-in-law explained that “[pregnant women] are told [by doctors] not to eat pistachios and nuts because they think the babies will be fat”. This observation was supported in the FGDs with in-married women, one of who stated, “Doctors tell [pregnant women] not to eat nuts, noodles, bread, foods rich with carbohydrates and recommend to eat more fruits and juice.” Both quotes suggest women consider restriction of certain foods key to physician recommendations for the prenatal diet. In-married women additionally emphasized the importance of fruits and vegetables to maternal diets during their focus groups.

Health beliefs around breastfeeding

Breastfeeding practices only emerged as a topic of conversation within women’s FGDs. Within these discussions, women participants reflected on the challenges of breastfeeding amidst breastmilk insufficiency, financial hardship, and inadequate breastfeeding promotion, awareness, and education. Insufficient milk production was the most commonly cited reason for early termination of breastfeeding and appears to be a relatively common challenge among young mothers in the region. As a result of insufficient breastmilk, infants receive supplemental foods at an early age (before the age of 6 months). For example, one in-married stated, “my baby was four months old, and I gave him cow’s milk because I didn’t have enough milk.” While some participants reported that women may purchase formula when breastmilk is insufficient, there was an overall preference to supplement infant diets with animal-source milk. Women cited financial or nutritional grounds to support this choice. For many women and their families, formula is too expensive to consider as a breastmilk replacement. For others, animal milk is simply preferred due to the perception that it is more nutritious. As one in-married woman explained: “I am not in condition to buy formula, but I buy cow milk for my children which may be healthier.”

Food taboos during infancy and childhood

Following pregnancy, food taboos prevalent during pregnancy decline alongside emerging food taboos specific to their new infant. Similar to antenatal taboos, food taboos during infancy and childhood are intended to protect children during vulnerable stages in life. Across all participant groups, infants and children were considered highly sensitive to gastroenteric upset based on the belief that they cannot digest foods as effectively as adults —prevention of upset stomach was the most common reason for excluding certain foods from infant’s and children’s diets.

Discussions around egg avoidance departed from the narrative of preventing gastric upset. Participant groups also diverged in their reasons for restricting egg consumption among young children. For example, mothers-in-law believed that “babies who didn’t start talking, they shouldn’t eat eggs, because it will influence, they will start speaking very late." In the previous quote, the mother-in-law highlights the importance of restricting egg consumption during a critical period for cognitive development. Since children usually begin speaking around 18–24 months, we estimated that this participant group considered children under the age of 2 years most at-risk to the perceived detrimental effects of eggs. Mothers-in-law also mentioned that “…if [children] eat eggs they have the problems with their stomach." This respondent connected egg taboos with the common motivation to protect children from gastric upset. Men, meanwhile, diverted from both of these reasons and believed that eggs should be excluded from children’s diets because they are high-calorie foods.

Across focus group discussions, participants differentiated between appropriate and taboo foods for young children between 6 months and 2 years of age according to two primary categories: light/ soft (considered appropriate) and heavy/hard foods (considered taboo). Light/soft and heavy/hard foods were grouped together in our analysis because some villages used the words “light” and “heavy” to describe appropriate and taboo foods, respectively, while “soft” and “hard” were used by others. The difference in categorization of foods between villages emerged due to linguistic variation between the study sites. Translation of Uzbek, Tajik, and Russian into English resulted in slightly different interpretations. However, we considered these words linguistic equivalents based on the parallel descriptions of each food type given by participants. Participants referred to soft-textured, mild-tasting, and carbohydrate-rich foods as light/soft. Hard/heavy foods were often diluted with water to make them more palatable for children between 6 months and 2 years of age. Participants described oily and carbohydrate-rich staple foods as hard/heavy. Foods within these categories included fatir (a type of bread), sambusa (a meat or vegetable filled pastry), osh (a rice dish), and mantou (a meat or vegetable-filled dumpling). Again, participants state these foods should be excluded from young children’s diets “because [it is] difficult to digest these meals” (In-married woman). One in-married women explained that hard/heavy foods can be introduced “starting at two, three years, but in very small amounts starting from two years” while another stated that, for some children, these dietary practices continue past the age of 2 years due to taste preference or household dietary practices.

Within women’s FGDs, in-married women and mothers-in-law believed some fruits and vegetables should be excluded from the diets of children under 2 years because of their association with gastric upset. This practice was affirmed by an in-married woman who stated, “We don’t give them tomato, cucumber, watermelon, and grapes, because of diarrhea.” Fruits and vegetables grown under certain conditions, inside greenhouses (according to in-married women) or with contaminated irrigation water (according to mothers-in-law), were considered more likely to cause gastric illness in young children. Participants identified accounts from neighboring villages and personal experiences with sick children as their sources of information. One in-married woman recounted, “Some people even died when they ate watermelons and melons, some people died from botulism,” a mother-in-law, meanwhile, voiced the general observation that children “[have diarrhea] after they eat cucumber.” Avoidance of fruits and vegetables in this case is protective of young children, who women in FGDs identify as most vulnerable to food-borne illness.

Food taboos unspecific to gender or stage in life

Some food taboos and health beliefs were reported as unspecific to gender or stage in life. Instead, unspecific food avoidances applied to all members of the family. However, only in-married women and mothers-in-law discussed unspecific food taboos in their FGDs. Women identified imported food and “foods grown with chemicals” (mother-in-law) as unsafe for human consumption. Imported foods were overwelmingly viewed with distrust; As one in-married woman stated, “We don’t eat imported chicken. We eat our chicken from our houses, but we don’t eat imported chicken.” Others regarded imported food as "impure" and the cause of poor health. This was supported by dialog among mothers-in-law, one of who explained, “At the time that we were pregnant everything was pure, now it’s all Chinese and that’s why they have a problem with health.” This quote highlights that consumption of imported food and the subsequent avoidance of imported food are relatively new facets of village life, occurring within the lifetime of the mothers-in-law. Finally, this quote serves to underscore the interaction between diet and the changing agro-food system in Tajikistan. As noted with taboos during pregnancy, breastfeeding, and early childhood, the motivations of avoiding imported foods are tied up in protecting human health.

Women participants also discussed that foods with additives and foods “grown with chemicals” should be avoided by all household members, regardless of age or gender. The reason, given by one in-married woman, was that foods like sausage may have “other bad things” added during preparation. This links back to the perceptions of impurity and contamination discussed with regards to imported foods. Along these same lines, many women perceived fruits and vegetables grown with synthetic fertilizers or insecticides as unsafe. This was considered a pervasive issue in the region, where, according to one in-married women, “fruits and vegetables have a lot of fertilizer and chemicals.” The extent to which these taboos were actually practiced, however, is unclear. Fruits and vegetables were overwhelmingly perceived as healthy by participants across all FGDs. Participants simultaneously grappeled with the risk of consuming contaminated vegetables. As the evidence connecting synthetic pesticides with adverse health grows, growing methods, food choices, and dietary values may change to reflect what some participants described as "pure" food. For example, women participants reported active efforts to reduce the risks of eating contaminated fruit and vegetables through alternative growing methods. As one in-married woman explained, “Using fertilizer less, using compost instead of chemicals. The methods for combating insects… we think we will overcome these obstacles, like we will use chemicals less.”

Our findings point to several food taboos that restrict consumption of key staple foods and nutrient-rich fruits and vegetables for members of the Tajik household. We know from our previous work with this data that wheat, rice, and oil are the foundations the study population’s diet [ 17 ]. In Khatlon Province, approximately 73% of the average dietary energy consumption (DEC) is provided by carbohydrates, placing carbohydrate consumption in this region slightly above the national level and near the upper limits recommended by the WHO (71% and 75%, respectively) [ 29 ]. Wheat alone, in the form of breads, noodles, porridge, and dumplings (called mantou ), accounts for more than two-thirds of total caloric intake per day [ 30 ]. That said, carbohydrates clearly represent a crucial source of daily calories for those living in Khatlon Province and Tajikistan as a whole. Fats and oils by comparison represent the second most crucial source of calories in the Tajik diet (20% of average DEC). Nevertheless, food taboos and health beliefs related to carbohydrates and fats/oils dominated discussions among in-married women, mothers-in-law, and men. Given the significance of carbohydrates, fats, and oils to the regional diet, potentially 90% of calories could be at risk should restrictive practices associated with food taboos overlap at any time. Simultaneously, food-limiting practices are informed by and respond to complex socio-ecological, economic, and politically-grounded challenges. Here we expand our analysis to consider the various ways taboos and health beliefs are embedded within such complex systems and influence community health. 

Our discussions suggest that carbohydrate and fat/oil-related taboos coincide during pregnancy and early childhood (between 6 months and 2 years of age). Antenatal food taboos call for the restriction of both oils/fats and carbohydrates to reduce the likelihood of specific pregnancy-related health hazards: morning sickness and difficult delivery, respectively. Nausea and vomiting in the first trimester of pregnancy, commonly referred to as “morning sickness,” is widely experienced by women during pregnancy. Symptoms typically peak 6–18 weeks into pregnancy and subside mid-way through the second trimester [ 31 ]. In Khatlon Province, oily and fatty foods are considered taboo during this period of pregnancy because they exacerbate morning sickness symptoms. Food aversion during pregnancy is widely documented and estimated to affect 50-90% of women globally [ 32 ]. That said, diet modification in response to morning sickness symptoms may result in inadequate intake of calories and nutrients if dietary changes compromise the consumption of local staples [ 33 ]. In the context of Khatlon, the risk of negative health outcomes brought on by food aversion is greatest during times of food scarcity when supplemental, non-taboo foods are more expensive or unavailable. Khatlon Province seasonally experiences food insecurity due to harsh winters and, increasingly, climate change-induced crop failure [ 34 ]. Supporting prenatal nutrition in the face of these challenges depends on sufficiency of supplemental food choices that do not agitate morning sickness symptoms. 

During this sensitive period of pregnancy, women also avoid carbohydrates to suppress gestational weight gain (GWG). Participants reported that greater GWG contributes labor complications associated with delivering an infant of higher birth weight. This belief, previously unstudied in Tajikistan, has been reported in rural Ethiopia, Nigeria, the Central African Republic, among other contexts [ 3 , 35 , 36 ]. While excessive weight gain during pregnancy can pose risks to antenatal health, moderate GWG (15–40 pounds depending on the baseline BMI of the woman) is a natural outcome of pregnant women meeting the increased energy requirements of pregnancy [ 37 ]. Our findings indicate that women in Khatlon Province may experience a reduced capacity to access and allocate sufficient food to support prenatal health and fetal development during the first 18 weeks of pregnancy due to the overlap of carbohydrate- and fat-limiting taboos. Poor nutrition during this phase in pregnancy, considered the “critical window” for the developing fetus due to rapid cell proliferation, impedes the development of organs and survival of the child [ 38 ].

While the restriction of oil and fat subsides with decreased likelihood of morning sickness, carbohydrates are considered taboo for the full duration of pregnancy. This appears connected to the nature of the health hazard being avoided: morning sickness is most relevant during the first two trimesters, while the fear of delivering a large baby is continual until pregnancy is complete. However, continued exclusion of carbohydrates from the prenatal diet can contribute to maternal undernutrition, which holds additional implications for child health as the primary cause of low birth weight (LBW; weight of under 2500 g). In Tajikistan, maternal undernutrition is considered the leading driver of the country’s high neonatal mortality rate (52 deaths per 1000 live births) [ 19 ]. Low birth weight is also associated with long-term developmental outcomes including subnormal growth, illness, and cognitive problems [ 39 ].

While the maternal and child health risks associated with LBW are considerable, the worries voiced by participants concerning GWG, birth weight, and risky delivery are well-founded. Evidence from public health research substantiates that heavier birth weight (4000 g or more) can pose serious risks for the mother and child [ 38 , 39 ]. The possibility of obstetric complications is even higher for mothers who experienced chronic malnutrition during childhood—a common occurrence in Khatlon Province—that can lead to small stature in adulthood. Smaller placenta, uterus, and narrower pelvis accompany smaller body composition and increase the possibility of uterine rupture, obstructed labor, and other serious problems [ 40 ]. Khatlon Province (and Tajikistan as a whole) has a long history of childhood stunting which, in the last decade, has gradually declined [ 40 , 41 ]. Thus, food taboos that restrict the prenatal diet may have emerged to deal with obstetric complications brought on by early childhood malnutrition of mothers who, with recent improvements in nutrition, give birth to proportionally larger infants. These findings should alert practitioners of the need to address women’s concerns around risky delivery in order to influence food-limiting taboos during pregnancy. Recently, significant investment has been placed in increasing the number of deliveries assisted by a skilled provider (physician, nurse, or midwife). According to the Demographic and Health Survey, as of 2017, 95% of births are assisted by a skilled attendant nationally (over 90% in all provinces)—a significant increase from 75% coverage in 2005 [ 42 ]. Skilled birth attendants are able to respond in the case of labor complications. In light of the linkage between prenatal diet and women’s concern toward labor complications, the recent expansion of assisted delivery may play a role in reducing carbohydrate-limiting food practices during pregnancy.

In the context of morning sickness and gestational weight gain, dietary changes aimed to mitigate the negative outcomes of nausea and vomiting during pregnancy and complications during labor, respectively. Although dietary modifications respond to symptoms and concerns that are widely experienced by mothers around the world, changes in prenatal diet impact women's and children's health in context-specific ways. In the case of Tajikistan, carbohydrates and oily foods are simultaneously avoided and central to the local diet. Dietary changes around GWG stem from broader, structural inequalities that are entangled with complications during pregnancy. Upon disolution of the Former Soviet Union in 1989, newly independent Central Asian Republics faced rapid degredation of social services, growth of unemployment, and transformation of agricultural sector and, regionally, nutrition status deteriorated [ 43 ]. Regional differences in food security reflect the uneven experiences of Tajik communities in the aftermath of the Soviet crash [ 8 ]. Today, young mothers of rural Khatlon Province, who were young children at the time of Tajik independence, are situated at a generational turning point such that the nutrition status of their children will be markedly improved compared to their own at birth and early childhood. Interestingly, our participants' concerns about heavier birth weight and labor complications are echoed in other global contexts where a generational divide in nutrition status between mothers and their children is striking [ 3 , 35 , 36 ]. 

Women participants reported that some maternal food avoidances are supported by recommendations from local health care providers. In-married women and mothers-in-law discussed the role of physician recommendations in their interpretation of the appropriate prenatal diet as carbohydrate-limiting. It is unclear whether a miscommunication occurred as the result of patients misunderstanding medical advice, poor communication or inappropriate messaging around antenatal diets on the part of clinics and physicians, or the effective communication of poor medical advice on the part of health care providers. Due to the recent increase in skilled antenatal care coverage in Khatlon Province (87% in 2017 compared to 65% in 2005), the link between prenatal dietary recommendations and carbohydrate restriction may indicate this is a recent phenomenon[ 41 , 42 , 43 ]. However, given the observation of similar taboos across diverse contexts throughout the world [ 23 ] and the extent of awareness and practice of this taboo by men and women participants across different villages in the region, it is more likely that misinterpretation of medical advice reinforces long-standing taboos or that long-standing taboos confirmed the communities' subsequent interpretations of medical advice. Based on these findings, additional clarity is needed to determine the role of health care advice in carbohydrate-restricting taboos during pregnancy.

Like pregnant women in the first and second trimesters, children between 6 months and 2 years of age experience overlapping food taboos relating to staple carbohydrates, oils, and fats. Additionally, early childhood taboos encompass certain fruits and vegetables and eggs. Such taboos may restrict the diversity of foods consumed upon introducing complementary foods (consumed alongside breastmilk starting at 6 months of age) or transitioning to a solid food diet (generally after 12–18 months). These taboos are aimed to protect children’s health by lessening the risk of upset stomach and foodborne illness associated with heavy foods and certain fruits and vegetables, respectively. According to participants, cucumbers, watermelons, grapes, and tomatoes are contaminated through growing conditions in irrigated greenhouses. Food taboos related to greenhouse-grown fruits and vegetables may be indicative of broader issues relating to water, sanitation, and hygiene (WASH) as irrigation water can be a potential source of foodborne pathogens [ 44 ]. If community experiences of food and water contamination are driving early childhood food taboos, WASH research and interventions could represent an entry point into child nutrition outcomes.

Egg-related taboos among children under two appear to be preserved by mothers-in-law—who provided detailed explanation on the topic. Awareness of egg-related taboos was also observed by men’s groups, though their justification was not congruent with discussions with mothers-in-law. Mothers-in-law associated eggs with late language acquisition and gastric irritation. According to the literature, however, child egg consumption has a significant positive influence on child growth and development. Both an observational study and a randomized control trial have linked early introduction of eggs during complementary feeding to lower rates of child stunting [ 44 , 45 ]. Interestingly, the random control trial also found an association between acute diarrhea and egg consumption; though it was unclear whether foodborne illness, allergy, or reporting bias contributed to that finding [ 45 ]. Given the overall potential shown by recent studies for eggs to improve child nutrition, minimizing the effect of taboos in egg consumption during early childhood may present an avenue for addressing malnutrition in Khatlon Province.

Participants reported no food taboos specific to women after giving birth. At this point in the life cycle, health beliefs around breastfeeding emerge regarding appropriate methods for lactation management. A common challenge reported in women’s FGDs was insufficient breastmilk production, the solution to which was early cessation of exclusive breastfeeding and introduction of breastmilk replacements. Several studies echo that mothers’ concerns about insufficient lactation are a key driver of early cessation of exclusive breastfeeding [ 46 , 47 ]. However, as maternal milk production is tuned to infant consumption, frequent nursing is essential for maintaining milk production [ 46 ]. In this case, early introduction of complementary foods may be exacerbating insufficient lactation described by study participants. Furthermore, the introduction of solid foods or liquids (including water) before the age of 6 months increases the risk of foodborne illness among infants and negative health outcomes into childhood [ 48 ]. Health beliefs regarding the safety and nutritional benefit of feeding animal milk versus formula as a breastmilk replacement also emerged during women’s FGDs wherein animal milk was sometimes preferred. Delayed introduction of animal milk after 1 year of age is recommended for avoiding associated risks including foodborne illness, dehydration, undernutrition, development of milk allergy, and development of type 1 diabetes mellitus [ 49 ].

Previous research suggests participants’ concerns about insufficient breastmilk may be fueled by lack of knowledge and confidence around breastfeeding or limited access to information on breastfeeding [ 50 ]. In the context of Tajikistan, knowledge of appropriate breastfeeding practices among mothers-in-law is another likely determinant of breastfeeding practices. This is supported by the literature, which suggests that senior women play a central role in determining initiation and duration of exclusive breastfeeding. Their impact can be supportive, providing young mothers with valuable knowledge and experience, or negative should they lack accurate knowledge about appropriate feeding practices [ 51 ]. Given the hierarchical household relationships observed in Khatlon Province, wherein senior mothers-in-law are respected by junior in-married women, ensuring 6 months of exclusive breastfeeding will require tapping into those structures to encourage positive, supportive relationships and a strong knowledge base across both senior and junior women.

Overwhelmingly, our findings suggest that food taboos and health beliefs disproportionately affect those whose intersecting identities confer greater nutritional vulnerability within household hierarchies at specific points in the life cycle. While taboos relating to pregnant women and young children were pervasive in the data, somefood taboos were unspecific to any subpopulation within the communities. Interestingly, unspecific taboos only emerged in our discussions with women, suggesting that women are the holders, managers, and preservers of this knowledge [ 18 ]. According to women participants, imported and processed foods and fruits and vegetables grown under certain conditions should be avoided because of the possibility of contamination by agro-chemicals that could lead to poor health among any consumer, regardless of age or gender. Unspecific taboos are indicative of women's changing roles in agriculture. Though women have been involved in agriculture throughout Tajik history in managing kitchen gardens, the fall of the Soviet Union catalyzed women’s entry into larger scale, waged food production when a sudden drop in employment triggered the rise in men migrating for work [ 26 ]. In the absence of men, women filled many traditionally masculine occupations, agriculture among them. Today, 75% of women in Tajikistan are involved in waged agricultural labor [ 16 ]. A second consequence of the fall of the Soviet bloc was the sudden drop in agricultural inputs entering former Soviet bloc countries, which plummeted to less than one-third of their former value within 3 years [ 52 ]. Food systems changed, naturally, in the hands of women. Women held generations expertise in low-input growing methods and received limited access to agricultural inputs (e.g. fertilizers, pesticides, improved seeds, high-quality irrigation, extension services) traditionally targeted towards men in agriculture [ 53 , 54 ]. Thus, implementation of low-input agriculture accompanied women’s entry into larger-scale farming as a result of necessity and familiarity [ 26 ].

Cultural values are responsive to behavior, and vice versa. This relationship may be heightened in the face of extreme consequences. In the case of post-Soviet Tajikistan, the threat of starvation facing citizens the mid-1990s demanded changes in values and practices throughout the food system. The emergence of unspecific food taboos may represent a response to emerging values around low-input, domestically produced food products. Interestingly, similar trends have been reported in other countries that shared close economic ties to Soviet Russia and experienced extreme challenges to food security after 1991, most prominently Cuba [ 52 ].

The gendered terrain of production and reproduction in Tajikistan is dynamic and fluid. Men’s transience amidst waves of out-migration confers instability to their identities and traditional roles while women occupy new, formerly masculine spaces within and outside of the home. It is unclear how new household relations play out in the absence of men. Our findings from focus groups and participant observations suggest the continued dominance of the mother-in-law as the informal head of house. The experience of in-married women is likely to depend heavily on her relationship with her mother-in-law [ 17 ] facilitate. Additionally, the knowledge and confidence displayed by in-married women and mothers-in-law during FGDs brought to light clear gender differences in health and nutrition knowledge between men, mothers-in-law, and in-married women. While women gave consistent responses regarding which foods were taboo and why, men were often unable to provide detailed or congruent information. As suggested in previous studies, such health and nutrition knowledge may be preserved by women, who pass knowledge are related practices from mother to daughter and from mothers-in-law to daughters-in-law [ 15 ]. Women were also comparatively more active during FGDs, engaging and debating with fellow participants, while men were more hesitant in their contributions. This may reflect lack of confidence among men to contribute discussions situated beyond familiar terrains of knowledge. However, differentiation along gendered knolwedges may be perpetuated by long-standing stereotypes that classify nutrition as a “women’s issue” (separate from masculinity) and include women (while excluding men) in nutrition interventions [ 4 ]. The focus on women in the health sector is blatant within large survey datasets, which house rich information on the Tajik context while nearly excluding men’s health statistics (For example, [ 41 ]). Researchers across gender and health increasingly emphasize that gender hegemonies operate through both masculinities and femininities and, in this way, are mutually reinforcing [ 4 ]. The impact of such gender orders is further compounded according to the co-experiences of age, race, class, education status, caste, among other identities. Furthermore, migration of men out of Tajikistan is a destabilizing force that can affect household nutrition [ 26 ]. Thus, while women and men may face unique health priorities attached to their position within the broader socioecological context of Tajikistan, women’s and men’s health are inseparable [ 9 ].

Interventions that address the gendered nature of health knowledge and the dynamic intrahousehold arrangements unique to Tajikistan require practitioners to actively engage with all members of the family. Nutrition interventions that engage men and women can address the broader sociocultural factors that influence food taboos and health beliefs. A recently published review showed that men’s involvement in carefully planned health interventions can improve men’s knowledge of good household nutrition practices [ 55 ]. Additionally, the study revealed that men who are engaged in household nutrition interventions can encourage adoption of supportive health knowledge and behaviors by other household members. Lastly, involvement of men and women together in nutrition interventions can contribute positive changes in marital relationships. In the context of Tajikistan, engaging men may serve to emotionally empower men as fathers and as decision-makers regarding their own health status by narrowing the gender gap in health literacy and minimizing men’s isolation from the family. This is particularly relevant to Tajik families that experience frequent or son for work/or son for work [ 55 ].

This research represents the necessary first step toward building an understanding of the potential impact of food taboos and health beliefs on household nutrition in Tajikistan. However, several limitations must be considered when interpreting these findings. First, health beliefs and food taboos may be associated with geographic proximity to nutrition and health services and vary by the participant’s education status. The villages were selected based on participation in the Women’s Economic Empowerment Program (WEEP) activities, therefore FGDs were arranged to accommodate WEEP members who may have more in-depth knowledge of appropriate health and nutrition practices due to their involvement in the program. Also, this may contribute to the stark difference in health literacy demonstrated by men and women. Finally, researchers faced difficulty reaching saturation within men’s FGDs due to the high rate of male migration. In some villages, men who met inclusion criteria for this study were completely absent. Therefore, the lack of men in these villages reflects the small sample size among this target population. Furthermore, as this study represents formative work on the intersection of food taboos and nutrition in Tajikistan, continued research is necessary to further characterize and define the nuances within this area of study. For example, investigations into nutrition in Khatlon call for additional study around the extent to which food taboos are practiced and their impact on nutrition status via collection of anthropometric data. Rich ethnographic data would further illuminate the recent interactions between migration, gender, and health.

Despite considerable investments in nutrition education in the last 30 years, little progress has been made in identifying interventions that contribute to sustained, long-lasting improvements. The unclear outcomes of these programs may reflect the limited attention placed on addressing social norms, cultural practices, and historic factors that contribute to dietary practices. This research contributes to that effort in Tajikistan by identifying food taboos and health beliefs that may impact nutrition and characterizing them within the sociocultural context of Khatlon Province. Our study suggests that gender plays a significant role in shaping dietary knowledge and practices in the study population. Similar connections between gender and knowledge are reflected in the findings of other scholarly works (See [ 18 ]). Analysis of gender-differentiated dietary practices and knowledges serves to illuminate intersecting patterns of social difference that contribute to various health outcomes by moving beyond investigation along a man-woman binary. A gender relations approach looks closely at differentiated categories within gendered groups and their relations therein, such that food practices and nutrition are conceptualized within the contexts of power, history, environment, economics, and politics in which they are embedded [ 9 ]. We hope the findings of this study are supportive for guiding nutrition-sensitive extension work that engages all members of the household within efforts to improve nutrition. Extension programs that seek to integrate these findings into future work should (1) address the sociocultural arrangements that perpetuate food taboos among vulnerable members of society; (2) focus on critical points in the life-cycle nutrition status which is most vulnerable; (3) consider labor migration as a destabilizing factor within men’s, women’s, and children’s’ health, and (4) address emerging unspecific food taboos and health beliefs as they relate to changing values and cultural beliefs within Tajikistan.

In exploring the gender dynamics of nutrition, the interactions between local knowledge and the evolving political, economic, and environmental context of Khatlon Province, Tajikistan comes forward as central to local adaptive strategies around health. Food taboos and health beliefs are situated within and shaped by these integrated processes and thus cannot be divorced from them. This study details how these embedded interactions can influence health outcomes like nutrition status. Gender and age emerged as intersecting subjectivities that reproduce hierarchical familial arrangements while holding implications within and beyond the household. As seen in other contexts, the social interactions through which performance of gendered subjectivities takes place are saturated with power [ 55 , 56 ]. Our study further explored the role of intrahousehold relations in reproducing gendered knolwedge and practices around health and diet; The focus on food taboos and health beliefs reflect themes identified during previous research (see [ 17 ]). We found differential implications of adaptive health practices and beliefs among the subpopulations identified during focus ground discussions. Vulnerability (here, defined as a comparatively higher susceptibility to malnutrition, severity of its effects, and risk of long-term health consequences due to poor nutrition) was concentrated among those whose intersecting subjectivities conveyed a lower position within the household social structure at specific points in the life cycle. These patterns may contribute immediate health impacts among in-married women and children under the age of two. Among these subpopulations, increased physiological needs intersect with restricted intake of carbohydrates, the foundation of many staple Tajik dishes. Based on participant discussions, we present food taboos as dynamic, flexible, and in a constant state of emergence in response to ongoing socioecological changes; the topics of shifting demographics, agricultural labor, and unspecific taboos were most salient in this respect. While men did not practice any food restrictions, the instability of migration inherent to their transience in family and community life may convey novel challenges to their health. However, men's health is globally understudied and men's presence as actors in nutrition-sensitive initiatives is minimal—save as a comparative model by which to measure the status of women. Recognizing the mutual constitution of health across gendered subjectivities is crucial to long-term improvements in population wellbeing.

According to the findings of this study, an increase in agricultural production is insufficient to improving household nutrition status. Instead, it is crucial for organizations to rethink the way nutrition-sensitive interventions are planned and implemented. While targeted appraoches to malnutrition can hold value, they can also impose unintended consequences when behaviors and beliefs are extracted from their location within a dynamic socialenvironment complex. Among the opportunities for change, a gender relations approach to understanding health can transform the systems that separate gendered experiences into silos. This study is situated within the context of agriculture extension services due to their potential to pursue plural strategies to improved health where agriculture is the dominant livelihood. Agriculture extensionists hold a unique position at the nexus of agro-food systems, nutrition, and gender and are able to build meaningful participant-led interventions through long-term relationships with communities. Such involvement at the local level is necessary for nuanced practice-based work within complex processes described in this article. This research has applications beyond extension and agriculture sectors, however, and we call on scholars and practitioners of diverse epistemologies to draw connections to their many areas of inquiry. 

Abbreviations

Agriculture extension services

Dietary energy consumption

Extension home economist

Focus group discussion

Gestational weight gain

Integrated pest management

Infant and young child feeding

Key informant interview

Low birth weight

Tajikistan Agrarian University

Tajikistan Agriculture and Water Activity

University of Florida

United States Agency for International Development

Women Entrepreneurship for Empowerment Project

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Acknowledgements

This research was produced as part of the United States Agency for International Development (USAID) and US Government Feed the Future project “Integrating Gender and Nutrition within Extension and Advisory Services” (INGENAES) under the Leader with Associates Cooperative Agreement No. AID-OAA-LA-14-00008. The United States Agency for International Development is the leading American government agency building social and economic prosperity together with the government and people of Tajikistan. The University of Illinois at Urbana-Champaign is the prime awardee, and partners with the University of California-Davis, the University of Florida, and Cultural Practice, LLC. www.ingenaes.illinois.edu

The research was made possible by the generous support of the American people through USAID. The contents are the responsibility of the authors and do not necessarily reflect the views of USAID or the United States government.

The authors thank the Feed the Future Tajikistan Agriculture and Water Activity project that provided facilitators and logistical support, the Feed the Future Tajikistan Health and Nutrition Activity project, and the Tajikistan Agrarian University students as well as the University of Florida Masters in Public Health students for their contributions.

This study was supported by funding from the United States Agency for International Development (USAID). Funding was allocated through the Feed the Future project “Integrating Gender and Nutrition within Agriculture Extension Services” (INGENAES).

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EW collected data using qualitative methods in the field. KM analyzed and interpreted transcripts from focus group discussions with participants and identified major and minor themes relating to dietary practices, food taboos, and health beliefs. KM drafted and revised the manuscript several times with substantial input from EW. Both KM and EW read and approved the final manuscript.

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McNamara, K., Wood, E. Food taboos, health beliefs, and gender: understanding household food choice and nutrition in rural Tajikistan. J Health Popul Nutr 38 , 17 (2019). https://doi.org/10.1186/s41043-019-0170-8

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• Published: 16 March 2023

Food taboo practices and associated factors among pregnant women in Ethiopia: a systematic review and meta-analysis

• Berhanu Gidisa Debela 1 ,
• Daniel Sisay 1 ,
• Habtamu Endashaw Hareru 1 ,
• Helen Ali Ewune 2 ,
• Anene Tesfa 3 ,
• Daniel Alayu Shewaye 1 &
• Temesgen Muche Ewunie 2  

Scientific Reports volume  13 , Article number:  4376 ( 2023 ) Cite this article

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• Health care
• Risk factors

Food taboos have a negative impact on pregnant women and their fetuses by preventing them from consuming vital foods. Previous research found that pregnant women avoided certain foods during their pregnancy for a variety of reasons. This review aimed to determine the pooled prevalence of food taboo practices and associated factors in Ethiopia. In compliance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guideline, we searched the literature using PubMed/MEDLINE, AJOL (African Journal Online), HINARI, Science Direct, Google Scholar, and Google electronic databases. The random-effects model was used to estimate the pooled prevalence of food taboo and its determinants at a 95% confidence interval with their respective odds ratios. The pooled food taboo practice among Ethiopian pregnant women was 34.22% (95% CI 25.47–42.96), and after adjustment for publication bias with the trim-and-fill analysis, the pooled food taboo practice of pregnant women was changed to 21.31% (95% CI: 10.85–31.67%). Having less than a secondary education level (OR = 3.57; 95% CI 1.43–8.89), having no ANC follow-up (OR = 4.35; 95% CI 1.12–16.94), and being a rural resident (OR = 3.08; 95% CI 1.14–8.28) were the significant factors. Dairy products, some fruits, green leafy vegetables, meat, and honey are among the taboo foods. The most frequently stated reasons for this taboo practice were: fear of producing a big fetus, which is difficult during delivery; attachment to the fetus's body or head; and fear of fetal abnormality.

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Ziyi Wang, Yan Wang, … Cuncun Lu

Introduction

During the course of pregnancy, physiological changes like new tissue development and synthesis, mother tissue growth, and the growing fetus significantly increase energy and food needs 1 . To fulfill this increased demand, pregnant women must consume an adequate and balanced diet that includes a sufficient number of macronutrients and micronutrients 2 . Pregnant women restrict themselves from specific foods for several reasons. Pregnant women avoid foods because of a strong dislike (aversion) caused by pregnancy; others avoid them due to medical grounds. However, a high proportion of pregnant women avoid specific foods due to cultural beliefs or impositions in developing countries like Ethiopia 3 , 4 . Food taboos vary by culture, society, and even among pregnant women, especially in rural areas, and are typically passed down from generation to generation 5 , 6 .

Although the consumption of important, diversified foods is essential to producing the hormones needed during pregnancy, food taboos during pregnancy are a common practice, particularly in developing countries 7 , 8 . Prenatal dietary taboo influence what they eat, leaving them vulnerable to micronutrient deficits, including vitamin A, folate, iodine, iron, calcium, and zinc, which are all important during pregnancy. Previous studies from Nigeria 9 , 10 , Gambia 11 , Kenya 12 , and Ethiopia 13 , 14 , 15 show that pregnant women are typically prohibited from eating foods high in iron, carbohydrates, animal products, and micronutrients. Avoiding most vital food groups leaves these pregnant women with limited dietary diversity and vulnerable to many nutrient deficiencies, including micronutrient deficiencies, which can lead to pregnancy malnutrition 9 , 11 . Worldwide, about 9.8 million women are deficient in vitamin A 16 , and iron deficiency, contributes to at least 18% of maternal mortality in developing countries 16 , 17 . In sub-Saharan Africa, women are particularly exposed to inadequate intake of micronutrients, resulting in different types of malnutrition, which can occur even in the presence of adequate energy and protein intake due to food restrictions during pregnancy 7 , 18 .

A number of researchers have reported the prevalence of food taboo practices in Ethiopia 15 , 19 , 20 , 21 . The study done in Addis Ababa shows 18% of pregnant women avoid one or more food items due to food taboos 19 . Previous studies identified age, parity, support from husbands and communities, knowledge, dietary counseling, attendance at antenatal care (ANC), educational status, and cultural beliefs as major determinants 22 . Individual studies on the prevalence of food taboo practice and associated factors in Ethiopia show varying and inconsistent findings. Previous studies conducted on pregnant women's food taboo practices provided a qualitative discussion on the most commonly avoided foods and their reasons, but they didn’t provide pooled food taboo practices among pregnant women in Ethiopia and associated factors using statistical analysis 23 . This systematic review and meta-analysis included the most recent primary studies available, which can provide a recent summarized magnitude of food taboo practices and factors influencing them. By reviewing 16 articles that mentioned food taboos during pregnancy as well as the reasons for the food prohibition, this review may help to fill a gap in summarized information on the prevalence of food taboo practices during pregnancy. The findings of this study can help policymakers, planners, and health service providers by generating and disseminating evidence-based information that can aid in the design and implementation of appropriate interventions. Our study paves the way for future investigations on the determinants of changes and levels of food taboo practices during pregnancy. Hence, the goal of this systematic review and meta-analysis study is to determine the pooled prevalence of food taboos and associated factors among pregnant women in Ethiopia.

Methods and materials

Study design and search strategy.

We systematically reviewed and analyzed available research articles to determine the pooled prevalence of food taboo practices and associated factors among pregnant women in Ethiopia. The review protocol and reporting were done using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocol (PRISMA-P) and the Meta-Analysis of Observational Studies guideline. The review protocol was filed with the International Registration of Systematic Reviews (PROSPERO) under the registration number CRD42022304915 on February 20, 2022, in order to reduce duplication of reviews and increase transparency in the review process. The study question's core topics were used to develop a search strategy that included food taboo, pregnant women, prevalence, factors, and Ethiopia. For each key concept, appropriate free-text words and Medical Subject Headings (MeSH) were developed. The Boolean logic operators AND, OR, and NOT were used to combine free-text words (truncated or with wildcards) and MeSH terms. The search was not bound by the year of publication, in which case all articles published and/or reported up to December 30, 2022, were included. The electronic search was exhaustively searched by BGD and DAS through PubMed/MEDLINE, AJOL (African Journal Online), HINARI, Science Direct, Google Scholar, and Google electronic databases. In addition, reference lists of already identified articles were also searched to retrieve more relevant studies. The search terms "food taboo" OR "food restriction" OR "food avoidance" OR "food prohibition" AND "prevalence" OR "magnitude" OR "proportion" OR "burden" AND "risk factors" OR "predictors" OR "determinants" AND "pregnant" OR "pregnant woman" OR "pregnant mother" AND "Ethiopia" were used.

Eligibility criteria and study selection

Cross-sectional, case–control, and cohort studies from the community and facilities were considered. We used both published and unpublished articles in the English language from Ethiopia. Only studies that estimated the proportion and/or associated factors of food taboos were included. Studies that were duplicated, unrelated, or abstract-only were removed, as well as studies with unclear reporting of the burden and/or factors associated with food taboo practices. Two independent reviewers (HEH and DS) acquired the complete texts of the remaining publications and reviewed them thoroughly before data extraction to ensure their eligibility.

Data extraction procedure and items

Two independent reviewers (BGD and DAS) abstracted data from the primary studies using a standardized data abstraction form devised according to the sequence of variables required. The following characteristics were used to extract data: author's first name, publication date, region; study design (cross-sectional, case–control), sample size, sampling technique, the prevalence of food taboos, odds ratio, and factors that influence food taboos, such as family size, religion, occupation, residence (urban or rural), age, monthly income, education, and ANC follow-up. The degree of agreement between the two independent data extractors is in the range of almost perfect agreement, according to Kappa statistics. We attempted to contact and seek missing outcome data from the original authors by e-mail, and sensitivity analysis was done to find out the robustness of the meta-analysis findings and to show the influence of missing data on review results.

Quality assessment

The Newcastle–Ottawa Scale for cross-sectional studies was employed to assess the quality of all the included papers for risk of bias 24 . Each paper was critically evaluated by two independent reviewers (BGD and HEH). The problem of subjectivities between the two reviewers was solved through discussion and with the involvement of other review teams (HA, DS, and TME). The papers with a quality evaluation score of 6 out of 10 on the Newcastle–Ottawa Scale were judged low-risk and included in the systematic review and meta-analysis based on the relevant literature cut-off point (Supplementary 2).

Outcome variable

The primary outcome of this review is the pooled prevalence of food taboo practices among pregnant women at the national level. The numerator was the number of pregnant women who have food taboo practices, while the denominator was the total number of pregnant mothers who participated in the study. The second aim of this review was to identify factors affecting the practice of food taboos among pregnant women in Ethiopia. Unadjusted (raw data) and adjusted odds ratios were extracted for associated factors.

Statistical analysis

The extracted data was entered into a computer via an Excel sheet for the title, abstract, and full-text screening before being exported to STATA v. 16. The findings were presented in a table and tested using descriptive statistics. The Metaprop program was used to calculate the pooled prevalence of food taboos using the random-effects meta-analysis model. On a forest plot, the single studies and pooled prevalence of food taboo, 95% CI, the author's name, and the publication year were plotted. We performed a subgroup analysis based on the study's publication year, place of residence, and region because the random-effect model with 95% CI had substantial variability among forest plots. Regarding factors influencing food taboo practices, we have pooled the unadjusted odds ratio (raw data) for three factors (age, educational status, and place of residence) (Figs.  6 , 7 , 9 , and 10 ). However, for ANC follow-up, we pooled both the unadjusted odds ratio (raw data) and the adjusted odds ratio separately, and both were presented to investigate the differences (Figs.  8 and 9 ). For both adjusted and unadjusted odds ratios, a p-value less than 0.05 with a 95% CI was considered statistically significant. Review Manager 5.4 (RevMan version 5.4) 25 was used to identify factors influencing food taboo practices among pregnant women using a random-effects model with an inverse-variance method.

Publication bias and heterogeneity

Heterogeneity between the results of the primary studies was assessed using the Cochran’s Q test and quantified with the inverse variance (I 2 ) statistic of 25, 50, and 75% as low, moderate, and severe heterogeneity, respectively, with a p-value less than 0.05. The random-effects model was used to incorporate heterogeneity in meta-analyses. Further, meta-regression was performed using Comprehensive Meta-Analysis software version 4.0 26 to identify the source of heterogeneity by considering both continuous and categorical data. Region, number of included samples (continuous variable), publication year (during or before 2016 and after 2016), and place of the study (rural/semi-urban, and urban) were considered in the meta-regression. Publication bias was assessed using Begg’s and Egger’s tests with a p-value of less than 0.05 as a cutoff point to declare the presence of publication bias 27 , 28 . Due to significant publication bias, a non-parametric Duval and Tweedie’s Trim and Fill analysis was undertaken to manage the publication bias 29 (Fig.  4 ).

Ethics approval

No human subject participant was involved.

Search results

In the first step of our search, 640 articles were systematically retrieved from electronic databases (PubMed/MEDLINE, Google Scholar, AJOL (African Journal Online), HINARI, Science Direct, and gray literature from Google) and reference lists of previous studies. From the 640 articles, 197 were excluded due to duplication. Additionally, 421 articles were excluded after we reviewed their titles, abstracts, and full texts and found them to be non-relevant to our review. Among the 22 full-text articles accessed, we excluded six articles as they did not report the prevalence of food taboo practices and/or associated factors among pregnant women 15 , 20 , 30 , 31 , 32 , 33 . Finally, 16 articles were found to be eligible and included in the analysis (Fig.  1 ).

A PRISMA flow chart explaining the selection of primary studies for systematic review and meta-analysis of food taboo practices among pregnant women in Ethiopia.

Characteristics of included studies

After assessment of the titles, abstracts, and full texts, a total of 16 studies that met the inclusion criteria were included in the review. The included studies were conducted between 1995 and 2022 in the English language. Four studies from each of the Oromia 14 , 34 , 35 , 36 and Amhara 37 , 38 , 39 , 40 regional states as well as eight studies from different regions 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 of Ethiopia were included. This review includes five community-based studies and eleven institution-based studies, with sample sizes ranging from 276 to 845 in the Dimma district of Gambella 42 and West Amhara respectively 39 . A total sample of 6730 pregnant women was included to estimate the pooled prevalence of food taboo practices among pregnant women at the national level. The lowest level of food taboo practice among pregnant women was reported in Mekelle, Tigray region (12%) 41 and the highest level was reported in Gursum district, Somali region (67.4%) 47 (Table 1 ). The quality score of the articles ranged from 6 to 10 out of 10 points (Supplementary 2).

Meta-analysis

The pooled prevalence of food taboo among pregnant women in ethiopia.

The pooled prevalence of food taboo practices among pregnant women in Ethiopia was 34.22% (with 95% CI 25.47–42.96) using visual forest plots in the random-effect model (Fig.  2 ). Heterogeneity was seen across the studies, which is detected by the I 2 statistic (I2 = 98.6%, p value < 0.0001). Therefore, we employed a random effect meta-analysis model to estimate the pooled prevalence of food taboo practices among pregnant women in Ethiopia (Fig.  2 ).

A forest plot of pooled prevalence of food taboo practices among pregnant women in Ethiopia.

Publication bias and Trim-and-fill analysis

Publication bias: A visual inspection of the funnel plot indicated an asymmetrical distribution of studies showing publication bias (Fig.  3 ). The presence of publication bias was also checked using Begg's test, which shows insignificant publication bias at a p-value = 0.65, whereas Egger’s test indicates the presence of significant publication bias as evidenced by P = 0.04 (Table 2 ). Therefore, Duval and Tweedie’s Trim and Fill analysis was done (Fig.  4 ).

Funnel plot presented the visual inspection of publication bias for systematic review and meta-analysis of food taboo practices among pregnant women in Ethiopia, 2022.

Duval and Tweedie’s Trim and Fill funnel plot.

Trim-and-fill analysis: Trim-and-fill analysis shows six studies were imputed for missing studies during the analysis, making the total number of studies of 22 and after adjusting publication bias, the estimated pooled awareness of pregnant women toward food taboo practices appeared to be 21.31% (95% CI 10.85 to 31.67%) (Fig. 4 ).

Meta-regression

A meta-regression was conducted to identify the source of heterogeneity using region, residence, sample size, and publication year as covariates. Meta regression revealed that the prevalence of food taboo practices among pregnant women in Ethiopia was significantly associated with the region of the study, meaning that the prevalence of pregnant women food taboo practices was higher among regions categorized as others (Somali, Benishangul Gumuz, Gambela, and Afar) with a coefficient of 1.40, and a p-value of 0.048 when compared with Addis Ababa city administration (Table 3 ).

Sub-group analysis

A subgroup analysis was computed to compare the prevalence of food taboo practices by classifying to region, publication year, and residence place. Based on this analysis, the lowest prevalence of food taboo practices among pregnant women was observed in the Tigray region which is 11.5% (with a 95% CI 8.07–14.93) and the highest prevalence was in the Somali region which is 67.4% (with a 95% CI 63.68–71.12). The pooled prevalence of food taboo practices among the studies conducted after the year 2016 was slightly lower than the pooled prevalence from the studies conducted during and before the year 2016. A higher prevalence of food taboo practices was observed in the studies conducted in rural and semi-urban areas (36.6%) than from those conducted in urban study areas (27.02%) (Table 4 ).

Sensitivity analysis

A sensitivity analysis was done to evaluate the effect of a single study on the overall effect estimate. The results indicated that removing a single study did not have a significant influence on pooled prevalence (Fig.  5 ).

Sensitivity analysis of the pooled prevalence of included studies (n = 16).

Factors associated with pregnant women's food taboo practices in Ethiopia

Eleven studies 14 , 34 , 36 , 37 , 41 , 42 , 43 , 44 , 46 , 47 were included for the analysis of risk factors for food taboo practices. Accordingly, four risk factors had data that could be used in the quantitative meta-analysis. The pooled odds ratios of four identified risk factors were ranged from 1.08 (for age) to 4.35 (for ANC follow-up) ((Figs.  6 , 7 , 8 , 9 , 10 ).

Forest plot using an unadjusted odds ratio for the association between age and food taboo practices among pregnant women in Ethiopia, 2022.

Forest plot using an unadjusted odds ratio for the association between education and food taboo practices among pregnant women in Ethiopia, 2022.

An unadjusted odds ratio forest plot for the Association of ANC with food taboo practices among pregnant women in Ethiopia, 2022.

Forest plot using adjusted odds ratio for the association of ANC with food taboo practices among pregnant woman in Ethiopia, 2022.

Association between place of residence and food taboo practices among pregnant women in Ethiopia, 2022 .

Age and food taboo practices

A total of four articles 14 , 34 , 37 , 41 , with 1334 participants were included to assess the association between age and food taboo practices. The pooled odds ratio of included studies shows there is no significant association between the age of pregnant women and food taboo practices (Fig.  6 ).

Educational status and food taboo practices

Four articles 34 , 42 , 43 , 46 with a total of 1275 participants were included in the analysis to detect the association between education and food taboo. Pregnant women with primary and below educational status were 3.57 times more likely (with 95% CI 1.43, 8.89, and I 2  = 90%) to practice food taboos during pregnancy than those with secondary and above educational status (Fig.  7 ).

ANC counseling and food taboo practices

A total of five articles 36 , 37 , 39 , 41 , 44 with 1986 participants were included to determine the association between ANC counseling and food taboo practices using an unadjusted odds ratio. Those mothers who had no ANC follow-up were 4.35 times (with 95% CI 1.12, 16.94, I 2  = 97%) more likely to practice food taboo as compared to those who had ANC follow-up (Fig.  8 ). The pooled AOR (Fig.  9 ) was 3.48 (with 95% CI 1.92, 6.29; I 2  = 81%; n = 4 studies). Both the unadjusted OR and AOR suggest that pregnant women who have no ANC follow-up have significantly higher odds of engaging in taboo food practices when compared to those who have ANC follow-up during their pregnancy.

Place of residence and food taboo practices

Three articles 39 , 46 , 47 with a total of 1755 participants were included in this analysis. Mothers who live in rural areas were 3.08 times (with 95% CI 1.14, 8.28; I 2  = 91%) more likely to practice food taboo during their pregnancy than those who live in urban areas (Fig.  10 ).

Types of foods considered taboo in Ethiopia and the reasons

Among the 16 included studies, 13 of them assessed the types of prohibited foods for pregnant women and their reasons. From the findings of the studies, seven of them 14 , 34 , 38 , 41 , 43 , 44 , 46 , 48 reported that mainly milk and milk products were prohibited due to beliefs that they plastered on the fetal head, prolonged labor, fear of abortion, making the baby fat, disclosures of the fetus, etc. Fruits and vegetables were also among the most frequently reported food types prohibited by pregnant women due to the most common reasons: attachment to the fetus's body, making a fatty baby, and fear of fetal abnormality. Other types of prohibited foods were meat and eggs due to the fear of producing a large fetus, which is difficult to deliver (Table 5 ).

Ethiopian pregnant women avoid certain foods for a range of reasons, and some of these relate to factors associated with pregnancy outcome, the birthing process, culture, and others to avoid undesirable aesthetic features in the baby 14 , 15 . This study, the first systematic review and meta-analysis as far as our knowledge goes, is aimed at estimating the pooled prevalence of food taboo practice and associated factors among pregnant women in Ethiopia. The findings of this meta-analysis showed that the pooled proportion of food taboo practices among pregnant women in Ethiopia is 34.22% (95% CI 25.47–42.96), and after adjustment for publication bias with the trim-and-fill analysis, the pooled food taboo practice of pregnant women was changed to 21.31% (95% CI: 10.85–31.67%). Since we were unable to find another meta-analysis that reported food taboo practices among pregnant women, we didn't compare the findings with similar studies.

The subgroup analysis shows a variation of food taboo practices between regions, with the lowest (11.5%; 95% CI 8.50–15.49) from the Tigray region and the highest (67.4%; 95% CI 63.68–71.12) from the Somali region. The variation could be due to the difference in health service accessibility and utilization. This possible explanation is supported by evidence from the 2019 Ethiopian Mini-Demographic Health Survey (EDHS 2019) 49 and recent reports 50 on "Progress in Health among Regions of Ethiopia", show regional differences in health service accessibility and utilization. With regard to variation in health service utilization among regions the data from the 2019 Ethiopian Mini-Demographic Health Survey (EDHS 2019) 49 show the percentage of pregnant women who received antenatal care from a skilled provider was 70.8% in Oromia and 30.2% in Somali region.

The variation could also be due to the difference in educational status of study participants, which varies among regions. According to the Ethiopian Demographic Health Survey (EDHS 2016) 51 the percentage of the female household population who completed primary education ranges from 5.2% in Addis Ababa city administration to 0.7% in the Somali region, which may influence their level of food taboo practices. Furthermore, the possible explanation could be due to socio-cultural differences, as food taboo practices are strongly linked to specific communities' cultural beliefs, as the Federal Democratic Republic of Ethiopia is divided into ethnic-linguistic regions.

The pooled prevalence of food taboo practices among the studies conducted after the year 2016 was slightly lower than the pooled prevalence from the studies conducted during and before the year 2016, which was 33.89% and 35.3%, respectively. The possible explanation for the difference could be an improvement in the accessibility of health services, which increases community awareness, particularly through Ethiopian health extension workers. Another reason could be the improvement of the educational levels of women and their partners, as the accessibility of education also shows improvement from time to time.

The findings of this review show the most commonly taboo food types are from four major food groups: proteins, fats, and fruits and vegetables. These include green chili pepper, spinach, lettuce, kale, broccoli, linseed, cabbage, banana, pimento, groundnut, sugarcane, pumpkin, fatty meat, egg, honey, and some cereal products. This is similar to a meta-analysis conducted on food taboos 52 and a narrative literature review done in Ethiopia 53 , which show similar types of foods were prohibited by pregnant women. Among the reasons explained for food taboo, foods getting attached to the fetus's body or head, making the baby gain weight, and fear of fetal abnormality are the most frequent ones. This is similar to a literature review done in Ethiopia 53 , a meta-analysis conducted worldwide 52 , and a systematic review conducted in Ethiopia 23 , which show fear of producing a big fetus, which is difficult during delivery or prolonged labor, fear of abortion, discoloring of the fetus, nausea, abdominal cramps in the mother, and fetal head plastering as the primary drivers of food taboo. Another systematic review supports this, finding that pregnant women's food restrictions are related to their fear of unfavorable pregnancy outcomes, such as the risk of abortion, and are used to avoid child problems such as cutaneous and respiratory disorders 54 .

Regarding factors associated with food taboo practices, the odds of practicing food taboo during pregnancy were 3.57 times (OR = 3.57; 95% CI 1.43–8.89) higher among pregnant women who have primary and below educational status when compared with those who have secondary and above educational status. This finding is supported by meta-analysis study 55 from Ethiopia, which found that pregnant women with lower educational levels have less dietary diversity than those with higher education levels, possibly due to food taboos. This finding also aligned with other primary studies carried out in Sudan and Nigeria, which indicated that higher maternal education was linked to a lower likelihood of practicing food taboos during pregnancy 56 , 57 . The possible reason could be the knowledge that they obtained from formal education and reading from different sources about appropriate maternal nutrition.

The ANC follow-up of pregnant women was also significantly associated with food taboo practices during pregnancy. The finding shows pregnant women who had no ANC counseling were 3.48 (AOR = 3.48; 95% CI 1.92–6.92) times more likely to practice food taboos during the pregnancy period than those who had ANC counseling. The finding is in line with a review of evidence on traditional beliefs and practices during the pregnancy period in Asian countries, which suggests that nutrition education should be given to both mothers and husbands in order to alleviate malpractices during pregnancy 58 . The possible reasons for the association may be due to the nutrition counseling provided by health care providers’ during ANC follow-up.

Another factor that significantly affected the pregnant woman's food taboo practices was her place of residence. Pregnant women who reside in rural areas are 3.08 (OR = 3.08; CI 1.14–8.28) times more likely to practice food taboo than those who live in urban areas. The finding is slightly supported by the meta-analysis study from Ethiopia, which shows pregnant women who reside in rural areas are more likely to get inadequate dietary diversity than those who live in urban 55 . The probable justification is that urban mothers have more access to health services and health information from different sources than rural pregnant women.

According to the results of this meta-analysis, more than one-third of pregnant Ethiopian women practice food taboo during their pregnancy. Dairy products, fruits, vegetables, meat, eggs, and honey were among the foods prohibited for pregnant women. Food clinging to the fetus's body or head, fear of having a huge fetus that would be difficult to deliver, fear of abortion, and fear of the fetus's appearance were the most often reported reasons for food taboo practices. Educational status, ANC follow-up, and place of residence had a substantial impact on the outcome variable. Therefore, healthcare organizations and other concerned bodies should work on reducing food taboo practices focusing on the identified factors. The findings can be used by healthcare professionals, managers, and policymakers to improve nutrition programs by devising plans and making active efforts to address gaps in dietary practices during pregnancy.

Strength and limitation of the study

We strictly followed PRISMA flow charts and searched a wide range of databases to retrieve related articles. To provide a comprehensive review, additional searches such as hand searching reference lists and citation searching were conducted. Procedures to minimize human error and subjectivity like double independent screening, and double independent quality assessment was used. The limitation of this systematic review and meta-analysis might be due to the cross-sectional nature of the included studies, which couldn’t show the temporal relationship between the outcome and independent variables. Another limitation might be due to the presence of heterogeneity between studies and publication bias, which readers should consider when using this finding. We also have faced difficulties comparing our findings with other findings due to the lack of similar systematic reviews and meta-analyses.

Data availability

All data generated or analyzed during this study are included in this published article (and its Supplementary Information files).

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Berhanu Gidisa Debela, Daniel Sisay, Habtamu Endashaw Hareru & Daniel Alayu Shewaye

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B. G. selected the studies. B. G, H.E.H, T. M. E, and A.T. performed the literature search and helped with study selection process. B. G. and H.E.H. extracted the data. B. G., H.E.H., T. M. E., H. A. E., D. S., and D. A. designed the study. B. G., H.E.H., D. S., and D. A. software utilization. B. G., H.E.H., T. M. E., H.A.E., A. T., D.S., and D. A. performed the statistical analyses. B. G. wrote the initial draft. B. G., H.E.H., T. M. E., H.A.E., D.S., D. A., and A. T. interpreted data and revised the manuscript for important intellectual content. All authors reviewed the manuscript.

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Debela, B.G., Sisay, D., Hareru, H.E. et al. Food taboo practices and associated factors among pregnant women in Ethiopia: a systematic review and meta-analysis. Sci Rep 13 , 4376 (2023). https://doi.org/10.1038/s41598-023-30852-0

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• Published: 06 November 2023

The misbeliefs and food taboos during pregnancy and early infancy: a pitfall to attaining adequate maternal and child nutrition outcomes among the rural Acholi communities in Northern Uganda

• Peter Vivian Acire 1 ,
• Arthur Bagonza 1 &
• Nicolas Opiri 2  

BMC Nutrition volume  9 , Article number:  126 ( 2023 ) Cite this article

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In developing countries, the practice of food taboo is pervasive. The types of foods considered as taboos and the reasons attached to taboos vary from society to society. Food taboos have been recognized as one of the factors contributing to maternal undernutrition in pregnancy, especially in rural settings. In the rural Acholi community where malnutrition is prevalent, very little is known about these food taboos and misbeliefs. This study, therefore, aims to explore various misbeliefs and food taboos in the time of pregnancy that can influence maternal and child nutrition outcomes in Acholi.

A community-based qualitative cross-sectional study was conducted between April and May 2022 in five districts in the Acholi subregion. Focus group discussions (FGDs) and key informant interviews (KIIs) were used to collect data. Data transcription was done verbatim, organised into themes, assigned unique color codes, and manually analysed thematically.

Upon scrutiny of the transcripts, three themes were eminent. The first theme focused on foods that are considered taboos in Acholi community and the reasons linked to them. Participants indicated offals, chicken, wild birds, smoked meat and fish, sugarcane, garden egg (‘ Tula ’), groundnut, bush meat, mushrooms, honey, sour fruits, or meals (oranges, mango, passion fruits, lemon, tamarind, ‘ Malakwang ’), goat’s meat, ‘ Lalaa ’ (the bitter green leafy vegetable), and ‘ Lamola ’ ( Hyptis spicigera ) as the major taboo foods. The second theme was the reasons underlying the adherence to the food taboos and misconceptions. Cultural dictates, individual characteristics, and societal context were the main reasons for the adherence to food taboos. The third theme looked at the misconceptions and other taboos during pregnancy. It was found that pregnant women are not allowed to touch grave soil, shave their hair, walk over an anthill, slaughter chicken or birds, have sex during pregnancy, sit on animal’s hide or skin, and/or touch needles.

Conclusions

Nutritional counseling and education should focus more on addressing food taboos. The mode of delivery of the nutrition message should be inclusive, targeting pregnant women and their spouses, school-going children, adolescent girls, and cultural leaders at their respective points of contact.

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Introduction

Food taboos exist in one form or another in every society on Earth. Nowhere in the world do people, a tribe, or an ethnic group exploit the full potential of edible resources in their surroundings [ 1 ]. For example, the hunters and gatherers of the Paraguayan jungle (the Ache people) are believed to exploit only 50 of the several hundred edible mammalian, avian, reptilian, amphibian, and piscine species found in the tropical forest. As with plants, fruits, and insects, only 40 of them are exploited. 98% of the calories in the diet of the Ache are supplied by only seventeen different food sources in the tropical forest [ 2 ]. The term food taboo is used to describe the deliberate avoidance of a specific food item for reasons other than a simple dislike of food preferences [ 3 ]. However, in almost all societies, food taboos are understood as a systematic set of rules about which foods or combinations of foods may not be consumed [ 4 ].

Although ordinary restraint from certain foods may in itself not mean food taboo, regular avoidance usually culminates into a tradition and eventually as a food taboo [ 2 , 5 , 6 ]. Social anthropological research on eating and food taboos underpins habitual avoidance of foods as stemming from utilitarian doctrine and magico-religious motives [ 5 , 7 ]. The delineation of food taboos as mechanisms for conserving resources as well as a person’s health has been documented by functionalists [ 8 ]. The explanation of rituals and taboos based on spiritual, religious, and magic ideation has also been cited [ 5 , 9 , 10 ].

In developing countries, the practice of food taboos is prevalent. The type of food considered taboo and the reasons attached to the taboos vary from society to society. In most settings, food taboos often target pregnant women to prevent what is perceived as harmful effects of these foods on the newborn [ 11 , 12 ]. For example, a study in South Africa revealed that foods such as meat, fish, potatoes, fruits, beans, eggs, butternut, and pumpkin, which are good sources of essential nutrients, are avoided [ 13 ]. In Ethiopia, food items such as dairy products (milk, yogurt, cheese), vegetables, egg, linseed, fruits, sugarcane, honey, and fatty meat are avoided [ 14 ]. In Gambia, Nigeria, Gabon, the Democratic Republic of Congo, and Asia, pregnant women are usually forbidden from consuming the richest food sources of iron, carbohydrates, animal proteins, and micronutrients [ 11 , 12 , 15 ].

For many cultures in Uganda, there is a belief that being loyal to food-based taboos often results in a healthy pregnancy. For instance, in Buganda, taboos restrict pregnant women from eating slaughtered animals. In Karamoja, women are debarred from eating the meat of dead animals, offal, and chicken. Lack of adherence to these taboos is believed to result in preeclampsia, general body weakness, being sick, abnormal fetus movement, miscarriages, abdominal pains, malaria and fevers, weight loss, being pregnant beyond the gestation period of nine months, bleeding, vaginal discharge, and sexually transmitted diseases [ 16 , 17 ]. Other studies elsewhere in the world other than in Uganda also show similar reasons for avoidance of other food items. The avoidance of certain foods was linked to adverse pregnancy outcomes (macrosomia, dystocia, fear of miscarriages or abortion, and fetal abnormalities), labor, and avoiding an undesirable body appearance for the baby [ 13 , 18 ].

Malnutrition, especially among pregnant women and adolescents, increases the risk of maternal and neonatal mortality and morbidity, low birth weight babies, slow growth, and impaired cognitive development, which often translate to an intergenerational cycle of malnutrition. Addressing existing barriers is critical to ensuring adequate maternal nutrition during pregnancy and lactation. Although adequate dietary intake during pregnancy could be affected by many factors, including food affordability and accessibility, food taboos have been recognized as one of the factors contributing to maternal undernutrition in pregnancy, especially in rural settings [ 19 , 20 ]. Despite this recognition, little is known about these misbeliefs and food taboos and their contributions to maternal and child nutrition outcomes in Uganda and, in particular, the Acholi subregion due to limited literature.

The Maternal, Infant, Young Child, and Adolescent Nutrition (MIYCAN) 2020 action plan and the National Nutrition Action Plan (UNAP II) of the government of Uganda call for a reduction in all forms of malnutrition among the vulnerable population. However, addressing the growing concerns on maternal child undernutrition will likely require further actions in addition to what is previously envisaged. According to the World Health Organization’s global nutrition targets (2025), Uganda is still off-track in achieving two out of the six critical indicators of a 40% reduction in the number of stunted children and a 50% reduction in anaemia prevalence among women of reproductive age. The Uganda Demographic and Health Survey (UDHS, 2016) shows that one-third of children under five are stunted, with those in rural areas more likely to be stunted (30%) than those in urban settings (24%). Similar to stunting, the prevalence of anaemia is higher in rural areas (54%) than in urban areas (48%). Over half (53%) of the children 6–59 months of age and 32% of the women 15–49 years old are anaemic. However, there is regional variation in the prevalence of anaemia; 71% of children and 47% of women in the Acholi region are anaemic, which is higher than the national average and twofold-fold higher than the prevalence in other regions. The real causes of these marked regional variations remain poorly understood. There are indications that the challenges of malnutrition go beyond physical access to food. Cultural shortcomings seem to play a key role in exacerbating the triple burden of malnutrition in this country.

The Acholi districts in Northern Uganda have been referred to as the breadbasket of Uganda (Remigio, 2010). Despite the abundance of food sources in Acholi, the prevalence of malnutrition, especially anaemia, is still high in children and women. Anecdotal evidence regarding misbeliefs and food taboos among the Acholi communities is eminent and has been in practice for years. Notwithstanding, there is no available literature to fully show and describe the practices or beliefs related to food taboos due to a scanty study in the area. It is likely that the practice of various food taboos among the Acholi communities could be the major reason for poor maternal and child nutrition outcomes in the region and thus could explain the regional variance in nutrition outcomes in the country. This study, therefore, aims to explore various misbeliefs and food taboos in the time of pregnancy that could influence maternal and child nutrition outcomes in Acholi.

Research methods

Study setting.

This study was conducted in the Acholi subregion located in northern Uganda. The Acholi subregion is composed of eight districts, namely Agago, Amuru, Gulu, Kitgum, Lamwo, Nwoya, Omoro, and Pader. Five districts, Gulu, Omoro, Amuru, Pader, and Kitgum, were sampled for this study. The Acholi, with a population of over 1.5 million, constitutes one of the about 65 ethnic groups in Uganda [ 21 ]. The Acholi area covers a greater majority of mainland northern Uganda, occupying approximately 11,264 square miles with the border of South Sudan [ 22 ]. This accounts for 12% of the total land area of Uganda. The areas within which the Acholi lives are vastly forested, grasslands, semi dry lands, and swampy. The availability of vast fertile land encourages wildlife hunting, agrotourism, animal rearing, and the growing of various food and cash crops. The main food crops grown in the area are rice, sweet potatoes, sorghum, maize, millet, beans, cassava, and groundnuts, while cotton, tobacco, soybean, and sugarcane, are majorly for income [ 23 , 24 ]. Livestock such as cattle, small ruminants (e.g., goats, sheep, rabbits), and poultry are reared for both domestic and economic purposes. There are 132 government health facilities in the Acholi subregion. These comprised 116 HC III, 9 HC IV, and 7 hospitals. Depending on the level, these facilities provide outpatient and inpatient services and emergency and obstetric care services [ 25 ].

Research design and participants

This study was conducted between April and May 2022. A community-based qualitative cross-sectional study design using focus group discussions (FGDs) and in-depth interviews (IDIs) of key informants (KIs) was used. The methods were chosen to allow for in-depth probes due to sensitivity around the practices. Participants were selected from five randomly sampled districts, i.e., three from West Acholi Gulu, Omoro, and Amuru, and two others from East Acholi, i.e., Pader and Kitgum. Study participants included the health care providers (HCPs) attached to the antenatal clinic (ANCs), village health teams (VHTs), traditional birth attendants (TBAs), 'Rwodi of Ker Kal Kwaro Acholi’, pregnant women, and their spouses.

Participant recruitment

Purposive sampling techniques were used to select KI and FGD participants. Pregnant women attending antenatal clinics in five rural government health facilities in the sampled districts, namely, Gulu, Amuru, Omoro, Pader, and Kitgum, were purposively selected to participate in the study. Atiak HC IV in Amuru, Awach HC IV in Gulu, Lalogi HC IV in Omoro, Pajule HC IV in Pader, and Namukora HC IV in Kitgum district were the health facilities purposefully sampled for the study. These facilities were chosen because of their rural location and the capacity to offer obstetric care services. Records of women were obtained from registers available at the health centres. Only those who met the selection criteria (i.e., were pregnant, able to speak the local language, lived in a rural area, were not weak/sick, had a partner living together, and were willing to give consent) were selected. Partners of women attending ANCs automatically became potential KII participants. Phone numbers of spouses of women attending ANC were obtained from the medical records for telephone interviews. The ‘Rwodi me Ker Kal Kwaro Acholi’ (the chiefs of the Acholi chiefdom) were identified and selected from the 54 chiefs listed in ‘Ker Kal Kwaro Acholi’s Strategic Plan 2009 document. Telephone contacts of the ‘Rwodi’ were obtained at the time of selection to schedule interview appointments. Village health teams (VHTs) were identified from the staff inventory available at the targeted health facilities. Lists of the former TBAs registered with the respective health authorities were obtained, and participants were identified to participate in the study.

Data collection tools and methods

Forty semistructured interviews using a pretested interview guide were conducted with the key informants to gather a range of views regarding misbeliefs and food taboos during pregnancy and early infancy. This data collection method was chosen because it’s appropriate for the research questions being explored. The interview guides used (supplementary file 1 ) were specifically developed by the researcher for this study. After the development of the tool, it was first piloted with 10 participants who were later excluded from the main study. Questions that showed deviations, or were unclear, too long, and difficult to understand were effectively validated to improve the validity of the tool. Additionally, the interview guides were updated whenever an information gap was discovered during the data collection. In-depth interviews were conducted with the KIs participants, i.e., 10 ‘Rwodi of Ker Kal Kwaro Acholi’’ (the chiefs of the Acholi chiefdom) from across the 5 selected Acholi districts to harness a range of views and opinions, 10 health care providers attached to the Ante-Natal Clinic, and 05 Village Health Team (VHTs), 05 spouses (husbands) of the pregnant women, and 10 former Traditional Birth Attendants (TBAs). Nine FGDs were conducted with purposively selected pregnant women. Interviews with the health care providers and pregnant women were conducted at the health facilities. All the other participants (Rwodi, VHTs, TBAs, and partners of pregnant women) were interviewed from their respective homes either via telephone or face to face. To ensure the reliability of the data being collected, all the interviews were conducted in the medium of Acholi language by the principal investigator (PI) and trained research assistants. The decision on the actual number of in-depth interviews to conduct with the KIs and FGDs with pregnant women was reached based on the level of information saturation, which was ascertained by transcribing the discussions of each day’s session. All data were audio-recorded. Notes and memos of participants’ behavior and contextual aspects were taken during the interviews. The FGDs took on average between 40 and 60 min, while IDIs with the KI took an estimated 30–40 min. Some KI participants, especially ‘Rwodi (the chiefs)’ and TBAs whom the research team could not meet in person, were interviewed on the phone. Additionally, the interviewing of spouses of pregnant mothers was done via telephone calls. Upon completion of data collection, data was checked for errors and inconsistencies to ensure data quality.

Data analyses

This study employed appropriate statistical analyses method for the research questions and data collected. The notes and voice recordings taken during the focus group discussions and key informant interviews were synthesised verbatim and the principles of systemic text condensation were applied to manually analysed the data [ 26 ]. Transcripts were checked several times to fully understand its content, pick out the actual meaning, summarise the content using color coding, and then categorise the main themes based on the condensed text. The data were then thematised. Parts of the discussions were restated verbatim, and some were amended to improve clarity. The results were narratively presented using the verbatim of the respondents to elucidate and provide further proof for key statements. All quotes expressed in the local language (Acholi) were translated into English. Basically, the phases of the thematic analysis of the qualitative data were data transcription, data familiarization, initial code generation, thematic search and reviews, thematic definition and naming, and reporting.

Sociodemographic characteristics of the study participants

Nine FGDs were held. Key informant interviews were conducted with 32 participants. Altogether, a total of 118 respondents participated in the nine FGDs (8–10 members for each discussion) and 32 KIIs. The final number of in-depth interviews and FGDs conducted was established based on the level of information saturation, which was ascertained after transcribing the discussions of each day’s session by the research team.

The 118 study participants consisted of 86 pregnant women, 8 Rwodi of Ker Kal Kwaro Acholi, 7 health care providers, 9 former traditional birth attendants, 4 village health teams, and 4 spouses of pregnant women. The participants’ age groups ranged from 16 to 82 years old. Their educational status varied widely, i.e., ranging from no education to tertiary formal education. 95% of participants lived in rural areas, and 83.1% engaged in agriculture as their major occupation, except for health care providers and some ‘Rwodi’ (Table  1 ).

Following rigorous reviews and in-depth analysis of the scripts, five key themes were identified:-

Main factors that determine food choices in the community.

Foods that are considered special to pregnant women and newborn babies.

Foods that are considered taboos in the Acholi community and the reasons linked to them.

Reasons underlying adherence to food taboos and misconceptions.

Misconceptions and other taboos during pregnancy in the Acholi community.

Main factors that determine food choices in the community

Participants were asked about their opinions regarding factors that determined food choices during pregnancy in their communities. Varied views were expressed to explain why some people chose what to eat and what not to eat. Most of the respondents, particularly pregnant women, TBAs, and health care providers, believed that most women have specific food preferences because of the existing medical conditions, cultural beliefs, level of income, availability of food items, prescribed menu, individual preference, state of pregnancy, and knowledge about food and nutrition. A KII participant, a traditional birth attendant, stated,

“……. for me I have ulcers and my doctor advised me not to consume sour food such as oranges, Malakwang , soda, and or eat beans…….”

Another TBA elaborated on how a household or individual’s economic status can influence which food to eat and what food to forgo.

“……. If you do not have money, there is no way you can eat the foods you like. Currently, with the current economic crisis and food insecurity, foods have become very expensive and scarce. You just have to eat whatever is available…….”

One KII participant added,

“…. the Acholi culture dictates what pregnant women should eat and what they shouldn’t. For example, women are banned from eating bush meat when they are pregnant . This kind of belief does  not only restricts women from eating such food but also affects the entire household’s food choices.…….”

An FGD participant pregnant woman indicated,

“…… The pregnancy period can be a very confusing moment in a woman’s life, especially in the first and second trimesters. I almost detested all foods in my first three months of pregnancy with my second born. Most often, a simple smell of certain food would make me vomit everything from my stomach….”

Another KII participant, a health care provider, associated food preference with the education of the woman. She explained that knowledge about nutrition contributes greatly to determining what one should eat.

“……. If you know the food groups that are good for your health, for example, when you are sick or pregnant, you will rightly choose the types of food to include on the menu…….”

Similarly, another FGD participant pregnant woman reckoned,

“……. Food availability is a major reason for differing food choices. You might have cash, but if the food you want to buy is not available in the local market, what can you do? You will have to change your plan and look for alternatives. For me, if I want to eat fish and I don’t find it in the market, I go for silverfish….”

Foods that are considered special to pregnant women and newborn babies

Pregnant women and their spouses, healthcare providers, TBAs, and VHTs believed that some foods are ‘special’ for expectant mothers and their newborns. For the pregnant mothers, foods such as meat; leafy vegetables (pumpkin leaves, boo , cabbage, Malakwang , Akeyo ); silverfish; millet food; soybean porridge; carrots; milk; fruits (pawpaw; Avocado); and pumpkin leaves were reported as special and should be consumed as much as possible. These foods are perceived to fatten and offer general nourishment to the baby while in the womb. Malakwang is consumed specifically to enhance milk let-down during breastfeeding.

For newborns, breast milk is given exclusively in the first two months. Some mothers, however, introduce sugar solution, black tea, and soup immediately after birth. From 3 months onwards, the infants are given soybean, millet, and maize flour porridge mixed with sesame or groundnut paste (peanut butter).

A pregnant mother, a participant of an FGD, indicated,

“……. when my third born was in the womb, I ate a lot of pumpkin leaves, and the baby came out very big that I almost failed to deliver normally…….”

A KII participant, one of the traditional birth attendants, also expressed her experience with her first-born son. She stated,

“…… . Pasted foods are miracle meals during pregnancy. In my first pregnancy, my mother-in-law advised me to include pasted beans, Malakwang , Boo , Akeyo , porridge, and meat in my diet. I did that, and the outcome was amazing when I gave birth. My son came out all glittering and very big …….”

Additionally, another KII participant, a health care provider, stressed that maternal nutrition during pregnancy should be given careful attention. Meal planning should include the different food groups available within the community. These foods should be able to provide essential nutrients for nourishing both the mother and the growing fetus. Thus, foods rich in carbohydrates, proteins, minerals, and vitamins should be included in the daily diet. Micronutrient supplementation, especially of iron and folic acid, is equally important. These can be started immediately before the woman conceives and continued during pregnancy until 3 months postpartum. For infants younger than 6 months, exclusive breastfeeding is advised. The participant added,

“……. We often advise women when they come for their antenatal visit to eat a balanced diet. Those who cannot afford certain foods can opt for alternatives; for example, if fish are expensive, we advise them to buy silverfish. Those who have land can establish a small kitchen garden to grow vegetables. We also give these women combined iron and folic acid tablets and encourage them to continue intake throughout their pregnancy and after they have given birth. Our routine advice to mothers regarding infant feeding is that infants below 6 months should not be given solid foods. The child should be fed entirely on breast milk except for syrups and vitamins. Breastfeeding should continue until the baby reaches two years….”

Foods that are considered taboos in the Acholi community and the reasons linked to them

FGD and KII participants indicated that certain foods are taboos in some Acholi clans and should not be eaten or even touched by pregnant women. Overall, 14 foods are held as taboos across the Acholi community for various reasons (Table  2 ). FGD and KII participants mentioned avoidance of high carbohydrate foods, especially sugarcane and honey, during pregnancy. Consumption of these foods was viewed to be associated with generalized fetal skin fissures and having a newborn with excessive birth weight, which was believed to lead to a difficult birth. A KII participant, a TBA, stated,

“……. My son almost killed me if I was not an experienced TBA. He was too big because I ate too much honey in the last three months of my pregnancy. I got a lot of tears during delivery….”

Similarly, an FGD participant, a pregnant mother, added,

“…My own brother’s son was born with generalized skin cracks and tears when the mother consumed sugarcane during her pregnancy. It took some time for the wounds to completely heal. In fact, the boy bled too much at the time of his birth that we thought he would die…….“

The consumption of protein-rich and nutrient-dense foods such as offal, smoked meat, fish, chicken, goat meat, and wild meat is restricted during pregnancy for various reasons depending on the clan. Many of the participants believed that eating offal and chicken skin, particularly during advanced pregnancy, causes ‘baby strangling’, a condition in which the umbilical cord ties around the baby’s neck, leading to choking. Handling or eating smoked meat and fish a few weeks prior to childbirth is feared to cause infection of the umbilical cord after the baby is born. The perception behind barring women from eating goat meat and chicken is basically to show respect for the men. One of the KII participants, Rwot, emphasized,

“………In Acholi, women are banned from eating goat and chicken because these foods are very small whenever cooked and so served only to the men. Usually, more than one meal is prepared on the day a chicken or goat is cooked. The women eat the other foods while the meat is left for the men. This is a sign of respect that has been in practice from time immemorial…….”

Likewise, an FGD participant, a pregnant woman, commented,

“……… My neighbor ate goat’s offals in her pregnancy and her baby came out with the umbilical cord wrapped around the baby’s neck. On the day of her delivery, her husband had also bought some smoked meat. A few days later, the baby developed a serious infection on the umbilical cord stump…….”

Participants also reported that foods such as fruits, particularly oranges, lemons, passion fruits, mango, and tamarind, including some types of vegetables such as garden eggs ( tula ), ‘ Lalaa ’ (the bitter green leafy vegetable), and ‘ Lamola ’ ( Hyptis spicigera ), are considered taboo for women throughout the gestation period. When probed, participants disclosed various reasons attached to the ban on the consumption of these foods. The garden egg, which some people call the bitter eggplant and in the local language it is referred to as ‘ Tula’ , is known by some communities in Acholi to cause inflammation of the skin of the growing fetus. Lamola ( Hyptis spicigera ) is believed to cause fetal blindness, and consumption of ‘ Lalaa’ is thought to cause impotence to the newborn. A few of the KII participants, TBAs, cited eating sour fruits and/or other foods to cause generalized fetal skin rashes. In a discussion to explain this, a Traditional Birth Attendant, KII participant affirmed that,

“……. it’s forbidden for a woman in my clan to consume anything sour during her pregnancy. Sour foods make the body of the baby look rough and unpleasant…….”

In the same tone, another TBA, KII participant, stated,

“……. If you want to lose the sight of your baby just eat ‘Lamola’ when you are pregnant. It happened to my aunt’s daughter; she was born blind. At first, no one knew what had happened to the eyes, but this was confirmed when the mother disclosed she ate ‘Lamola’ when the baby was still in the womb…….”

Many FGD and KII participants, particularly TBAs, Rwodi, and pregnant women, associated the consumption of raw or roasted groundnuts with the whitish plastered substance that normally appears on the baby immediately after delivery. On the other hand, certain types of wild edible mushrooms are believed to cause miscarriage, infertility in women, and fetal body sores. One of the Rwodi of Ker Kal Kwaro Acholi said,

“…… A ban on the consumption of mushrooms during pregnancy is unfamiliar in some clans in Acholi. This taboo is common to some specific clans. In some clan, the belief is so strong that when a woman consumes mushroom during pregnancy, she loses the fetus instantly or the mother never ever give birth again…….”

In contrast, a pregnant woman one of the FGD participants testified,

“……. I ate lots of raw and roasted groundnuts when I was pregnant with my 2-year-old son, but he came out clean on the day of his delivery. I think some things are simply misconceptions that should be abolished in this generation…….”

Reasons that underlie adherence to food taboos and misbeliefs

Based on the views expressed and submissions made by many of the respondents, the reasons that underlie adherence to food taboos can broadly be categorized into three categories, namely, cultural dictates, individual characteristics, and societal context.

Cultural dictates

It is apparently clear that every clan in Acholi has its own cultural beliefs that they hold so dearly, and it is expected that every member of the clan adheres to them. Failure to comply with the taboos tantamount to being thrown out as an outcast or facing grave consequences. When a man marries a woman, she is first allowed to stay with her mother-in-law for about a year before moving to her own house to start living independently. During this time, she is taken through the dos and don’ts of that family that she must follow. This kind of informal teaching continues for generations after generations. The message about taboo foods is usually passed to children from an informal setting called ‘ wang oo ’ (literally meaning the fireplace). One KII participant, a traditional birth attendant, testified,

“……. when I eloped, I first stayed with my mother-in-law for eight months. While I was with her, she groomed me into becoming a woman of the home. She told me never to eat meat before I was oriented. She also advised me never to eat mushrooms if I think I’m pregnant to avoid miscarriage…….”

To further support the claim, another FGD participant, a pregnant woman, added,

“……. Back in those days, my father used to tell us from ‘wang oo’ never to eat chicken when I’m married. He added that it was disrespectful for a woman to eat chicken. This got stacked in mind and up to now I still do not eat chicken….”

Individual characteristics

Some taboos are linked to spiritual attachment and/or appeasement. It was vividly expressed by many of the participants that some clans in Acholi have ‘ jok ’ (the spirit) that they respect. The ‘ jok ’ can befall any member of the clan. Usually, the spirit demands avoidance of certain foods, and failure to adhere to the wish of the spirit, the individual could face severe consequences. One KII participant, a TBA, expounded,

“……. The ‘jok koma’ (my spirit) does not allow me to eat any four-legged animals. When I eat it, I get paralyzed and develop sores all over my body. This started when I was still young and, in my life, I haven’t eaten any meat from animals with four legs. There was a day I accidentally ate beef from a wedding ceremony, I almost died, I completely became paralyzed, and people could not explain what was happening to me….”

Social dimensions

From the views expressed, certain taboos seem to be losing relevance, but societal pressure and influence appear to play a large role in holding people onto it. Society often expects adherence to preset norms without questioning. There were general concerns that elders, particularly older women, usually impose and/or dictate certain taboos on younger women. Adherence to some taboos was thus linked to fear of reprimand and rejection. One of the FGD participants, a pregnant woman, expressed,

“…….My mother-in-law told me his son would not take cows to our home if I indulged in eating meat. I asked myself how eating meat was related to my marriage…….”

Another KII participant, a TBA, added,

“………When I was a girl, my mother told me never to eat chicken if I wanted to be a respectful girl. She gave me an example of a girl in the neighborhood who was chased from her marital home for eating the gizzard of a chicken….”

Misbeliefs and other taboos during pregnancy in the Acholi community.

Respondents were further asked about their awareness regarding other taboos or misconceptions attached to pregnancy. Most of the KII and FGD participants expressed varied views pertaining to taboos that pregnant women should respect. A total of 9 issues were raised during interviews with key informants and discussions with the focus group participants (Table  3 ).

Five out of nine taboos mentioned were linked to miscarriage. KII and FGD participants expressed that most of the Acholi taboos, especially those practiced during pregnancy, aim to protect the fetus. In support of these views, one of the Rwodi of Ker Kal Kwaro Acholi stated,

“……. in our culture, taboos during pregnancy are meant to protect the fetus from coming out preterm. People tend to adhere more to taboos than formal laws because of the immediate consequences associated with taboos. So we use taboos to shape behaviors that would harm lives and societies….”

Although in some clans these beliefs and taboos are still strongly held, the majority of the respondents think that the adherence to such things is waning in most Acholi communities. An FGD participant, a pregnant mother, and a KI respondent put it straight that,

“……. These things called taboos no longer work. Women held needles, sat on hides or skins, and ran over anthills, but nothing happened to them. We need to find a way of detaching ourselves from such attachments…….”

However, one of the spouses of a pregnant woman indicated,

“……It’s unfortunate that today’s generation is losing track of their culture. Taboo in some clans is alive, let no one deceive you that these things are outdated. A case in point, in the neighboring clan last year, a pregnant woman in the fourth month of pregnancy had a miscarriage because she walked over an anthill when she went to fetch firewood. It truly depends on the family one comes from…….”

This study explored misbeliefs and food taboos during pregnancy and early infancy among rural Acholi communities in Northern Uganda. From the results, participants aged 36 years and above were richer in information regarding food taboos than their younger counterparts. Younger people, especially those younger than 18 years, felt slightly uncomfortable talking about the topic even when the researcher could see the responses on their faces. The researcher was able to probe and make the discussions more interactive and participatory to enable them to bring out the issues clearly. In Acholi, it is forbidden to talk about taboos in public, especially by young people, which could explain why younger respondents felt uneasy discussing taboos. Their role is simply to adhere to it. The information gap about food taboos among young people could also be due to the breakdown in the informal teaching system, the ‘ Wang oo’ . One of the Rwodi of Ker Kal Kwaro Acholi indicated that most young people are losing direction and are becoming ignorant of their culture because the ‘ Wang oo’ , which used to be a sort of informal school, is no longer common. Fournier [ 27 ] reported that the 20-year civil war in Acholi injured the formal space to bind the community. The cessation of the ‘ Wang oo’ (a central, communal fireplace where elements of the culture – stories, songs, riddles, and parables – were told and passed) severely undermined the cultural systems and the continuity of traditional values from one generation to the next [ 28 , 29 ]. Additionally, the advent of Christianity and formal education, as explained by one of the respondents, distanced children even more from older people, who could be a rich source of information.

Among the Acholi community, food taboos seem to target women more and men to a lesser extent. Most of the taboos mentioned other than those practiced during pregnancy excluded men. It was eminent during the discussion that women had more information about food taboos than men, and the practices appeared to be more prevalent among the women. In several instances, the researcher witnessed men consulting their wives for certain responses. Lambek [ 30 ] found that women bear heavier burdens of taboos and observance than men. He added that the gender bias of taboos raises a complex of issues related to the paradoxical relations between autonomy and values that were beyond the scope of his study. This finding agrees with the results of this study.

The results from the present study show medical conditions, cultural beliefs, level of income, availability of food items, prescribed menu, individual food preference, state of pregnancy, and knowledge about food and nutrition as key factors that influence maternal nutrition during pregnancy. During pregnancy, physiological changes that occur due to hormonal interactions, excessive weight gain, fat disposition, and modification in cardiovascular, respiratory, and gastrointestinal functions can affect the woman’s dietary intake [ 31 , 32 ]. The changes in diet during pregnancy appear to reflect a woman’s efforts to balance physiological changes accompanying pregnancy with the desire for a healthy baby. Forbes, Graham [ 33 ] found that women frequently select and accept certain foods for the health of their babies and to satisfy cravings. [ 34 , 35 ] reported that the interaction of individual values and beliefs about nutrition in pregnancy, nutrition knowledge, physical and physiological changes with the determinants of other eating behaviors often change the woman’s food choices during pregnancy. Further compounding the results from the present study, Versele, Stok [ 36 ] found social influence, home/environment food availability, food knowledge, and self-regulation to influence food choices during pregnancy.

This study summarizes the foods considered special by the respondents into four main categories, namely, carbohydrate sources (which include porridge, rice, cassava, and maize), protein sources (e.g., pulses, fish, meat, nuts legumes), fat and oil (such as nuts, ‘ odii ’ peanut butter, and sheer butter), vitamins, and minerals (mainly from fruits and vegetables). Other components of the special nutritional requirement during pregnancy cited in this study are oral micronutrient supplementation, especially iron and folic acid. For infants younger than 6 months, the results show that breast milk is preferred, although other respondents indicated feeding infants older than two months on sugar solution, soup, and porridge as alternative meals, especially for mothers with breastfeeding challenges. According to Trumbo, Schlicker [ 37 ], and the Academy of Nutrition and Dietetics, approximately 300 extra calories are needed each day to maintain a healthy pregnancy. These calories should come from a balanced diet of proteins, fruits, vegetables, and whole grains. Protein intake during pregnancy is 60 g/day, which is equivalent to 1.1 g consumption of protein/kg/day [ 37 ]. Meyers, Hellwig [ 38 ] recommend that women take folic acid from fortified food or supplements daily in addition to consuming a diet rich in food sources of folate to reduce the risk for neural tube defects in their offspring. Accordingly, breastfeeding and breast milk are the global standards for infant feeding. Experts advise that children should be breastfed exclusively for the first 6 months, and this should continue for at least through the first year of life [ 39 ]. Although the foods listed as special for women to consume during pregnancy in this study agree with some of these recommendations and other available feeding guidelines [ 38 , 39 , 40 , 41 ], the knowledge regarding the consumption of these foods is unclear and is beyond the scope of this present study. However, efforts to promote adherence to culturally appropriate nutrition practices and education may be an important care practice for many pregnant women.

This study found more than fourteen foods, namely, Offals, Chicken, Wild birds, Smoked meat and fish, Sugarcane, Garden egg (‘Tula’), Groundnut, Bush meat, Mushrooms, Honey, Sour fruits or meals (oranges, mango, passion fruits, lemon tamarind and ‘Malakwang’), Goat’s meat, ‘Lalaa’ (the bitter green leafy vegetable), and ‘ Lamola ’ ( Hyptis spicigera ), also known as the black sesame, that are held as taboos among the Acholi community. The consumption of these foods is prohibited during pregnancy for pertinent reasons cited by the study participants. The main reasons advanced for the ban on these foods held as taboo in this study were the fear that it would cause the umbilical cord to tie around the neck of the fetus and thus choke it, leading to miscarriage, causing blindness to the fetus, causing navel/umbilical cord infection, resulting in generalized fetal skin fissure, skin inflammation to the fetus, causing whitish plasters onto the fetal baby, leading to infertility in women, causing fetal skin rashes, leading to large babies, erectile dysfunction, and respect for the men. It is important to note that the practices of these food taboos are not cast in stone throughout the Acholi community but rather specific to some clans. Each clan has its own clearly distinct cultural norms that its members uphold. Although some sections of the respondents indicated that allegiance to taboos is losing grip in the modern Acholi, many believe that the practice is still strongly held. Consistent with these findings, Tsegaye, Tamiru [ 42 ] reported instances of beliefs and taboos that restrict the consumption of certain foods during pregnancy among the rural communities of the Illu Aba Bor zone in Southwest Ethiopia. In their study, they found that food items held as taboo were vegetables (mainly cabbage and pumpkin), milk and milk products, sugarcane, fruits (e.g., bananas and avocado), and eggs. Two key reasons congruent with this result were the beliefs that the foods would plaster onto the foetal head or make the baby too large to be delivered. Similarly, Zerfu, Umeta [ 18 ] disclosed the practice of food taboos in Arsi, rural central Ethiopia, where common taboos were related to restrictions on the consumption of green leafy vegetables, yogurt, cheese, sugar cane, and green pepper during pregnancy. Furthermore, a study in the Eastern Cape, South Africa, found that meat products, fish, potatoes, fruits, beans, eggs, butternut, and pumpkin were foods commonly avoided by pregnant women [ 43 ]. In all circumstances, the reasons underlying adherence to food taboos were profoundly embedded in the individual characteristics, the influence of the social environment, and the cultural decree [ 19 , 42 ]. As revealed in the present study, individual characteristics such as possession of some spirits may limit them from consuming certain foods. Compatible with this finding, the ‘ trumba ’ spirit of the Malagasy speakers prohibited the host from eating chicken. This is an example to show that taboos are imposed on their human host by spirits [ 42 ]. It is evident that most of the foods reported as taboo in the present and previous studies provide rich sources of essential macro- and micronutrients, which are vital for maternal health, foetal development, and desired pregnancy outcomes, including infant and child growth and development. For example, fruits and vegetables supply dozens of essential nutrients, including potassium, magnesium, dietary fibre, folate, and vitamins A and C; fruits and a variety of other bioactive substances that play a key role in health [ 44 ]. Although there is no plausible proof yet to support the suggestion that the practices of food taboos during pregnancy could be the reason for the poor nutrition outcomes in the Acholi subregion, this study set forth a novel understanding of the complexities surrounding maternal and child nutrition in the region, particularly from the cultural perspective. Further study is recommended to investigate the cause‒effect relationship between food taboos and nutritional outcomes in the Acholi.

The results from this study also revealed that food taboos during pregnancy are not practiced in isolation but in association with other established sets of cultural norms. Depending on the clan, the Acholi people attach several taboos to pregnancy. In some families, as seen in our results, a pregnant woman is not allowed to associate herself with certain practices. Reasons in support of these restrictions were mainly related to the avoidance of miscarriage. With respect to the avoidance of sex during pregnancy, the justification was the perception that the sperm would plaster onto the foetal body and therefore look unpleasant during delivery. Although participants expressed the realities of consequences associated with defiance, there is no scientific evidence to explain the phenomena. Contrary to the view attached to sexual intercourse in this study, Shojaa, Jouybari [ 45 ] reported the reasons to evade sex during pregnancy among Iranian women to be associated with the fear of abortion, fetal suffocation, fetal abnormality, rupture of fetus hymen, and concern of harm to the mother. Orji, Ogunlola [ 46 ] also found the reasons for the avoidance of sex during pregnancy among pregnant women in Ilesa, Nigeria, to include nausea and vomiting during early pregnancy, fear of miscarriage, fear of harming the fetus, physical awkwardness, lack of interest, discomfort, fear of membrane rupture, fear of infection, and fatigue. It appears that perceptions of sexual intercourse during pregnancy as well as the nature of other beliefs and practices vary with cultural and social contexts. A study in the District of Ilocos Sur, Philippines, Oyo State, Nigeria, and Shama District of the Western Region, Ghana, reported disparate taboos and misconceptions and reasons attached to them [ 47 , 48 , 49 ].

The main strength of this current study is its ability to document for the first time an account of taboos, especially during pregnancy in Acholi. In addition, the novelty finding regarding the adherence to culturally appropriate nutrition practices and education may offer an important care practice for many pregnant women especially those living in remote settings for improved nutrition outcomes. However, this study was only limited to exploring the taboos and cultural misbeliefs associated with nutrition during pregnancy, but not the cause-effect relationship. Future studies should examine this linkage. Another limitation pertinent to this study was the young women being hesitant to openly talk about taboos during the FGDs because of fear of retribution. The researcher addressed this by categorising the FGD participants into different age groups. Each age group was interviewed separately to ensure a free expression of views during the discussions.

This study unveiled the eminent food taboos, other cultural beliefs, and misbeliefs related to maternal and infant nutrition and general well-being during pregnancy within the Acholi community in Northern Uganda. Adherence to these practices was found to be driven by established cultural edicts, social contexts, and individual characteristics that vary from clan to clan. Grossly, the anxiety of losing the fetus, fear of poor birth outcomes, the suspicion that the mother would die or become impotent, and the worry of a social outcast were put forward as key reasons for the assent to these taboos. Notably, the foods condemned for consumption during gestation mainly include offals, chicken, wild birds, smoked meat, smoked fish, sugarcane, garden egg (‘ Tula ’), groundnuts, wild meat, mushrooms, honey, ‘ Malakwang’ , oranges, mango, passion fruits, lemon, tamarind, goat meat, ‘ Lalaa ’ (the bitter green leafy vegetable), ‘ Lamola ’, and black sesame ( Hyptis spicigera ). From an expert point of view and the global standards on maternal nutrition, restricting the consumption of these vital foods during the critical period of developmental programming would likely leave dire implications on the development of the growing fetus and maternal health, including child growth and development later in life. From the results, health care providers appear to pay less attention to issues of taboos during their routine encounters with pregnant women. Based on the reality expressed regarding these practices, nutritional counselling and education should focus more on addressing food taboos. Appropriate nutrition interventions targeting pregnant women and their spouses, school-going children, adolescent girls, and cultural leaders in their respective points of contact would go a long way to confronting this barrier for improved nutrition outcomes in the region. Further studies focusing on investigating the cause-effect relationship between food taboos and specific nutrition outcomes are recommended.

Data Availability

The datasets used and/or analysed during the current study are available from the corresponding author on reasonable request.

Abbreviations

Antenatal care

Focus Group Discussion

Health Centre

Health Care Provider

In-depth Interview

Key Investigators

Key Informant Interview

Maternal Infant Young Child and Adolescent Nutrition

Principal Investigator

Traditional Birth Attendant

Uganda Bureau of Statistics

Uganda Demographic and Health Survey

Uganda Nutrition Action Plan

United Nations Children’s Fund

Village Health Team

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Acknowledgements

We truly recognize the participation of the District Health staff in the Acholi subregion, members of ‘ Ker Kal Kwaro’ Acholi and the entire research team for their immense contribution in the study implementation process. Our special thanks go to all the pregnant mothers and Village Health Teams who consented to participate in the study.

This study was funded by Makerere University School of Public Health under the Small Grant for Young Scholars. The funder had no role in the study design, data collection, analysis, interpretation of findings, or preparation of this manuscript. The content of this paper is solely the responsibility of the authors and does not necessarily represent the official views of the Funder.

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P.V.A wrote the manuscript. NO managed the research data and headed the data analysis process. AB reviewed the manuscript for intellectual content to enrich it further. All authors read and approved the final manuscript.

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This study protocol was conducted in accordance with the Declaration of Helsinki and approved by the Higher Degrees, Research, and Ethics Committees of Makerere University School of Public Health. Prior to visiting the health facilities, formal authorizations were sought from the respective District Health Offices. Informed consent was obtained from all participants ahead of the interviews and FGDs. Where children/minors were involved, informed consent was sought from a parent and/or legal guardian for their participation in the study.

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Acire, P.V., Bagonza, A. & Opiri, N. The misbeliefs and food taboos during pregnancy and early infancy: a pitfall to attaining adequate maternal and child nutrition outcomes among the rural Acholi communities in Northern Uganda. BMC Nutr 9 , 126 (2023). https://doi.org/10.1186/s40795-023-00789-8

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• Food taboos
• Maternal and child nutrition
• Northern Uganda

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Food taboo practices and associated factors among pregnant women in Ethiopia: a systematic review and meta-analysis

Affiliations.

• 1 School of Public Health, College of Health and Medical Science, Dilla University, Dilla, Ethiopia. [email protected].
• 2 School of Public Health, College of Health and Medical Science, Dilla University, Dilla, Ethiopia.
• 3 Department of Human Nutrition, College of Health and Medical Science, Dilla University, Dilla, Ethiopia.
• 4 Ethiopian Public Health Institute, Addis Ababa, Ethiopia.
• PMID: 36927859
• PMCID: PMC10020167
• DOI: 10.1038/s41598-023-30852-0

Food taboos have a negative impact on pregnant women and their fetuses by preventing them from consuming vital foods. Previous research found that pregnant women avoided certain foods during their pregnancy for a variety of reasons. This review aimed to determine the pooled prevalence of food taboo practices and associated factors in Ethiopia. In compliance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guideline, we searched the literature using PubMed/MEDLINE, AJOL (African Journal Online), HINARI, Science Direct, Google Scholar, and Google electronic databases. The random-effects model was used to estimate the pooled prevalence of food taboo and its determinants at a 95% confidence interval with their respective odds ratios. The pooled food taboo practice among Ethiopian pregnant women was 34.22% (95% CI 25.47-42.96), and after adjustment for publication bias with the trim-and-fill analysis, the pooled food taboo practice of pregnant women was changed to 21.31% (95% CI: 10.85-31.67%). Having less than a secondary education level (OR = 3.57; 95% CI 1.43-8.89), having no ANC follow-up (OR = 4.35; 95% CI 1.12-16.94), and being a rural resident (OR = 3.08; 95% CI 1.14-8.28) were the significant factors. Dairy products, some fruits, green leafy vegetables, meat, and honey are among the taboo foods. The most frequently stated reasons for this taboo practice were: fear of producing a big fetus, which is difficult during delivery; attachment to the fetus's body or head; and fear of fetal abnormality.

© 2023. The Author(s).

Publication types

• Meta-Analysis
• Systematic Review
• Ethiopia / epidemiology
• Pregnant Women*

• Open access
• Published: 16 February 2023

Food taboos and their perceived reasons among pregnant women in Ethiopia: a systematic review, 2022

• Hadush Gebregziabher 1 ,
• Amaha Kahsay 1 ,
• Fereweini Gebrearegay 1 ,
• Kidanemaryam Berhe 1 ,
• Alem Gebremariam 2 &
• Gebretsadkan Gebremedhin Gebretsadik 1  

BMC Pregnancy and Childbirth volume  23 , Article number:  116 ( 2023 ) Cite this article

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There are foods considered as taboo across different communities in the world and in Ethiopia in particular. Although food taboos exist across all ages or physiologic states, they are predominant among pregnant women and children. Identifying such foods among pregnant women is crucial in providing focused interventions and prevents their negative consequences. Therefore, the aim of this review was to review the available evidence on food taboos and their perceived reasons among pregnant women in Ethiopia to provide comprehensive and precise evidence for decision making.

Electronic search of the literature was made from Pub-Med, Google Scholar, Google Scopus, and Medline databases using search terms set based on the PICO/PS (Population, Intervention/exposure, Comparison, and Outcome) and PS (Population and Situation) search table. The search was made from December 05, 2020 – December, 29, 2021, and updated on January, 2022. All quantitative and qualitative studies published in English were included in the review. The systematic review protocol was registered at INPLASY (Registration number: INPLASY202310078). The outcome of interest was food taboo for pregnant women and its perceived reasons. The results of the review was narrated.

After identifying eighty two articles, thirteen were found eligible for the review. Vegetables, fruits, and fatty foods like meat, and dairy products were considered as taboo for pregnant women in different parts of Ethiopia. The reasons stated for the food taboo vary from fear of having a big baby, obstructed labour, and abortion to evil eye and physical and aesthetic deformities in the newborn.

Conclusions

Though not uniform across the country, there are foods considered as taboo for pregnant women in Ethiopia due to several perceived reasons, misconceptions, and societal influences. This could increase the risk of malnutrition and could have short and long term consequences on both the mother and her growing foetus. Therefore, context specific nutritional counseling with emphasis during ante-natal care and post-natal service is important.

Peer Review reports

Pregnancy is a particular period when physiological nutrient demands are substantially increased. Maternal nutrition guidelines recommend pregnant women to meet this increasing amount and quality of nutrient requirements [ 1 ]. A healthy maternal diet during pregnancy contains adequate energy, fats, proteins, vitamins and minerals, obtained from consuming a variety of food groups including whole grains, vegetables, fruits, legumes, milk, meat, fish, and nuts [ 2 ]. However, in many societies, there are foods considered as taboo for pregnant women. This compromises the ability of pregnant women to meet the recommended dietary intake. It further puts the mother and her newborn at a greater risk of adverse outcomes [ 3 ].

In low and middle income countries like Ethiopia where girls and women usually have unjust access to basic entities like health care and education, maternal undernutrition remains a major concern. Pregnant women in these countries usually have insufficient food intake especially late in the 2nd and 3rd trimesters resulting in poor nutritional status of the mother and her growing fetus [ 4 ]. While dietary intake during pregnancy is affected by several factors including affordability and accessibility of food, restricted eating of some food items because of cultural prohibitions, has also been a prominently reported attribute [ 5 , 6 ].

The extent of the practice of food taboos and the specific tabooed foods vary from one community to another. However, compared to urban and more educated communities, food taboos are generally more common among rural and less educated ones [ 7 ]. Food taboo related information is mainly transferred from people considered highly influential including grandmothers, elders, and experienced mothers. Such highly rated and respected members of a community play central roles in encouraging the public to practice food taboos by spreading information on which specific foods are taboos and why [ 8 , 9 , 10 ].

Undernutrition among pregnant women has been one of the serious public health challenges in Ethiopia. This could be related to the high magnitude of maternal and child mortality in the country [ 11 ]. A study conducted in Western Ethiopia showed that nearly 30% of pregnant women are undernourished (mid upper arm circumference less than or equal to 21 cm) [ 12 ]. Food taboos prevent eating certain food items thus compromising one’s dietary diversity and quality which, in turn, would lead to poor health and nutritional outcomes [ 13 , 14 ]. Evidence shows that food taboos are largely associated with maternal and fetal malnutrition during pregnancy [ 15 , 16 ] and could have consequences on the mothers and their children later in life [ 17 ].

The risk of undernutrition during pregnancy is enhanced due to the physiological increases in nutrient demand and the subsequent incapability to meet this demand by women [ 18 ]. This situation often even gets worse due to the food taboo-related limited dietary intake [ 19 ] increasing the likelihood of developing scores of negative pregnancy outcomes, maternal anemia, and low birth weight (LBW) [ 20 ]. In Ethiopia, about 13.5% of newborns are LBW (birth weight less than 2500 g) [ 21 ]. Such problems during pregnancy could also impose deleterious effects on child survival and economic productivity later in adult life.

Though it is not uniform, the practice of food taboos is a common problem in developing countries. Based on the few studies available in Ethiopia, food taboos prevail with varying type and severity across the different culture and topography of the country. For instance, in Oromia region linseed, honey, and milk/ yoghurt are commonly avoided food items for a perceived fear that these food items would be plastered on the fetal head [ 22 ]. Besides, while organ meat and dark green leafy vegetables were avoided for fear of infection in Addis Ababa [ 23 ], consumption of livestock derived foods was restricted in South nation, nationalities, and people’s region (SNNPR) for fear of difficult delivery that could lead to increasing size of the fetus [ 24 ].

To our knowledge, there is paucity of systematically narrated evidence on food taboos and their perceived reasons among pregnant women in Ethiopia. This review is intended to synthesize information on the main foods considered taboos by pregnant women and their perceived reasons using a systematic search of the available literatures in Ethiopia. This would help to design and implement evidence based interventions.

Searching strategy

A comprehensive search was made from Pub-Med, Google Scholar, Google Scopus, and Medline databases. The search was done using search terms including “maternal dietary practice”, OR “harmful traditional practice on feeding” and “food taboos for pregnant women”, “Impact of food taboo” OR “feeding practice”. These search terms were set using search tables of the PICO (Population, Intervention/Exposure, Comparison, and Outcome) and PS (Population and Situation) for quantitative and qualitative articles, respectively. Besides, reference lists of this systematic review included articles and reviews were also scanned for potential articles. The search was made from December 05, 2020 – December 29, 2021, and updated on January, 2022. All quantitative and qualitative studies published in English were included in the review.

Study selection and data extraction

Studies were identified by searching electronic databases, scanning reference lists of articles, grey literature, and other non-bibliographic sources. Two authors performed the search activities independently. The following information was extracted from each study that met the inclusion criteria: the name of the first author, year of publication, study design, and food taboos and their perceived reasons. The first screening was based on a double-screening of titles and abstracts. Results which met explicit exclusion criteria were excluded. In the second step, the remaining articles were assessed for full-text reading. In case of disagreement among reviewers, a third reviewer assessed the study and a decision for inclusion was reached by consensus. The mean age of the participants and the educational status were extracted from the articles.

Eligibility criteria

Inclusion criteria: all quantitative and qualitative primary research articles published related to food taboos, food prohibitions, and restrictions during pregnancy and perceived reasons. Studies which were not in line with our objectives in terms of abstract, full text content, and duplicated articles were excluded.

During the primary search, 82 records were identified. After screening the title and abstract of the studies, 22 records were excluded leaving 60 records. Again, we excluded 32 duplicate records and only 28 records were left. After assessing the full texts we excluded 15 records using the exclusion criteria. Finally, 13 studies were found to be eligible for this systematic review (Fig. 1 ). The results of the review was synthesized descriptively and presented under the themes.

Flow chart showing the selection of articles included in the systematic review in Ethiopia, 2022

Protocol registry

The systematic review protocol was registered at INPLASY (Registration number: INPLASY202310078).

Assessment on quality of the studies

The studies were assessed using the criteria proposed check list called the Joanna Briggs institute (JBI) critical appraisal for systematic review tool for quality assessment [ 25 ]. The parameters include how the review questions were stated, appropriateness of the inclusion criteria, search strategy, source and resource used to search, criteria for appraising studies, number of authors conducted for appraisal, how errors were minimized in the data, method used to combine studies, assessing publication bias, supporting recommendation for policy /or practice, and use of specific directive approach for new research.

Characteristics of the included articles

Thirteen articles fulfilled the inclusion criteria. The included articles were from Addis Ababa, Tigray, Afar, Oromia, SNNPR, and Amahara Regional states (Table 1 ).

Food taboos and their perceived reasons among pregnant women in Ethiopia

According to a study in Shashemene District of Oromia Region, 147 (49.8%) study participants encountered food taboos at least for one food item [ 22 ]. This study also showed that eating honey during pregnancy was considered a taboo for perceived reasons that it leads to a painful prolonged false labour and that it is also the main cause of constipation during the course of pregnancy [ 22 ]. Besides, according to a study conducted in Addis ababa, linseed, honey, and milk/ yoghurt were found to be restricted during pregnancy for the perception that they could be plastered on the fetal head and result in fatty baby and difficult delivery, fear of abortion, evil eye, and fetal abnormality [ 23 ]. This study also described that pregnancy related food taboos were responsible for avoidance of at least one food item for about a fifth (18.2%) of the study participants [ 23 ]. Another study conducted in Raya Alamata, Tigray region found that eating brassica seed (locally known as “senafiche”), pepper, sugar cane, milk, cheese, honey, meat, banana, tomato, onion, cactus fruit, chickpea, lentils, and roasted grains (locally called “kollo”) were considered as taboos by women during pregnancy for perceived reasons including prolonged labour, difficulty in delivery, abortion and miscarriage, large fetus, and feeling of indigestion [ 28 ].

In a quantitative study from Amhara Region, which reported a 27% practice of food taboos, certain fruits and vegetables such as banana, pimento, cabbage, and sugarcane were considered taboos for perceived reasons including that banana attaches to the head of the fetus, pimento burns the fetus, cabbage disturbs the fetus, and sugarcane increases seminal fluids [ 29 ]. A qualitative study done in rural Tigray found that pregnant women avoided eating food items such as yogurt, banana, legumes, honey, and “kollo” (roasted barley and wheat) because these foods were believed to cause abortion, abdominal cramps in the mother and new-born, prolonged labour, or coating of the fetus’s body [ 30 ]. Another study in Mekelle city reported that around 12% of the pregnant women avoided at least one type of food during their current pregnancy for one or more reasons [ 27 ]. In perception, if a pregnant woman eats leafy vegetables, the leaf passes to the womb and attaches to the baby’s head to form some “particles” that are considered harmful to the child and are even considered to cause immediate death of the new born [ 33 ]. In another study, pregnant women reported avoiding dairy products like yoghurt and cheese, particularly as the gestational age advances, because of the perception that dairy products can pass to the womb and attach to the baby’s head [ 34 ].

In a study in Abeala, Afar region, bread-like foods locally named as “Burkutta”, “Himbassha”, “Bahamo”, and “Mengelle” and roasted grains (“kolo”) were tabooed for pregnant women for perceived reasons of severe bleeding during delivery and remaining painted at the foetus’s head till birth, respectively [ 31 ]. In another study, more than half (55.3%) of the total pregnant women reported food taboo for at least one food item [ 26 ]. On the same note, it is perceived that pregnant woman should avoid eating high fat foods like meat, camel milk and yoghurt, which are locally considered as “good foods”, to prevent the foetus from being large [ 26 , 35 ]. Summaries are depicted below (Table 2 ).

This review revealed that there are foods considered as taboos among pregnant women for several perceived reasons and that such restrictions are higher during the last trimester of pregnancy. Foods considered as taboos among pregnant women in Ethiopia include vegetables, solid foods made of cereals, dairy products, meat, and oil seeds like linseed. The main perceived reasons for such practices were the effect of these foods on increasing the size of the foetus which they supposed could later cause complicated labour and negative birth outcomes and cosmetic effect of some of the foods on the newborn. Similarly, a study from Egypt reported that carbohydrate based food groups were avoided by pregnant women for perceived reasons that they could cause bloating and excessive weight gain in the mother [ 36 ]. Avoidance of these foods may negatively affect the dietary intakes of these women, as dietary diversity recommendations for pregnant women emphasize the need for pregnant women to eat diverse foods with adequate energy, protein, fat, fiber, and micronutrients [ 37 ].

This review has seen some variation in the meaning given to the same food items in differet locations that are considered taboos during pregnancy. This could be due to differences in cultural values and knowledge and experience of highly influential and experienced community figures like grandmothers, elders, or others who spread food taboo related information.

This review showed that pregnant women should avoid eating high fat foods such as meat and milk to prevent from having big foetus that could later lead to difficult labour. This is consistent with a study conducted in Kenya which stated that pregnant women do not usually eat meat for fear of having obstracted labour [ 38 ]. Such taboos related to animal source of foods (ASF) might lead to poor pregnancy weight gain and increase the risk of giving birth to a low birth weight baby. Moreover, low consumption of ASFs during pregnancy could also lead to protein, energy, and micronutrient deficiencies, as these foods are also good sources of many bioavailable micronutrients [ 39 ].

The fear of having big baby and difficult labour, abortion, placental disruption was documented in studies conducted in Aligarh, India, in which pregnant women were supposed to avoid papaya, fish, badi food (which cause gas in stomach), citrus foods, groundnuts, and tea [ 40 ] and in Ghana in which eggs, fresh meat, fresh mik, and cold and sugary foods were considered taboos for pregnant women [ 41 ]. Another study done in India also reported taboos during pregnancy on sugarcane juice, hot foods, carbonated drinks, tapai or fermented glutinous rice, bamboo shoots, and cold foods for perceived reasons including risk of abortion, excessive bleeding during labour, and deformities in the newborn [ 42 ]. Moreover, a study in Tajikistan described that consumption of carbohydrates during pregnancy leads to excessive weight gain and a risky delivery because high gestational weight gain “makes the baby very big” [ 43 ]. A study among malay pregnant women found out a significant association between practice of food taboos and weekly rates of weight gain [ 44 ].

However, continued exclusion of carbohydrates from the prenatal diet can contribute to maternal under nutrition, which holds additional implications for child health as the primary cause of LBW. The recommended dietary allowance for carbohydrate intake for pregnant women is 175 g per day, which is 45 g more than the recommended dietary allowance for non-pregnant [ 45 ].

Pregnant women are recommended to take extra nutrients than other women physiologically due to the increased basal metabolic rate by 10 – 15 percent and energy needed, especially from 20 weeks later, for the growing foetus and for the placenta [ 46 ]. The raised energy requirements are maintained by foods containing carbohydrate, protein, fat, vitamins, and minerals by adding one extra meal on the normal meal sequence. However, this review revealed that some pregnant women are restricted from consuming vegetables, grains, ASFs and fiber rich foods due to the stipulated taboos in the community. This could lead the mother to burn its own fat and then its tissue proteins which further could lead to energy deficiency. Besides, restricting fiber rich foods like linseeds and legumes could lead to constipation and other disturbances of the colon. Moreover, denying ASFs like milk and meat during pregnancy could result in retardation of growth of the foetus and its future wellbeing. Therefore, the role of food taboos could be of paramount importance in the challenges faced during the prevention of malnutrition in the first one thousand days of life. This implies the need for unreserved effort for the implementation of nutritional social behavioral change and communication strategies to mitigate the practice of food taboos and their consequences during pregnancy.

The systematic review’s methodological quality and its efforts in dealing with possible bias in its design and/or analysis was assessed and deemed appropriate using the JBI critical appraisal tool [ 25 ]. The review question was clearly and explicitly stated as food taboos and their perceived reasons among pregnant women in Ethiopia. The inclusion criteria were appropriate in a way they match the review question. Articles were identified appropriately using a comprehensive electronic search strategy using relevant terms, sources, and resources. Critical appraisal of the review was conducted by two independent reviewers. To minimize bias in data extraction, training was provided to the authors and searching and data extraction were made two times by separate individuals. Methods used to synthesize results are in harmony with the methodology used. Besides, the findings were supported with clear summary descriptions and explanations taken from the original articles. The findings of the review are able to lead to policy recommendations. This review has recommended researchers to expand the geographical scope of the study and to work on behavioral change interventions to mitigate food taboos and their effects on maternal and child nutrition.

Strengths and limitations of the review

This review had its strengths and limitations. Its main strength is the fact that it used clearly specified inclusion and exclusion criteria and a comprehensive search strategy to minimize publication bias. The most notable limitation of this review is that it couldn’t present numbered outcomes or effects because it didn’t conduct a meta-analysis of the studies. Besides, the articles included in this systematic review do not represent all regions of Ethiopia.

This review found out that, in Ethiopia, food taboos among pregnant women exist with varying features and for several perceived reasons. Such practices are leading pregnant women in Ethiopia to miss foods which provide critical nutrients for themselves and for the growth of their foetus. As a solution to deal with these practices, studies set out that guided context specific nutritional counseling with emphasis during ante-natal care and post-natal service on the dietary practices of pregnant women is an effective approach. Moreover, conducting community based interventional studies could help in providing targeted and specific nutritional interventions in the country.

Availability of data and materials

All data regarding this systematic review are contained and presented in this document.

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Acknowledgements

The authors of this study would like to acknowledge the researchers whose articles have been used to produce this review.

This study did not receive any specific funding.

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Department of Nutrition and Dietetics School of Public Health, College of Health Sciences, Mekelle University, Tigray, Ethiopia

Hadush Gebregziabher, Amaha Kahsay, Fereweini Gebrearegay, Kidanemaryam Berhe & Gebretsadkan Gebremedhin Gebretsadik

Department of Public Health, College of Medicine and Health Science, Adigrat University, Tigray, Ethiopia

Alem Gebremariam

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HG conceptualized the study. AK, FG, KB, AG and GG designed the study and performed the literature search, selection, analysis, writing and reviewing the manuscript. Finally, all authors read and approved the final manuscript.

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HG: BSc in Public Health, MPH in Public Health Nutrition; AK: BSc in Public Health, MPH in Public Health Nutrition, FG: BSc in Public Health, MPH in Public Health Nutrition, KB: BSc in Public Health, MPH in Public Health Nutrition, AG: BSc in Public Health, MPH in Epidemiology, PhD in public health. GG: BSc in Public Health, MSc in Dietetics.

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Gebregziabher, H., Kahsay, A., Gebrearegay, F. et al. Food taboos and their perceived reasons among pregnant women in Ethiopia: a systematic review, 2022. BMC Pregnancy Childbirth 23 , 116 (2023). https://doi.org/10.1186/s12884-023-05437-4

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Helping children eat healthier foods may begin with getting parents to do the same, research suggests

Assistant Professor of Marketing, Indiana University

Ben L. Fryrear Chair in Marketing and Associate Professor of Business Administration, University of Pittsburgh

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Kelley Gullo Wight receives funding from the Duke-Ipsos Research Center & Think Tank.

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Most parents, educators and policymakers agree that children should eat healthy foods. However, our peer-reviewed paper suggests the strategy adults often use to achieve that can sometimes backfire . Fortunately, there’s an easy fix.

We , along with fellow marketing scholars Lingrui Zhou and Gavan Fitzsimons , conducted five experiments with over 3,800 parents as well as 10 in-depth interviews. We found that parents tend to choose unhealthy foods for themselves after choosing a healthy meal for their young children. This happens because parents said they are uncertain whether their child will eat their healthy dishes, and so they use their own meal as backup to share to ensure that their child at least eats something.

This dynamic is not ideal. For one, it could result in parents eating unhealthier foods, and children may also end up eating unhealthily if they eat mostly from their parent’s plate. Additionally, it does not set a good example of healthy eating.

How, then, to change this dynamic?

After testing several interventions, one stood out as particularly simple and effective: nudging parents to think of their meals as their own, rather than backup options for their kids.

We partnered with a nursery school that was interested in promoting healthier eating among children. Parents associated with the school were offered a free family dinner. Parents first chose a meal for their child from a healthy kid’s menu. They then chose a meal for themselves from a menu that had a mix of healthy and unhealthy options. Half of the parents – randomly assigned – saw a menu that prompted them to think of their own meal as “for you and only you!” The other half did not see this additional prompt to think of their own meal as only for them.

This intervention was successful: By encouraging parents to think of their meal as their own, it made about a third more likely to choose the healthy option for themselves.

Our findings suggest policymakers and schools may want to consider the role parents – and their food choices – play in efforts to encourage healthy eating among children. As for parents, we suggest nixing the backup plan and making sure both they and their children are eating nutritiously.

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Food taboos: their origins and purposes

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Several studies have explored the close affinity between religion and food. It is evident from such studies that food plays a ritual role in most world religions. On the social level, food creates group identity and offers reasons for group interaction. Studies have also shown that food preferences are culture-specific. As a result, nearly all societies have rules on what may or may not be consumed. This selection and/or rejection of food substances have been described by many as ‘food taboo’. Nonetheless, the term in its strictest sense may present some conceptual challenges, and thus require some considerable review. This paper reviews the shades of meaning of the concept of ‘food taboo’ and the difficulty it poses in food discourse within the broad spectrum of religion. In the main, the paper provides a functional definition of ‘food taboo’ but proposes a shift in paradigm from merely considering the prohibitions associated with food to an exploration of the guiding principles un...

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Comparing food taboos across 78 cultures, this paper demonstrates that meat, though a prized food, is also the principal target of proscriptions. Reviewing existing explanations of taboos, we é nd that both functionalist and symbolic approaches fail to account for meat’ s cross-cultural centrality and do not reè ect experience-near aspects of food taboos, principal among which is disgust.

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Gadhave earns ‘new innovator’ research award from Foundation for Food and Agriculture Research

Texas a&m agrilife research scientist is developing next-generation pest management tool.

April 3, 2024

Kiran Gadhave, Ph.D., Texas A&M AgriLife Research entomologist, has been selected as one of 11 recipients of the New Innovator in Food and Agriculture Research Award from the Foundation for Food and Agriculture Research , FFAR.

An assistant professor within  Texas A&M’s Department of Entomology  with a multidisciplinary background in conducting basic, applied and translational research in insect vector-plant virus and plant-microbe interactions, Gadhave is stationed at the Texas A&M AgriLife Research and Extension Center in Amarillo .

The award seeks to promote the career advancement of highly creative and promising new scientists who intend to make long-term career commitments to researching food and agriculture. Recipients should initiate innovative, ground-breaking research and provide thought leadership for challenges facing food and agriculture, according to FFAR.

Gadhave’s project selected for award by FFAR, funded at almost $500,000, is to develop an integrated pest management tool to offer a next-generation breakthrough solution to one of the largest hindrances to expanding specialty crop production in the Texas Panhandle — tomato spotted wilt virus and thrips.

But his research findings will impact beyond that region. Gadhave’s research will pave a new way to use independent-mobile RNA, or iRNA, as a tool against a broad spectrum of pest-pathogen threats in multiple specialty and staple food crops worldwide. He is developing a type of RNA that can deliver targeted therapeutics specifically tailored against viruses and thrips.

Gadhave described the process as preventive, almost like vaccinating plants prior to infection, as well as curative. This novel approach is economically viable, environment-friendly and can be used in multiple integrated pest management programs.

“Dr. Gadhave’s proposed work aligns with the AgriLife Research agency’s mission of supporting the production of high-quality food while protecting the environment and fostering economic viability in production agriculture,” said G. Cliff Lamb, Ph.D., director of AgriLife Research, Bryan-College Station.

Tackling a major pest to the specialty crop industry

Tomato spotted wilt virus is an agricultural pandemic pathogen that infects over 1,000 specialty and staple food crops worldwide. Among the specialty crops, novel strains of the virus have been of particular concern to tomato and pepper plants, reported in at least 10 countries so far. It causes over $1 billion in crop losses each year in the U.S. alone.

The virus’ predominant vector is western flower thrips, which are a pest of economic importance as well. Together they present a substantial dual threat to crops, Gadhave said. 

The problem is current pest management strategies are failing, he said. Resistant plants no longer offer full resistance against the virus because new variants are overcoming the genetic protection. 

“Our RNA therapy research is based on virus-induced gene silencing, or VIGS,” he said. “This allows the delivery of targeted therapeutics that are highly specific against the virus and thrips directly at the site of virus replication.”

Gadhave contributed to developing the technology, licensed by Silvec Biologics, in citrus in his position prior to joining AgriLife Research. 

Building on research

Gadhave said this research will lay a strong foundation for understanding the mechanisms that drive vector-virus-plant interactions and for developing an economically viable and environmentally safe next-generation pest management tool.

The multi-year research will include collaborations with Silvec Biologics and Texas A&M College of Agriculture and Life Sciences professors Jeanmarie Verchot, Ph.D., Department of Plant Pathology and Microbiology , and Kevin Crosby, Ph.D., AgriLife Research vegetable breeder and plant geneticist, Department of Horticultural Sciences .

The FFAR-funded research continues after promising results were obtained by Gadhave, Verchot and Crosby in a seed project on tomato spot wilt virus funded by AgriLife Research.

A novel tomato spot wilt virus reverse genetic system currently being developed by the Verchot lab will be tailored to tomato spot wilt virus RB strains from Texas, California and Mexico identified by Gadhave and used to rigorously test the efficacy of RNA therapy.

The iRNA compatibility with regionally adapted tomato spot wilt virus resistant tomato and pepper germplasm from Crosby’s program will be assessed.

The results will generate proof-of-concept efficacy data that will enable this technology to move from the lab/greenhouse through the regulatory pipeline, into the private sector for commercialization and to the hands of the growers. Gadhave said the tool has tremendous translational and commercialization potential.

Gadhave background

Gadhave earned his doctorate in microbial ecology/entomology from the University of London, a master’s in plant breeding and genetics from Cornell University, and a master’s in entomology from Tamil Nadu Agricultural University.

Prior to coming to Texas, he was a research scientist in the Department of Microbiology and Plant Pathology at the University of California, Riverside.

Gadhave was awarded the Comstock award from the Entomological Society of America and named a Fellow of the Royal Entomological Society for his significant contributions to entomology, especially for his work on the development of novel iRNA-based tools for crop protection and improvement.

His work has been published in interdisciplinary journals, including the Journal of Pest Science , Viruses , Virus Research , Frontiers in Plant Science , Frontiers in Microbiology and Microbial Ecology .

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Study finds that bees need food up to a month earlier than provided by recommended pollinator plants

New research from the Universities of Oxford and Exeter has revealed that plant species recommended as ‘pollinator friendly’* in Europe begin flowering up to a month too late in the spring to effectively contribute to wild bee conservation. This ‘hungry gap’ results in low colony survival, however enhancing existing hedgerows with early blooming species could be an effective strategy to combat this. The findings have been published in the journal Insect Conservation and Diversity .

The study is the first time that research has quantified the decline in wild bee colony survival and queen production due to a shortage of early season food. The findings demonstrate that pollen and nectar availability during the early colony founding stage is a critical, and previously under-appreciated, factor in bee colony success.

The results give us a simple and practical recommendation to help bees: to enhance hedgerows with early blooming species, especially ground ivy, red dead-nettle, maple, cherry, hawthorn, and willow, which improved colony success rate from 35% to 100%.   Senior author  Dr Tonya Lander , Department of Biology, University of Oxford

Senior author Dr Tonya Lander (Department of Biology, University of Oxford) said: ‘The results give us a simple and practical recommendation to help bees: to enhance hedgerows with early blooming species, especially ground ivy, red dead-nettle, maple, cherry, hawthorn, and willow, which improved colony success rate from 35% to 100%. This approach focuses on existing hedgerows in agricultural land and doesn’t reduce farm cropping area, so can appeal to land managers whilst also providing important conservation outcomes for pollinators.’

The study looked at two example European species: the buff-tailed bumblebee ( Bombus terrestrisi ) and the common carder bee ( B. pascuorum ). These were assessed using the BEE-STEWARD model, which integrates data and runs simulations to predict how changes in different factors may impact bee populations over time. The researchers explored when during the year bumblebee food (pollen and nectar) demand is highest, how colony survival is impacted by periods of food scarcity, how food requirements relate to seasonal changes in colony composition (numbers of adults, eggs, larvae, and pupae), and how availability of early spring-blooming plants affects colony survival and queen production.   

The results showed that bumblebee food demand is highest March to June, and lack of food during this critical period has catastrophic consequences for colony survival and queen production, increasing the risk of local population extinction. March and April are particularly critical months, where a two-week gap in forage availability can result in a 50-87% drop in the production of daughter queens.  

Despite years of pollinator planting and conservation initiatives, pollinators are still in decline around the world. Very early spring flowers are likely to increase bee colony survival and queen production, contributing towards halting and reversing this decline. 

The study ‘Resource gaps pose the greatest threat for bumblebees during the colony establishment phase’ has been published in the journal Insect Conservation and Diversity .

*Plant species recommended for pollinators are those given by the United Kingdom Countryside Stewardship Program and Local Nature Recovery scheme (DEFRA), the United States Department of Agriculture Pollinator Habitat Initiative (USDA CP-42), and the European Union Pollinators Initiative. 

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Natural Products Expo West

NIQ neuroscientists uncover what marketing resonates with women about health, nutrition

02-Apr-2024 - Last updated on 02-Apr-2024 at 19:20 GMT

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“In women’s health, we are seeing so much innovation across the store – from personal care to supplements to even food in terms of really meeting the unique needs that women have,” but which have long been overlooked due to a lack of scientific research on women, Sherry Frey, VP, Total Wellness, NielsenIQ.

For example, she said, “there are a lot of things happening right now in menopause,” for which there are more than 40 associated conditions, but which most women would be hard-pressed to identify more than three.

“What we are finding is more and more brands are innovating for the broader and holistic needs states that consumers have,” and there is a “more authentic and transparent” conversation developing, she added.

She also sees increased innovation and white space for food related to fertility, nursing, pregnancy and women’s digestive health as it relates to skin and brain health.

She added women are often still the gatekeeper for which foods households buy, and each time they move through a different health or life stage, what they buy for themselves and their family evolves – making them a key demographic with which brands should build a relationship.

Many brands are ‘hesitant’ to talk openly about women’s health ​

Despite increased innovation and consumer interest in products that cater to women’s health, many brands are still “hesitant” about how to talk about topics that have long been taboo, Frey said.

“We have a team of brilliant folks [who] measure brainwaves” to see how consumers respond regardless of their biases, Frey said.

“If you asked me, ‘Do you like this?’…there is a bias of what I am going to say when I am doing a survey. But if you are actually monitoring my brain” you can see what parts of the brain “light up” to see if a message resonates or is a turn-off, she said.

What messages resonate with women about health? ​

NIQ’s neuroscience research around women has revealed that women respond positively around their health when they are treated as sexual – but not sexualized – beings, she said.

Women also positively receive messaging that recognizes the research they often conduct and affirms their findings or initial decision, Frey said.

“It resonates so much when women feel that they are being empowered and that they’re already on the right path,” she said.

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Considerations for open-label clinical trials: design, conduct, and analysis

2023 FDA Science Forum

Randomization and blinding are regarded as the most important tools to help reduce bias in clinical trial designs. Randomization is used to help guarantee that treatment arms differ systematically only by treatment assignment at baseline, and blinding is used to ensure that during the trial the two arms are treated the same with differences only arising from the treatment received and not, for example, the expectation or desires of people involved. However, there are times when it is not feasible or ethical to conduct fully blinded trials. This poster reviews what can be done to improve the trial when fully blinding a trial is not considered possible.

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The future of food: Scion hosting new Jooules research scientist

2 April 2024

Scion is helping support what could be the future of food hosting a research scientist for biotech start up Jooules.

Scientist Dr Usama Mukhtar has joined biotechnology research company Jooules as a research scientist and will be based at Scion’s Rotorua headquarters. Jooules aims to pioneer ethical, functional, and resilient protein production, utilising fermentation to convert CO2 and renewable energy into protein for the future.

Founded in April 2022, Jooules is in its growth phase and Mukhtar will provide research to develop Jooules’ technology in the laboratory. His work will include development and analysis of microbial strains, and their cultivation/fermentation protocols and optimising growth of strains of bacteria for use in Jooules’ sustainable food production platform.

Mukhtar recently completed his PhD in Plant Biology at Massey University with a focus on genomics and physiology of plastids and mitochondria. He is originally from Pakistan where he did a bachelor’s degree before moving to the United States where he did a master's degree through Cornell University and undertook various short-term projects, spanning synthetic biology, biochemistry and stem cells.

“I enjoy interdisciplinary work and am always open to new fun challenges. I am looking forward to moving to Rotorua with my partner (Amat) and son (Nuh - 1 year) and enjoying the lakes. Maybe this can motivate me to finally take up mountain biking.”

Scion has had a commercial contract with Jooules since December with staff already doing some work.

Potential for real impact

Jooules’ Chief Scientific Officer Luke Stevenson and Founder David McLellan visited Scion this week. McLellan says Jooules is aiming to create ethical proteins from captured CO2 using a gas fermentation process using thermophilic microbes (capable of growing in extreme temperatures).

“These are ingredients for the future of food.” He says Jooules is ultimately trying to build an efficient protein production platform to transform how food is produced and feed ourselves sustainably.

Stevenson says working with Scion is a clear choice, given Scion's gas fermentation expertise and capabilities. “Gas fermentation is linked to everything we’re doing. That’s where it all starts ... We’ve been impressed by the attitude the Scion team has approached this work with.”

Bioproducts and packaging portfolio leader Alec Foster says the work with Jooules touches on multiple aspects of Scion including fermentation, chemistry and physics. “It leverages off a lot of our capabilities and could have real impacts.”

For more information about Jooules, visit the website: https://www.jooules.com

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Research Identifies Characteristics of Cities That Would Support Young People’s Mental Health

Survey responses from global panel that included young people provide insights into what would make cities mental health-friendly for youth

As cities around the world continue to draw young people for work, education, and social opportunities, a new study identifies characteristics that would support young urban dwellers’ mental health. The findings, based on survey responses from a global panel that included adolescents and young adults, provide a set of priorities that city planners can adopt to build urban environments that are safe, equitable, and inclusive. 

To determine city characteristics that could bolster youth mental health, researchers administered an initial survey to a panel of more than 400, including young people and a multidisciplinary group of researchers, practitioners, and advocates. Through two subsequent surveys, participants prioritized six characteristics that would support young city dwellers’ mental health: opportunities to build life skills; age-friendly environments that accept young people’s feelings and values; free and safe public spaces where young people can connect; employment and job security; interventions that address the social determinants of health; and urban design with youth input and priorities in mind. 

The paper was published online February 21 in  Nature .

The study’s lead author is Pamela Collins, MD, MPH, chair of the Johns Hopkins Bloomberg School of Public Health’s Department of Mental Health. The study was conducted while Collins was on the faculty at the University of Washington. The paper was written by an international, interdisciplinary team, including citiesRISE, a global nonprofit that works to transform mental health policy and practice in cities, especially for young people.

Cities have long been a draw for young people. Research by UNICEF projects that cities will be home to 70 percent of the world’s children by 2050. Although urban environments influence a broad range of health outcomes, both positive and negative, their impacts manifest unequally. Mental disorders are the leading causes of disability among 10- to 24-year-olds globally. Exposure to urban inequality, violence, lack of green space, and fear of displacement disproportionately affects marginalized groups, increasing risk for poor mental health among urban youth.

“Right now, we are living with the largest population of adolescents in the world’s history, so this is an incredibly important group of people for global attention,” says Collins. “Investing in young people is an investment in their present well-being and future potential, and it’s an investment in the next generation—the children they will bear.” 

Data collection for the study began in April 2020 at the start of the COVID-19 pandemic. To capture its possible impacts, researchers added an open-ended survey question asking panelists how the pandemic influenced their perceptions of youth mental health in cities. The panelists reported that the pandemic either shed new light on the inequality and uneven distribution of resources experienced by marginalized communities in urban areas, or confirmed their preconceptions of how social vulnerability exacerbates health outcomes. 

For their study, the researchers recruited a panel of more than 400 individuals from 53 countries, including 327 young people ages 14 to 25, from a cross-section of fields, including education, advocacy, adolescent health, mental health and substance use, urban planning and development, data and technology, housing, and criminal justice. The researchers administered three sequential surveys to panelists beginning in April 2020 that asked panelists to identify elements of urban life that would support mental health for young people.

The top 37 characteristics were then grouped into six domains: intrapersonal, interpersonal, community, organizational, policy, and environment. Within these domains, panelists ranked characteristics based on immediacy of impact on youth mental health, ability to help youth thrive, and ease or feasibility of implementation. 

Taken together, the characteristics identified in the study provide a comprehensive set of priorities that policymakers and urban planners can use as a guide to improve young city dwellers' mental health. Among them: Youth-focused mental health and educational services could support young people’s emotional development and self-efficacy. Investment in spaces that facilitate social connection may help alleviate young people’s experiences of isolation and support their need for healthy, trusting relationships. Creating employment opportunities and job security could undo the economic losses that young people and their families experienced during the pandemic and help cities retain residents after a COVID-era exodus from urban centers.  

The findings suggest that creating a mental health-friendly city for young people requires investments across multiple interconnected sectors like transportation, housing, employment, health, and urban planning, with a central focus on social and economic equity. They also require urban planning policy approaches that commit to systemic and sustained collaboration, without magnifying existing privileges through initiatives like gentrification and developing green spaces at the expense of marginalized communities in need of affordable housing.

The authors say this framework underscores that responses by cities should include young people in the planning and design of interventions that directly impact their mental health and well-being. 

“ Making cities mental health friendly for adolescents and young adults ” was co-authored by an international, interdisciplinary team of 31 researchers led by the University of Washington Consortium for Global Mental Health, Urban@UW, the University of Melbourne, and citiesRISE. Author funding is listed in the Acknowledgements section of the paper.

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Innate food aversions and culturally transmitted food taboos in pregnant women in rural southwest India: separate systems to protect the fetus?

Caitlyn d. placek.

a The Robert Stempel College of Public Health & Social Work, Florida International University, 11200 SW 8th Street, AHC5 505, Miami, FL 33199

b Public Health Research Institute of India, 89/B, Ambika, 2nd Main, 2nd Cross, Yadavagiri, Mysore, India 570020

c Department of Anthropology, Washington State University, 14204 NE Salmon Creek Avenue, Vancouver, WA 98686-9600

Purnima Madhivanan

Edward h hagen, associated data.

Pregnancy increases women’s nutritional requirements, yet causes aversions to nutritious foods. Most societies further restrict pregnant women’s diet with food taboos. Pregnancy food aversions are theorized to protect mothers and fetuses from teratogens and pathogens or increase dietary diversity in response to resource scarcity. Tests of these hypotheses have had mixed results, perhaps because many studies are in Westernized populations with reliable access to food and low exposure to pathogens. If pregnancy food aversions are adaptations, however, then they likely evolved in environments with uncertain access to food and high exposure to pathogens. Pregnancy food taboos, on the other hand, have been theorized to limit resource consumption, mark social identity, or also protect mothers and fetuses from dangerous foods. There have been few tests of evolutionary theories of culturally transmitted food taboos.

We investigated these and other theories of psychophysiological food aversions and culturally transmitted food taboos among two non-Western populations of pregnant women in Mysore, India, that vary in food insecurity and exposure to infectious disease. The first was a mixed caste rural farming population ( N = 72), and the second was the Jenu Kurubas , a resettled population of former hunter-gatherers ( N = 30). Women rated their aversions to photos of 31 foods and completed structured interviews that assessed aversions and socially learned avoidances of foods, pathogen exposure, food insecurity, sources of culturally acquired dietary advice, and basic sociodemographic information. Aversions to spicy foods were associated with early trimester and nausea and vomiting, supporting a protective role against plant teratogens. Variation in exposure to pathogens did not explain variation in meat aversions or avoidances, however, raising some doubts about the importance of pathogen avoidance. Aversions to staple foods were common, but were not associated with resource stress, providing mixed support for the role of dietary diversification. Avoided foods outnumbered aversive foods, were believed to be abortifacients or otherwise harmful to the fetus, influenced diet throughout pregnancy, and were largely distinct from aversive foods. These results suggest that aversions target foods with cues of toxicity early in pregnancy, and taboos target suspected abortifacients throughout pregnancy.

1. Introduction

We report a study in two rural Indian populations designed to test several evolutionary hypotheses regarding the function of pregnancy food aversions and culturally transmitted food taboos. Influential theories of dietary shifts in pregnancy propose that because the fetus is particularly vulnerable to developmental disruption during organogenesis, which occurs early in pregnancy, women evolved to experience physiological aversions in the first trimester towards toxic plant foods ( Hook, 1978 ; Profet, 1995 ). Immunological shifts early in pregnancy that accommodate the developing fetus were thought to increase mothers’ susceptibility to infection, so mothers should also be averse to foods likely to harbor pathogens, such as meat ( Fessler, 2002 ; Flaxman & Sherman, 2000 ). Food aversions and nausea and vomiting in pregnancy (NVP) were therefore hypothesized to be evolved mechanisms that protect women and fetuses, which is commonly referred to as “the maternal-fetal protection” hypothesis ( Patil & Young, 2012 ; for reviews, see Patil, Abrams, Steinmetz, & Young, 2012 ).

Although several lines of evidence support the maternal-fetal protection hypothesis, many of these come from studies in high income countries with a low burden of infectious disease ( Patil, 2012 ). Some studies in populations facing resource scarcity, however, have failed to support it. A study in southern Ethiopia for example, found that pregnant women avoided cereals, which were non-toxic staple foods, but craved meat and other livestock products, which were scarce ( Demissie, Muroki, & Kogi-Makau, 1998 ). In Turkana pastoralists, I. L. Pike (2000) found that NVP was associated with adverse health indicators among both mothers and developing fetuses, contrary to the maternal-fetal protection hypothesis. More generally, some studies have found variation in the timing and types of items that women find aversive, or avoid, in pregnancy, not all of which are consistent with maternal-fetal protection ( Patil, 2012 ; A. G. Young & Pike, 2012 ).

Shifts in dietary preferences might instead be a strategy to diversify nutrient intake for pregnant women with high levels of food insecurity or nutritional deficiencies ( Demissie et al., 1998 ). East African women, for example, have reported aversions towards staple foods, such as maize, and cravings for meat and milk, two foods perceived by women to increase strength, but that are limited due to reduced food availability and low socioeconomic status ( A. G. Young & Pike, 2012 ). South Indian women have reported cravings for pica substances, including mud and chalk, that have questionable health consequences but were directly linked to resource scarcity and psychological distress ( Placek & Hagen, 2013 ).

Culturally transmitted food taboos also shape food choices during pregnancy (e.g., Aunger, 1994 ; Dentan, 1966 ; J. Henrich & Henrich, 2010 ; Placek & Hagen, 2013 , 2015 ). The Semai horticulturalists, for example, avoid unripe fruit in pregnancy because consumption is believed to cause malaria and subsequent fetal death ( Dentan, 1966 ). Aunger (1994) found that for some individuals in the Congo basin, particularly pregnant women, adherence to food taboos reduced caloric intake by up to 9%.

Classic anthropological theory suggests that food taboos could function to protect the environment by limiting resource consumption ( Harris, 1998 ), increase group cohesion by serving as a marker of social identity ( Whitehead, 2000 ), or spread due to symbolic reasoning; e.g. through perceptions of purity and pollution ( Douglas, 2003 ).

Alternatively, food taboos might have culturally evolved to identify dangerous foods. Learning about dangerous foods from parents and other local “experts” reduces costs of individual learning ( Aunger, 1994 , 2000 ; Boyd & Richerson, 1985 ; Boyd, Richerson, & Henrich, 2011 ; Cashdan, 1994 ; Cavalli-Sforza & Feldman, 1981 ; Fessler & Navarrete, 2003 ; J. Henrich & Boyd, 2002 ; J. Henrich & Henrich, 2010 ; Richerson & Boyd, 2005 ). J. Henrich & Henrich (2010) found that in Fiji, pregnancy and postpartum food taboos targeted toxic marine species, likely to protect mothers, fetuses, and nursing infants from harm. More generally, as similar functionality can evolve genetically or culturally ( Boyd & Richerson, 1985 ), functional hypotheses for food aversions, e.g., increasing dietary diversity, could also apply to food taboos.

Cultural information can be transmitted vertically, from parents to offspring; obliquely, from members of the older generation to members of the younger; and horizontally, among siblings, friends, and other members of the same generation. These modes of transmission are favored by genetic natural selection under different environmental conditions. Vertical transmission is expected for behaviors that impact fertility and are under strong selection in stable environments. Oblique learning, on the other hand, allows more rapid adaptation in variable environments ( McElreath & Strimling, 2008 ). J. Henrich & Henrich (2010) argue for the importance of a prestige bias toward oblique learning, finding that women acquired pregnancy food taboos vertically from mothers and grandmothers, and obliquely from mothers-in-law, elders, and prestigious wise women.

The relationship between pregnancy food aversions and taboos has received relatively little theoretical or empirical attention. If aversions and taboos both function to protect mothers and fetuses from dangerous foods, are these the same foods or different foods? Fessler & Navarrete (2003) propose the socially mediated ingestive conditioning hypothesis , in which aversive reactions of individuals to a particular food, such as meat, are observed by others, who then learn to associate that food with an aversive response, avoiding it themselves. Aversions acquired via socially mediated ingestive conditioning can gain moral weight via various mechanisms (e.g., normative moralization or egocentric empathy ; for details, see Fessler & Navarrete 2003 ), leading to a widespread taboo of that food. Under some scenarios, common aversions might become common taboos; under others, idiosyncratic aversions of a few individuals might become common taboos. The few previous studies found little correspondence between food aversions and food taboos ( Aunger, 1994 ; J. Henrich & Henrich, 2010 ), raising doubts about scenarios in which common food aversions become common taboos.

During socially mediated ingestive conditioning, individuals associate a food with an aversive reaction (e.g., “papaya made me sick”). As there is no scientific, let alone cultural, consensus on the functions of pregnancy food aversions (if any), food taboos might be accompanied by explanations that have little or nothing to do with their underlying functionality. Indeed, Fessler & Navarrete (2003) suggest that “investigators would do well to pause before assuming that such cultural rationales are the principal factor motivating the generation, acquisition, and perpetuation of attitudes and behaviors – they are as likely, if not more likely, to be justifications rather than causes” (p. 24).

Alternatively, because physiological cues of toxicity, such as bitterness and nausea, do not reliably indicate teratogenicity, women might have evolved to individually and socially learn associations between foods and poor pregnancy outcomes, independent of their own or others’ aversive reactions ( Hagen, Roulette, & Sullivan, 2013 ; Placek & Hagen, 2015 ), consistent with generic cultural transmission models (e.g., Boyd & Richerson, 1985 ). Under this hypothesis, individual learners would know why they avoided a food, but might or might not transmit this reason to others (e.g., “do not eat papaya because it causes abortion” vs. “do not eat papaya.”).

1 Study goals and predictions

We investigate four major questions: (1) What is the function of pregnancy food aversions, if any? (2) What is the function of pregnancy food taboos, if any? (3) From whom are pregnancy food taboos acquired? (4) If, as several theorists have suggested, aversions and taboos both function to protect individuals from dangerous foods, are these the same foods or different foods? Because pathogen exposure and constrained access to food are key factors in influential theories of aversions and avoidances, we conducted our study in India, a region of high food insecurity and communicable disease.

Currently, 300 million (30%) of India’s rural population is impoverished and lacks access to sufficient foods, basic health care, and education (“India Food Security Portal,” n.d.). In 2012, 41% of Indian deaths were due to communicable disease (“WHO India,” n.d.). Of those with electricity, power outages occur on a daily basis and last for hours ( Wilson, Mignone, & Sinclair, 2014 ). Hence refrigeration, and thus safe food storage, is often absent or unreliable. Finally, India ranks as one the highest in iron deficiency anemia in the world, with rural pregnant women and children at highest risk ( Kalaivani, 2009 ).

In India, health and illness are framed in terms of humoral theory, in which combinations of five elements in the body --- earth, fire, ether, air, and water --- determines one’s constitution, and thus one’s well-being. Pregnancy is considered a period of increased heat in the body during which women must avoid “hot” foods (“hot” does not refer to spiciness or temperature) and only consume “cooling” foods in order to bring internal balance and thus ensure a successful pregnancy outcome ( Nag, 1994 ; Placek & Hagen, 2015 ; Van Hollen, 2003 ).

Placek & Hagen (2015) found that humoral theory had a strong influence on pregnancy diet: South Indian women primarily avoided “hot” foods, mostly fruits but also some meats; often acquired food avoidances via learning; and frequently stated that foods were avoided to prevent fetal or infant harm. Placek & Hagen (2015) also found that pathogen avoidance seemed to best explain avoidance of meat. This study did not systematically distinguish foods that were avoided due to aversive reactions versus those that were avoided due to advice from others, however (instead relying on mothers to make that distinction); did not determine from whom avoidances were learned; and its best-fitting exploratory model of meat aversions used number of household members as an index of pathogen exposure ( McDade, Rutherford, Adair, & Kuzawa, 2009 ), which is an indirect measure at best.

We aimed to improve on Placek & Hagen (2015) by measuring aversive reactions to food photos, creating two separate free-lists of foods that were individually aversive and those that were avoided due to advice from others, determining the sources of dietary advice, the emic reasons for food taboos (“emic”” refers to indigenous concepts; “etic” refers to Western scientific concepts), assessing pathogen exposure with multiple questionnaire items, and including fruits as a priori targets of food taboos.

The word “taboo” derives from the Fijian word “tabu,” which is a culturally transmitted prohibition that, if violated, would bring social or supernatural sanctions. According to local informants at our field site, women who consumed foods they were supposed to avoid would be heavily scolded. Following J. Henrich & Henrich (2010) , we therefore operationalize food taboos as food avoidances and will use the terms food taboo and food avoidance interchangeably (for more discussion, see J. Henrich & Henrich, 2010 ).

We specifically tested the following theoretical models of pregnancy food aversions and avoidances that aim to explain (1) which foods are aversive and avoided, and (2) which women will experience aversions and adhere to avoidances. These theories are not mutually exclusive; all could help explain aversions and avoidances.

Maternal-fetal protection

This model posits that in the first trimester of pregnancy foods that pose a high risk of pathogen and toxin ingestion, such as meat and vegetables, will stimulate aversions, nausea, and vomiting, and be more likely to be avoided ( Fessler, 2002 ; Fessler & Navarrete, 2003 ; Flaxman & Sherman, 2000 ; Profet, 1995 ). We therefore tested if early trimester, nausea, and vomiting predicted aversions to, and avoidances of ethnic, strong, and spicy (ESS) foods (spices are often toxic), vegetables, and meat, but not other food categories (e.g., grains, fruits, sweets).

Pathogen avoidance

We added pathogen exposure and disease susceptibility to the previous model to test if these variables predicted aversions to, and avoidances of meat, but not other food categories.

Exploratory Pathogen Avoidance Model

In an exploratory analysis, Placek & Hagen (2015) found that number of household members, a possible index of exposure to pathogens ( McDade et al., 2009 ), and early trimester of pregnancy were the strongest predictors of meat aversions among village women in Tamil Nadu. To confirm this exploratory result, we tested if higher numbers of household members and early trimester of pregnancy predicted aversions to, and avoidances of meat, but not other food categories.

Dietary diversity

Demissie et al. (1998) proposed that, among pregnant women with limited access to food, aversions to staple foods would increase dietary diversity and access to micronutrients, a hypothesis supported by some studies ( A. G. Young & Pike, 2012 ) but not others ( Placek & Hagen, 2015 ). Accordingly, we tested if higher food insecurity predicted aversions to, and avoidances of staple food items (grains, legumes), but not other food categories.

Social transmission model

Food taboos are hypothesized to protect the environment by limiting resource consumption ( Harris, 1998 ), serve as markers of social identity ( Whitehead, 2000 ), or protect individuals from dangerous foods via social rather than individual learning (e.g., J. Henrich & Henrich, 2010 ). Previous studies found that in some populations pregnancy food taboos functioned to protect mothers and fetuses from dangerous foods, particularly abortifacients ( J. Henrich & Henrich, 2010 ; Placek & Hagen, 2015 ), which in south India are often fruits ( Placek & Hagen, 2015 ); did not closely correspond to aversions ( Aunger, 1994 ; J. Henrich & Henrich, 2010 ); and were acquired vertically from mothers and grandmothers, and obliquely from mothers-in-law and wise women ( J. Henrich & Henrich, 2010 ). We therefore investigated (1) the emic function of taboos, (2) if avoided foods were usually fruits, (3) if dietary advice or pressure from others predicted avoidances of food, (4) if the same foods that were aversive were also avoided, and (5) from whom food taboos were acquired.

Sociodemographic model

Some studies found that dietary aversions vary according to age and education ( Drewnowski, 1997 ; Sanjur, 1982 ). We therefore tested if sociodemographic variables predicted aversions to, and avoidances of any commonly aversive or avoided food categories.

There have been very few studies that systematically compared pregnancy food aversions and avoidances. A final goal of this study was therefore to provide detailed comparisons of their distributions in traditional populations as a foundation for future research.

2 Study Populations

This research took place in Mysore District, Karnataka, India from June to August, 2015. Mysore is located in tropical Southwest India at 12.30° N, 76.65° E., and is about 300 km west of Tiruvannamalai, the site of the research reported in Placek & Hagen (2015) . Mysore district has over 900,000 living in the urban area, and over 1.6 million people in rural villages ( India, 2011 ).

2.1 Rural farmers

The “Rural farmer” population comprised ten rural farming villages in Mysore Taluk (a subdistrict of Mysore), which were typical of most of the rural population of Mysore. Rural farmers raise livestock (dairy cattle and poultry) and crops (ragi, millet, pulses, groundnuts, fruits, and vegetables) ( Divya & Belagali, 2014 ). Some rural farmers work their own farms whereas others are low-paid agricultural laborers. There were a total of thirteen castes and subcastes represented in our sample of rural farmers. Main categories included Scheduled Tribes ( Nayaka ), Scheduled Castes, and several others.

2.2 Jenu Kurubas

The Jenu Kurubas , also referred to as the Kattu Nayaka , are former hunter-gatherers who are honey gatherers by tradition. In 1972, the majority of Jenu Kurubas in Mysore, along with others, were displaced from the forest in the name of development by the Indian government and forced to live in small settlements, apart from other castes and tribal populations ( Roy, Hegde, Bhattacharya, Upadhya, & Kholkute, 2015 ) (the other Nayakas in this study live in mixed-caste farming villages). The Jenu Kurubas primarily work as daily wage agricultural laborers and cultivators, and many are involved in tobacco production. They number around 30,000–35,000 members within the state of Karnataka. Our sample lived in five government-protected hamlets in the eastern section of Mysore district.

Tribal populations in India, such as the Jenu Kurubas , are considered to be the most socially and economically disadvantaged members of society ( Vijayalakshmi, 2003 ). They also differ from other castes in terms of health status, social structure, marital patterns, gender equality, and cultural practices related to maternal health ( Prabhakar & Gangadhar, 2011 ; Vijayalakshmi, 2003 ). One goal of this study was to further investigate similarities and differences between the Jenu Kurubas and the neighboring rural farmers, as well as contribute to the growing literature on cultural transmission in this group ( Demps, Zorondo-Rodriguez, García, & Reyes-García, 2012 ; Demps, Zorondo-Rodríguez, García, & Reyes-García, 2012 ).

The study was a cross-sectional design. Pregnant women completed an interviewer-administered questionnaire in the local language of Kannada that asked about physiological aversions and cultural avoidances, modes of acquisition for avoidances, and consequences of consuming the culturally proscribed items.

3.1 Participants

We recruited pregnant women ( N = 102). Those from rural farming villages ( N = 72) were recruited by female Accredited Social Health Activists (ASHA) and Anganwadi workers. ASHA are trained by the National Rural Health Mission in India to liaise with the public health system, help launch public health programs, and educate women in their communities ( Mission, 2014 ). Anganwadi Centres are run by local workers to improve the nutritional status of women and children. Jenu Kuruba women ( N = 30) were recruited by Peer Health Educators trained by the Public Health Research Institute of India (PHRII). Due to the health workers’ level of community integration and knowledge of pregnancy status within their respective communities, this sample is likely representative of the pregnant women who live in these rural regions.

Participants were given a small amount of money in accordance with local norms. The Institutional Review Boards at Washington State University and PHRII in Mysore reviewed and approved this study. Literate women provided written informed consent, and the others provided verbal consent and thumbprints to satisfy PHRII IRB requirements.

3.2 Outcome Variables

Rating a fixed list of foods has the advantage that all participants rate all foods, but the disadvantage that the list might omit foods that are important for some participants, whereas free-listed foods will likely include all important foods, but not all participants will rate all foods. We therefore used both techniques.

Participants rated each of a fixed set of 31 photographs of foods that were commonly disliked in pregnancy in this region ( Placek & Hagen, 2015 ) and are also thought to be potentially toxic or pathogenic (e.g. meat, vegetables, ESS foods) ( Fessler, 2002 ; Flaxman & Sherman, 2000 ; Profet, 1995 ). They reported their preferences before pregnancy and during pregnancy (two ratings per food), using a 3-point scale: 0=dislike, 1=sometimes like, 2=always like. Independent of the photo rating task, informants provided a potential emic negative consequence of consuming each food for most foods depicted in the photos: “abortion” (miscarriage), “heat”, and “kembara”, a local illness that participants often described as difficulty breathing in infant, or red rashes on the infant’s skin. Some foods, which were compiled in a different South Indian population ( Placek & Hagen, 2015 ), did not have identified negative consequences in these populations.

Participants then free-listed foods that they found “physically aversive,” and described the symptoms caused by each food.

Participants free-listed foods they were avoiding because someone told them to, and then described who told them to avoid each food and the consequences if they consumed it.

We coded all aversive and avoided foods according to Flaxman & Sherman (2000) etic food categories: fruits, meat, non-alcoholic beverages, vegetables, alcoholic beverages, ESS foods, dairy/ice cream, sweets, and grains/starches. In addition, we also distinguished nuts/seeds/legumes; miscellaneous foods such as salt; tobacco; and non-foods (e.g., mud). Each food item listed by each participant was included in only one category.

This coding scheme does not easily accommodate dishes that combine foods from two or more categories. An important example is sambar -- a popular spicy lentil-based vegetable stew in south India -- that is often prepared with chicken, fish, or mutton, and could thus be included in the ESS, meat, nuts/seeds/legumes, or vegetable categories. If a woman explicitly mentioned a meat-based sambar, such as “chicken sambar”, we classified the food as a meat, and if she mentioned “dal sambar” (dal is dried pulse), we classified it as nuts/seeds/legumes. Otherwise, we classified “sambar” as an ESS food. See Placek & Hagen (2015) for more details. For the list of the specific foods assigned to each category, see Table S1 .

3.3 Explanatory variables

Each participant completed a structured questionnaire that included the following items designed to test the models described in the Study Goals and Predictions section.

3.3.1 Maternal-fetal protection

Month of pregnancy.

Self-reported month of pregnancy.

Nausea or vomiting

Self-reported current presence/absence of nausea or vomiting (either=1; neither=0).

Four-item instrument. Two items were from the hand-washing with soap (HWWS) scale ( Curtis, Danquah, & Aunger, 2009 ): In the past seven days, did you HWWS after using the toilet (0=never, 1=sometimes, 2=always)? and before handling food (0=never, 1=sometimes, 2=always)? (We omitted two items that did not apply to primigravida.) The second two items were perception of drinking water cleanliness (unclean=0, clean=1) and existence of a household toilet (no=0 or yes=1). (All toilets were “squat” style.) The total sanitation score was the sum of Z-scores of the HWWS, clean water, and toilet items.

Perceived susceptibility to disease

Three items from the 7-item perceived infectability measure ( Duncan & Schaller, 2009 ): “In general, I am very susceptible to colds, flu and other infectious diseases;” “My immune system protects me from most illnesses that other people get;” and “I have a history of susceptibility to infectious disease.” (Four items were omitted because they did not translate into Kannada .) The score was the sum of all items, which were on a 3-point scale (0=strongly disagree, 1=sometimes agree, 2=strongly agree).

3.3.2 Exploratory Pathogen Avoidance Model

Computed from month of pregnancy (see above).

Household size

Self-reported number living in the household.

3.3.3 Dietary diversity

Food insecurity.

The 6-item short-form household-level food insecurity measure, which assesses one’s access to sufficient foods, is reliable and valid ( Blumberg, Bialostosky, Hamilton, & Briefel, 1999 ), has been used in other studies in India ( Agarwal et al., 2009 ; Ghosh-Jerath et al., 2013 ), and has been used in previous investigations of dietary shifts in pregnancy ( Placek & Hagen, 2013 , 2015 ). The 6 items were summed. Higher scores indicate greater food insecurity.

3.3.4 Social Learning Model

Diet advice.

“To whom do you go to for advice regarding your diet during pregnancy?” Participants free-listed advisors, and the dietadvice score was the number of advisors.

Diet pressure

“Does anyone pressure you to follow certain guidelines for health during pregnancy? If so, who?” The pressure score was the number of free-listed individuals pressuring each participant.

Pregnant social partners

Mothers might acquire avoidances from pregnant social partners. We therefore asked, “Are any of your sisters or friends pregnant?” (yes=1, no=0).

We asked each participant if she knew someone who experienced adverse pregnancy outcomes from consuming a particular food, but only 3 did, so we did not analyze this variable further.

3.3.5 Sociodemographic model

Age in years. Because several Jenu Kuruba women did not know their precise age, research assistants estimated them using year of marriage and year of first pregnancy.

Years of education.

Jenu Kurubas =0, Rural farmers=1.

3.4 Analyses

We tested our a priori models as follows: For each scientific food category, we coded each woman as 1 if she was averse to any food in that category, and 0 otherwise. We then used logistic regression to fit each of our models ( Table 1 ) to the presence/absence of an aversion in each of the top three or four most commonly aversive scientific food categories. For each food category, we ranked the seven models using the Akaike information criterion (AIC), corrected for finite sample sizes (AICc), and then report the top-ranked model ( Burnham & Anderson, 2003 ). We conclude that a model is supported if it is the top AIC-ranked model for the target food(s), and unsupported otherwise. We did the same for the common food avoidances. Akaike weights for each model are reported in the supplementary material . We also explored broad patterns of aversions and the consequences of consuming various foods using hierarchical cluster analysis and by plotting our data.

Variables included in each of the 7 logistic regression models used to test our a priori hypotheses of aversions and avoidances. The Target scientific food categories are those that are predicted to be aversive or avoided according to that model.

Continuous variables were centered at their means and divided by two standard deviations so that regression coefficients represent a 2 SD change, roughly from “low” to “high” values, and are directly comparable to those of binary variables with equal class probabilities, which have a standard deviation of 0.5 ( Gelman, 2008 ). Our main binary variable, Population (Rural farmers vs. Jenu Kurubas ), did not have equal numbers of participants in both groups, but its standard deviation was 0.46, which is reasonably close to 0.5. For logistic regression models we report adjusted odds ratios (OR) and Tjur’s coefficient of discrimination (Tjur’s D) ( Tjur, 2009 ). Tjur’s D equals zero when the model does not discriminate between the two classes, and equals one when it discriminates perfectly. We report 95% confidence intervals on all parameters, and chose α = 0.05.

Statistical analyses and document preparation were conducted with R version 3.3.2 (2016-10-31), using the following packages: AICcmodavg ( Mazerolle, 2016 ), binomTools ( Christensen & Hansen, 2011 ), the heatmap function from NMF ( Gaujoux & Seoighe, 2010 ), ggplot2 ( Wickham, 2009 ), and knitr ( Xie, 2015 ).

Summary statistics of the explanatory variables for the two populations are in Table 2 .

Summary statistics of the explanatory variables by population. Cohen’s d is the effect size of the difference between the two populations; p is the result of a Wilcoxon rank test. Sorted by the absolute value of d. See the Methods section for the definition of each variable.

There were small, non-significant differences between the two populations in mean age, months pregnant, experience of nausea or vomiting, and perceived susceptibility to disease, and the Jenu Kurubas had marginally higher parity and dietary pressure than the rural farmers. There were large, highly significant differences in several variables: Rural farmers received more dietary advice from others and avoided more foods, and had more education and better sanitation (and thus lower exposure to pathogens), whereas the Jenu Kurubas had higher levels of food insecurity. In the combined sample, 57% did not have a toilet in the house. Using the established cutoff ( food insecurity score ≥ 5 on a 6 point scale; Blumberg et al., 1999 ), 31.4% of women were experiencing food insecurity with hunger, the most extreme category.

4.1 Food photo aversion ratings

Comparing the pregnancy ratings to the pre-pregnancy ratings, 41 (40%) women reported a shift in preferences for one or more foods, with 24 (24%) reporting a new disliking for one or more foods in pregnancy, and 26 (26%) a new liking for one or more foods in pregnancy. The most common newly disliked foods were fruits (9), which we had predicted for food taboos but not for aversions. ESS foods were the second most common newly disliked foods (6), consistent with the maternal-fetal protection from plant teratogen model. Meats were only the seventh most newly disliked foods, inconsistent with the maternal-fetal protection from pathogen model. The most common newly liked foods were fruits (15) and grains (7).

For any specific scientific food category, the number of participants who newly disliked a food in that category was low, perhaps because these foods were compiled in a different South Indian population ( Placek & Hagen, 2015 ). We therefore restricted further analyses to the pregnancy ratings only, regardless of pre-pregnancy ratings.

We report the top AIC-ranked logistic regression model ( Table 3 ) for the three most commonly aversive scientific food categories: nuts/seeds/legumes, sweets, and grains. For all AICc values and Akaike weights, see Table S2 .

Logistic regression models of the three most common aversions in the food photo ratings. Displayed are top AIC-ranked models of each aversion. Coefficients are odds ratios (95% CI). Jenu Kurubas are the base level for Population. The last row indicates if the top-ranked model for that food aversion supports an a priori prediction.

Dietary diversity was the top-ranked model of aversions to a staple food category, nuts/seeds/legumes, as predicted, but it had a very small effect size. The Demographic and Null models best predicted aversions to sweets and grains, respectively, but neither effect size was scientifically meaningful.

It was possible that food preferences involved groups of foods that cut across our scientific categories. To explore this possibility we used hierarchical cluster analysis, which identified a group of foods that were more often liked ( Figure 1 , top), and a group of foods that were mostly disliked ( Figure 1 , bottom). The disliked foods were significantly more often identified as causing abortion than the liked foods ( χ 2 = 6.23, p = 0.013), consistent with the maternal-fetal protection hypothesis, but there were no significant differences in heat or kembara between the liked and disliked food groups (results not reported). Chicken, fish, and egg (animal products), formed a distinct cluster of unliked foods that were thought to cause abortion, consistent with the pathogen avoidance model.

Heatmap of ratings of photos of foods (rows) by each participant (columns). Rows and columns clustered using the Euclidean metric and the Ward agglomeration algorithm. Do not like: 0 (dark purple); Sometimes like: 1 (dark yellow); Always like: 2 (bright yellow). Columns annotated by population. Jenu Kurubas : red. Rural farmers: orange. Rows annotated with the emic potential negative consequences of eating that food during pregnancy. Not all foods had identified negative consequences. White cells indicate missing data. The top cluster of foods were generally liked, and the bottom were generally disliked. The bottom cluster included significantly more foods thought to cause abortion (see text).

The cluster analysis also revealed that the two populations have distinct dietary preferences. The left cluster was mostly Jenu Kuruba women, and the right cluster was mostly rural farmer women. Jenu Kurubas mostly liked bitter gourd and bamboo whereas rural farmers mostly did not. Jenu Kurubas also mostly disliked dill whereas the rural farmer women liked it ( Figure 1 ).

4.2 Free-listed aversions

Participants free-listed 156 aversive foods, 47 of which were unique. Grains (primarily rice, a staple) were the most common aversion (29% of participants), consistent with the dietary diversity model, followed by nuts/seeds/legumes (23%). Aversions to ESS foods (16%), primarily sambar , were also common, consistent with the fetal protection model, as were aversions to meat (16%) consistent with pathogen avoidance.

We used AICc to rank our seven logistic regression models ( Table 1 ) for the presence/absence of aversions to the top four food categories. The Maternal-Fetal Protection model was the highest-ranked model of ESS foods, as predicted, and was also the highest ranked model of nuts/seeds/legumes, contrary to predictions; both models had small-to-modest effect sizes. Grain aversions were best predicted by the Exploratory pathogen avoidance model, contrary to predictions, and meat by the Null model, but the effect sizes were not scientifically or statistically significant for either model. See Table 4 .

Top AIC-ranked logistic regression models of the four most common aversions among the free-listed foods. Coefficients are odds ratios (95% CI). Jenu Kurubas are the base level for Population; no nausea or vomiting is the base level for nausea or vomiting. The last row indicates if the top-ranked model for that food aversion supports an a priori prediction.

4.3 Free-listed food avoidances

Participants avoided 333 foods, 55 of which were unique. Fruits (primarily papaya and jackfruit) were the most commonly avoided food category (70%), the pattern found by Placek & Hagen (2015) , followed by vegetables (52%), nuts/seeds/legumes (41%), and meat (41%).

All self-reported reasons for avoiding foods involved negative health outcomes, primarily abortion or kembara , which were frequently linked with fruit; harm to baby and “heat” were important secondary concerns. “Don’t know” was also a common response, especially among the Jenu Kurubas , who also often did not report avoiding any foods based on advice from others, which might indicate some form of individual learning. No reasons for avoiding foods involved resource conservation, protecting the environment, or identity. See Figure 2 , top row.

Top row: Heatmaps showing the consequences of eating avoided foods, by population. Bottom row: Sources of advice about negative consequences of eating avoided foods, by population. The color of each cell represents the count of participant responses for that combination of row and column variables (cross-tabulations). Row and column clusters were computed with the Euclidean metric and the Ward agglomeration algorithm.

The Social Transmission model was the highest ranked model of fruit avoidances, as predicted, with a small-to-modest effect size. None of the other models supported our predictions: Vegetable avoidances were best predicted by the Dietary Diversity model, with a statistically significant effect of modest size; meat avoidances were best predicted by the Null model (population only), with a statistically significant but small effect; and nuts/seeds/legumes were best predicted Null model, but the effect was small and not statistically significant. See Table 5 . For all AICc values and Akaike weights, see Table S3 .

Top AIC-ranked logistic regression models of the four most common avoidances among the free-listed foods. Coefficients are odds ratios (95% CI). Jenu Kurubas are the base level for Population; None is the base level for Pregnant social partners. The last row indicates if the top-ranked model for that food avoidance supports an a priori prediction.

4.3.1 Sources of food avoidances

Women listed all individuals that gave them dietary advice during pregnancy (M = 2.5, SD = 0.8), who we termed “dietary advisors.” The top four most frequently mentioned advisors were mothers, health workers, doctors, and mothers-in-law, who together accounted for 61% of all nominated advisors. For each free-listed avoided food we then asked participants who, if anyone, told them to avoid that food. Mothers, grandmothers, and mothers-in-law were the primary sources of advice against eating specific avoided foods, with abortion and kembara the main reasons among rural farmers ( Figure 2 , bottom row). These female relatives were responsible for 75.9% of all food avoidances. Combined, all family members were responsible for 83.3% of food avoidances.

Participants did not free-list any dietary advisor that was the equivalent of the “wise women” reported by J. Henrich & Henrich (2010) , but doctors, nurses, and health workers are plausibly interpreted as prestigious, knowledgeable sources of dietary information. Combined, these latter sources were responsible for 1.4% of food avoidances. See Figure 3 .

A: Dietary advisors (free-listed). B: The number of food avoidances acquired from each source (free-listed).

We coded dietary advice from fathers, mothers, and grandmothers as vertical transmission; from siblings, siblings-in-law, husbands and friends as horizontal transmission; from parents-in-law and aunts/uncles as oblique transmission; and from everyone else, such as neighbors, health-workers and others of indeterminate age, as horizontal/oblique transmission. Then, across all participants, we computed the percent of “Dietary advisors” and “Food avoidances” that were vertical, horizontal, oblique, horizontal/oblique, or none (i.e., personal experience only). See Figure S1 .

The main difference between populations was the importance of personal experience (the “none” category), which was the source of 24% of Jenu Kuruba food avoidances, but only about 1% of Rural farmer food avoidances. See Figure 3 and Figure S1 .

4.4 Comparing free-listed aversions and avoidances

Participants avoided more than twice as many foods as they found aversive (333 vs. 156). Although the distributions of number of aversions were similar in each population ( Figure 4 ), 15 (50%) of the 30 Jenu Kuruba women were averse to at least one food, whereas 61 (85%) of the 72 rural farmer women were averse to at least one food, a significant difference ( χ 2 = 13.4, 3 = 2.5 × 10 −4 ).

Cumulative distributions of numbers of aversions and avoidances by population.

Among the Jenu Kurubas , the distribution of number of avoidances was similar to that of aversions. Among the rural farmer women, however, there were many more avoidances ( Figure 4 ), indicating an important difference in this culturally transmitted repertoire. Specifically, 18 (60%) Jenu Kurubas avoided at least one food, whereas 70 (97%) rural farmers avoided at least one food, a significant difference (( χ 2 = 24.8, 3 = 6.4 × 10 −7 ).

Aversive foods were rarely avoided, and avoided foods were rarely aversive ( Figure 5 ), and few women were both averse to, and avoidant of, foods in the same scientific category (green bars, Figure 6 ). Note that most women were not averse to, and did not avoid, most food categories ( Figure 6 ), and if they did avoid foods in a category, such as fruits, it was only one or two foods in the category and not all foods. For a list of specific foods avoided in each category, see Table S1 .

Free-listed food aversions vs. avoidances: x- and y-values were the percent of each population ( Jenu Kurubas vs. Rural farmers) avoiding, or averse to, each food. Food labels displayed for foods that were avoided by, or aversive to, at least 10% of women in each population. “None” indicates the proportion of women in each population that either did not avoid, or were not averse to, any food.

Distribution of avoidances and aversions by scientific food category and population. Sorted by the number of avoidances in each scientific category.

Finally, whereas the number of aversions decreased by month of pregnancy, the number of avoidances increased ( Table S4 and Figure S2 ).

5 Discussion

This study examined both pregnancy aversions and avoidances in two neighboring but culturally distinct populations that experienced considerably greater resource stress and infectious disease burden than typically found in high income populations. The Jenu Kuruba women reported higher food insecurity and less education than rural farmer women, however, worse sanitation, fewer food avoidances, and less dietary advice.

The clearest support emerged for the theories proposing that aversions and avoidances both protect fetuses and mothers from foods high in potentially teratogenic plant secondary compounds, yet aversive and avoided foods were largely distinct. There was weaker and less consistent support for theories emphasizing protection from meat-borne pathogens and dietary diversification.

5.1 The function(s) of pregnancy food aversions

We tested 7 a priori models of the presence/absence of aversions and avoidances of foods grouped into 11 scientific categories (e.g., meat, vegetables).

5.1.1 Maternal-fetal protection

In the food photo rating study, the most common foods that were newly disliked in pregnancy were ESS foods (usually sambar, a spicy vegetable stew), as predicted, and fruits, similar to Placek & Hagen (2015) . Although fruits are not typically viewed as containing high levels of plant secondary compounds, many do, even when ripe, and many contain latexes, which are potent allergens and can cause anaphylaxis during pregnancy ( Cipollini & Levey, 1997 ; Placek & Hagen, 2015 ). In addition, compared to the “liked” food cluster ( Figure 1 , top), the “unliked” food cluster ( Figure 1 , bottom) contained significantly more foods thought to cause abortion.

Contrary to the maternal-fetal protection model, the top three aversions in the food photos (not necessarily new aversions) were grains, nuts/seeds/legumes, and sweets, which are either non-meat staple foods or do not contain teratogens (sweets), and none were well predicted by any of our logistic regression models.

For the free-listed aversions, the maternal-fetal protection logistic regression model was the highest AIC-ranked model of ESS foods ( Table 4 ), as predicted, and also of nuts, seeds, and legumes, with moderate effect sizes (Tjur’s D = 0.23 and 0.2, respectively). Although nuts/seeds/legumes were not an a priori food target for fetal protection, seeds and nuts are plant reproductive organs that are often chemically defended ( Zangerl & Bazzaz, 1992 ). The latter result therefore provides some exploratory (not confirmatory) support for the maternal-fetal protection hypothesis.

Taken together, these results support teratogen avoidance as one function of pregnancy food aversions ( Profet, 1995 ), similar to other recent studies ( McKerracher, Collard, & Henrich, 2016 ; Mckerracher, Collard, & Henrich, 2015 ).

5.1.2 Pathogen avoidance

In our sample of women, 57% of whom did not have a household toilet (indicating low levels of sanitation and high pathogen exposure), meats formed a distinct cluster in the food photo ratings (and all were thought to cause abortion), and were among the top four aversive free-listed foods, consistent with the pathogen avoidance model ( Flaxman & Sherman, 2000 ; Fessler, 2002 ). Only 16 (16%) were averse to meat, however, and meat aversions were not well predicted by any of our logistic regression models ( Table 4 ), including our pathogen avoidance model, which assessed sanitation and perceived vulnerability to disease. We also did not replicate our previous finding that trimester and household size predicted meat aversions ( Placek & Hagen, 2015 ).

This mixed support for the pathogen avoidance model could partly be due to the high rate of vegetarianism in India ( Flood, 1996 ), including in our rural farmer population, or inability to afford meat, as in the Jenu Kurubas . If women are already less likely to consume meat prior to becoming pregnant, then pregnancy meat aversions might be unnecessary to protect the fetus. Our sample was also biased toward women in later pregnancy, whereas meat aversions are expected earlier in pregnancy.

5.1.3 Dietary diversity

In our sample, 31.4% of the women were experiencing food insecurity with hunger and the staple food category grains (primarily rice) was among the top aversive categories in both the food photos and free-listed foods, as predicted by the dietary diversity model, and a pattern seen in other populations ( Steinmetz, Abrams, & Young, 2012 ; A. G. Young & Pike, 2012 ). Dietary diversity was also the top AIC-ranked model of aversion to nuts, seeds, and legumes in the food photos, as predicted by this model, but the effect size was too small to be scientifically significant ( Table 3 ).

Aversions to staple foods could support the idea that pregnancy food aversions function to increase dietary diversity ( Coronios-Vargas, Toma, Tuveson, & Schutz, 1992 ), but these aversions were not associated with food insecurity, contrary to predictions. Alternatively, because grain dust can contain pesticides and mycotoxins, which can lead to early labor in pregnancy and other adverse health outcomes ( Douwes, Thorne, Pearce, & Heederik, 2003 ; Kristensen, Irgens, Anderson, Bye, & Sundheim, 1997 ), this pattern could support Profet’s (1995) theory that pregnancy aversions protect against plant teratogens. In summary, our study provided mixed support for the dietary diversification model.

5.1.4 Sociodemographics

Our sociodemographic model, comprising population, age, and education, was the highest AIC-ranked model of aversion to sweets in the food photos, but the effect size was small and not scientifically significant ( Table 3 ). Our study therefore did not find support for the role of these sociodemographic variables in aversions to any food category, contrary to some previous studies ( Drewnowski, 1997 ; Sanjur, 1982 ).

5.2 The function of pregnancy food taboos

Considering the theoretical and empirical attention paid to pregnancy aversions in most studies, striking results of our study included that (1) participants, especially rural farmers, reported more than twice as many food avoidances as food aversions ( Figure 4 ); (2) avoidances shaped diet throughout pregnancy ( Figure S2 ); (3) fruits were most avoided ( Figures 2 & 6 ); (4) avoided foods were largely distinct from aversive foods ( Figure 5 ); and (5) the emic function of pregnancy food avoidances was almost always to protect the fetus from harm, with abortion and kembara the most frequently listed types of fetal harm, and “heat” also common ( Figure 2 ). An important caveat is that some mothers, especially among the Jenu Kurubas , could not identify a function for a particular avoidance, or claimed there was none ( Figure 2 ).

As predicted, social learning was the top AIC-ranked model of fruits ( Table 5 ), the most frequently avoided food category (70% of women avoided fruit). Papaya, the primary avoided fruit (and food) in this study ( Figure 5 ), is a known abortifacient that is widely used to terminate pregnancy across South and Southeast Asia ( Anuar, Zahari, Taib, & Rahman, 2008 ; Boer & Cotingting, 2014 ; Odirichukwu, 2015 ), and is also widely avoided in pregnancy ( Nag, 1994 ; Placek & Hagen, 2015 ; Van Hollen, 2003 ). Jackfruit, avoided by many women in this study, is also linked to abortion ( Morton, 1987 ; Visaria, Ramachandran, Ganatra, & Kalyanwala, 2004 ). Vegetables and nuts/seeds/legumes, which often contain plant teratogens, were also frequently avoided ( Figure 6 ).

Overall, our results strongly support the basic social transmission model of food taboos that emphasizes avoidance of dangerous foods ( Aunger, 1994 ; Boyd & Richerson, 1985 ; Cashdan, 1994 ; Fessler & Navarrete, 2003 ), especially during pregnancy (e.g., J. Henrich & Henrich, 2010 ). None of the emic reasons ( Figure 2 ) were consistent with limiting resource consumption to protect the environment ( Harris, 1998 ) marking social identity ( Whitehead, 2000 ), or any other function.

Meat avoidances were common (41% of women avoided meat), supporting the argument that meat is “good to taboo” ( Fessler & Navarrete, 2003 ), but were not associated with pathogen exposure. Instead, they were best explained by the Null model (population only; Table 5 ), although the Akaike weight for the Fetal protection model (sans pathogen exposure variables) was nearly as large ( Table S3 ). In either case, the effect size was small. Eggs were the most avoided meat ( Figure 5 ), probably reflecting concerns over Salmonella contamination, which is common in South India ( Suresh, Hatha, Sreenivasan, Sangeetha, & Lashmanaperumalsamy, 2006 ). Fessler & Navarrete (2003) also noted that food taboos might be manipulated to benefit certain group members at the expense of others. Pregnant and nursing women have increased caloric requirements. Conceivably, pregnancy meat taboos might restrict access to this valuable resource by some pregnant women, to the benefit of other group members. See the supplementary information for a brief exploratory test of this hypothesis.

Dietary diversity was also the top AIC-ranked model of avoidance of vegetables, with a moderate effect size ( Table 5 ), but vegetables were not an a priori target food for this model: this category contained a staple food -- potatoes -- but also several non-staple foods that would contribute to dietary diversity (only 1 woman was averse to potatoes, and 2 avoided them).

Although the distribution of numbers of aversions was similar in both populations, the rural farmers had many more avoidances ( Figure 4 ). Higher food insecurity might have predisposed Jenu Kurubas to avoid fewer foods, but their food insecurity scores did not significantly correlate with the number of avoidances ( r = 0.18, p = 0.34). Given the relatively short amount of time the Jenu Kurubas have spent in their settlements, it is possible that they have not culturally evolved the repertoire of avoidances that rural farmers have.

5.2.1 Sources of food taboos

Immediate family members were responsible for 83.3% of all specific dietary avoidances, with most, 75.9%, acquired vertically from mothers and grandmothers, and obliquely from mothers-in-law, relatives with a high degree of relatedness to the infant. Although mothers did not free-list any equivalent of older “wise” women outside the family, doctors and health workers were frequently listed as general dietary advisors, consistent with a prestige bias, yet combined they were only responsible for 1.4% of specific food avoidances, contrary to a prestige bias. See Figure 3 .

This heavy reliance on familial sources of dietary advice was strikingly similar to the pattern found by J. Henrich & Henrich (2010) , who nevertheless argued for the important influence of prestigious, knowledgeable older women outside the immediate family. J. Henrich & Henrich (2010) explain this discrepancy as follows: when the cultural evolutionary process is at or near equilibrium, mothers should learn from easily accessible “low cost” family members who have an incentive to help kin, turning to outside sources when far from equilibrium. The Jenu Kurubas , however, are arguably further from equilibrium than rural farmers, yet relied even more heavily on their mothers ( Figure 2 ). In addition, our informants stated that women in our study populations would be expected to follow advice from family members not because they would be more convenient but because they would be more trusted than non-family members.

Mothers-in-law were more influential among rural farmers than Jenu Kurubas ( Figure 2 and Figure 3 ). Rural farmers are traditionally patrilineal and patrilocal, with arranged marriages (Suchitra & Swaminathan, n.d.). In patrilocal Indian societies, mothers-in-law are known to play an influential role in women’s health and reproductive decision making ( Chandran, Tharyan, Muliyil, & Abraham, 2002 ; Char, Saavala, & Kulmala, 2010 ). The Jenu Kurubas have “love marriages” and commonly elope, however, and although this tribe is patrilineal, they are neolocal. Neolocality might explain the reduced influence of mothers-in-law among the Jenu Kurubas .

For a brief discussion of the relative importance of vertical, oblique, and horizontal transmission, see the supplementary material .

In summary, our results provided only mixed support for a prestige bias. Future research on pregnancy dietary advisors should investigate the role of biological relatedness to the infant, trust, and if mothers are selecting among their relatives based on perceived expertise.

5.3 The relationship between aversions and avoidances

Individual women rarely reported aversions and avoidances of the same specific foods ( Figure 5 ), and even infrequently reported aversions and avoidances of the same scientific food categories (green bars in Figure 6 ). In part, this is because most women reported only 1–2 aversive foods ( Figure 4 ). Aunger (1994) identified 15 types of food taboos among ethnic groups living in the Ituri Forest, only three of which involved personal avoidances due to aversive reactions to the food or other idiosyncratic reasons. J. Henrich & Henrich (2010) found no connection between pregnancy food taboos and pregnancy aversions. Thus, despite evidence presented here that aversions and avoidances both protect mothers and fetuses from plant teratogens, aversive and avoided foods seem to be largely distinct. These results cast doubt on scenarios in which common aversions become common avoidances, at least in these populations.

It is possible that more idiosyncratic aversions could culturally evolve into common avoidances via various mechanisms ( Fessler & Navarrete, 2003 ). However, most rural farmer women identified harm to the fetus or infant as the reason for a food avoidance, as did a number of Jenu Kuruba women. For example, although no woman free-listed an aversion to papaya, 51 women avoided it, all but 6 of whom identified abortion or other fetal harm as the reason. Fetal harm could be a post hoc justification ( Fessler & Navarrete, 2003 ), but we think it is more consistent with generic individual and social learning models (e.g., Boyd & Richerson, 1985 ) in which individuals learn an association between consumption of a particular food and a poor pregnancy outcome (e.g., “papaya caused my miscarriage”) and then transmit this information to others, independent of psychophysiological food aversions.

Humans have numerous adaptations to detect toxins, such as bitter taste receptors, nausea, and vomiting. Some substances that are highly toxic are not teratogenic, however, some that have low toxicity are potent teratogens, and some that are teratogenic in one species are not teratogenic in other species. Thalidomide, for example, which belongs to the same chemical family as natural plant glutarimide alkaloids, is tasteless, has low toxicity, is not teratogenic in rodents, and is antiemetic, so it was widely prescribed to pregnant women to treat nausea and vomiting. Tragically, thalidomide turned out to be a potent human teratogen that caused severe birth defects in thousands of children ( R. C. Gupta, 2017 ).

There might therefore have been a selection pressure for adaptations to learn associations between consuming certain foods and poor pregnancy outcomes, independent of bitterness, nausea, and other cues of toxicity (for more discussion, see Hagen et al., 2013 ; Hagen & Sullivan, forthcoming; Placek & Hagen, 2015 ). Such learned associations would presumably be accurate only if the poor pregnancy outcome occurred relatively soon after consumption of a particular food (e.g., within a few days). Socially transmitted warnings about such dangerous foods might or might not include the reason (e.g., “do not eat papaya because it causes miscarriage” vs. “do not eat papaya”). These warnings gain moral weight, we propose, because older women with a direct fitness interest in a good pregnancy outcome, such as mothers, grandmothers, and mothers-in-law, enforce them.

In our view, the rural farmer results are more parsimoniously explained by individually and socially learned associations with poor pregnancy outcomes than by theories that root food avoidances in learned associations with aversive reactions. This is not so different from the US and other populations in which pregnant women are advised to avoid dangerous foods that might not be aversive, such as fish with high levels of methylmercury, a neurotoxin that can disrupt neural development at very low doses ( Mahaffey et al., 2011 ).

Other results are more consistent with Fessler & Navarrete (2003) . Many Jenu Kuruba women could not provide a reason for an avoidance, for example ( Figure 2 ), and the “unliked” food cluster ( Figure 1 ) contained taboo foods that were thought to cause abortion, suggesting a link between aversive and taboo foods. (There were also some discrepancies between the food photo ratings and the free-listed aversions, with some women not liking a food but not free-listing it as aversive. This is probably because in the food photo task women only indicated if they liked or disliked a food, and disliking might not involve a physical aversion, whereas in the free-listed aversion task women only included foods that were physically aversive.) It is likely that aversive reactions and learned associations with poor pregnancy outcomes each play a role in the origins and cultural evolution of pregnancy food taboos.

5.4 Limitations

This study was cross-sectional so it is impossible to know how individual women’s dietary preferences varied over the course of pregnancy. The sample was not a probability sample, and therefore might not accurately represent dietary choices of pregnant women in these populations. Effect sizes for top-ranked models were modest, and the sample size was also relatively small, which would limit our power to detect smaller effects. Women might also have responded in ways they deemed more socially acceptable, which would also introduce bias. Social learning is complex and women might have had a difficult time recalling exactly how they acquired information on diet. Future research could include interviews with “teachers” to help corroborate findings and learn more about the consequences of consuming taboo food items. In addition, women were asked about aversions prior to avoidances, perhaps making them feel like they needed to give distinct responses for each question. However, women were told that it is okay to mention similar items for both questions. Although our categorization of the various sambar dishes did not influence our primary conclusions regarding the importance of the social transmission of food avoidances, it undoubtedly influenced the relative importance of aversions of ESS foods vs. meats. If we had instead classified all sambars as ESS foods, for instance, this would have reduced the frequency of meat aversions. It is possible that our measures of pathogen exposure, based on self-report, did not accurately reflect actual pathogen exposure. Finally, other than papaya, we do not have evidence that avoided foods are in fact harmful to the fetus and/or mother.

6 Concluding remarks

The most common newly disliked foods in pregnancy were plant foods with high levels of defensive chemicals, and aversions to them were associated with early trimester, nausea, and vomiting. Staple foods like rice were also aversive to some women, however, a pattern seen in populations, like ours, with high levels of food insecurity ( Steinmetz et al., 2012 ; A. G. Young & Pike, 2012 ), and which deserves further investigation, perhaps as a strategy to increase dietary diversity. On the whole, though, our results best support the hypothesis that psychophysiological aversions function, in part, to protect fetuses from plant teratogens ( Hook, 1978 ; Profet, 1995 ).

Culturally transmitted food avoidances in pregnancy have been studied much less than food aversions, yet in our study, one of the few to systematically compare them, avoidances outnumbered aversions by more than two-to-one, influenced diet throughout pregnancy, not just in early pregnancy, and their emic function was overwhelmingly to prevent abortion (miscarriage) or other harm to the fetus. Avoidances were largely acquired from mothers, grandmothers, and mothers-in-law, individuals with a direct fitness interest in the infant, and personal experience. Fruits, the most avoided category of foods, included papaya, a known abortifacient, and were best predicted by our social transmission model. Although aversions and avoidances both appeared to protect mothers and fetuses from plant teratogens, they involved almost completely different foods.

In a rural tropical region with a higher burden of infectious disease than most populations in high-income countries, meat avoidances were not uncommon, but neither avoidances nor aversions to meat were associated with exposure to pathogens. Additional dimensions of sanitation, like access to refrigeration, should be assessed, and additional hypotheses for meat taboos should be considered, such as intragroup competition for resources.

Taken together, the results of J. Henrich & Henrich (2010) , whose study was conducted in Fiji, and our results suggest that there might be two systems that protect fetus and infants from dangerous foods: aversions to foods that provide cues of toxicity (and perhaps pathogenicity) early in pregnancy, and culturally acquired avoidances of potential abortifacients throughout pregnancy. Future research should investigate if taboo foods are actually harmful to the fetus or mother and the extent to which they are grounded in learned associations with aversive reactions or poor pregnancy outcomes, or both.

Supplementary Material

Acknowledgments.

Many thanks to the staff at the Public Health Research Institute of India, particularly Fazila and Lakshman, for assistance in data collection; Courtney Meehan, Rob Quinlan, Andrea Wiley, and two anonymous reviewers for numerous helpful comments; and the pregnant women in our two populations who participated in our study.

Funding : This work was supported by the Washington State University Meyer Award and Washington State University Vancouver mini-grant.

8 Data Availability

The data associated with this research are available at doi: 10.5281/zenodo.836844.

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