Social context of child care practices and nutrition in Niger

Summary of published research¹

In 2004-5, Niger suffered a food crisis during which global attention focused on high levels of acute malnutrition among children. In response, decentralised emergency nutrition programmes were introduced into much of southern Niger. However, based on the premise that child malnutrition is a chronic problem with complex links to food production and household food security, Concern Worldwide commissioned a qualitative anthropological study to investigate pathways by which children are rendered vulnerable in the context of a nutritional emergency. The study focused on household-level decisions that determine resource allocation and childcare practices in order to explain why practices apparently detrimental to children's health persist. Data were collected in January and February 2006 in Tahoua and Illela Districts from three major ethnic groups. A range of qualitative methods, e.g. semi-structured interview, direct participant observation, etc, were used to elicit local understanding and coping practices, with triangulation of material from different sources. Sampling was purposive to include households with diverse child nutritional status, livelihood security, subsistence systems, ethnic groups and distance from health services. Current and recent health status was ascertained from children's growth and health records.

Child care practices found to contribute to nutritional vulnerability included poor infant feeding practices, failure to direct high quality foods towards young children, poor hygiene practices and uptake of health services, and failure to dedicate extra resources to sick or failing children. Wider constraints on child-care practices and household decision-making included poverty and livelihood insecurity. This led to risk aversion and constrained decision-making, identity and status, e.g. not selling off a wedding trousseau, intra-household gender relations and bargaining power, and negotiation of beliefs and practices, e.g. cultural norms for infant and child feeding also have deleterious outcomes for child health and nutrition.

According to the authors of the study, child care practices, including intra-household allocation of food and health resources, must be understood within the range of constraints under which parents operate. These include chronic livelihood insecurity, with the concomitant need to maintain productive assets and social and symbolic capital. They also hinge upon power relations within households, with shifts of balance occurring where there is widespread out-migration and polygamy.

There are a number of policy implications of these findings.

• There is a need to invest in understanding the social context.
• It must be a priority to increase women's economic autonomy.
• There is a need to reduce costs of health care for children.
• Support for sustainable dietary improvement for children is critical.

The authors conclude that understanding and responding to the social context of child malnutrition will help humanitarian workers to integrate their efforts more effectively with longer-term development programmes aimed at improving livelihood security. It is now clear to humanitarian workers in Niger that they are dealing with a protracted crisis, which involves moving to a more integrated 'twin track approach' addressing both short-term needs and longer term causes of nutritional vulnerability. The authors argue that adequate prevention activities in the broadest sense must be implemented alongside the treatment programmes, and both should be gradually mainstreamed into health services and livelihood programmes.

¹Hampshire. K et al (2009). The social context of childcare practices and child malnutrition in Niger's recent food crisis. Disasters, 2009, vol 33 (1), pp 132-151