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Breastfeeding and fisheries management: Exploring infant nutrition as a socioeconomic driver in artisanal fisheries of the Philippines
Ocean and Coastal Management 153 (2018) 12–16
Contents lists available at ScienceDirect
Ocean and Coastal Management journal homepage: www.elsevier.com/locate/ocecoaman
Breastfeeding and fisheries management: Exploring infant nutrition as a socioeconomic driver in artisanal fisheries of the Philippines
T
Brooke A. Portera,b,∗ a b
School of Hospitality and Tourism, Auckland University of Technology, Auckland, New Zealand Coral Triangle Conservancy, Taguig, Philippines
A R T I C L E I N F O
A B S T R A C T
Keywords: Breastfeeding Fishing effort Philippines Socioeconomic drivers Infant nutrition Fisheries management
Destructive fishing practices and overfishing are common throughout the Philippine archipelago. This, coupled with a rapidly increasing human population, puts the marine resources at risk as more and more people become reliant upon the fisheries for sustenance. This paper unpicks infant nutritional choices as a potential socioeconomic driver in fishing effort. Research from a larger study focusing on the viability of tourism as a supplemental livelihood for remote artisanal fishing communities in the Philippines unexpectedly exposed five cases of fishing families going into debt to purchase breast milk substitutes for their children. Building upon previous research that has demonstrated the influence of economic need on fishing effort, infant nutritional choices, specifically the unnecessary use of milk substitutes is discussed as a potentially overlooked driver in fishing effort. This paper discusses potential impacts of infant nutritional choices in the context of economic need, population growth and fisheries management.
1. Introduction Limited livelihood opportunities lead to critical dependencies. For coastal communities in the developing world this situation translates to increased or shifting pressures on the fisheries (Kronen et al., 2010; Kleiber et al., 2014; Turner et al., 2007) on declining fisheries (Hilborn et al., 2003; Stobutzki et al., 2006; UNFAO, 2010; Watson et al., 2002). This situation has been documented in the Philippines where fisherfolk are described as among the poorest segments of the population (Green et al., 2003). The rapidly increasing population of the Philippines has led to over-exploitation of the fisheries (Castro and D'Agnes, 2008). Filipino fishing households have a poverty incidence twice that of the national rate (Castro and D'Agnes, 2008). A recent report showed that most small-scale fishermen in the Philippines fall below the national poverty threshold, making it difficult to meet the necessary nutritional food requirements (Ramiscal et al., 2015). Lack of access to diversified economies may lead to resource overexploitation (Kronen et al., 2010). Porter's (2014) research showed economic need to be an influencing factor in fishing effort with some fishermen refusing work because they did not need to do it. Economic need may also influence how people fish (Kronen et al., 2010). Fabinyi (2007) noted that the first response to a declining catch is an increase in fishing effort combined with the use of more “efficient” fishing methods and gears (e.g., dynamite fishing, cyanide fishing). The reduced concept
∗
of long-term consequences and the need for short-term sustenance makes over-exploitation of the resources economically beneficial to fishing families living in poverty (Turner et al., 2007). Malnutrition and food strategies in fishing communities are well studied; however, Béné et al. (2016) note the “lack of focus on nutritionally vulnerable groups such as pregnant women and children” as a point of weakness in the literature (p. 181). Kleiber et al. (2014) noted the significant role of gender in understanding fisheries and marine ecosystems. Noting that fisheries literature often overlooks important determinants such as breastfeeding, Akintola and Fakoya (2017) emphasise its importance in child nutrition in small-scale fishing communities. Poverty causes poorer families to prioritise expenditures. These choices may translate to school drop-outs or changes in family nutrition (see Sobel et al., 2012). Products such as infant formula create a substantial cost for a family living in poverty. Given the economic restrictions of many fishing households, and the negligible cost of breastfeeding, it becomes important to explore the use of breast milk substitutes (BMS) among fishing families in the Philippines, especially in the absence of a restrictive medical condition (e.g., active tuberculosis) or in instances when the mother must be away from the infant (e.g., work responsibilities) (see also Porter and Orams, 2014).
School of Hospitality and Tourism, Auckland University of Technology, Auckland, New Zealand. E-mail address: [email protected].
https://doi.org/10.1016/j.ocecoaman.2017.12.005 Received 6 February 2017; Received in revised form 30 November 2017; Accepted 5 December 2017 0964-5691/ © 2017 Published by Elsevier Ltd.
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(16 years and over) of active fishing households. All participants were provided with a participant information sheet, informed that participation was voluntary and further, that they were able to opt out of any questions or withdraw from the interview at anytime. Verbal or written consent was obtained prior to beginning interviews. Due to potential ethical risks associated with the data set, participant confidentiality was prioritised. Participant names were replaced with numbers in transcription data. The interview questions focused on describing fishing livelihoods, personal environmental footprint of fishing and tourism awareness and willingness to engage in tourism as a supplemental livelihood. The survey instrument did not address infant nutrition. The data discussed in this paper resulted from two scenarios. The first, specific to Victory, was a combination of questions regarding basic living expenses and ability to make ends meet. It is also noted that the researcher was pregnant during these interviews and shared this openly with participants of Victory. The second scenario, specific to Decabobo, was interpreted as a result of having a then 4-month old baby in tow during the interview sessions. The researcher's son was present during the interviews and the presence of a foreign and comparatively “fat” baby inspired some participants to ask about his diet, which, at the time, was exclusively breast milk. This study analyses a limited data subset involving debt and infant nutrition choices. Infant nutrition data first emerged from inductive approach set in a realist paradigm following the six phases of thematic analysis as outlined by Braun and Clarke (2006). The cases presented in this paper have been triangulated with case-specific primary data (e.g., expenses, feelings towards infant nutrition) as well as broader secondary data (e.g., costs of BMS, fisheries data).
1.1. Rationale Resource management requires an understanding of the socioeconomic drivers that influence behaviour and resource use (Kronen et al., 2010) including the role of gender (Kleiber et al., 2014). Given, the current state of the fisheries, identifying the dynamics of marine resource use and the socioeconomic factors driving these uses becomes important for ensuring food security and sustainable livelihoods (Turner et al., 2007). Past research has shown that economic need influences fishing effort (Baticados, 2004; Fabinyi, 2007; Porter, 2014). Thus, operating under the assumption that the use of BMS creates a significant additional need for income (Salud et al., 2009), it is likely that fishing households respond to this type of economic need through an increase in fishing effort. The purpose of this paper is to explore infant nutrition as a potential socioeconomic driver in the fisheries. This is done through an exploration of the literature and reported cases of debt associated with infant nutrition and care choices as they relate to fishing livelihoods and fishing effort in the Philippines. 2. Methods This descriptive paper explores a subset of data from a larger study on the viability of marine tourism as a supplemental livelihood for Filipino fishing communities. Between October 2011 and April 2013, semi-structured interviews were conducted with 42 members of fishing households from three separate fishing communities in the Luzon region of the Philippines (see Fig. 1). In all three communities, purposive and snowball sampling were used to collect data from adult members
3. Results 3.1. Infant care and nutrition Breastfeeding seems a rational choice for low-income families given that it does not require any special equipment (e.g., bottles, potable water for mixing formula) and its ability to provide customised nutrition for at least six months (Pugh et al., 2002). Data from 42 members of fishing households, in three fishing communities (Victory, Dimipac, and Decabobo) in Luzon revealed that the majority of fisherfolk (n = 37) surveyed were able to make ends meet. There were, however, five exceptional cases (over 8%) of members with reported debt. Three respondents were from Barangay Victory in the Pangasinan province and two respondents were from Barangay Decabobo in the Palawan Province. The common thread between all five cases was the use of/ need for BMS to feed young children. These households described the costs associated with infants and young children, primarily the use of BMS, as the causative factor of the debt. For example, one Victory mother cited their weekly income as “not enough because the baby needs milk, vitamins, and diapers”. Another Victory mother said they “ask money from the parents because their child still needs milk”. A Victory father, when asked about his weekly expenses, stated, “I have a new baby boy”, this statement was interpreted as indicating a need for BMS and/or other baby items (e.g., diapers). In Decabobo, two mothers responded that milk was a weekly expense noting that they both only breastfed part time. When asked, the two mothers felt that supplementing with BMS was best for their children. The mothers described by these five cases were not regularly employed, however, did participate in “sideline” activities such as gleaning. It is worth noting that because the participants were not asked specific questions on infant feeding practices, no information was derived on the preparation of formula. Previous evidence suggests families dilute formula products to make them last longer and reduce costs (see Bayanihan para sa MagIna, 2013). Fig. 1. Map of the Philippines. Research sites where semi-structured interviews took place are indicated with arrows. The capital city, Manila is indicated with a circle.
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(see Mendoza, 2013). While it may appear that the distribution of complimentary BMS products is beneficial, it does little to aid those affected. The use or introduction of BMS will cause a decline in a breastfeeding mother's milk supply (Wilde et al., 1995). A secondary concern associated with the use of BMS in remote communities and following natural disasters, is the inability to source clean water necessary for BMS products. Sourcing clean water is an obvious concern following disaster events, yet remains a common challenge within many artisanal fishing communities. In the Philippines, access to indoor plumbing in many fishing households is uncommon. Drinking water (needed for BMS products) must be purchased and transported to households. Due to this issue, among other factors, low-income families may not have the economic means and/or knowledge to support the correct use of BMS products (Barennes et al., 2012). Research has demonstrated that exclusive breastfeeding can prevent common causes of infant death and illness such as neonatal sepsis, pneumonia, and diarrhoea (Hengstermann et al., 2010). Campbell (2008) wrote, “Interrupted breastfeeding and inappropriate complementary feeding heighten the risk of malnutrition, illness and mortality” (p 43). Likewise, Daniels and Adair (2005) suggested, in the Philippines “socioeconomic factors that correlate negatively with breastfeeding would correspond positively with the quality of non-breast milk foods consumed” (p. 2594). An additional factor associated with vulnerable groups is a lack of access to competent medical care and information. Access to quality health care remains an issue in remote fishing communities (Béné, 2003; Pomeroy et al., 2006). Although globally it is accepted that exclusive breastfeeding is the best nutritional choice for infants 0–6 months (American Academy of Pediatrics, 2005; Dewey et al., 2001; WHO, 2015), such information may not be effectively disseminated among vulnerable groups such as fisherfolk. Barennes et al. (2012) documented medical misinformation as a cause for mothers to cease breastfeeding. Similarly, Bayanihan para sa Mag-Ina (2013), described a case in the Philippines in which a woman stopped breastfeeding due to a urinary tract infection at the advice of a doctor. This mother switched to BMS; however, already living in poverty, she could not shoulder the costs of the milk products. She was diluting the BMS with water to make the product last longer. This misuse of BMS resulted in kwashiorkor and bronchopneumonia in her child (Bayanihan para sa Mag-Ina, 2013). Similar to the findings of Barennes et al. (2012), the two women from Barangay Decabobo felt that it was best to supplement with BMS; the families from Barangay Victory did not justify the use of BMS. The unnecessary use of BMS not only creates a direct economic strain on an already vulnerable group (Hengstermann et al., 2010; Sobel et al., 2012), but it may also contribute indirectly to increased family size of households. The postpartum period in which a breastfeeding woman experiences an absence of menses is referred to as lactational amenorrhea. This period has been shown to conserve nutrients in the mother including iron (Dewey et al., 2001). The period of lactational amenorrhea is positively correlated to an increase in child spacing (Simondon et al., 2003). Further, lactational amenorrhea has been described as the most widely used form of birth control (Short, 1992). Relative to vulnerable groups, the benefit of increased child spacing is a reduction in family size. This may be of increased value in developing nations, where family planning options are largely absent. In the Philippines, birth control options are limited due to the influence of the Catholic Church (Hunt, 1992). Unfortunately, the benefits of lactational amenorrhea from exclusive breastfeeding may not be well known within these vulnerable audiences. Given that fisherfolk live a primarily subsistence lifestyle, a larger family size increases the economic and nutritional needs of a household equating to an increased pressure on the fisheries (Manson, 2012). The findings of this study suggest infant nutrition may be an important socioeconomic driver in the fisheries.
3.2. Income The daily income of the Victory participants discussed in this study varied from about $3 - $4 USD per day (see Porter and Orams, 2014), while the participants from Decabobo reported a much lower daily income of $1 USD or less per day (Porter, 2014). Some of the daily nutritional needs of the participants were supplemented with catch. The five cases presented offer some insight into the influence of infant nutrition and care choices in fishing livelihoods. Data on the subject is considered limited as it was outside of the scope of the research project; therefore, the interview instrument did not address the topic of infant nutrition. Thus, the emergence of infant nutrition and care as a socioeconomic driver in eight percent of the cases was notable. 3.3. Fishing effort Fishing effort was collected as part of the larger data set. Participants were asked how much time per day they spent on fishing activities. In general, it was difficult to validate the reported data, as the majority of participants indicated they fished daily, yet they were not fishing during the days of the interviews (and in some cases the day(s) prior); weather was mild at the time of interviews and, therefore, not considered a factor. The Victory participants described fishing an/or gleaning at six to ten hours a day, with one participant specifying that “Sunday, time for drinking, and time for church” were the only exceptions. Decabobo participants reported about half the effort at around five hours per day. 4. Discussion In the Philippines, it is common for a fishing household to earn less than 100 USD per month (Baticados, 2004; Dalabajan, 2009; Porter and Orams, 2014). It is estimated that, if administered correctly, the cost of formula feeding a single infant in the Philippines will cost upwards of 40–80 USD per month (Salud et al., 2009). Thus, the use full time use of BMS, in the recommended amounts, would require around at least half to nearly all of a fishing household's monthly income based on the reported incomes of participants. The correct use of BMS is unlikely due to multiple factors common to remote artisanal fishing communities, such as proper access to health care (Pomeroy et al., 2006), poverty (Béné, 2003) and misinformation about the appropriate use of BMS (Barennes et al., 2012). Additionally, research has shown that nonbreastfed infants have increased rates of hospitalisation (Hengstermann et al., 2010) and medical expenses (Sobel et al., 2012). Given the frequency of poverty within fishing communities in the Philippines, it would seem logical that fishing households would avoid the use of BMS for economic reasons alone. However, there are multiple factors specific to fishing communities that contribute to infant nutrition choices. Largely, the risks associated with being a part of a “vulnerable” group may influence the infant nutrition choices among Filipino fisherfolk. Vulnerable groups are targeted by large food-product corporations (see Barennes et al., 2012; Campbell, 2008; Muller, 1974; Raya, 2008). For example, Barennes et al. (2012) found that mothers in Laos were misusing non BMS-milk products as BMS due to misleading marketing (e.g., a coffee creamer packet with a suckling bear). Another longstanding promotional strategy employed by formula-producing companies has been the complimentary distribution of BMS in hospitals and other venues (Barennes et al., 2012; Muller, 1974; Salud et al., 2009). The complimentary distribution marketing strategy has also been combined with disaster relief efforts (Campbell, 2008). The Philippines, which is subject to over 20 typhoons annually, is an ideal location for such tactics. Bayanihan para sa Mag-Ina Organisation, a Filipino volunteer project aimed at supporting mothers and protecting infants and young children during disaster situations including offering support for breastfeeding mothers, reported multiple incidences of complimentary BMS distributions following Super Typhoon Yolanda/Haiyan in 2013 14
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4.1. Limitations and future implications
References
Data regarding infant nutrition choices was unsolicited as it was not relevant to the originally cited research objectives, hence the data set is limited in size. It is noted that this data on infant nutrition choices was partially affected by the researcher's pregnancy or breastfeeding during the time of data collection (February 2011–April 2013). Also worth mentioning is that the instrument used for data collection did not discriminate gender. Both female and male adult members of fishing households were able to participate, with the majority of the 42 participants being male (76%). Given that four of the five described cases were from female participants, it is likely that a study that solicited responses only from female participants would have elicited more information on infant nutritional choices (see also Kleiber et al., 2014).
Akintola, S.L., Fakoya, K.A., 2017. Small-scale fisheries in the context of traditional postharvest practice and the quest for food and nutritional security in Nigeria. Agric. Food Secur. 6 (1), 34. American Academy of Pediatrics, 2005. Breastfeeding and the use of human milk. Pediatrics 100, 1025–1039. Barennes, H., Empis, G., Quang, T.D., Sengkhamyong, K., Phasavath, P., Harimanana, A., Sambany, E.M., Koffi, P.N., 2012. Breast-milk substitutes: a new old-threat for breastfeeding policy in developing countries. A case study in a traditionally high breastfeeding country. PLos One 7, e30634. http://dx.doi.org/10.1371/journal.pone. 0030634. Baticados, D.B., 2004. Fishing cooperatives' participation in managing nearshore resources: the case in Capiz, central Philippines. Fish. Res. 67, 81–91. Bayanihan para sa Mag-Ina, 2013. Nanay Bayanihan in Maglalambay, Busuanga with Other PGH Doctors. [Facebook post]. 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Philippines fisheries in crisis: a framework for management. In: Coastal Resources Management Project of the Department of Environment and Natural Resources, Cebu City, Philippines, Available from: http://oneocean.org/download/db_files/philippine_ fisheries_in_crisis.pdf, Accessed date: 25 May 2015. Hengstermann, S., Mantaring, J.B.V., Sobel, H.L., Borja, V.E., Basilio, J., Iellamo, A.D., Nyunt-u, S., 2010. Formula feeding is associated with increased hospital admissions due to infections among infants younger than 6 months in Manila, Philippines. J. Hum. Lactation 26 (1), 19–25. Hilborn, R., Branch, T.A., Ernst, B., Magnusson, A., Minte-Vera, C.V., Scheuerell, M.D., Valero, J.L., 2003. State of the world's fisheries. Annu. Rev. Environ. Resour. 28, 359–399. Hunt, C.L., 1992. Catholicism and the Philippine population problem. Journal of Social Issues in Southeast Asia 7, 208–222. Kleiber, D., Harris, L.M., Vincent, A.C., 2014. Improving fisheries estimates by including women's catch in the Central Philippines. Can. J. Fish. Aquat. Sci. 71 (5), 656–664. Kronen, M., Vunisea, A., Margron, F., McArdle, B., 2010. Socio-economic drivers and indicators for artisanal coastal fisheries in Pacific island countries and territories and their use for fisheries management strategies. Mar. Pol. 34, 1135–1143. Manson, J., 2012. Church's Ban on Contraception Starves Families and Damages Ecosystem. National Catholic Reporter 6 February. Available from: http://ncronline. org/blogs/grace-margins/churchs-ban-contraception-starves-families-and-damagesecosystem, Accessed date: 12 July 2015. Mendoza, J., 2013, November 19. Groups Urge Breast Milk for Babies in Storm Shelters. Inquirer News Retrieved from: http://info.babymilkaction.org/velvet. Muller, M., 1974. The Baby Killer: a War on Want Investigation into the Promotion and Sale of Powdered Baby Milks in the Third World (Pamphlet). War on Want, London, UK. Pomeroy, R.S., Ratner, B.D., Hall, S.J., Pimioljinda, J., Vivekanandan, V., 2006. Coping with disaster: rehabilitating coastal livelihoods and communities. Mar. Pol. 30, 786–793. Porter, B.A., 2014. Marine tourism as a Supplemental Livelihood: an Exploration of Remote Fisheries-based Communities in the Philippines. (PhD Thesis). Available from: http://hdl.handle.net/10292/7867, Accessed date: 5 May 2015. Porter, B.A., Orams, M.B., 2014. Exploring tourism as a potential development strategy for an artisanal fishing community in the Philippines: the case of Barangay Victory in Bolinao. Tourism Mar. Environ. 10, 49–70. Pugh, L.C., Milligan, R.A., Frick, K.D., Spatz, D., Bronner, Y., 2002. Breastfeeding duration, costs, and benefits of a support program for low-income breastfeeding women. Birth 29, 95–100. Ramiscal, R.V., Dickson, J.O., Lamarca, N.S.J., Hilario, E.V., Romero, R.O., 2015. Socioeconomic Study of Trawl Fisheries in Samar Sea, Philippines. 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5. Conclusion The Philippines is home to a rapidly growing population, one that remains critically dependent on degraded marine resources. It is understood that the unnecessary use of BMS creates additional expenses and vulnerabilities for fishing families already living a subsistence lifestyle and further contributes to poverty. Sobel et al. (2012) stated “poor families may buy infant formula instead of investing in education or medical care” (p. 178). This paper has carried this idea beyond expenditure prioritization to cost recovery suggesting a positive correlation between the use of BMS and fishing effort. Based on this notion, reducing the use of BMS through exclusive breastfeeding would have short-term and long-term benefits to the fisheries. First, a reduction in the use of BMS could reduce the level of poverty, thus reducing economic need and fishing effort short-term. Second, a reduction in BMS use through exclusive breastfeeding could slow population growth (Short, 1992; Simondon et al., 2003). This would translate to a longterm fisheries benefit. Future research that focuses on documenting the frequency and effects of BMS use, as well as infant care choices (e.g., vitamin, diapers), in fishing households is recommended. Understanding the significance of this correlation may open new doors for fisheries management strategies, such as educational breastfeeding outreach (Salud et al., 2009). In general, management strategies for coastal areas have stagnated. New approaches are necessary to recover what has already been lost and ensure sustainable livelihoods for coastal residents. Understanding the drivers in infant nutrition choices in fishing communities and their effects on fishing effort is urgent in the Philippines and throughout coastal communities in lesser-developed nations. The identification of such factors seeks to provide new information and ultimately new fisheries conservation and management approaches. Funding Part of this research was funded by an AUT student grant. The Coral Triangle Conservancy provided additional in-kind support. Ethical standards The research presented in this paper was covered by AUTEC application number 11/241 and complies with the research laws of the Philippines. Acknowledgements A special thank you to Mark Orams, Michael Lück, and Annette Menez whose input and support contributed to the success of this research. I would also like to thank the anonymous reviewers for their inputs that improved the quality of this article. 15
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Stobutzki, I.C., Silvestre, G.T., Talib, A.A., Krongprom, A., Supongpan, M., Khemakorn, P., Garces, L.R., 2006. Decline of demersal coastal fisheries resources in three developing Asian countries. Fish. Res. 78, 130–142. Turner, R.A., Cakacaka, A., Graham, N.A.J., Polunin, N.V.C., Pratchet, M.S., Stead, S.M., Wilson, S.K., 2007. Declining reliance on marine resources in remote South Pacific societies: ecological versus socio-economic drivers. Coral Reefs 26, 997–1008. UNFAO, 2010. The State of the World's Fisheries and Aquaculture 2010. United Nations Food and Agricultural Organization (FAO), Rome, Italy Available from: http://www. fao.org/docrep/013/i1820e.pdf, Accessed date: 12 May 2015. Watson, R., Zeller, D., Christensen, F., Guénette, S., Sumaila, U.R., Walters, C.J., Pitcher, T.J., 2002. Towards sustainability in world fisheries. Nature 418, 689–695. WHO, 2015. The World Health Organization's infant feeding recommendation. Available from: http://www.who.int/nutrition/topics/infantfeeding_recommendation/en/, Accessed date: 3 September 2015. Wilde, C.J., Prentice, A., Peaker, M., 1995. Breastfeeding: matching supply with demand in human lactation. Proc. Nutr. Soc. 54, 401–406.
Raya, R.R., 2008. The Philippine breastfeeding struggle continues. The Lancet 371 (9615), 794–795. Salud, M.A.L.B., Gallardo, J.I., Dineros, J.A., Gammad, A.F., Basilio, J., Borja, V., Olivé, J.M., 2009. People's initiative to counteract misinformation and marketing practices: the Pembo, Philippines, breastfeeding experience, 2006. J. Hum. Lactation 25, 341–349. Short, R., 1992. Breastfeeding, fertility and population growth. In: Nutrition and Population Links: Breastfeeding, Family Planning and Child Health [Paper no. 11].Geneva, Switzerland: United Nations. Simondon, K.B., Delaunay, F., Diallo, A., Elguero, E., Simondon, F., 2003. Lactational amenorrhea is associated with child age at the time of introduction of complementary food: a prospective cohort study in rural Senegal, West Africa. Am. J. Clin. Nutr. 78, 154–161. Sobel, H.L., Iellamo, A.D., Raya, R.R., Padilla, A.A., Sta Ana III, F.S., Nyunt-u, S., 2012. The economic burden of infant formula on families with young children in the Philippines. J. Hum. Lactation 28 (2), 174–180.
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Contents lists available at ScienceDirect
Ocean and Coastal Management journal homepage: www.elsevier.com/locate/ocecoaman
Breastfeeding and fisheries management: Exploring infant nutrition as a socioeconomic driver in artisanal fisheries of the Philippines
T
Brooke A. Portera,b,∗ a b
School of Hospitality and Tourism, Auckland University of Technology, Auckland, New Zealand Coral Triangle Conservancy, Taguig, Philippines
A R T I C L E I N F O
A B S T R A C T
Keywords: Breastfeeding Fishing effort Philippines Socioeconomic drivers Infant nutrition Fisheries management
Destructive fishing practices and overfishing are common throughout the Philippine archipelago. This, coupled with a rapidly increasing human population, puts the marine resources at risk as more and more people become reliant upon the fisheries for sustenance. This paper unpicks infant nutritional choices as a potential socioeconomic driver in fishing effort. Research from a larger study focusing on the viability of tourism as a supplemental livelihood for remote artisanal fishing communities in the Philippines unexpectedly exposed five cases of fishing families going into debt to purchase breast milk substitutes for their children. Building upon previous research that has demonstrated the influence of economic need on fishing effort, infant nutritional choices, specifically the unnecessary use of milk substitutes is discussed as a potentially overlooked driver in fishing effort. This paper discusses potential impacts of infant nutritional choices in the context of economic need, population growth and fisheries management.
1. Introduction Limited livelihood opportunities lead to critical dependencies. For coastal communities in the developing world this situation translates to increased or shifting pressures on the fisheries (Kronen et al., 2010; Kleiber et al., 2014; Turner et al., 2007) on declining fisheries (Hilborn et al., 2003; Stobutzki et al., 2006; UNFAO, 2010; Watson et al., 2002). This situation has been documented in the Philippines where fisherfolk are described as among the poorest segments of the population (Green et al., 2003). The rapidly increasing population of the Philippines has led to over-exploitation of the fisheries (Castro and D'Agnes, 2008). Filipino fishing households have a poverty incidence twice that of the national rate (Castro and D'Agnes, 2008). A recent report showed that most small-scale fishermen in the Philippines fall below the national poverty threshold, making it difficult to meet the necessary nutritional food requirements (Ramiscal et al., 2015). Lack of access to diversified economies may lead to resource overexploitation (Kronen et al., 2010). Porter's (2014) research showed economic need to be an influencing factor in fishing effort with some fishermen refusing work because they did not need to do it. Economic need may also influence how people fish (Kronen et al., 2010). Fabinyi (2007) noted that the first response to a declining catch is an increase in fishing effort combined with the use of more “efficient” fishing methods and gears (e.g., dynamite fishing, cyanide fishing). The reduced concept
∗
of long-term consequences and the need for short-term sustenance makes over-exploitation of the resources economically beneficial to fishing families living in poverty (Turner et al., 2007). Malnutrition and food strategies in fishing communities are well studied; however, Béné et al. (2016) note the “lack of focus on nutritionally vulnerable groups such as pregnant women and children” as a point of weakness in the literature (p. 181). Kleiber et al. (2014) noted the significant role of gender in understanding fisheries and marine ecosystems. Noting that fisheries literature often overlooks important determinants such as breastfeeding, Akintola and Fakoya (2017) emphasise its importance in child nutrition in small-scale fishing communities. Poverty causes poorer families to prioritise expenditures. These choices may translate to school drop-outs or changes in family nutrition (see Sobel et al., 2012). Products such as infant formula create a substantial cost for a family living in poverty. Given the economic restrictions of many fishing households, and the negligible cost of breastfeeding, it becomes important to explore the use of breast milk substitutes (BMS) among fishing families in the Philippines, especially in the absence of a restrictive medical condition (e.g., active tuberculosis) or in instances when the mother must be away from the infant (e.g., work responsibilities) (see also Porter and Orams, 2014).
School of Hospitality and Tourism, Auckland University of Technology, Auckland, New Zealand. E-mail address: [email protected].
https://doi.org/10.1016/j.ocecoaman.2017.12.005 Received 6 February 2017; Received in revised form 30 November 2017; Accepted 5 December 2017 0964-5691/ © 2017 Published by Elsevier Ltd.
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(16 years and over) of active fishing households. All participants were provided with a participant information sheet, informed that participation was voluntary and further, that they were able to opt out of any questions or withdraw from the interview at anytime. Verbal or written consent was obtained prior to beginning interviews. Due to potential ethical risks associated with the data set, participant confidentiality was prioritised. Participant names were replaced with numbers in transcription data. The interview questions focused on describing fishing livelihoods, personal environmental footprint of fishing and tourism awareness and willingness to engage in tourism as a supplemental livelihood. The survey instrument did not address infant nutrition. The data discussed in this paper resulted from two scenarios. The first, specific to Victory, was a combination of questions regarding basic living expenses and ability to make ends meet. It is also noted that the researcher was pregnant during these interviews and shared this openly with participants of Victory. The second scenario, specific to Decabobo, was interpreted as a result of having a then 4-month old baby in tow during the interview sessions. The researcher's son was present during the interviews and the presence of a foreign and comparatively “fat” baby inspired some participants to ask about his diet, which, at the time, was exclusively breast milk. This study analyses a limited data subset involving debt and infant nutrition choices. Infant nutrition data first emerged from inductive approach set in a realist paradigm following the six phases of thematic analysis as outlined by Braun and Clarke (2006). The cases presented in this paper have been triangulated with case-specific primary data (e.g., expenses, feelings towards infant nutrition) as well as broader secondary data (e.g., costs of BMS, fisheries data).
1.1. Rationale Resource management requires an understanding of the socioeconomic drivers that influence behaviour and resource use (Kronen et al., 2010) including the role of gender (Kleiber et al., 2014). Given, the current state of the fisheries, identifying the dynamics of marine resource use and the socioeconomic factors driving these uses becomes important for ensuring food security and sustainable livelihoods (Turner et al., 2007). Past research has shown that economic need influences fishing effort (Baticados, 2004; Fabinyi, 2007; Porter, 2014). Thus, operating under the assumption that the use of BMS creates a significant additional need for income (Salud et al., 2009), it is likely that fishing households respond to this type of economic need through an increase in fishing effort. The purpose of this paper is to explore infant nutrition as a potential socioeconomic driver in the fisheries. This is done through an exploration of the literature and reported cases of debt associated with infant nutrition and care choices as they relate to fishing livelihoods and fishing effort in the Philippines. 2. Methods This descriptive paper explores a subset of data from a larger study on the viability of marine tourism as a supplemental livelihood for Filipino fishing communities. Between October 2011 and April 2013, semi-structured interviews were conducted with 42 members of fishing households from three separate fishing communities in the Luzon region of the Philippines (see Fig. 1). In all three communities, purposive and snowball sampling were used to collect data from adult members
3. Results 3.1. Infant care and nutrition Breastfeeding seems a rational choice for low-income families given that it does not require any special equipment (e.g., bottles, potable water for mixing formula) and its ability to provide customised nutrition for at least six months (Pugh et al., 2002). Data from 42 members of fishing households, in three fishing communities (Victory, Dimipac, and Decabobo) in Luzon revealed that the majority of fisherfolk (n = 37) surveyed were able to make ends meet. There were, however, five exceptional cases (over 8%) of members with reported debt. Three respondents were from Barangay Victory in the Pangasinan province and two respondents were from Barangay Decabobo in the Palawan Province. The common thread between all five cases was the use of/ need for BMS to feed young children. These households described the costs associated with infants and young children, primarily the use of BMS, as the causative factor of the debt. For example, one Victory mother cited their weekly income as “not enough because the baby needs milk, vitamins, and diapers”. Another Victory mother said they “ask money from the parents because their child still needs milk”. A Victory father, when asked about his weekly expenses, stated, “I have a new baby boy”, this statement was interpreted as indicating a need for BMS and/or other baby items (e.g., diapers). In Decabobo, two mothers responded that milk was a weekly expense noting that they both only breastfed part time. When asked, the two mothers felt that supplementing with BMS was best for their children. The mothers described by these five cases were not regularly employed, however, did participate in “sideline” activities such as gleaning. It is worth noting that because the participants were not asked specific questions on infant feeding practices, no information was derived on the preparation of formula. Previous evidence suggests families dilute formula products to make them last longer and reduce costs (see Bayanihan para sa MagIna, 2013). Fig. 1. Map of the Philippines. Research sites where semi-structured interviews took place are indicated with arrows. The capital city, Manila is indicated with a circle.
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(see Mendoza, 2013). While it may appear that the distribution of complimentary BMS products is beneficial, it does little to aid those affected. The use or introduction of BMS will cause a decline in a breastfeeding mother's milk supply (Wilde et al., 1995). A secondary concern associated with the use of BMS in remote communities and following natural disasters, is the inability to source clean water necessary for BMS products. Sourcing clean water is an obvious concern following disaster events, yet remains a common challenge within many artisanal fishing communities. In the Philippines, access to indoor plumbing in many fishing households is uncommon. Drinking water (needed for BMS products) must be purchased and transported to households. Due to this issue, among other factors, low-income families may not have the economic means and/or knowledge to support the correct use of BMS products (Barennes et al., 2012). Research has demonstrated that exclusive breastfeeding can prevent common causes of infant death and illness such as neonatal sepsis, pneumonia, and diarrhoea (Hengstermann et al., 2010). Campbell (2008) wrote, “Interrupted breastfeeding and inappropriate complementary feeding heighten the risk of malnutrition, illness and mortality” (p 43). Likewise, Daniels and Adair (2005) suggested, in the Philippines “socioeconomic factors that correlate negatively with breastfeeding would correspond positively with the quality of non-breast milk foods consumed” (p. 2594). An additional factor associated with vulnerable groups is a lack of access to competent medical care and information. Access to quality health care remains an issue in remote fishing communities (Béné, 2003; Pomeroy et al., 2006). Although globally it is accepted that exclusive breastfeeding is the best nutritional choice for infants 0–6 months (American Academy of Pediatrics, 2005; Dewey et al., 2001; WHO, 2015), such information may not be effectively disseminated among vulnerable groups such as fisherfolk. Barennes et al. (2012) documented medical misinformation as a cause for mothers to cease breastfeeding. Similarly, Bayanihan para sa Mag-Ina (2013), described a case in the Philippines in which a woman stopped breastfeeding due to a urinary tract infection at the advice of a doctor. This mother switched to BMS; however, already living in poverty, she could not shoulder the costs of the milk products. She was diluting the BMS with water to make the product last longer. This misuse of BMS resulted in kwashiorkor and bronchopneumonia in her child (Bayanihan para sa Mag-Ina, 2013). Similar to the findings of Barennes et al. (2012), the two women from Barangay Decabobo felt that it was best to supplement with BMS; the families from Barangay Victory did not justify the use of BMS. The unnecessary use of BMS not only creates a direct economic strain on an already vulnerable group (Hengstermann et al., 2010; Sobel et al., 2012), but it may also contribute indirectly to increased family size of households. The postpartum period in which a breastfeeding woman experiences an absence of menses is referred to as lactational amenorrhea. This period has been shown to conserve nutrients in the mother including iron (Dewey et al., 2001). The period of lactational amenorrhea is positively correlated to an increase in child spacing (Simondon et al., 2003). Further, lactational amenorrhea has been described as the most widely used form of birth control (Short, 1992). Relative to vulnerable groups, the benefit of increased child spacing is a reduction in family size. This may be of increased value in developing nations, where family planning options are largely absent. In the Philippines, birth control options are limited due to the influence of the Catholic Church (Hunt, 1992). Unfortunately, the benefits of lactational amenorrhea from exclusive breastfeeding may not be well known within these vulnerable audiences. Given that fisherfolk live a primarily subsistence lifestyle, a larger family size increases the economic and nutritional needs of a household equating to an increased pressure on the fisheries (Manson, 2012). The findings of this study suggest infant nutrition may be an important socioeconomic driver in the fisheries.
3.2. Income The daily income of the Victory participants discussed in this study varied from about $3 - $4 USD per day (see Porter and Orams, 2014), while the participants from Decabobo reported a much lower daily income of $1 USD or less per day (Porter, 2014). Some of the daily nutritional needs of the participants were supplemented with catch. The five cases presented offer some insight into the influence of infant nutrition and care choices in fishing livelihoods. Data on the subject is considered limited as it was outside of the scope of the research project; therefore, the interview instrument did not address the topic of infant nutrition. Thus, the emergence of infant nutrition and care as a socioeconomic driver in eight percent of the cases was notable. 3.3. Fishing effort Fishing effort was collected as part of the larger data set. Participants were asked how much time per day they spent on fishing activities. In general, it was difficult to validate the reported data, as the majority of participants indicated they fished daily, yet they were not fishing during the days of the interviews (and in some cases the day(s) prior); weather was mild at the time of interviews and, therefore, not considered a factor. The Victory participants described fishing an/or gleaning at six to ten hours a day, with one participant specifying that “Sunday, time for drinking, and time for church” were the only exceptions. Decabobo participants reported about half the effort at around five hours per day. 4. Discussion In the Philippines, it is common for a fishing household to earn less than 100 USD per month (Baticados, 2004; Dalabajan, 2009; Porter and Orams, 2014). It is estimated that, if administered correctly, the cost of formula feeding a single infant in the Philippines will cost upwards of 40–80 USD per month (Salud et al., 2009). Thus, the use full time use of BMS, in the recommended amounts, would require around at least half to nearly all of a fishing household's monthly income based on the reported incomes of participants. The correct use of BMS is unlikely due to multiple factors common to remote artisanal fishing communities, such as proper access to health care (Pomeroy et al., 2006), poverty (Béné, 2003) and misinformation about the appropriate use of BMS (Barennes et al., 2012). Additionally, research has shown that nonbreastfed infants have increased rates of hospitalisation (Hengstermann et al., 2010) and medical expenses (Sobel et al., 2012). Given the frequency of poverty within fishing communities in the Philippines, it would seem logical that fishing households would avoid the use of BMS for economic reasons alone. However, there are multiple factors specific to fishing communities that contribute to infant nutrition choices. Largely, the risks associated with being a part of a “vulnerable” group may influence the infant nutrition choices among Filipino fisherfolk. Vulnerable groups are targeted by large food-product corporations (see Barennes et al., 2012; Campbell, 2008; Muller, 1974; Raya, 2008). For example, Barennes et al. (2012) found that mothers in Laos were misusing non BMS-milk products as BMS due to misleading marketing (e.g., a coffee creamer packet with a suckling bear). Another longstanding promotional strategy employed by formula-producing companies has been the complimentary distribution of BMS in hospitals and other venues (Barennes et al., 2012; Muller, 1974; Salud et al., 2009). The complimentary distribution marketing strategy has also been combined with disaster relief efforts (Campbell, 2008). The Philippines, which is subject to over 20 typhoons annually, is an ideal location for such tactics. Bayanihan para sa Mag-Ina Organisation, a Filipino volunteer project aimed at supporting mothers and protecting infants and young children during disaster situations including offering support for breastfeeding mothers, reported multiple incidences of complimentary BMS distributions following Super Typhoon Yolanda/Haiyan in 2013 14
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4.1. Limitations and future implications
References
Data regarding infant nutrition choices was unsolicited as it was not relevant to the originally cited research objectives, hence the data set is limited in size. It is noted that this data on infant nutrition choices was partially affected by the researcher's pregnancy or breastfeeding during the time of data collection (February 2011–April 2013). Also worth mentioning is that the instrument used for data collection did not discriminate gender. Both female and male adult members of fishing households were able to participate, with the majority of the 42 participants being male (76%). Given that four of the five described cases were from female participants, it is likely that a study that solicited responses only from female participants would have elicited more information on infant nutritional choices (see also Kleiber et al., 2014).
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5. Conclusion The Philippines is home to a rapidly growing population, one that remains critically dependent on degraded marine resources. It is understood that the unnecessary use of BMS creates additional expenses and vulnerabilities for fishing families already living a subsistence lifestyle and further contributes to poverty. Sobel et al. (2012) stated “poor families may buy infant formula instead of investing in education or medical care” (p. 178). This paper has carried this idea beyond expenditure prioritization to cost recovery suggesting a positive correlation between the use of BMS and fishing effort. Based on this notion, reducing the use of BMS through exclusive breastfeeding would have short-term and long-term benefits to the fisheries. First, a reduction in the use of BMS could reduce the level of poverty, thus reducing economic need and fishing effort short-term. Second, a reduction in BMS use through exclusive breastfeeding could slow population growth (Short, 1992; Simondon et al., 2003). This would translate to a longterm fisheries benefit. Future research that focuses on documenting the frequency and effects of BMS use, as well as infant care choices (e.g., vitamin, diapers), in fishing households is recommended. Understanding the significance of this correlation may open new doors for fisheries management strategies, such as educational breastfeeding outreach (Salud et al., 2009). In general, management strategies for coastal areas have stagnated. New approaches are necessary to recover what has already been lost and ensure sustainable livelihoods for coastal residents. Understanding the drivers in infant nutrition choices in fishing communities and their effects on fishing effort is urgent in the Philippines and throughout coastal communities in lesser-developed nations. The identification of such factors seeks to provide new information and ultimately new fisheries conservation and management approaches. Funding Part of this research was funded by an AUT student grant. The Coral Triangle Conservancy provided additional in-kind support. Ethical standards The research presented in this paper was covered by AUTEC application number 11/241 and complies with the research laws of the Philippines. Acknowledgements A special thank you to Mark Orams, Michael Lück, and Annette Menez whose input and support contributed to the success of this research. I would also like to thank the anonymous reviewers for their inputs that improved the quality of this article. 15
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