Effect of food taboos on prenatal nutrition

ing nutrition becomes a prime opportunity for affecting the physical and mental health of society. We have to live our good or poor nutrition. We all live with our poor, mediocre, or excellent health. BIBLIOGRAPHY Hallman, R. G., "Techniques of Creative Teaching," I. of Creative Behavior, 1 :325, Summer 1967. Rice, E. P., "Social Aspects of Maternity Care," Obst. and Gyn ., 23:307, 1964. Stearns, G., "Nutritional State of the Mother Prior to Conception," I. Amer. M ed. Assn., 168 : 1655, 1958. Wilson, N. L., editor, Obesity, Davis Company, Philadelphia, 1969. Vital Statistics of the Unit ed States, 1962, Volum e I-Natality, Public Health Ser-

vice, U.S. Dept. of Health, Education and Welfare, Washington, D.C., 1964.

SUGGESTED RESOURCES Periodicals

Dairy Council Digest and Nutrition News.

National Dairy Council, III N. Canal St., Chicago, Ill. 60606. Quarterly publications, available free which will help keep you current. Nutrition Today, 1140 Connecticut Ave., N.W., Washington, D.C. 20036. Quarterly publication available free to profes-

sionals. It will keep you abreast of research and new ideas in a very interesting manner. You don't need to be a biochemist to understand it. Booklets and Other Materials

of prenatal life with a large chapter on nutrition. Reiff, F. M., Steps In Home Living, Charles A. Bennett Co., Inc., Peoria, Ill., 1966. This book is written for dull and retarded home economics students in either junior or senior high school. I don't know of another such book. It is a good one. Scrimshaw, N. S. and J. E. Gordon, editors,

Baby food companies - free educational material which can be beneficial if used properly. National Dairy Council - very good material when properly used. Height-weight charts, Mead Johnson Laboratories, Main Office, Evansville, Ind. 47721. Vitamin Manual, Upjohn Company, Kalamazoo, Mich., 88-page booklet with realistic pictures of vitamin deficiency diseases. An interesting reference.

Wyden, P., The Overweight Society, Pocket Books, New York, 1965. This pocketbook is an expose of the obese American Society. It is fun and the students could read it.

Leverton, R. M., Food Becom es You, A Dolphin Book, Doubleday and Co. , Inc., Garden City, N.Y., 1961. Students could read it easily. Good reference. McWilliams, M., Nutrition for the Growing Years, John Wiley and Sons, Inc., 1967. This is a fairly new textbook. It is more readable than most nutrition books. It has good information. It would be a good reference book for your collection. Montagu, A., Life Before Birth, Signet Books, The New American Library of World Literature, New York. This is a pocketbook for lay readers. The students would enjoy it. It is a fascinating account

"Iennie Is A Good Thing," produced by Project Head Start. Available rental free from Modern Talking Picture Service Film Libraries or dist rict offices of Office of Economic Opportunity. An excellent movie; it describes how nutrition can become functional in the lives of preschoolers. The principles may be transferred to other age groups. "Hungry Angels," $5.00 rental fee from Associated Films, Western Division, 25358 Cypress, Hayward, Calif. 94544. This movie is a rather depressing account of the severe malnutrition in deprived children of the world.

Books

Malnutrition, Learning and Behavior,

M.I.T. Press, Cambridge, Mass., 1968. For the Teacher

Movies

EFFECT OF FOOD TABOOS ON PRENATAL NUTRITION Mary Jo Bartholomew and Frances E. Poston Superstitions and taboos about food are as old as history. While many false ideas have given way, nutrition educators will still encounter some which grow out of seeds of truth. An earlier survey of food habits conducted at our clinic revealed varying dietary inadequacies among a group of 50 pregnant women. The entire group failed to meet the National Research Council's requirements for Recommended Daily Dietary Allowances. Each patient was deficient in at least one of the essential nutrients. The adolescent prenatal not only failed to meet the recommendations for pregnancy, but, in addition, failed to meet the requirements for growth and development. This evidence served as stimulus for the present study. Our purpose was to investigate the 'ex(sting food habits and to determine whether or not there was any correlation between present day food taboos and the dietary inadequacies found among our patients. More specifi-

THE AUTHORS are, respectively, Nutritionist, Maternal and Infant Care Project #531, and Nutrition Consultant, Charleston County Health Department, Charleston, S.C. 29401. SUMMER. 1970

cally, did bizarre notions and false beliefs about food interfere with recommended intakes of essential nutrients during pregnancy, chiefly those high in protein, iron, calcium, and vitamins A andC. Since the food habits of an individual tend to reflect those of his environment (1,2), it is important for nutrition educators to recognize differences in regional, national, and religious food customs. Recognizing eating patterns and appreciating their significance, gives us a basis for approaching the multiple avenues leading to effective nutrition education (3, 4). Also, such a survey would give us a clearer appreciation of the backgrounds, tastes, and dietary habits of our patients. Furthermore, the facts gathered would provide us information which would assist in adjusting our present teaching program to more adequately meet individual nutritional needs during the prenatal period. The information presented here

is a description of the findings of our investigation. The 200 subjects selected for dietary evaluation were '3 random sample of pregnant women registered at the Maternal and Infant Care Project Clinic, Medical College of South Carolina, Charleston. The group comprised 160 Negroes and 40 white women ranging in ages from 14 to 46 years. Each prenatal was interviewed individually. Dietary information obtained during the conference was reviewed with the patient by asking various questions designed to reveal idiosyncrasies and peculiar beliefs about food . Responses were recorded and tabulated.

Results and Discussion Table I shows the foods believed to be taboo during pregnancy. Of the 200 patients questioned, 99 voiced a belief and practice in at least one fallacy associated with food while only six (three percent) mentioned more than one they considered factual. On the other hand, there JOURNAL OF NUTRITION EDUCATION / 15

were 101 subjects commenting on various "sayings" about food but also stating that they did not believe in them or put them into practice. Ninety-five percent of the superstitions reported were expressed by Negro women. Age and education did not appear rel ated. However, those living in rural areas tended to exhibit more peculiar food habits than did those living in towns or in the city. Moreover, if a grandmother was living under the same roof, she appeared to be the most influential factor contributing to any peculiar idea which they had about food. Opinions voiced by elders were believed and respected. Existing superstitions seem to be associated with protein and protein rich foods (Table I). According to six women interviewed, drinking milk while pregnant would cause cancer either to the expectant mother or the developing fetus, and they refused to drink it. None could be convinced that there was no scientific evidence supporting this concept. Consequently, an inadequate amount of dietary calcium was being consumed since this belief also included the omission of all dairy products from the diet. This finding also suggested that daily intakes of protein were insufficient to meet the increased demands of pregnancy. "Eating pork during the prenatal period and for one month after the baby is born results in death for the mother," supposedly, by "rotting" the uterus. This belief was the one most frequently practiced, but fortunately, did not interfere with adequate nutrition. The origin of this idea, like others suggested earlier, probably dates back to the days of inadequate refrigeration, and unsatisfactory methods of handling and preparing food. Three percent of the group considered fish to be poisonous to a woman while pregnant because it would also cause "rotting of the womb." Six prenatals believed, "If you are pregnant and eat eggs, sores will get on the \ baby's head and cause its brain to go bad(S)." Thirteen (6.5 'percent) subjects felt that they must not eat cheese to prevent the fetal head from sticking to the womb and causing "a dry labor." Five women also felt that eating peanuts would cause "a dry labor." Ten of the 13 stated that they never drank milk, or if they did, it was far less than the recommended amount of a quart each day. They made it clear, ,however, that this was not for superstitious reasons, but rather a strong 16 / JOURNAL OF NUTRITION EDUCATION

dislike for milk. Other foods containing milk were seldom eaten because they were also disliked. Hence, this custom to eliminate cheese from the diet contributed to low levels of calcium since each of the 13 women stated that she liked cheese but was afraid to eat it. Green leafy vegetables (collards, turnip, mustard) were considered taboo foods by 10 patients because they would "mark the baby." In addition, 6 of the 10 women believed that milk produced cancer(6). Refusing to eat cucumbers "to prevent polio" was mentioned by seven but was of little concern in regards to adequate nutrition intake. The same holds true for the fallacy associated with rice. Eating "rice cake", the crisp, brown, and sometimes scorched portion which forms at the bottom of an over-heated or over-cooked pot of rice, is supposed to bring about a "difficult" labor. The word difficult could not be defined. It is pointed out here that the 12 women relating this belief lived in rural areas and under the same roof with a grandmother. Of these -three were white and nine were Negro. Finally, according to 11 subjects, "To drink diet colas will poison the fetus." Two other patients believed "drinking any beverage, including water, from a bottle will strangle the unborn infant." Professional advice did not change this belief. As stated earlier, our primary concern was to ascertain whether or not existing superstitions about food interposed recommended nutrient intake during pregnancy. The main concentration of our efforts was focused on inadequacies as related to increased demands for protein, iron, calcium, and vitamins A and C during this period. On the whole, our investigation revealed that the poor nutrition found among our patients was due primarily to nutrition ignorance, and secondly, to spe-

TABLE I "Taboo" Foods During Pregnancy Food

Milk Pork Fish Crabs Eggs Cheese Peanuts Cooked Greens Cucumbers "Rice Cake" Diet Colas

Frequency Mentioned

6 27 6 8

6 13 5 10 7 12 11

Percent of Patients

3.0 13.5 3.0 4.0 3.0 6.5 2.5 5.0 3.5 6.0 5.5

cific dislikes for various foods, mainly those high in calcium. Intakes of protein, iron, and vitamins A and C rich foodfl were also low according to recommended dietary standards. Superstitions and bizarre food customs played a smaller but certainly significant role. Six patients would not drink milk, 10 refused cheese, even though they liked it, and 10 scorned green leafy vegetables for superstitious reasons. Thus, in 10 percent of the 200 women interviewed, diets were considered to be substandard because of folklore. As evidenced by the present survey, "old wives' tales" and mysterious food beliefs are obviously still with us today and their role in relation to adequate nutrition continues to be significant. Nutrition educators must strive to erase such practices by realizing their continuing significance and the role they play in food habits. It becomes essential that more attention be given to the background, beliefs, and customs of an individual not only when determining his nutritional status, but also when giving constructive or corrective guidance. By assessing an individual in this manner, dietary counseling can be tailored more appropriately. New avenues and approaches in motivating, educating, and guiding should be explored. The scope of this survey does not cover "cravings" which many women develop for certain foods during pregnancy. In most cases it is reasonable to humor these cravings, such as, "dill pickles and ice cream at 2: 00 a.m." as long as they do not interfere with adequate nutrition intake and become a health hazard. In an earlier study made at our clinic of pica diet cravings, 40 out of 200 pregnant women admitted the bizarre habit of consuming dry cornstarch. In some cases as much as a pound per day was consumed. The eating of such unusual items is not uncommon (7,8,9,10). Laundry starch, clay, and baking powder are all familiar samples. Various reasons are given for "indulging," but, whatever the reason, such items may seriously interfere with adequate nutrition by either retarding the absorption of various nutrients or by dulling the appetite (11). Such cravings cannot be humored. One authority, Dr. Harry Roselle of St. Luke's Hospital in New York, reported treating at least 50 people during five years for clay and starch addiction (12). He feels the custom originated in Africa, since "African warriors would take bags SUMMER, 1970

of dirt with them into battle and partake of the earth from their homeland to gain strength when far away." His theory is that African slaves brought bags of earth with them to America where hunger forced them to continue the custom which in turn led to clay addiction. He reasons further that country people moving to towns and cities may have switched to starch when clay was no longer available.

Summary The food habits of 200 women were evaluated to ascertain existing food taboos and determine their relationship, if any, to Recommended Dietary Allowances during pregnancy. Results of our study revealed that 50 percent of the women participating in the evaJuation actually practiced superstitious food beliefs. As much as 10 percent of the group rejected nutritious foods which interfered with adequate prenatal nutrition, particularly those high in calcium and vitamin A. Pregnancy appeared to be a time of much concern in relation to food taboos and evidence of firm convictions was ap-

parent. This was especially true of Negro patients who voiced 95 percent of the folklore reported. Superstitions about food continue to exist today in significant proportion, and they can deprive the believer of important elements of nutrition during pregnancy. Our findings indicate a need for further investigation and study of the background, beliefs and customs of an individual before determining his nutritional status and giving constructive guidance. Every effort should be made to explore new avenues and approaches in motivation, education, and guidance in this area. REFERENCES 1. Cassel, I ., "Social and Cultural Implications of Food and Habits," Arne}" . .1. Pub. H ealth, 47:732, 1957. 2. Litman, T. J., I. P. Cooney and R. Stief, "The Views of Minnesota School Children On Food," J . Amer. Diet. Assoc., 45 :433 , 1964. 3. Anderson, L. and I. H. Browe, Nutrition and Family H ealth Services, Saunders, Philadelphia, 1960. 4. MitchelJ, H. S., et. al., Cooper's Nutrition in Health and Disease, Ed. 15., 1. B. Lippincott, Philadelphia, .1968.

1

5. Schultz, G., "Food Taboos," Today's Health, 42 : 28, 1964. 6. Community Nutrition Section, "Food Facts Talk Back," Amer. Diet Assoc., Chicago, 1957. 7. O'Rourke, D. E., J. G. Quinn, J. O. Nicholson, and H. H. Gibson, "Geophagia During Pregnancy," Obstet. Gynecol. , 29 :581, 1967. 8. Ferguson, I . H. and A. Keaton, "Studies On the Diet of Pregnant Women In Mississippi. Ingestion of Clay and Laundry Starch," New Orleans Med. Surg. J., 102 :460, 1950. 9. Edwards, C. H., et. ai., "Clay and Cornstarch-eating Women ," 1. Aml'l". Diet. Assoc., 35:810, 1959. 10. Posner, L. B., C. M. McCottry, and A. C. Posner, "Pregnancy Craving and Pica," Obstet. Gynecol., 9 :271 , 1957. 11. Halsted, I. A., "Geophagia in Man ; Its Nature and Nutritional Effects," ArneI'. 1. CUn. Nutr ., 21: 1384, 1968. 12. Nathan, R. , "The Things Some People Eat," This Week, Oct. 1, 1967, p. 13. ACKNOWLEDGEMENT The authors wish to express their appreciation to Dr. A. Bert Pruitt, formerly Medical Project Director, for his advice and editorial assistance. Published with the approval of Hilla Sheriff, M.D., Assistant State Health Officer, State Board of Health, Columbia, South Carolina.

CHANGING SIGNIFICANCE OF FOOD Margaret Mead The Twentieth Century has brought about changes in relationships between nations, between the classes, between the rich and the poor. These changes affect the work of nutrition educators. Editor's N ote : This is a condensation oj rill article by Margaret Mead which appeared in American Scientist, 58:176, March-April 1970. Dr. Mead presented this material at the American Association for the Advancement oj Science symposium in Boston, D ecember 1969. Dr. Mead, the well-known anthropologist, has frequently related her studies to food. Her remarks call be very helpful to the nutrition educator in understanding the relation oj food to th e environment.

Today the state of nutrition in each country is relevant and important to each other country. Any talk of one world, of brotherhood, rings hollow to those who have come face to face on the television screen with the elI)aciation of starving children and to the people whose children are starving as they pore over month-old issues of glossy American and European magazines where full color prints show people glowing with health, their plates piled high with food that glistens to match the shining textures of their clothes. Through human history there have been many stringent taboos on watching other people eat, or on eating in the SUMMER, 1970

presence of others. The taboos go back to the days when food was so scarce and the onlookers so hungry that not to offer them half of the little food one had was unthinkable and every glance was a plea for at least a bite.

Cries of the Hungry Today the articulate cries of the hungry fill the air channels and there is no escape from the knowledge of the hundreds of millions who are seriously malnourished, of the periodic famines that beset whole popUlations, or of the looming danger of famine in many other parts of the world. The age-old divisions between one part of the world and another, between one class and another, between the rich and poor everywhere, have been broken down, and the tolerances and insensitivities of the past are no longer possible. Today, for the first time in the history of mankind, we have the productive capacity to feed everyone in the world, and the technical knowledge to see that their stomachs are not only filled but

that their bodies are properly nourished with the essential ingredients for growth and health. These new twentieth-century potentialities have altered the ethical position of the rich all over the world. In the past, there were so few who lived well, and so many who lived on the edge of starvation, that the well-to-do had a rationale and, indeed, almost a necessity to harden their hearts and turn their eyes away, Before, the well-fed turned away their eyes in the feeling that they were powerless to alleviate the perennial poverty and hunger of most of their own people and the peoples in their far-flung commonwealth. And such turning away the eyes, in Britain and in the United States and elsewhere, was accompanied by the rationalizations, not only of the inability of the well-to-do - had they given all their wealth - to feed the poor, but of the undeservingness of the poor, who had they only been industrious and saving would have had enough, although, of course, of a lower quality, to keep JOURNAL OF NUTRITION EDUCATION / 17