"When I Breastfeed, It Feels as if my Soul Leaves the Body": Maternal Capabilities for Healthy Child Growth in Rural Southeastern Tanzania.

Zaina Mchome,Ajay Bailey,Sepideh Yousefzadeh,Hinke Haisma

doi:10.3390/ijerph17176215

Abstract

The burden of childhood stunting in Tanzania is persistently high, even in high food-producing regions. This calls for a paradigm shift in Child Growth Monitoring (CGM) to a multi-dimensional approach that also includes the contextual information of an individual child and her/his caregivers. To contribute to the further development of CGM to reflect local contexts, we engaged the Capability Framework for Child Growth (CFCG) to identify maternal capabilities for ensuring healthy child growth. Ethnographic fieldwork was conducted in Southeastern Tanzania using in-depth interviews, key informant interviews, participant observation, and focus group discussions with caregivers for under-fives. Three maternal capabilities for healthy child growth emerged: (1) being able to feed children, (2) being able to control and make decisions on farm products and income, and (3) being able to ensure access to medical care. Mothers’ capability to feed children was challenged by being overburdened by farm and domestic work, and gendered patterns in childcare. Patriarchal cultural norms restricted women’s control of farm products and decision-making on household purchases. The CFCG could give direction to the paradigm shift needed for child growth monitoring, as it goes beyond biometric measures, and considers mothers’ real opportunities for achieving healthy child growth.

Highlights

The problem of poor growth among children under five in different regions in Africa is becoming increasingly acute [1,2]
We discuss each of these capabilities by showing how they are influenced by contextual and/or individual factors and caregivers’ agency, and how they shape the promotion of healthy child growth
Through the use of Capability Framework for Child Growth (CFCG) framework, the findings show that healthy growth—a functioning at an early age—is a result of the interactive interplay of maternal capabilities, among others

Summary

Introduction

The problem of poor growth among children under five in different regions in Africa is becoming increasingly acute [1,2]. The current evidence indicates that in African countries, 58.8 million (33%). Under-five children are stunted and about 14 million are wasted, and 9.5 million children were overweight in 2018, up from 6.6 million in 2000 [3]. In the Sub-Saharan region, 33% of under-five children are stunted, 2.3% are wasted, and 3.5% are overweight [1]. In Eastern Africa, 35.2% of under-five children are stunted, 1.6% are wasted, and 4.7% are overweight (Ibid). Res. Public Health 2020, 17, 6215; doi:10.3390/ijerph17176215 www.mdpi.com/journal/ijerph

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Discussion

Conclusion