Incorporating Nutrition Education: An Affordable, Nutritious and Convenient Weaning Food and Income Generation into an Infant Feeding Project in New Delhi, India
The year was 1991, the place was New Delhi, India. As I drove my Toyota down the dusty, winding road into the section of the city known as Kotla Mubarakphur, the road was congested with pedestrians, bicycles, carts, trucks and the occasional water buffalo roaming the streets. One of the students in the car said we should park just before the railroad tracks and walk the short distance into the “jugghi” (slum) area. The two students would soon deliver the cooking demonstration in Hindi. We walked down the narrow paths between the houses, past goats, and started to attract the interest of many children. We went to Santosh’s house and started to unpack our things. Women with small babies had been told that there would be a cooking lesson that day and they were starting to assemble. We had infant weaning food ingredients packed into plastic containers, bottled water, UHT milk, an assortment of utensils and our charts and posters on this day’s topic. It had taken a long time to get to this phase of the project, the annual return of community members to their villages, summer heat and monsoon floods had caused unexpected delays. We had interviewed families in the community and mothers with children between the ages of four months to three years to learn about their infant feeding practices. We developed a weaning food and were marketing it during cooking demonstrations/nutrition lessons. There were many factors that influenced the health and nutritional status of these women and infants, some comprehensible and others completely new to me, a foreigner, in spite of my living in many other countries during the past twenty years. The following provides a picture of the social, cultural and environmental factors impacting these mothers and infants in New Delhi. It explains how an infant feeding project was designed to help improve the nutritional health of infants in an urban slum in New Delhi.
New Delhi has witnessed one of the fastest growth rates when compared to other metropolitan cities. The steady migration of rural labor to urban areas in India has resulted in a rapid proliferation of urban slums. These poor face increased health risks from poor sanitation, insufficient and unsafe water supplies, poor personal and food hygiene, inadequate garbage disposal, indoor air pollution, and crowded and inferior housing. Severe forms of protein-energy malnutrition, kwashiorkor and marasmus, are found among children. Infants exhibit a slower rate of growth. One explanation is that in poor urban communities, supplementary foods are not introduced until much later, in some cases, not until the infant is 12-18 months of age, thereby increasing the chances of malnutrition. Weaning practices of mothers in these communities are influenced by social networks, kinship, religion, and sex-related taboos. Faulty feeding practices can arise from ignorance, superstition and food misconceptions. Environmental factors such as housing conditions, water supply, sanitation, disease and availability of adequate food also play a role. However, the problems of malnutrition among these infants can be minimized, even under slum conditions, through education and a means of providing affordable, convenient, nutritious foods during this critical period of development.
Dr. S. Malhan of the Institute of Home Economics, University of Delhi, was aware of the problems associated with infant feeding in low income communities in New Delhi and recognized the need for a project that would help raise the nutritional status of infants in these communities. This project was carried out by the Institute from 1991-1994. The objectives were:
- to identify current weaning practices of a target population of an urban slum in New Delhi
- to develop a weaning food appropriate to the nutritional needs of the infant and the specific needs of the urban slum mother living in New Delhi
- to educate the mothers on the importance of the weaning food
- to market the weaning food and use this concept as an opportunity to generate income for a member of the community.
The project area, Kotla Mubarakpur located in South Delhi, extends to about 1.25 square km. with a population over 65,000. 274 families from among those living in four jugghi clusters of Peer Baba, Bapu Park, Prem Nagar and New Khanna Market were randomly interviewed by students from the Institute of Home Economics. Basic demographic information was collected. The average per capita income/month was 298 rupees ($9.61 US). Family members were daily wage earners or were engaged in semi-skilled jobs such as construction labor, office assistants or in professions involving skills such as embroidery, darning, rope making, etc. Many women worked as part time domestic workers and left their child with an older sibling who was responsible for feeding the child during the day. Food was the families' greatest expense. They generally bought food in smaller quantities according to the money in hand and their immediate requirements. Bulk buying was not prevalent as the one-room flats were not suitable for bulk storage. Fuel to prepare food was also expensive. The lack of income prevented these mothers from buying expensive, commercial infant foods at the local store and they believed that if they breast-fed infants longer, the money saved on supplemental foods could be used to feed others in the family. Therefore, our goal was to find various ingredients which would be affordable, yet provide additional nutritional value.
From among the 274 families, 144 women having children between the ages of four months and 30 months were interviewed to obtain specific information on infant feeding practices. In this project, 6.5% of the infants received semisolid foods before 6 months, 89.43% within nine months. and 4% within 12 months. Most of the women decided additional foods should be given to their infant. The majority started giving foods because their child seemed hungry even after being fed breast milk. Fifty percent felt that the supplementary foods were good for the baby while 27.5% were advised by someone else of the benefits of the foods for the child's health. We wanted to educate the women as to the importance of introducing supplemental/weaning foods at an appropriate age for the health of their infant. The supplemental food in this project had to be nutritious.
Many mothers worked outside the home doing manual labor, her infant is either carried to the worksite or left in the care of an older sibling. In addition to working outside the home, the daily household chores were numerous. Water had to be obtained from a well in the community, food storage areas were non-existent, so food had to be purchased for the family on a daily basis. A large amount of time was spent on preparing food for the family, yet mothers spent no time preparing special/separate supplementary food for their infant. A premixed, packaged food that is easily transported and prepared would be easy to use. Therefore, the supplemental food had to be convenient.
Based on this information collected in interviews, weaning food recipes were developed. The best recipe which met the criteria of being highly nutritious, convenient and affordable was produced in sufficient quantities for field testing. This cereal mix was made of murmura (dried rice flakes), channa (roasted chickpeas), sugar and peanuts. To make a nutritious infant cereal the following components were considered: a basic staple, an energy-rich supplement and a protein-rich supplement. The rice flakes were the basic staple, the sugar and the oil in the peanuts provided energy and the chickpeas provided protein. All of the ingredients, purchased at the local market, were weighed out into recipe amounts, ground into a dry cereal mix and packaged in plastic bags at the Institute.
We then went to the “jugghi” (slum) to test the cereal mix at cooking demonstrations. Since many of the mothers were illiterate, posters were used to explain the various ingredients in the cereal. Instructions for preparing the cereal mix, e.g. the amount of milk or water to mix with the cereal, were explained to the mothers/caretakers. Samples of the cereal were distributed to mothers/caretakers in resealable (500 gram) plastic bags with “picture” instructions for preparation. The mothers/caretakers were asked to return the following week with the bag so we could record how much cereal the child consumed. At that time, the mothers/caretakers indicated that they would purchase it because they didn't have time to make such a mix themselves.
And so production began. More ingredients were purchased and additional cereal was produced. The cereal was packaged in two sizes, a 50 gram bag which cost 1.5 rupees and a 500 gram bag for 15 rupees. To eliminate the storage requirement, small packages enabled the women to purchase the cereal on a frequent basis. The larger bag was available to mothers needing a greater quantity.
At the onset of the project, it was decided that this would not be a food assistance/distribution project. We wanted to “turn over” the project to the community. We purchased a domestic food grinder and one woman in the community was trained to produce the cereal. She and her friends could produce and package the cereal, and use the sales from the cereal as a source of income. They would also serve as educators to their peers on the importance of introducing nutritious weaning foods at the appropriate age to their infants.
In summary, the project interviews identified the need to disseminate information to the mothers about the importance of supplemental foods at an appropriate age for their infants. The project was designed to take into consideration the many factors which affect these mothers’ ability to provide nutritious weaning foods for their infants. Their lifestyle is not easy; they need time-saving conveniences. Therefore, a nutritious, convenient and economically viable cereal mix was developed. Training sessions taught the mothers/caretakers about the ingredients, preparation, and the amounts of cereal mix to feed their infant. Production and marketing of the cereal mix by a community member served as an income generation scheme and added a valuable component to the project.
The project was low in cost. Students from the Institute of Home Economics performed the background interviews for this project. The ingredients used in the recipe for the cereal were all locally available and inexpensive. A household grinder was purchased for preparation of the cereal mix. Materials for the demonstrations included the ingredients for the cereal mix, utensils, plastic bags and paper and pens for posters. A $300 donation from the American Women’s Association of the American Embassy in New Delhi covered the expenses of the project
The project could be performed in any community where there is a need to educate mothers to the importance of supplemental foods for their infants. The development of a weaning food would require formulating recipes and analyzing their nutrient composition, and packaging considerations. Training sessions and cooking demonstrations could be devised to provide mothers and caretakers with information on the importance of supplemental foods at the appropriate age, the type of food that should be given and the amounts and frequency for feeding their infant. The project could serve as an income generation opportunity for members of the community thereby increasing their financial security. But the greatest impact would be to help safeguard the nutritional status of infants during the first year of life and alleviate protein-energy malnutrition among children in low income communities. Children deserve such efforts in the field of nutrition to help them have a healthy start in life.