Determinants of Maternal Anemia at Disaggregated Level
5.2. Iron Bioavailability and Dietary Concern in the Studied Areas
Table 5.7: Distribution of Population According to the Ill Effects of Anemia on Health
Ill Effects of Anemia No. %
Loss of energy 89 52.66
Rapid heart beat 61 36.09
Shortness of breath 84 49.70
Dizziness 97 57.40
Pale skin 76 44.97
Insomnia 69 40.83
Headache 98 57.99
Source: Field data 2014-15
Given such background of maternal anemia and its ill effects on health, the following subsection presents a short discussion on dietary-habits and status of iron supplementation.
most of the developing countries, maternal anemia is due to lack of dietary iron in habitual diets (Thompson, 2013). As per the recommendation of WHO (DeMaeyer, 1989), amount of iron absorption is influenced by the combination of foods taken in a given meal. Due to lack of sufficient food, individuals are at the risk of developing iron deficiency (ibid). Hema Priya (2016) and NRHM guideline (2013) also reveals that insufficient iron-rich food and low iron bioavailability are the main causes of developing iron deficiency anemia among women.
5.2.1. Observation from Field:
Discussion with ANM and ASHA workers have further revealed awareness about family planning methods and distribution of free IFA tablets is notwithstanding, improvement of hemoglobin level is not possible, without a proper diet. Observation from field visit shows that, proper diet is not maintained, particularly among the tea labourers. For instance, Table 5.8 provides that the per capita food expenditure on heme food product is high in Muhimari, Patgaon, Janzimukh and Kadamoni as compared to rest of the sample villages.50
Table 5.8: Village-wise Per Capita Food Expenditure on Heme and Non-Heme Food Product at Monthly Basis during 2014-15
Villages
Non-Heme product Heme product
Others
Total food expenditure Cereals Vegetables Fish Meat
Muhimari 273.68 109.14 52.11 36.12 42.76 513.82
Patgaon 257.45 125.96 68.09 54.79 50.64 556.91
Janzimukh 238.30 111.70 49.04 50.43 57.45 506.91
Lepetkatta TE 205.33 117.73 39.60 36.67 61.33 460.67
Kadamoni 221.95 119.88 65.73 59.51 51.22 518.29
Shakumato TE 290.20 101.67 31.23 25.00 56.67 504.75
Silcoori TE 243.16 130.32 27.89 23.47 56.53 481.37
Motinagar 264.71 116.86 25.88 23.73 55.20 486.37
Source: Survey data 2014-15
50 The monthly food expenditure of a household is calculated by estimating the rupees spent on food items like heme (meat and fish) and non-heme (cereals- rice, dal, and veg) product and others (oil, salt, and sugar) based on 1 week recall period.
It is clear from the Table 5.8 that in teagarden areas (such as Lepetkatta Tea Estate, Shakumato Tea Estate, Motinagar, Silcoori Tea Estate), the expenditure on heme product is low in their daily diet; typically, their diet is confined to staple foods (cereals) with low iron bioavailability. The population in teagarden areas have less access to diversified diet due to land and geographical bottlenecks. Report of Global Network for the Right to Food and Nutrition 2016, also reveals that given the lack of alternative means of livelihoods, teagarden workers are highly dependent on food rations provided by the Tea Company which are often insufficient, inadequate and of bad quality. The report also says that it is not affordable for the workers with their wage to have adequate amount of food or any additional food to maintain a diversified diet. The daily meal of a worker mostly consists of rice, dal and chapatti and occasionally (on payment day) meat or fish. Evidence from the field survey shows that most of the teagarden workers have no ration card as the causal workers (74.42 percent) are discriminated against in accessing ration card and other facilities like hospitals, housing and other amenities. They solely depend on daily market for their food. On the other hand, people of Janzimukh, Patgaon, Kadamoni, Muhimari have diversified food availability at their own land as they live in a geographically better position along with the available water resources and access to land of their own which help them go for diversified food consumption. Home-grown foods and green leafy vegetables, fish and poultry farms of their own house help to maintain proper food habits.
Additionally, in response to awareness about proper nutritional diet during pregnancy, women from Janzimukh, Patgaon, Muhimari and Kadamoni were quite aware of the nutritional food habits. On the contrary, teagarden workers live in either in quarters provided by management or temporary hut inside teagarden and they do not possess land of their own.
They do not have any homegrown food products and have limited access to daily intake of micronutrients either due to their lack of awareness regarding importance of nutritional food habits or lack of financial resources. In case of supplementary nutritional food from Anganwadi center, all respondents from Janzimukh and Patgaon agreed that they accessed rice and peas from Anganwadi center during their pregnancy. However, except in Muhimari (20 percent), more than 50 percent of pregnant women from Kadamoni, Silcoorie TE and Motinagar have received supplementary food during their pregnancy. On the other hand, none have received any such supplementary nutritious food during their pregnancy in
Lepetkatta T E and Shakuamto TE because of irregular distribution of foodstuff to Anganwadi workers to distribute the foods among pregnant women (Table 5.9).
Due to low economic status, women have to work hard for their livelihood with poor dietary diversification. Low dietary intake and consumption of high non-heme product lead to low bioavailability of iron. This results in low hemoglobin level and poor iron status in her body which becomes more vulnerable with high birth order during her childbearing age. In other words, prevalence of nutritional anemia due to low level of hemoglobin is associated with socio-economic factors such as financial and cultural barriers, educational attainment etc. In the next section, we conduct an investigation of several of socio-economic factors that may contribute to maternal anemia.
Source: Survey data 2014-15