Food Insecurity among Women in Malawi Receiving End of Life Care - - PDF document

10/28/2019 1 Food Insecurity among Women in Malawi Receiving End of Life Care

Anne Dressel, PhD, CFPH, MLIS, MA banda@uwm.edu

Pre resen enter er Di Disclosures es

(1) The following personal financial relationships with

commercial interests relevant to this presentation existed during the past 12 months: Anne Dressel No relationships to disclose

Malawi

• One of the poorest countries in the world
• Ranked 171 out of 189 countries – Human Development Index (2018)
• 70% of population lives below the international poverty line ($1.90/day)
• 19.8 million people
• 82% rural
• Subsistence farming
• HIV/AIDS
• 39% of population is food insecure
• 37% of children are stunted

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Food Security

• Food security exists “when all people at all times have physical, social

and economic access to food, which is safe and consumed in sufficient quantity and quality to meet their dietary needs and food preferences, and is supported by an environment of adequate sanitation, health services and care, allowing for a healthy and active life.”

Food Security

• Universal Declaration of Human Rights
• Adequate food
• UN Sustainable Development Goals
• Achieve food security and end hunger around the world by 2030

FAOs 4 Pillars of Food Security

Pillar Description Food Availability Refers to the supply side of food security, including the amount and type of food production, stock levels and net trade at the national level Food Access Refers to economic and physical access to food Food Utilization Refers to a body’s ability to utilize available food to ensure adequate nutrient uptake Food Supply Stability Refers to ongoing security in the other three dimensions -- availability, access, and utilization

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Gender and Food Security

• Women are the primary producers, procurers, preparers, and

providers of household food

• In Malawi, women constitute 70% of agricultural workforce, yet are

more likely to be food insecure

• Lack of access to:
• Credit
• Seeds
• Fertilizer
• Agricultural education
• Land

Study Background

• Kasungu District, central Malawi
• K2TASO – AIDS-Support Organization
• Study sought to describe the lived experience of female palliative care

patients in rural Malawi, and their caregivers

• Aims
• 1) analyze their physical, spiritual, and mental health needs
• 2) analyze best nursing practice for female palliative care patients in

Malawi at end of life

Methodology

• Qualitative critical ethnographic study
• Informed by feminist epistemology
• Interviews
• 26 adult women receiving end of life care at K2TASO
• 14 adult caregivers
• Conducted in Chichewa
• Deductive qualitative analysis
• Organized results based on FAO’s 4 pillars of food security

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Results - Availability

• Decreased maize production compared to previous years
• National maize production was 18-25 percent below average
• Farming
• No participants reported growing what they thought was enough maize

to feed their families

• “But at 30 [bags] there still were not enough because there are a lot
• f children. So I had to still purchase some and then I owed credit to

a lot of people. I told them I would return it after the harvest. But in terms of farming, I cannot lie. I am not farming along with them.”

Results - Availability

• Farming
• Participants were too ill to farm
• “The farming is difficult because when I am experiencing pain

sometimes… like when I started getting sick, then working was difficult for me.”

Results - Access

• Meal frequency
• Fewer than half of participants ate three times per day
• Poverty
• Women perceived that they had a lack of money to buy the foods they

preferred

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Results - Access

• Gender
• Participants stayed in abusive intimate partner relationships in order to

have access to food

• “moving about [being promiscuous], he [my husband] certainly does

move about… I think it was 2011, he married [a second wife] a woman and then the marriage ended. Now he is saying that this year…when it dries, as soon as we harvest, he will marry again.”

Results - Utilization

• Dietary diversity
• Participants lacked dietary diversity
• “Because they [K2TASO staff] tell us that we should be eating

six food groups. But for some of us, once we eat nsima, that’s

• it. So we see that we are unable to manage what it is they tell

us to do. If we were able to do it, things would be much better.”

• Access to water and cooking
• Participants relied on children or others to fetch water
• 8 participants were too ill to cook

Results - Utilization

• Illness
• Participants noted that their illness made it difficult for them to eat
• “I am failing to eat because I am sick…”
• “What I feel… and what is hurting is… my stomach... and [I am] also

vomiting…”

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Results - Stability

• Environmental degradation and climate change
• Malawi has experienced alternating periods of droughts and

floods over the past decade, which have contributed to crop and livestock destruction and reduced food supply

• Unemployment
• Participants were too ill to farm or work
• Caregivers were away from their own gardens and jobs

Results - Stability

• “The food is really insufficient because it’s not consistent.”
• “Food… because this is the hunger season [between harvests] so it’s

difficult for someone to cook food for you every day. It’s difficult.”

Recommendations

• Programs must take into account the vulnerabilities faced by low-

income women, especially those in end of life care.

• Addressing their needs can help to ensure increased food security for

the women, and for their caretakers, and children.

• Guidelines need to be developed about possible and practical diets to

which they might adhere particularly when food stores have run low.

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Recommendations

• Community cooperatives
• Land tenure reform
• Education
• Best agricultural practices
• Broaden thinking about food security beyond maize

Recommendations

• Advocate
• Mitigate climate change
• Policies
• Behavior
• Vote
• Ethical responsibility