10/28/2019 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 Anne Dressel (1) The following personal financial relationships with commercial interests relevant to this presentation existed during the past 12 months: 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 1
10/28/2019 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 2
10/28/2019 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 3
10/28/2019 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 of 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 4
10/28/2019 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 …” 5
10/28/2019 Results - Stability • Environmental degradation and climate cha nge • 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. 6
10/28/2019 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 7
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