With the title, “Latinx Foodways in North America,” we aim to put the series in a more international perspective, inclusive of the United States, Caribbean, Mexico, Central America, and Canada. Here we introduce Dr. Meghan Farley Webb’s informative piece on fieldwork methods and nutrition with indigenous communities in rural Guatemala. Her work illustrates the global framework of this series. Enjoy!
Food Insecurity and Chronic Malnutrition in Rural Indigenous Guatemala
Wuqu’ Kawoq | Maya Health Alliance is an NGO providing high-quality, evidence-based health care in indigenous communities in Guatemala. Guatemala is especially affected by chronic malnutrition, or stunting, with some Maya communities experiencing stunting rates of seventy-five percent.1 As part of our Complete Child program, we have undertaken several mixed-methods studies to explore why stunting remains a problem in Maya communities.2-3 Food insecurity, common in rural indigenous communities, contributes to the persistence of stunting in Maya communities. In some communities where we work, all households experience moderate to severe food insecurity, as measured by the FANTA Food Access and Insecurity Scale. The FANTA scale provides a quick (only nine questions) and cross-culturally reliable means of assessing household food insecurity. The scale pays special attention to the issue of reliable access to healthy food.
Poor Feeding Indicators & Food Availability
Twenty-four hour food recalls are an important tool in nutritional assessment, but they have been shown to underestimate caloric and dietary diversity in Guatemala.4 Our investigations show similar problems, in part because most rural communities have a once weekly market where diverse fruits and vegetables can be purchased. Little access to refrigeration means that nutritionally diverse foods are often not available during the week. While seven-day food frequency questionnaires report higher quantities of fruits and vegetables, children’s diets remain deficient in dairy, flesh foods, eggs, and vitamin-A rich foods. Use of these questionnaires—which query the frequency of consumption of culturally relevant food items, divided into WHO food groups—is imperfect, as it may over- or underestimate consumption of some items; however, we find they provide an accurate general assessment of dietary diversity.
In contrast to the limited availability of fresh fruits and vegetables, pre-packaged junk food is readily available in tienditas (small corner stores). Focus groups and ethnographic interviews reveal that the ease of preparation of pre-packaged foods as well as children’s requests for junk foods and their relative low cost were additional drivers for the consumption of low-quality, processed foods. The proliferation of junk foods—sometimes referred to as “coca-colonization”5—means that Guatemala must simultaneously work to combat both stunting and obesity.
Poverty & Food Expenditures
In addition to this limited access to high-quality, nutritionally diverse foods, our research shows how endemic poverty contributes to food insecurity. We use the Quick Poverty Score to assess poverty in the communities we serve. The tool uses locally relevant “poverty indicators” to assess the likelihood that a household member is at or below $2 USD or $1USD/day. It is unsurprising that many households in rural indigenous Guatemala experience high levels of poverty. On average food expenditures are low, often so low that it would be impossible to meet caloric and micronutrient needs. Our research shows that underemployment and agricultural cycles result in high variability in income, and therefore, limit money available to spend on food.
Non-Traditional Agricultural Exports
Stunting rates remain high even in agricultural communities for two reasons. First, many households do not own enough land to sustain domestic production. Second, many rural agricultural communities have shifted from milpa (corn and beans) production to production for export. In the Guatemalan highlands, broccoli, snow peas, green beans, and blackberries have replaced traditionally grown and locally eaten crops. The shift to non-traditional agricultural exports negatively impacts dietary diversity not only because of a loss of subsistence crops, but also because growing these non-traditional exports often requires taking on significant debts for seeds and other agricultural inputs. Non-traditional agricultural exports have further worsened the conditions of food insecurity as the majority of rural Maya farmers do not report economic benefits to growing these crops. This is due in large part to the practice of selling crops to middlemen, rather than directly to exporters.
Programmatic Implications & Additional Research
Our research has shown how economic and environmental factors contribute to food insecurity and chronic malnutrition in rural indigenous Guatemala. Programs aimed at improving nutritional outcomes in indigenous children must also address cultural factors. For example, focus groups and numerous clinical interactions have demonstrated the importance of secondary caregivers, especially paternal grandmothers. Multi-generational family compounds mean that mothers, at whom most nutritional programming is aimed, may not be fully in control of food purchasing and/or preparation decision making. Home-based nutritional counseling offers one way to address barriers to improving nutritional outcomes in infants and young children. Internal evaluation of our nutritional programming and a recent clinical trial demonstrate the effectiveness of such intensive, home-based nutritional counseling to improve dietary diversity, minimum acceptable diet, and height/length-for-age. More information about our research, including copies of our published work and training materials, can be found here.
Meghan Farley Webb is a Staff Anthropologist with Wuqu’ Kawoq|Maya Health Alliance.
1 Black, R. E., C. G. Victora, S. P. Walker, Z. A. Bhutta, P. Christian, and M. Onis. 2013. “Maternal and child undernutrition and overweight in low-income and middle-income countries.” Lancet 382. doi: 10.1016/s0140-6736(13)60937-x.
2 Ministerio de Salud Pública y Asistencia Social, Instituto Nacional de Estadística, and Secretaría de Planificación y Programación de la Presidencia. 2015. Encuesta Nacional de Salud Materno Infantil 2014-2015: Innforme de Indicadores Básicos. Guatemala City: Ministerio de Salud Pública y Asistencia Social (MSPAS).
3 Chary, Anita, Sarah Messmer, E. Sorenson, Nicole Henretty, Shom Dasgupta, and Peter Rohloff. 2013. “The Normalization of Childhood Disease: An Ethnographic Study of Child Malnutrition in Rural Guatemala.” Human Organization 72 (2):87-97.
4 Rodriguez, M. M., H. Mendez, B. Torun, D. Schroeder, and A. D. Stein. 2002. “Validation of a semi-quantitative food-frequency questionnaire for use among adults in Guatemala.” Public Health Nutrition 5. doi: 10.1079/phn2002333.
5 Leatherman, T.L. and A Goodman. 2005. “Coca-colonization of Diets in the Yucatán.” Social Science and Medicine 61(4):833-846. doi:10.1016/j.socscimed.2004.08.047
Photo provided by the author and Wuqu’ Kawoq:
Image 1: A vendor sells fresh produce in the market. Most rural indigenous communities in Guatemala have only one market day a week.