A well-nourished and healthy population is a central tenet of sustainable development. In South Africa, cultural beliefs and food taboos followed by some pregnant women influence their food consumption, which impacts the health of mothers and children during pregnancy and immediately afterwards. We documented food taboos and beliefs amongst pregnant isiXhosa women from five communities in the Kat River Valley, South Africa. A mixed-methods approach was used, which was comprised of questionnaire interviews with 224 women and nine focus group discussions with 94 participants. Overall, 37% of the women reported one or more food practices shaped by local cultural taboos or beliefs. The most commonly avoided foods were meat products, fish, potatoes, fruits, beans, eggs, butternut and pumpkin, which are rich in essential micronutrients, protein and carbohydrates. Most foods were avoided for reasons associated with pregnancy outcome, labour and to avoid an undesirable body form for the baby. Some pregnant women consumed herbal decoctions for strengthening pregnancy, facilitating labour and overall health of both themselves and the foetus. Most learnt of the taboos and practices from their own mother or grandmother, but there was also knowledge transmission in social groups. Some pregnant women in the study may be considered nutritionally vulnerable due to the likelihood of decreased intake of nutrient-rich foods resulting from cultural beliefs and food taboos against some nutritious foods. Encouraging such women to adopt a healthy diet with more protein-rich foods, vegetables and fruits would significantly improve maternal nutrition and children’s nutrition. Adhering to culturally appropriate nutrition education may be an important care practice for many pregnant women in the Kat River Valley.

The lack of dietary diversity is a severe problem experienced by most poor households globally. In particular; women of reproductive age (WRA) are at high risk of inadequate intake of micronutrients resulting from diets dominated by starchy staples. The present study considered the diets, dietary diversity, and food security of women aged 15–49 years along the rural-urban continuum in three South African towns situated along an agro-ecological gradient. A 48 h dietary recall was conducted across two seasons with 554 women from rural, peri-urban, and urban locations of Richards Bay, Dundee, and Harrismith. Minimum Dietary Diversity for WRA (MDD-W) were calculated and a dichotomous indicator based on a set of ten food groups was used to determine if women had consumed at least five food groups the previous 48 h to achieve minimum dietary intake for women. The mean (±sd) MDD-W for Richards Bay (3.78 ± 0.07) was significantly higher than at Dundee (3.21 ± 0.08) and Harrismith (3.36 ± 0.07). Food security and MDD-W were significantly higher in urban locations than in peri-urban or rural ones. There was lower dependence on food purchasing in Richards Bay compared to Dundee and Harrismith. The majority of women in Richards Bay practiced subsistence agriculture, produced a surplus for sale, and collected wild foods which improved dietary intake and food security. The peri-urban populations had limited dietary intake and were more food insecure because of high levels of poverty, unemployment, and lack of land. Peri-urban dwellers are therefore more sensitive to changes in incomes and food prices because they lack safety nets to absorb income or price shocks as they purchase more, rather than growing their own food. This compromises dietary diversity as they have limited access to diverse foods.

Background: Maternal and child undernutrition remain prevalent in developing countries with 45 and 11% of child deaths linked to poor nutrition and suboptimal breastfeeding, respectively. This also has adverse effects on child growth and development. The study determined maternal dietary diversity, breastfeeding and, infant and young child feeding (IYCF) practices and identified reasons for such behavior in five rural communities in South Africa, in the context of cultural beliefs and social aspects. Methods: The study used mixed methodology technique. Questionnaires were administered to 84 households, pairing mother/caregiver and a child (0-24 months old) to obtain information on maternal dietary diversity, IYCF and breastfeeding practices. Qualitative data on breastfeeding perceptions, IYCF practices, perceived eating habits for lactating mothers and cultural beliefs related to mothers' decision on IYCF and breastfeeding practices were obtained through focus group discussions. Results: Maternal dietary diversity was very low and exclusive breastfeeding for the first 6 months of life was rarely practiced, with young children exposed to poor-quality diets lacking essential nutrients for child growth and development. Social circumstances including lack of income, dependence on food purchasing, young mothers' feelings regarding breastfeeding and cultural beliefs were the major drivers of mothers' eating habits, breastfeeding behaviour and IYCF practices. Fathers were left out in breastfeeding and IYCF decision making and young mothers were unwilling to employ indigenous knowledge when preparing food (especially traditional foods) and feeding their children. Conclusion: The study provides comprehensive information for South African context that can be used as an intervention measure to fight against malnutrition in young children. Finding a balance between mothers' income, dietary diversity, cultural beliefs, breastfeeding and considering life of lactating mothers so that they won't feel burdened and isolated when breastfeeding and taking care of their children is crucial. Paternal inclusion in breastfeeding decisions and safeguarding indigenous knowledge on IYCF practices is recommended.

The burden of food insecurity and malnutrition is a severe problem experienced by many poor households and children under the age of five are at high risk. The objective of the study was to examine household food insecurity, dietary diversity, and child nutritional status in relation to local context which influences access to and ability to grow food in South Africa and explore the links and associations between these and household socio-economic status. Using a 48-h dietary recall method, we interviewed 554 women from randomly selected households along a rural–urban continuum in three towns situated along an agro-ecological gradient. The Household Dietary Diversity Scores (HDDS) and the Household Food Insecurity Access Scale (HFIAS) tools were used to measure household dietary diversity and food insecurity, respectively. Anthropometric measurements with 216 children (2–5 years) from the sampled households were conducted using height-for-age and mid-upper arm circumference (MUAC) as indicators of stunting and wasting, respectively. The key findings were that mean HDDS declined with decreasing agro-ecological potential from the wettest site (8.44 ± 1.72) to the other two drier sites (7.83 ± 1.59 and 7.76 ± 1.63). The mean HFIAS followed the opposite trend. Stunted growth was the dominant form of malnutrition detected in 35% of children and 18% of children were wasted. Child wasting was greatest at the site with lowest agro-ecological potential. Children from households with low HDDS had large MUAC which showed an inverse association among HDDS and obesity. Areas with agro-ecological potential had lower prevalence of food insecurity and wasting in children. Agro-ecological potential has significant influence on children’s nutritional status, which is also related to household food security and socio-economic status. Dependence on food purchasing and any limitations in households’ income, access to land and food, can result in different forms of malnutrition in children. Responses to address malnutrition in South Africa need to be prioritized and move beyond relying on food security and nutritional-specific interventions, but rather on nutrition-specific and sensitive programs and approaches; and building an enabling environment. Land availability, agriculture (including climate-smart agriculture especially in drier areas), and wild foods usage should be promoted.

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