Using critical discourse analysis and the concept of food security to understand pregnant women’s nutrition in Aotearoa/New Zealand

Abstract

Background: Increasingly, pregnant women in Aotearoa/New Zealand (Aotearoa) are unable to achieve the dietary intakes recommended by the Ministry of Health (MOH). While health professionals express frustration at "being the ambulance at the bottom of the cliff", the continued government response to this public health concern is to "educate women", as per the current mantra of personal responsibility and choice-based rhetoric. Aim: Using critical discourse analysis (CDA), this study examined the discourses regarding nutrition in pregnant women in Aotearoa. Pregnant women's nutrition is further considered within the contexts of food security and empowerment. Method: In July 2017, using 30 documents from three different platforms-media, government and academia-with a focus on Aotearoa, the first author undertook a CDA. Findings: Three key messages were identified: firstly, pregnant women, in not being viewed holistically or relationally, are isolated as being solely responsible for nutrition; secondly, women are positioned as naïve recipients, and achieving a healthy pregnancy requires women to be educated and to adhere to complex food guidelines; and lastly, there is an authoritarian use of fear and monitoring to motivate adherence to guidelines. Thus, women are personally responsible for achieving complex, unrealistic and often unaffordable nutritional targets. Conclusion: The most dominant discourse is one whereby malnutrition is seen as deficit behaviour and thinking by women, and one of self-responsibility, regardless of context. This is very much in keeping with the modus operandi of public health and neo-liberal discourse. We argue, however, this renders silent the fact that malnutrition for some women results more from food insecurity and disempowerment. Midwives need to make audible other less dominant narratives, alongside advocating for woman-centred, policy-based approaches towards nutrition, whereby the underlying drivers of poverty are actively addressed.

Untitled

“…Poor nutrition, obesity and food insecurity become particularly significant during pregnancy. In South Auckland, the high number of morbidly obese pregnant women has become the new normal (Counties Manukau District Health Board [CMDHB], 2013[CMDHB], , 2019Raven & Stewart-Withers, 2019).…”

“…Based on their critical discourse analysis of 30 government, media and academic documents, Raven and Stewart-Withers (2019) argue that society regards pregnant women as being solely responsible for their own nutrition. They argue that, in fact, for some women malnutrition is more the result of food insecurity and disempowerment.…”

“…This includes personal behaviours in the context of the physical, economic, sociocultural and political environments (Signal et al, 2013). However, Raven and Stewart-Withers (2019), also citing Pearce et al (2011), argue that obesity "is strongly linked to an obesogenic environment, where culture, employment opportunities, the local housing market, and access to transport and healthy food impact on food accessibility and choices" (p. 37). People in the most economically deprived areas live in an obesogenic environment, with a higher than average representation of fast food outlets (Swinburn, 2020).…”

Untitled

“…In Aotearoa New Zealand, found that most pregnant women do not follow the current nutritional guidelines for pregnancy, with only 3% meeting the recommendations for the four identified food groups. Food insecurity is a major barrier to a healthy pregnancy, with food purchase often less a priority than rent and/or heating (Abrahams, Lund, Field, & Honikman, 2018;Raven & Stewart-Withers, 2019;van den Heuvel & Birken, 2018).…”

An exploration of midwives’ perspectives on the provision of maternity care to women with an increased BMI during pregnancy and childbirth in NZ

“…Blaming pregnant women for their obesity is termed maternal responsibilization by Parker (2014). It has been argued that this blaming has halted progress around obesity and instead resulted in individualised stigmatisation, siloed approaches to care, political inaction, and an absence of coherent strategies within food and health systems (Ralston et al, 2018;Raven & Stewart-Withers, 2019). Seeing obesity as a self-deficient behaviour, pressures women to engage and conform to medicalised approaches (Knight-Agarwal et al, 2014;Raven & Stewart-Withers, 2019).…”