Culturally adapted healthy eating information in midwifery - Using the familiar to bridge the gap

By Aniebiet Ekong, Public Health Nutritionist & PhD researcher, Bournemouth University, Bournemouth on 07 January 2022

In pregnancy, studies show that despite the preponderance of healthy eating information, healthy eating guides and policies, pregnant women do not meet(1) nor adhere to healthy eating recommendations(2).

Non-adherence to healthy eating guidelines can pose a risk to the mother and child especially in the first 1000 days of life. Several reasons for the non-adherence include “being confused with the myriad of healthy eating information on social media”, “healthy eating recommendations change in different countries”, and “healthy eating information is not being offered to them”(3).

In the UK, the National Institute for Health Care Excellence guidelines stipulate that midwives offer pregnant women healthy eating advice as a part of their antenatal care. There are however gaps in the uptake of this healthy eating advice.

My study was an exploration on the barriers and facilitators to the uptake of healthy eating messages by pregnant African immigrant women living in the UK. My specific focus was on Nigerian women. I conducted semi-structured interviews in two NHS trusts in the South of London.

Several themes evolved from the discussions that have been developed into several pieces of writing, which will be published over time. I will discuss one of the themes here.

The sense of familiarity

This quote below encapsulates the perspective of a pregnant woman.

“I will say stick to the midwife, even though it might not be too helpful, but if you can just listen. In the community I live now, I live in Deptford, its multicultural so you get some midwives that really give you advice on African food. They look at you and the way you look at the leaflet, they will just put the leaflet aside and they will talk to you from I guess from your background if they are from your background. Or let’s say they put their profession away for one minute and talk to you as a human being which I really appreciated because it’s more appreciative to me because they are talking to me from their heart. You can do this and that and you can eat this and that, even though they are not from the same background as you. They try to tell you about the food that you may eat from your own culture that will not harm you or the baby so yeah it’s much more helpful.”

One of the barriers to the uptake of healthy eating messages by these women is “sticking with the familiar”. Most of the women said that the advice offered were on foods that were unfamiliar to them. These women wanted to stick with the familiar, they just needed help to make the familiar healthy. That was the position of the woman whose quote I have used above.

As a black immigrant and a Nutritionist, “sticking with the familiar” is not new to me. The sense of familiarity especially with regards to an individual’s culture is very important as it provides a grounding for those individuals. Unfortunately, there are no resources that specifically address the cultural healthy eating needs of these individuals. This is despite the fact that they are at a higher risk of developing gestational diabetes and are four times more likely to die from complications in pregnancy(4,5).

Food is now mobile, and the world is slowly becoming a global village. Different cultural foods have migrated to different parts of the world. How do we position ourselves to meet the demands of the changing face in migration? There is therefore an urgent need to develop healthy eating tools that will aim at bridging the health inequality gap.

This is a gap; this is a potential path for future exploration. 

Further reading

1. Morton SM, Grant CC, Wall CR, Carr PEA, Bandara DK, Schmidt JM, et al. Adherence to nutritional guidelines in pregnancy: evidence from the Growing Up in New Zealand birth cohort study. Public Health Nutr. 2014;17(9):1919-29.
2. Malek L, Umberger W, Makrides M, Zhou SJ. Adherence to the Australian dietary guidelines during pregnancy: evidence from a national study. Public Health Nutr. 2016;19(7):1155-63.
3. Alavi N, Haley S, Chow K, McDonald SD. Comparison of national gestational weight gain guidelines and energy intake recommendations. Obes Rev. 2013;14(1):68-85.
4. Knight MB, K; Tufnell, D; Shakespeare, J; Kotnis, R;Kenyon,S ; Kurinczuk JJ (Eds.),. on behalf of MBRRACE-UK. Saving Lives, Improving Mothers' Care- Lessons learned to inform maternity care from the UK and Ireland Confidential Enquiries into Maternal Deaths and Morbidity 2015-17. . Oxford National Perinatal Epidemiology Unit, University of Oxford 2019.
5. Lindsay K, Gibney E, McAuliffe FJJohn, dietetics. Maternal nutrition among women from Sub‐Saharan Africa, with a focus on Nigeria, and potential implications for pregnancy outcomes among immigrant populations in developed countries. 2012;25(6):534-46.