Understanding Dietary Behaviours Among Primary Sector Worker Communities in India

"The findings will add critical insights when introducing/replicating nutrition interventions..., leverage contextually relevant knowledge, practices, and evidence to improve diet diversity and therefore their state of nutrition."



This cross-sectional, qualitative exploratory study explores the demand and supply factors that impact the diets and nutrition intake of 6 communities working in the primary sector in India: fishing community workers, the brick-kiln worker community, the forestry community, the farming community, tea and coffee plantation workers, and the salt pan worker community. It provides a view into collective and individual perspectives on dietary diversity, practices, and perceptions related to nutritional value, needs, and supplementation across these communities and locations. The research study was commissioned by Vitamin Angels Association India, supported by the United Nations Children's Fund (UNICEF) India.



Among the identified communities, the study employed a series of methods taking into account stakeholders in both the demand and supply side. These include:

• Focus group discussions (FGD) with pregnant and lactating women and mothers of young children;
• Personal interviews with husbands of pregnant women and fathers of young children;
• In-depth interviews (IDIs) with FGD participants among whom any unique case/positive deviance related to nutrition is identified;
• Home observation and IDIs with select FGD participants to document and visualise nutrition-related practices at the household level;
• IDIs with local kirana (grocery) stores, shopkeepers, and vegetable sellers from whom the community members procure food items; and
• Direct observation of markets/shop clusters frequented by the community.

Within each chapter in the study focused on one of the 6 working communities, the following are covered:

• Background of the Community
• Participant Context and Cumulative Community Profile
• Deconstructing Nutrition and Its Beliefs in The Community
• Deep Dive into Food Consumption and Its Implications
• Decision Making Related to Food Preparation and Procurement
• Supply Perspective
• Conclusion
• Case Study - Positive Deviance [Example from the fishing communities chapter: a 29-year-old woman with 3 daughters (aged between 1-8 yrs old) is not educated and lives in a nuclear family set-up with her mother. While her own health and condition is not the best owing to family dynamics, she has big aspirations for her children to study well and live a better life. She spends all her earnings on making sure her children eat healthy things; unlike the rest of the community, she purchases fruits twice a week. The community knows the woman's family dynamics but has offered no support. This woman's attitude toward her daughters and her desire to provide a better, healthier life for them makes her stand out.]

Following these detailed analyses, the report offers key points and areas for future action based on capability, opportunity, and motivation to change behaviour (COM-B) - e.g., to achieve dietary diversity. The pillars of the COM-B framework of analysis are:

• Capability refers to the inherent skill and knowledge available to individuals to carry out certain actions, including mental and physical abilities. Platforms for upskilling and knowledge-building can be set up to help individuals feel empowered to achieve the desired action.
  • Physical capability: (i) Ownership of land, livestock, or homes tends to enhance the capability to improve nutritional intake. (ii) Government focus on specific food items can boost the capability to produce, procure, and utilise nutritional alternatives.
  • Psychological capability: (i) Communities engaged in primary sector work related to food have greater exposure and knowledge about food and nutrition. (ii) Access to education and technology improves the ability to convert motivation for better nutrition into action, utilising resources like YouTube videos, access to doctors, etc. Antenatal and postnatal check-ups with doctors provide women with direct access to nutritional knowledge.
• Opportunity refers to the physical, environmental, social, or psychological factors that create an enabling environment for individuals or communities to take action. Improving opportunities may involve policy actions, programmatic interventions, creating knowledge exchange platforms, and providing access to resources, incentives, etc.
  • Physical opportunities: (i) Accessibility to markets plays a significant role, as communities closer to urban centres have better access to resources and can make wholesale purchases, whereas, in areas isolated from urban centres, it is mostly men who buy food items, leading to a communication and planning gap between women and men. Homes with adequate public distribution system (PDS) provisions tend to purchase more vegetables and fruits since their everyday staples are taken care of. Adequate availability of take home ration (THR) also provides pregnant women with access to nutritious supplementary diets like dalia or small amounts of fruits and nuts.
  • Social opportunities: (i) Community platforms like self-help groups (SHGs) and festive gatherings bring community members together, but they rarely involve interactions related to nutrition. (ii) exposure to Anganwadi workers (AWW) and anganwadi centres (AWC) offers knowledge about good nutritional practices, and in these communities, participants are more likely to refer to terms like "vitamins" and have technical knowledge about the importance of complementary feeding.
• Motivation refers to internal processes that impact decision-making, including fears, inhibitions, desires, and reflective motivation that involves planning. Improving motivation could involve leveraging positive motivations or demonstrating the positive outcomes of certain behaviours to increase desirability and likelihood of action. The greater the desirability, the greater the likelihood of enhancing motivation.
  • Automatic: (i) There is explicit motivation to prioritise the nutritional needs and well-being of children and pregnant women. However, there may be a lack of knowledge on how to best fulfill these motivations. (ii) For pregnant women, the actions focus on prioritising their desires/cravings and eliminating foods known to be harmful during pregnancy. (iii) For children, the priority is on diet modification until the age of 2 to 3 years to minimise negative impact. After 3 years, children are allowed to control and decide the quantity and quality of food they consume, and indulgence is considered important.
  • Reflective: Household food consumption is typically managed by women, but decision-making regarding planning and procurement of food items lies with men and elders in the household.

Key actions:

• Enable:
  • Provide access to information and knowledge, particularly among women in communities with limited knowledge about nutrition, especially community such as brick kiln workers, salt-pan workers, and the forestry community.
  • Focus on mandating access to nutritious resources at the district/state-level. For instance, the Government of Odisha focused on millet, which has led to increased knowledge, visibility, access, and utilisation of ragi as a wheat alternative.
• Enhance:
  • Consider incentivising community members to set up multiple kirana stores in smaller, isolated locations to improve access to food variety and competitive pricing, eliminating the need for long commutes to procure daily food items.
  • Introduce programmatic intervention by utilising existing social platforms: (i) Create a meta platform involving AWW, ASHA, and SHG and Panchayati Raj Institutions (PRI) members to highlight maternal and child health as a community cause. The platform can be used for multiple initiatives, including reviewing and monitoring PDS/THR access, exchanging knowledge on positive practices, and using SHG members (who tend to have greater social exposure and access) as catalysts for greater social interaction around the subject of nutrition. (ii) Consider incentivising SHG members to promote maternal and child nutrition for increased awareness on the subject.
• Extend:
  • Leverage existing motivations to provide nutritious alternatives for: lactating women (by piggybacking on the motivation to make special provisions for pregnant women) and children between 3 to 5 years of age (by emphasising the importance of continued monitoring of food quality and quantity).
  • Demonstrate and help communities visualise the negative impact on physical and mental development resulting from an unregulated diet or excessive consumption of packaged foods and snacks.
  • Consider communication interventions on collaborative food purchase planning between the husband and the wife (parents of young children) as a means to achieve positive household nutrition and ensure good health for the child "Swasthya parivaar, swasthya shisu (healthy family, healthy child)".

The report concludes with a multi-page chart that offers a comparative analysis of highlights from the 6 working communities.