'No protein in late pregnancy': battling dietary myths in South Sudan

A recent report says that an estimated 737,812 pregnant and lactating women in South Sudan will suffer acute malnutrition over the course of this year. (Photograph: Paul Jeffrey/Alamy)

On a mat under a mango tree in front of his large grass-thatched hut, a wealthy man is being persuaded to change his family’s eating habits. In Longu, a small South Sudanese town in the eastern outskirts of Nimule – about 200km south of Juba, the capital – Jane Keji and Rose Moriku sit on the mat.

They are in a deep conversation on healthy eating with Anje, 30, and her husband, Azo Daudi, 39. The Daudis are well off by local standards and Azo is a conservative man. Anje had a miscarriage in 2017 because of complications related to malnutrition. Their two children, four months and 18 months old, have been diagnosed as malnourished.

Anje is usually busy in the house during the harvest months, but today she has other priorities: the health of the child she is carrying and her two little ones.

“If it wasn’t for the intervention of the village chief, this meeting with Keji and Moriku would never have happened,” she says. “My husband’s clan believes that a pregnant woman who eats protein will have a miscarriage.”

A July 2023 WFP report estimated that 737,812 pregnant and lactating women and 1.4 million children under the age of five in South Sudan will suffer acute malnutrition over the course of this year. This is due to a number of factors, including the prevalence of myths associated with eating habits that are detrimental to maternal and child health in rural South Sudan. Keji and Moriku are part of a Unicef attempt to tackle these myths.

With her strict diet of leafy greens, Anje’s first pregnancy ended in a miscarriage. She still grapples with the guilt of having brought it upon herself. “We are blessed with all these domestic animals”, says Anje, “but it is neither reflected on my body nor on the bodies of my children.”

Keji and Moriku are in a 4,700-strong support group for pregnant women and new mothers aiming to root out deeply engrained misconceptions. The trained volunteers from the community make home visits to raise nutritional awareness. The initiative is part of Unicef’s broader maternal, infant and young child nutrition strategy, which was launched and rolled out in 2017, and is set to last until 2025.

Their work comes at a time when food insecurity in South Sudan has reached what Unicef describes as “at its highest level ever”, driven largely by floodings, ongoing conflicts, displacements and the rising costs of living that limits households’ access to food.

Lucy Adelino, a Unicef nutritionist in South Sudan, says the programme allows mothers share their experiences. “Pregnant and breastfeeding mothers join voluntarily. After three to four weeks of training, they help educate other mothers, pregnant women and community members on best practices related to child nutrition,” she says.

They learn healthy eating habits, how to cultivate vegetables essential for children in a small-scale kitchen garden, and to debunk myths associated with breastfeeding.

Moriku, 27, was herself a victim of these myths. “Even though my first-born child is seven now”, she says, “he looks much younger than his age because my father-in-law insisted that I follow their tradition of fasting during pregnancy.”

Among the Patibi clan of the Madi tribe, a pregnant woman is expected to fast in the last trimester with restrictions on eating protein. It is claimed that this purifies the body and leads to a healthy child. Like some older people in their village, Moriku’s father-in-law thought eating protein or fruits with seeds during pregnancy would cause harm.

“When I followed this advice the exact opposite happened,” said Moriku. “But when I was pregnant with Fiona, my second child, a mother-to-mother group convinced my husband that it was dangerous to fast during pregnancy and lactation,” she says.

“Everyone notices how active and healthy Fiona is. This is why I joined the group three years ago to help other mothers in the same situation.”
skip past newsletter promotion

At the Kimu primary health care centre in Juba, Unicef’s Adelino points to the empty seats. “Just six years ago, this centre used to be full of malnourished children, before our partner World Vision launched the programme here. Today, few malnourished children are admitted,” she says.

A 2021 UN assessment report showed an increase in breastfeeding from 45% in 2010 to 68% in 2020, but contended that “more needs to be done to reduce and prevent malnutrition in the first place”.

Moriku believes that Anje and Azo’s case has become a cautionary tale. “It’s a sign that knowledge is power and that women are taking a stand because it affects them,” she says.

A support group member, Betty Elevira, says that despite the prevalence of these myths, most pregnant women and mothers now turn to the group or medical staff before adhering to any family-proscribed diets, no matter what the consequences for them.

“If a support group says something is harmful, they will not do it because women value health and a healthy child more than staying in a marriage. What is the value of having a husband if there is no child or if the child is unhealthy?” she says.

Francis Chandiga, a former nutritionist with the Médecins Sans Frontières, says a lack of freedom for married women to make decisions independently in pastoral communities is a key issue. “Success can only come by educating the men who, in most cases, work outside the home,” he says.

But the biggest challenge of all to nutrition is the constant displacement of families by conflicts and climate disasters. “Regardless of your commitment, the success rate depends on the country’s security. If there is peace, we can overcome all other obstacles. Otherwise, the gains of two-plus years can be erased in a day’s fighting,” Chandiga says.

The article was published in collaboration with Egab.