TY - JOUR
T1 - “If there is no water, we cannot feed our children”
T2 - The far-reaching consequences of water insecurity on infant feeding practices and infant health across 16 low- and middle-income countries
AU - Household Water Insecurity Experiences-Research Coordination Network (HWISE-RCN)
AU - Schuster, Roseanne C.
AU - Butler, Margaret S.
AU - Wutich, Amber
AU - Miller, Joshua D.
AU - Young, Sera L.
N1 - Funding Information:
We are grateful to our funders who supported this work: the Competitive Research Grants to Develop Innovative Methods and Metrics for Agriculture and Nutrition Actions (IMMANA), which is funded with UK Aid from the UK government. This project was also supported by the Buffett Institute for Global Studies and the Center for Water Research at Northwestern University; Arizona State University's Center for Global Health at the School of Human Evolution and Social Change and Decision Center for a Desert City (National Science Foundation SES-1462086); the Office of the Vice Provost for Research of the University of Miami. We also acknowledge the National Science Foundation's HWISE Research Coordination Network (BCS-1759972) for support of the HWISE collaboration. SLY was supported by NIMH R21 MH108444 and NIMH K01 MH098902; MJB and DTK were supported by NIH 2R01ES019841; WEJ was supported by the National Science Foundation BCS-1560962. We greatly appreciate the efforts of the field teams including enumerators, identified in Young et al. (2019). We appreciate the support of Vidya Venkataramanan and Mira Wang in Atlas.ti data management; Nicholas Willis and Vidya Venkataramanan for Spanish translations; Ciera Babbrah for triple-checking the meta-theme coding; and Stephanie Martin for her comments on a draft of the manuscript.
Funding Information:
We are grateful to our funders who supported this work: the Competitive Research Grants to Develop Innovative Methods and Metrics for Agriculture and Nutrition Actions (IMMANA), which is funded with UK Aid from the UK government. This project was also supported by the Buffett Institute for Global Studies and the Center for Water Research at Northwestern University; Arizona State University's Center for Global Health at the School of Human Evolution and Social Change and Decision Center for a Desert City (National Science Foundation SES‐1462086); the Office of the Vice Provost for Research of the University of Miami. We also acknowledge the National Science Foundation's HWISE Research Coordination Network (BCS‐1759972) for support of the HWISE collaboration. SLY was supported by NIMH R21 MH108444 and NIMH K01 MH098902; MJB and DTK were supported by NIH 2R01ES019841; WEJ was supported by the National Science Foundation BCS‐1560962. We greatly appreciate the efforts of the field teams including enumerators, identified in Young et al. (2019). We appreciate the support of Vidya Venkataramanan and Mira Wang in Atlas.ti data management; Nicholas Willis and Vidya Venkataramanan for Spanish translations; Ciera Babbrah for triple‐checking the meta‐theme coding; and Stephanie Martin for her comments on a draft of the manuscript.
Publisher Copyright:
© 2019 Wiley Periodicals, Inc.
PY - 2020/1/1
Y1 - 2020/1/1
N2 - Objectives: Infant feeding plays a critical role in child health and development. Few studies to date have examined the link between household water insecurity and infant feeding, and none in a cross-cultural context. Therefore, we examined the perceived impact of household water insecurity in four domains: breastfeeding, non-breastmilk feeding, caregiver capabilities, and infant health. Our research was conducted as part of the Household Water Insecurity Experiences (HWISE) study. Methods: We interviewed respondents from 19 sites in 16 low- and middle-income countries (N = 3303) about the link between water insecurity and infant feeding. We then thematically analyzed their open-ended textual responses. In each of the four domains (breastfeeding, non-breastmilk feeding, caregiver capabilities, infant health), we inductively identified cross-cultural metathemes. We analyzed the distribution of themes across sites quantitatively and qualitatively. Results: Water was perceived to directly affect breastfeeding and non-breastmilk feeding via numerous pathways, including timing and frequency of feeding, unclean foods, and reduced dietary diversity. Water was perceived to indirectly affect infant feeding through caregiver capabilities by increasing time demands, exacerbating disease, undernutrition, and mortality, and requiring greater efficacy of caregivers. Respondents made connections between water challenges and infant health, for example, increased risk of infectious diseases, undernutrition, and mortality. Conclusions: These findings suggest that water presents many, and sometimes unexpected, challenges to infant feeding. By systematically investigating biocultural pathways by which water impacts infant and young child feeding, it will be possible to understand if, and how, water security can be leveraged to improve child nutrition and health.
AB - Objectives: Infant feeding plays a critical role in child health and development. Few studies to date have examined the link between household water insecurity and infant feeding, and none in a cross-cultural context. Therefore, we examined the perceived impact of household water insecurity in four domains: breastfeeding, non-breastmilk feeding, caregiver capabilities, and infant health. Our research was conducted as part of the Household Water Insecurity Experiences (HWISE) study. Methods: We interviewed respondents from 19 sites in 16 low- and middle-income countries (N = 3303) about the link between water insecurity and infant feeding. We then thematically analyzed their open-ended textual responses. In each of the four domains (breastfeeding, non-breastmilk feeding, caregiver capabilities, infant health), we inductively identified cross-cultural metathemes. We analyzed the distribution of themes across sites quantitatively and qualitatively. Results: Water was perceived to directly affect breastfeeding and non-breastmilk feeding via numerous pathways, including timing and frequency of feeding, unclean foods, and reduced dietary diversity. Water was perceived to indirectly affect infant feeding through caregiver capabilities by increasing time demands, exacerbating disease, undernutrition, and mortality, and requiring greater efficacy of caregivers. Respondents made connections between water challenges and infant health, for example, increased risk of infectious diseases, undernutrition, and mortality. Conclusions: These findings suggest that water presents many, and sometimes unexpected, challenges to infant feeding. By systematically investigating biocultural pathways by which water impacts infant and young child feeding, it will be possible to understand if, and how, water security can be leveraged to improve child nutrition and health.
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U2 - 10.1002/ajhb.23357
DO - 10.1002/ajhb.23357
M3 - Article
C2 - 31868269
AN - SCOPUS:85076880207
SN - 1042-0533
VL - 32
JO - American Journal of Human Biology
JF - American Journal of Human Biology
IS - 1
M1 - e23357
ER -