Abstract
Objectives:
This study aimed to explore food taboos among indigenous pregnant women in Bangladesh.
Methods:
A mixed-method study was conducted among the Tripura, Chakma, and Marma communities in Khagrachari district of Bangladesh. To identify the list of existing tabooed foods, six focus group discussions were conducted with 36 women aged 15 years and above. For the quantitative part, 75 indigenous pregnant women were interviewed face-to-face to identify the commonly avoided food items during their current pregnancy. All the interviews were conducted in the participant’s native language.
Results:
A total of 64 different items were identified as tabooed food during pregnancy. Among the current pregnant, 46.6% were adhering to food taboos. The most commonly avoided fruits were pineapple (33.3%) and papaya (20.0%). For vegetables, organic sweet potato (4.0%) and pumpkin (2.6%) were the most common. For animal products, 8.0% of participants avoided fish of any kind, and 2.6% restricted duck meat. Cold food (4.0%) was the most avoided beverages and snacks. Betel leaf and nut (2.6%) were also in the list of tabooed food. Distinct locally grown Ghut Ghutte, Chinese yam, and wild yam were also refrained. The health and well-being of the baby were the main concerns behind the food taboos.
Conclusion:
There is a high prevalence of food taboo practices among the indigenous pregnant women of Bangladesh. Tailored intervention programs to address misunderstandings, dispel myths, and encourage healthier food choices during pregnancy among the indigenous communities of Bangladesh can be beneficial for both pregnant and babies.
Background
Maintaining a nutritious diet throughout pregnancy is essential to suit the needs of both the mother and the developing fetus, which includes consuming enough proteins, vitamins, and minerals. 1 Insufficient nutrient intake during pregnancy can harm both the mother and her developing fetus, as their nutritional needs rise during this time. 2 Pregnant women with inadequate nutritional status are at a higher risk of experiencing complications like difficult labor, postpartum hemorrhage, poor birth outcomes, and increased morbidity and mortality. 3 Newborns who survive infancy but experienced fetal growth restriction due to inadequate maternal nutrition during pregnancy are at a significantly higher risk of stunting in childhood, as well as diminished mental and physical capabilities. 2
Food taboos are a widespread phenomenon observed in almost every human society around the world. 4 Pregnant women have suffered from dietary deficiencies as a result of food taboos, specifically pregnant women who reside in rural areas are forced to adhere to food taboos that limit calorie intake and specific nutrients. 5 Women who did not practice food taboos during pregnancy had significantly higher weights and gave birth to heavier babies than women who strongly practiced. 6
Food taboos are primarily influenced by religious, cultural, historical, and social factors. 7 Indigenous peoples are typically identified by a strong connection to ancestral lands and natural resources, a cultural identity that both they and others recognize, unique languages that may differ from the national language, traditional social and political institutions, and economies often centered around subsistence and local resources. 8
In Bangladesh, undernutrition and inadequate diets during pregnancy remain significant problems despite economic progress, with serious consequences for both maternal and child health. 9 Maternal Mortality Ratio was 196 per 100,000 live births according to the Bangladesh Maternal Mortality and Health Care Survey 10 while the neonatal mortality rate (NMR) was 20 deaths per 1000 live births as reported by the Bangladesh Demographic and Health Survey. 11
There are 3 million indigenous people residing in Bangladesh, divided into 54 separate communities, these communities are prevalent in the southeast of Bangladesh at Chittagong Hill Tracts (CHTs). 12 Among them, Chakma, Marma, Tripura are the major communities residing in that region. Food taboos differ significantly across various ethnic groups, yet there is limited information on the food taboo practices along with their reasons in these communities during pregnancy. Given this context, a study was conducted among indigenous women living in the Khagrachari district to determine the current food taboos during pregnancy along with their reasons of avoiding certain foods.
Methodology
Study area
The CHT located in the southeastern region of Bangladesh, is the country’s sole extensive hilly area. Renowned for its rich ethnic and cultural diversity and scenic beauty, the CHT covers approximately 13,184 km2, accounting for nearly one-tenth of the country’s total area. The region consists of three hilly districts: Rangamati, Bandarban, and Khagrachari. 13 It shares borders with Myanmar to the southeast, Tripura (an Indian state) to the north, Mizoram to the east, and the Chittagong district to the west. 14 These communities also inhabit regions such as Chittagong, greater Mymensingh, greater Rajshahi, greater Sylhet, Patuakhali, and Barguna. Among the most notable indigenous groups are the Chakma, Garo, Manipuri, Marma, Munda, Oraon, Santal, Khasi, Kuki, Tripura, Mro, Hajong, and Rakhine, each with its own rich cultural heritage and unique identity. 15 The indigenous people of Bangladesh, primarily of Mongoloid descent, exhibit significant cultural differences in food, clothing, religious practices, and housing compared to the Bengali population, and some communities. In CHT, slash-and-burn agriculture referred to locally as Jhum Chash is a subsistence food production system for ethnic minorities such as the Chakma, Marma, and Tripura. For generations, these communities have practiced Jhum cultivation, which encompasses fishing, hunting, and the gathering of forest products. 16 Jhum cultivation and the surrounding forests are essential to traditional societies, providing crucial sources of food, shelter, medicine, and other vital resources.16,17
Study site
Khagrachari district is one of the hill tracts districts situated in the southeast part of Bangladesh. Chakma, Tripura, and Marma are the major communities among the 11 different multilingual indigenous communities residing in that region. Khagrachari Sadar and Dighinala Upazila of Khagrachari district were purposively selected as the study area.
Study design and participants
A mixed-method approach, specifically an exploratory sequential design, was used 18 to identify taboo foods during pregnancy within three indigenous communities: Chakma, Tripura, and Marma. The qualitative part aimed to explore culturally significant foods considered taboo during pregnancy to construct a list of food items while the quantitative phase aimed to identify the most common tabooed food items. For the qualitative part, a micro-ethnography approach 19 was used to better understand the cultural beliefs behind food taboos. This method was chosen because it focuses on participants’ daily experiences, social interactions, and cultural practices, offering insights beyond what quantitative data could provide. The study used a sequential approach, starting with a qualitative phase to explore key themes. These findings guided the instrument development for the quantitative survey, ensuring questions were relevant and grounded in participants’ experiences. This enhanced the content validity of the survey. Combining both methods provided a comprehensive understanding of the topic, offering depth from qualitative data and breadth from quantitative data. The quantitative component further enhanced credibility by confirming and quantifying qualitative patterns.
For the qualitative part, participants were selected purposively from the Chakma, Tripura, and Marma communities, ensuring adequate representation from each group and reflecting the diversity within these populations. The sample consisted of two distinct age groups: one group of women aged 15–49 years and another group of elder women aged over 49 years, with 6 women chosen from each age group per community.
Study participants were selected for the focus group discussions (FGDs) through a multi-step approach. First, female local community leaders were contacted. They, in turn, communicated with respondents from same indigenous community to gather at least six indigenous women from each of two age groups. A total of 36 indigenous women participated in the qualitative phase of the study, with 12 women from each community. Data collection continued until saturation was attained, indicating that no additional themes or insights emerged from the interviews. This ensured that the sample size was sufficient to thoroughly capture the food taboos during pregnancy and provide a complete understanding of the topic.
To identify the commonly practiced tabooed food items, quantitative interviews were conducted with pregnant women who visited different government health centers, including community clinics, union sub-centers, Upazila health complexes, and the district general hospital for antenatal checkups. According to hospital records, only 2–3 indigenous women from the mentioned communities visited the health centers per day. Due to the short data collection period and the limited number of daily visits, a total of 75 pregnant women from the 3 indigenous communities were conveniently selected for the study.
Data management and analysis
Qualitative surveys
The qualitative data were collected through six FGDs using a guide developed from both literature review and previous studies. The guide covered topics including societal, religious, cultural, and personal reasons for food avoidance, health concerns for the baby (during pregnancy and after birth) and the mother, and sources of reinforcement such as family members, healthcare providers, and community leaders. The interview guideline was created based on an existing guideline that addressed the underlying taboos surrounding food. The designed guideline was previously developed by the same research group which was implemented in the plain land. It was piloted among indigenous people in a comparable situation for cultural validation. The finalized and adjusted guideline was based on the results of the pilot.
After finalizing the FGD guideline, study participants were invited and requested to arrive at the data collection station 30 min prior to starting the data collection. Four FGDs with the participants from the Tripura and Chakma community were held in one of the community members’ houses. Other two FGDs with the participants from the Marma community were held in a classroom of local high school during school holiday. Before conducting the FGD, the purpose of the study was explained to the respondents and written informed consent was taken. During the FGDs, each participant was given a number, enabling the note-taker to identify respondents while preserving their anonymity and any kind of leading questions were avoided. All the FGDs were held in quiet and comfortable setting, with each session lasting 1–1.5 h. FGDs were conducted using the participants’ native language (Kokborok for Tripura community, Chakma language for Chakma community, Marma language for Marma community). All conversations were audio-recorded, and field notes were taken simultaneously and verbatims were transcribed into Bangla and English. Transcriptions were coded manually using Microsoft Excel, and categorized under themes. Extracted codes were placed under specific themes like traditional heath beliefs, religious prohibitions, cultural variability, and those themes were analyzed by two researchers. This study also followed the COREQ checklist, covering aspects like the research team, study methods, context, findings, analysis, and interpretations for a thorough report. 20 Before conducting the study, ethical clearance was obtained from the Institutional Review Board of Bangabandhu Sheikh Mujib Medical University (Ref: BSMMU/2023/10287).
Quantitative surveys
Prior to conducting fieldwork, permission was obtained from the Civil Surgeon of Khagrachari district, the Resident Medical Officer of the district hospital, and the Upazila Health and Family Planning Officer. For data collection, 75 pregnant women were interviewed face to face in health centers utilizing a pre-tested semi-structured questionnaire. The questionnaire included sociodemographic information, a list of foods considered taboo during their current pregnancy along with the reasons and by whom were they reinforced to practice. An interview room was set up for data collection at union subcenter, community clinics, and Upazila health complex of Dighinala. However, in the district hospital, data were collected within the maternity and child health consultation room. Trained data collectors from respective communities conducted the face-to-face interview ensuring privacy and confidentiality. All quantitative data were entered and analyzed in Microsoft Excel 2016. The data were cleaned and then analyzed for frequency distribution.
Results
Qualitative assessment
Sociodemographic characteristics of the FGD respondents
Across the three communities, a total number of 36 participants were interviewed where the mean age was 43.7 ± 3.3 years. In terms of religion, all (100%) of Chakma and Marma participants follow Buddhism, while all (100%) of Tripura individuals were Hindu. The majority (83.3%) of Tripura respondents had no formal education, while 58.3% of Chakma individuals completed education up to the secondary level. Regarding occupation, 91.6% of Tripura participants were farmers, and 58.3% of both Chakma and Marma individuals were housewives.
Food taboos identified from the FGDs
A list of 64 items of tabooed food were identified from the three indigenous communities. The majority of these foods were avoided due to concerns for the baby’s health, with beliefs that they could cause low birth weight, deformities, allergies, skin rashes, eye ulcers, or serious conditions like malaria, tetanus, and convulsions after birth. Some foods were also avoided for the mother’s health, as it was believed they could lead to miscarriage, complications during labor, anemia, or uterine ulcers after delivery. The practice of these food taboos was primarily advised or reinforced by elders, including mothers and mothers-in-law of the pregnant women, sisters-in-law, grandmothers, and in some cases, traditional birth attendants. The tabooed food items are categorized into four major categories: fruits, vegetables, animal products, and beverages and snacks presented in Table 1.
List of tabooed foods with their reasons of avoidance across the three indigenous communities.
Fruits
Pineapple
One of the most commonly cited fruits tabooed in all the communities is pineapple. The indigenous communities believed that consuming pineapple would harm the fetus in the womb, potentially causing a miscarriage. This belief led them to widely avoid pineapple during pregnancy.
I refrained myself from eating pineapple during my pregnancy because I had heard it could cause a miscarriage. . . (Chakma participant ID 4, 15–49 years) My mother strictly warned me not to eat pineapple, as she believed it could destroy the fetus and lead to a miscarriage, ending my pregnancy. . . (Tripura participant ID 2, 15–49 years)
Similarly, participants from the Chakma community specifically mentioned that consuming pineapple during pregnancy is thought to carry several complications for the baby after the birth, such as the likelihood of developing eye ulcers, skin rashes, and even abscesses or boils.
My sister told me that. . .pineapple causes abscess as well as ulceration in the eye of the baby. . . (Chakma participant ID2, 15–49 years) My mother-in-law said that they have been practicing the habit of avoiding pineapple, as they believe it could harm the baby’s eyes by causing ulcers or lead to the development of large boils on the skin. . . (Chakma participant ID 1, above 49 years)
On the other hand, respondents from Tripura community exclusively mentioned about their additional fear of consuming pineapple because they believed it might get mixed with the breast milk and turn the milk poisonous for the baby and lead to baby’s death.
. . .consuming pineapple will get mixed with breast milk, turning it into poison and ultimately leading to the baby’s death. . . (Tripura participant ID 3, above 49 years)
Papaya
The second most commonly mentioned tabooed fruit was papaya. Respondents from Tripura and Chakma community perceived consuming papaya during pregnancy would cause miscarriage, abscess or boils on the skin of the baby.
One of the respondents stated,
. . .I heard from my mother and mother-in-law, green papaya is more harmful and dangerous than the ripe one due to the presence of white sticky substance in the papaya that destroys or kills the baby inside the womb causing miscarriage. . . (Tripura participant ID 5, 15–49 years)
Another participant stated on papaya consumption,
If the mother consumes papaya during pregnancy their babies are more prone to skin rashes like allergy, abscess and boil. . . (Chakma participant ID 2, above 49 years)
Tamarind, wild sour fruit (Ghut Ghutte/Thaichren/Gumutti)
Some participants from the Tripura community believe that eating sour fruits like tamarind and Ghut Ghutte during pregnancy can lead to low birth weight and skin rashes of the baby. They also perceived that sour fruits can make the pregnant mother’s blood thinner, which could be risky during pregnancy.
They stated that. . .
I did not eat any kind of sour fruits especially Ghut Ghutte. . . it is so much sour. . .I was afraid whether it could hamper my baby’s health. . .skin rashes like allergy, boil, and abscess, or. . .low birth weight. . . (Tripura participant ID 1, 15–49 years) My mother told me not to eat any sour fruit during pregnancy especially tamarind, because it destroys blood into water. . . (Tripura participant ID 6, above 49 years)
Jackfruit
Some participants from the Chakma community solely expressed concerns about consuming jackfruit during pregnancy, believing it could lead to health issues for the baby. They mentioned a belief that eating raw jackfruit might cause the baby to be born with spikes all over the body, similar to the fruit. Additionally, ripe jackfruit is regarded as a “hot” food, and participants fear it may cause digestive issues like bloating, nausea, and vomiting in the baby both during pregnancy and also after baby’s birth.
. . .ripe jackfruit. . .it is hot fruit, it produces heat inside the womb, baby will have abdominal discomfort like nausea, bloating. . . (Chakma participant ID 4, 15–49 years) More or less, I have heard of avoiding raw jackfruit during pregnancy because consuming this, baby will have spikes on the body as like it. . . (Chakma participant ID 3, above 49 years)
Vegetables
Local sweet potato (pink/red)
In the Chakma community, consuming local sweet potato is regarded as a taboo during pregnancy. They believe it poses a danger to the baby due to the potential development of hematomas or bruise-like lesions (initially red, then turning blue and black) after birth. This condition, locally known as fhw fera in the Chakma language, is additionally associated with bending of the body that can lead to convulsions in the body.
One of the respondents mentioned,
. . .I was told not to eat red sweet potatoes because it will cause red, blue and black pigmentations (hematomas or bruise) followed by body flexion, that leads to convulsion. . . (Chakma participant ID 6. 15–49 years, and ID 3 above 49 years)
Chinese yam (Tha naro)
In the hill tracts, a variety of yam known as Chinese yam grow naturally, each with its distinct characteristics. This yam is upheld as a food taboo in Tripura community where they believe that if a mother consumes Chinese yam during pregnancy, the baby will be born with excess whitish like coating on the body surface which they perceive as dirt.
. . .my in laws warned me not to eat yams, because it is sticky and its skin is quite dirty. . .so the baby will be born with severe dirt on the body during birth. . . (Tripura participant ID 5, 15–49 years)
Superstitions related to fruits and vegetables
Certain myths or superstitions warn pregnant women against consuming sliced fruits and vegetables transported via various means, such as rivers or roadways, as they fear it may lead to miscarriage. Additionally, there is a belief that pregnant women should avoid horizontally sliced fruits or vegetables, as they may cause discomfort or harm to the unborn baby’s neck, hips, or waist.
. . .they also restricted me during my pregnancy not to eat any fruits or vegetables, which are transported in pieces half by crossing a river, bridge, or any kind of route, because this might cause severe harm like miscarriage. . . (Tripura participant ID 2, above 49 years) . . .I have heard from my mother and neighbor’s, women during their pregnancy are not allowed to eat or even cut those fruits and vegetables horizontally, because it is believed that it will cause any kind of injury to the baby. . . (Tripura participant ID 1, 15–49 years) It is also said that the baby might feel the sensation of being sliced at its neck, hip or waist similar to that cutting fruits. . . (Tripura participant ID 3, 15–49 years)
Eating smashed fruit, typically resulting due to fall from a tree is avoided during pregnancy in the Tripura community. It is thought to believe the child will face severe consequences like loss of consciousness, intense crying as if beaten, facial deformities, rashes like abscesses and boils, and the risk of miscarriage.
Damaged or smashed fruit due to fall from the tree are not allowed to eat during pregnancy. If it is eaten baby will suffer from large sized abscess or baby will have deformed face surely. . .also baby will cry like as if they are beaten up by someone following unconsciousness. . .” (Tripura participant ID 4, 15–49 years)
Animal products
Meat
Duck and bird meat
Some respondents from Chakma and Tripura communities indicated that eating duck meat during pregnancy might impair the baby’s voice and cause leg deformities like palmate or crooked feet.
Respondent stated opinion that,
During my pregnancy I was advised not to consume duck meat because it will hamper baby’s voice which will sound like the duck quacks (Tripura participant ID 2, 15–49 years) I have heard earlier days; consuming duck meat, baby will have crooked feet like duck. . . (Chakma participant ID 3, above 49 years)
Additionally, respondents from the Tripura community perceived that eating meat of wild koel bird during pregnancy will cause leg or walking deformity in the baby. They stated that,
. . .among all other wild birds, meat of koel bird is prohibited during pregnancy, as baby will walk by rolling their feet just like the bird. . . (Tripura participant ID 6, 15–49 years)
Hunted meat
In many cultures, people hunt wild animals for meat using guns or sharp tools. But there is a strong belief in Chakma and Tripura communities that if a pregnant woman eats this meat, it could harm her and her baby, even causing death. This fear comes from their concern about disease of the animal, harmful substances of bullet, and cultural beliefs about the spiritual impact of eating hunted animals.
Because these wild animals are killed by guns or sharp weapons, the meats are hot due to effect of the bullet, so if any pregnant mother consumes, it will harm the fetus, even may die. . . (Chakma participant ID 1, above 49 years) . . .animals like deer, pig are hunted by bullets or sharp weapons. . .therefore their meat contains poison, which will definitely harm the baby. . . (Tripura participant ID 4, 15–49 years)
Fishes
Swamp eel (Kuiccha mach)
The Swamp eel, locally known as Kuiccha mach, is often avoided during pregnancy due to beliefs that it may affect the skin and shape of the baby’s head. They fear, if they consume Swamp eel during pregnancy, the baby’s skin will be slippery and the head will be formed in a shaped like that of a snake.
. . .if she eats. . . (Kuiccha mach) during her pregnancy, her baby’s skin will be slippery. . . (Tripura participant ID 5, above 49 years) I was forbidden to eat kuiccha mach. . . meanwhile I was also worried of my unborn child’s head whether it would look like that of the fish because it almost looks like a snake. . . (Chakma participant ID 3, 15–49 years)
Snake head murrel (Shol mach)
In Chakma community, snake head murrel, in local language known as shol mach is exclusively avoided during pregnancy with a perception that it could lead to health deterioration for both the mother and the baby. They fear that the mother might experience elevated blood pressure making it difficult to continue the pregnancy. Also, the baby could experience fever accompanied by convulsions. One of the respondents, who was knowledgeable about maternal health mentioned mothers may develop eclampsia from eating shol mach.
. . .previously there was saying that, consuming shol fish can cause any kind of harm to both mother and the unborn baby, I cannot clearly explain. . .it is something like mother will suffer from eclamp (eclampsia). . .or like that. . .very often pregnant women even die. . . (Chakma participant ID 2, above 49 years)
Egg
In the Tripura community, there is a traditional belief that consuming eggs during pregnancy can lead to physical abnormalities in the baby. It is believed that consuming eggs during pregnancy may result in the baby becoming larger, potentially complicating a normal delivery. They also feared that the baby’s eyes could grow unusually large, resembling the size of an egg, or that the child might be born with other eye deformities. Furthermore, they believed that consuming eggs during pregnancy could also harm the baby’s brain development.
Consuming eggs during pregnancy makes the baby bigger, complicating a normal vaginal delivery. . . (Tripura participant ID 3, 15–49 years) Well. . . it’s like. . . (if eggs consumed during pregnancy) baby’s eye might resemble as big as the egg. . .whereas I also heard that it also damages the brain of the baby. . . (Tripura participant ID 5, above 49 years)
Beverages and snacks item
Beverages
Participants from Tripura and Marma communities perceived that cold beverages like coconut water, any kind of soft drinks, and cold water are avoided during pregnancy, because they had a fear that baby might feel cold or suffer from pneumonia.
One of Tripura participants stated that,
Any kind of cold drinks are strictly prohibited in our community during pregnancy, because baby will suffer from cold while staying inside the womb. . . (Tripura participant ID 1, 15–49 years) I have heard coconut water can cause cold to the baby, if the mother drinks during pregnancy. . . (Marma participant ID 3, 15–49 years)
On the contrary, consuming hot water, hot tea, or coffee while pregnant is thought to be dangerous for the unborn child and could possibly be fatal as perceived by the participants from the Tripura community.
. . .drinking hot water during pregnancy, baby will die due to heat. . .also miscarriage can occur. . . (Tripura participant ID 2, above 49 years)
Stream water
Pregnant women are often advised against drinking water which is collected through a bamboo slide from the streams in the hill tracts specially during rainy season. This notion was particularly voiced by the respondents from the Tripura community as they believed that consuming water from this source could lead to tremors in the baby, experiencing of fever, and subsequently having convulsions.
. . .water collected from stream through a bamboo slide if consumed by pregnant women, baby will behave like as like he/she is trembling with fear associated with fever and convulsion. . . (Tripura participant ID 6, 15–49 years)
Traditional steamed pitha (local pitha)
A traditional pie consisting of black, reddish, or white binni rice (sticky rice), combined with fruits like banana and sliced coconut, is prepared by wrapping the mixture in banana or jackfruit leaves and steaming it using two pots, with both openings sealed, similar to how momos are made. This delicacy is widely enjoyed among indigenous communities residing in the hill tracts. However, food prepared using this method is prohibited exclusively in Tripura community during pregnancy due to the strong belief that it could lead to suffocation of the baby in the womb, which may be fatal.
. . .if this kind of steamed food like kola pitha, sainna pitha (Tripura local term) are consumed during pregnancy, baby will have difficulty in breathing, they may be suffocated to death. . . (Tripura participant ID 5, 15–49 years)
Quantitative assessment
Sociodemographic information of participants
Table 2 shows the sociodemographic characteristics of the pregnant visiting health centers for antenatal care services. The majority of respondents had attained education up to primary level, with proportions of 48.2% among the Tripura, 41.2% among the Chakma, and 21.4% among the Marma. In the Marma community, the highest levels of education attained were both 35.7% for those who completed secondary education and those who achieved education beyond the secondary level. Almost 75% of the participants were homemaker whereas only 6.7% of the participants were involved in farming, small trade, and service.
Sociodemographic characteristics of the study participants, N = 75.
Commonly practiced food taboos
Among the participants, 46.6% acknowledged adhering to food taboos. The most commonly known tabooed foods avoided by the indigenous pregnant women during their current pregnancy included pineapple (33.3%), papaya (20.0%), conjoint fruits (5.3%), organic sweet potato (4.0%), pumpkin (2.6%), fish of any kind (8.0%), duck meat (2.6%), cold food (4.0%), betel leaf and nut (2.6%). Besides, there were also several different foods considered as taboo which were only mentioned by 1.3% of the participants as shown in Table 3.
List of tabooed foods commonly practiced by indigenous pregnant, N = 75.
Discussion
This study aimed to identify the prevalence of food taboo practices and the frequently tabooed food items among pregnant women in three indigenous communities—Chakma, Tripura, and Marma residing in Khagrachari district of Bangladesh. The findings revealed that nearly half of pregnant participants practiced food taboos, and a list of 64 tabooed food items was generated from their responses. Most of these foods were avoided due to cultural beliefs and concerns for both maternal and infant health. These food taboos were primarily advised and reinforced by elders, including mothers, mothers-in-law, sisters-in-law, grandmothers, and in some cases, traditional birth attendants.
Food taboos are highly prevalent among pregnant women in Bangladesh9,21–23 significantly influencing dietary practices across various regions, including among indigenous communities. Such practices are highly prevalent in Asia and Africa, due to deep-rooted cultural, religious and traditional beliefs that influence dietary practices, special during pregnancy. 1 The prevalence of food taboos practiced identified in this current study was 46.6%, where the participants mentioned that they at least avoided one tabooed food item during this period. Rates similar to this study noted in Surendranagar district, India (41.6%) and Shashemene district, Ethiopia (49.6%).4,24 On the other hand, some studies reported a much higher prevalence like 67.4% in Eastern Ethiopia, 25 and 70.2% in Kuala Lumpur, 26 whereas some reported a much lower prevalence like 27.5% in the Ethiopian region, 7 while it was 27.9% in Buyende district, Eastern Uganda, 27 and 37.4% in Indonesia. 28 This variation in the prevalence of food taboos across different regions may be attributed to diverse cultural beliefs, socio-economic conditions, and levels of health awareness in these communities. 29
A major concern expressed by the participants was about their babies’ health, prompting them to avoid specific foods to prevent complications such as congenital deformities/anomalies, conjoint twins, growth retardation, with most focus group members believing that adhering to food taboos was crucial for avoiding miscarriages and labor complications, ultimately reducing the likelihood of hospital deliveries and cesarean sections. These concerns and their impact on maternal and child health have been corroborated by other studies conducted in Bangladesh, highlighting the apprehension among pregnant women about potential risks to their babies. 9 Unfortunately, these cultural beliefs and food taboos exclude foods that are rich in protein, iron, and essential micronutrients that are vital during pregnancy and often not consumed in sufficient quantities by women. 30 However, food taboos related to the same food or food group often vary across regions, influenced by cultural differences, beliefs, and underlying reasons. 1
The majority of pregnant women in the current study avoided pineapple and papaya due to the belief that these fruits could lead to abortion or miscarriage, which was also echoed in studies done in other regions of Bangladesh.9,22 These beliefs are widespread, with similar concerns documented in West Bengal, Andhra Pradesh, Assam, Pondicherry, South Africa, and other regions.1,26–28,31,32 Additional concerns expressed by the participants from the Chakma and Marma communities in this study were that consuming pineapple and papaya during pregnancy could result in the baby developing abscesses, eye ulcers, or allergic skin conditions after birth. Another unique belief in the Tripura community was that consuming pineapple during pregnancy could contaminate breast milk, rendering it harmful or poisonous to the baby. These cultural differences in belief between the communities might be due to their differences in ethnicity, religion, geography. 33 Jackfruit is a popular seasonal fruit consumed by the indigenous communities in the CHT for its taste and nutritional content. Yet, Chakma respondents in this study avoided consuming jackfruit fearing it could cause excessive heat and discomfort to the baby in the womb. Furthermore, other participants avoided this fruit as they believed it could cause the newborn to develop spike-like protrusions on their skin like the texture of the fruit. Earlier studies from India and Malaysia,31,34 similarly noted that jackfruit was considered a taboo for pregnant women. However, the reasoning differed, as it was believed to cause fetal deformity or complications during delivery.
Participants from the Tripura community specifically avoided sour fruits, including a local variety called Ghut Ghutte (wild sour fruit). They believed that consuming these fruits could lead to low birth weight, as well as cause fever, boils, and abscesses in the baby, and reduce blood level of the mother. Meanwhile, Lekey et al., 35 reported where the participants perceived lemon consumption may reduce blood levels, causing blood thinning and lightheadedness. Similarly, respondents of the studies conducted by Parmar et al., 24 and Ramulondi et al., 1 believed that eating citrus fruits could lead to low birth weight, smaller size of the baby, and potential placental disruption in newborns.
Participants across all communities also mentioned many vegetables which they avoided during pregnancy. Different types of gourds were commonly reported, where ridge gourd was believed to decrease breast milk production, snake gourd was thought to potentially cause uterine ulcers after delivery, and both bitter and white gourds were linked to the belief that they could result in a baby being born with rough, bumpy skin. The findings are consistent with those reported in certain regions among different ethnic groups of India where they considered snake gourd, bottle gourd, bitter gourd during pregnancy as harmful during pregnancy. 32 In the Tripura community, Khwrmai shak (a local green leafy vegetable) was found to be avoided due to the belief that it causes miscarriage. A similar belief was reported in Africa, where the pregnant women refrained from consuming local green leafy vegetable, Imifino, due to the belief that its consumption could cause excessive salivation, burnt skin, or dark marks on the skin of the unborn child after birth. 1
Pregnant women in the current study also refrained from eating animal-source foods such as eggs, fishes, and meat, which are rich in first-class proteins. In the Tripura community, pregnant women avoid all types of eggs, fearing that they might cause the baby to have unusually large eyes. Similarly, in mainland Bangladesh, duck eggs are believed to cause breathing problems in infants, 9 whereas it is also perceived by the pregnant that egg consumption may lead to psychological issues in children. 36 In Africa, studies by Ramulondi et al., 1 and Arzoaquoi et al., 37 where the interviewees stated that eggs are avoided to prevent physical deformities, oversized babies, and complications during childbirth. This belief extends to countries like Ghana, Zambia, and Indonesia, where eggs are also thought to cause issues such as hairless babies or prolonged labor.1,37,38
Participants from the Tripura and Chakma community in this study reported avoiding duck meat but with different perceptions. In Tripura, some participants believed that women who ate duck meat would give birth to babies with duck-like voices, while the Chakma community believed that such babies would be born with curled legs and palmate feet. Additionally, Tripura participants also avoided eating wild koel meat it could cause the baby to display rolling body and feet movements similar to those of the koel bird. Similarly, duck meat and pigeon meat are commonly considered taboo across various regions of Bangladesh, with multiple studies documenting these prohibitions.9,21,22 These meats are often avoided due to cultural beliefs that they may lead to breathing problems of the baby, with some also perceiving duck meat to result in a harsh voice of the newborn. 36 Other studies reported that consuming bird meat during pregnancy could lead to several outcomes such as the baby being smaller, more talkative, and the mother producing less milk. 1 A unique finding from this research is the identification of certain tabooed meats that were exclusively reported by the indigenous communities, which are not eaten in the mainland regions. These include pork, meat sacrificed and worshipped in religious rituals, snake meat, frog meat, and hunted game meat. These dietary restrictions reflect the deep-rooted cultural and religious beliefs that shape food practices among indigenous groups, highlighting a stark contrast to the dietary norms in the broader Bangladeshi population. This divergence in food practices underscores the importance of understanding local cultural norms when addressing food security, nutritional education, and health interventions. Additionally, it highlights the challenge of integrating indigenous food practices with broader public health recommendations, especially when considering nutritional needs and food accessibility in these diverse communities.39,40
This study highlights that Chakma and Tripura women avoided consuming swamp barb (puti mach), wallago catfish (boal mach), snake head murrel (shol mach), mrigal carp (mrigel mach), and a few more fishes, as they are believed to cause discomfort, skin lesions, mouth deformities, and convulsions in the baby. Similarly, many fishes are tabooed in different regions of Bangladesh during pregnancy due to their perceived association with health risks such as the potential to cause convulsions, skin ailments, or the baby being born with abnormal features like dark skin, wide mouth, fish-like scale, and excessive body hair.9,21,36,41 Seafood items like shark meat, snails, and black mussels are restricted among Tripura and Chakma communities in this study during pregnancy due to beliefs that consuming them may lead to fetal deformities and cause abdominal pain in the mother. Although not widely reported, the avoidance of snails, squid, shrimp, stingray, and octopus during pregnancy is also noted in Ghana and Indonesia, due to concerns about miscarriage, labor difficulties, fetal hiding, and placenta issues.37,42 However, these seafood items are not commonly consumed by the broader Bangladeshi population as they are not considered part of traditional food culture and are thus rarely mentioned in other studies.
This study also revealed the practice of avoiding both “hot” and “cold” foods during pregnancy, which aligns with similar belief in other regions of our country. Respondents from the Chakma and Marma communities voiced concerns about consuming cold foods and beverages, such as cold water, juices, watermelon, and cucumber, fearing these might cause ailments like colds, pneumonia, skin issues, or result in low birth weight for the baby. In contrast, Tripura participants believed that hot beverages posed a risk to the fetus, thinking that the excessive heat could even be fatal. Diabetic Bangladeshi mothers refrained from drinking tea or coffee during pregnancy, believing that it could result in their child having darker skin. 23 Another study from Ethiopia found that elders prohibited pregnant women from drinking tea and coffee, believing that these beverages could “burn” the fetus and lead to abnormalities. 5
Superstitious beliefs were also found to play a role in shaping the dietary habits of indigenous pregnant women. Prevailing superstitions in this study caution pregnant women against consuming horizontally sliced fruits and vegetables, those transported by road or river, smashed by falling from trees fearing miscarriage, facial deformities, intense crying, or harm to the baby’s neck or hips. Additionally, drinking water from bamboo slides in hill streams, especially during the rainy season, is thought to cause tremors, fever, and convulsions in the baby. The superstitions surrounding pregnancy vary across different regions of the country, with each region having its own set of beliefs.21,23 However, all these superstitions are rooted in a common concern: the fear of causing harm to the unborn baby. For example, pregnant mothers avoided eating food during prayer times, during an eclipse, when a new moon rises in fear of giving birth to a physically or mentally challenged child. 23
We recognize that this discussion warrants an explanation on the extent to which these food restrictions affect the nutritional status of the pregnant women who adhere to this practice; however, it was beyond the scope of this study to assess the direct impact of these restrictions on maternal nutrition. The dietary patterns of indigenous pregnant women are deeply rooted in their cultural traditions. Chakma, Tripura, and Marma women typically consume rice, corns, seasonal fruits and vegetables, and freshwater fish as staple foods, supplemented by wild greens and local meats. 43 Avoiding some of the food items as taboos during pregnancy impacts caloric and nutritional intake. There were no studies available that directly measured the nutritional status of the indigenous pregnant women in relation to these food restrictions. Previous studies, mostly conducted nearly 2 decades ago, documented the indigenous populations of the CHTs as malnourished, poor, uneducated, and underprivileged due to limited employment opportunities, poverty, poor housing, and inadequate access to education, healthcare, and sanitation.14,44–47 Additionally, the maternal mortality rate (MMR) and NMR serve as important indicators for understanding the nutritional status of pregnant women. The Maternal Indicators Dashboard by the Directorate General of Health Services, Bangladesh provides real-time data on maternal and neonatal health outcomes where the MMR in 2024 was reported as 89.8 per 100,000 live births, while the NMR was 3.4 per 1000 live births. 48 However, these rates vary regionally, with the MMR in Chattogram, where the Khagrachari district is located, reported 108.7 per 100,000 live births, primarily attributed to post-partum hemorrhage (40.4%) and anemia (8.9%). 49 Restrictions on nutrient-rich foods, such as meat, fish, and certain fruits, as observed in the list of tabooed foods in this study, may contribute to anemia and other nutrition-related complications, potentially increasing the risk of adverse maternal outcomes.
In this study, we highlight tabooed food items that are not only commonly reported in mainland Bangladesh but also identify certain food restrictions unique to the CHT regions among the three indigenous communities of Tripura, Chakma, and Marma. This distinction offers a novel contribution to the literature by capturing region-specific dietary practices that may significantly impact maternal nutrition in indigenous communities, an aspect that has received limited attention in previous research. A key strength of this study is capturing the voices of indigenous women from geographically disadvantaged areas regarding their experiences with food taboos. This contributes to a deeper understanding of the inequities surrounding food practices in indigenous pregnant women’s health. Another strength of this study is that recall bias was limited because the pregnancy-related information was collected at the time of pregnancy.
The current study, while providing valuable insights, has limitations. The findings of this study are limited in their generalizability due to the small sample size drawn from indigenous communities, which may not fully capture the diversity of experiences, beliefs, and practices across different groups. Furthermore, the absence of quantitative measurement of associations limits the exploration of food predictors related to food taboos and the evaluation of relationships between participants and sociodemographic factors. Also, the lack of nutritional evaluations and anthropometric measurements prevented the assessment of participants’ nutritional status. Lastly, as all interviews were undertaken and recorded in indigenous local language, where the authors relied on translated transcripts and the cultural interpretations of the research assistants leading to chance of biases in the interpretation.
To mitigate the impact of food taboos and improve maternal and child health outcomes in indigenous communities of CHT, it is crucial to promote nutrition counseling for pregnant women, facilitated by domiciliary and health facility workers native to these regions to ensure culturally appropriate care. Integrating traditional food knowledge into the existing counseling-based nutritional practices may encourage the adoption of healthier dietary habits during pregnancy without disregarding cultural beliefs. Additionally, strengthening access to ante-natal services, particularly in these areas, through community outreach and mobile health services could help bridge existing gaps. Addressing these challenges requires targeted policy measures that prioritize maternal nutrition and health in indigenous communities, though such efforts must contend with significant socio-economic and cultural barriers. The reality of implementing these measures in remote CHT communities is challenging due to significant barriers, including limited infrastructure, cultural resistance, and resource constraints. Finally, future research should explore the long-term health implications of food taboos and develop context-specific interventions for each community to promote adequate nutrition and positive birth outcomes.
Conclusion
A total of 64 different food items were identified as taboo among Chakma, Tripura, and Marma indigenous pregnant women of Bangladesh. Nearly half of the pregnant adhere to the tabooed foods. The majority of the foods practiced as taboo were for the well-being of the unborn baby. Pineapple, papaya, conjoint fruits, organic sweet potato, duck meat were commonly avoided. Locally food items like Thaicherem (Ghut Ghutte), Tha aro (Chinese yam), Batima (wild yam) that are distinct to these indigenous communities were also listed as taboo. This study suggests in developing tailored intervention programs to address misunderstandings, dispel myths, and encourage healthier food choices during pregnancy among the indigenous communities of Bangladesh.
Supplemental Material
sj-docx-1-smo-10.1177_20503121251342979 – Supplemental material for Food taboos among indigenous pregnant women of Khagrachari District, Bangladesh
Supplemental material, sj-docx-1-smo-10.1177_20503121251342979 for Food taboos among indigenous pregnant women of Khagrachari District, Bangladesh by Labanya Tripura, Shahrin Emdad Rayna, Anirban Chakma, Khan Mohammad Thouhidur Rahman, Md. Syed Shariful Islam and Md. Khalequzzaman in SAGE Open Medicine
Supplemental Material
sj-docx-2-smo-10.1177_20503121251342979 – Supplemental material for Food taboos among indigenous pregnant women of Khagrachari District, Bangladesh
Supplemental material, sj-docx-2-smo-10.1177_20503121251342979 for Food taboos among indigenous pregnant women of Khagrachari District, Bangladesh by Labanya Tripura, Shahrin Emdad Rayna, Anirban Chakma, Khan Mohammad Thouhidur Rahman, Md. Syed Shariful Islam and Md. Khalequzzaman in SAGE Open Medicine
Footnotes
Acknowledgements
The authors would like to acknowledge the cooperation of the civil surgeon of Khagrachari District Hospital, Upazila Health and Family Planning Officer of Dighinala Upazila Health Complex, community health care providers of different community clinics for conducting the study in the health facilities. The authors would also like to thank all the research assistants that were involved in data collection, and the participants for their valuable time and assistance in sharing their views for this study. The authors would like to thank Bangabandhu Sheikh Mujib Medical University for their funding.
ORCID iDs
Ethical considerations
Ethical clearance was taken from the Institutional Review Board of Bangabandhu Sheikh Mujib Medical University (Ref: BSMMU/2023/10287).
Consent to participate
Informed written consent was taken before each interview and each focus group discussion from all the participants of this study after explaining the objectives, assured of confidential handling of data, and provided with the right to refuse to participate or withdraw from the study at any point of time. Written informed consent was obtained from all subjects before the study.
Consent for publication
Consent for publication was also obtained from the participants to include any information they shared ensuring their privacy and respecting their cultural practices.
Author contributions
LT, MK, SSI, SER, KMTR, and AC: designed the study. LT, MK, and AC: conducted the research. LT, MK, and AC: analyzed the data. LT and SER: wrote the paper. SER, MK, and SSI: critically reviewed the manuscript. All authors have read and approved the final manuscript.
Funding
The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This study was funded by Bangabandhu Sheikh Mujib Medical University (Ref: BSMMU/2023/10287), (Grant number 175276222).
Declaration of conflicting interests
The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Data availability statement
Upon reasonable request for data access, please contact the corresponding author.
Supplemental material
Supplemental material for this article is available online.
References
Supplementary Material
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