Foods proscribed (restricted) during pregnancy on Kei Besar Island
Participants mentioned several food items that should be avoided or minimized during pregnancies (Table 2).
Certain types of fish
Nine out of 17 informants (53%) mentioned that certain kinds of fish are better avoided or minimized during pregnancy. These include fish that have been stored in the freezer, komo (black skipjack; Euthynnus affinis), and momar (scad fish; Decapterus sp.) [25, 26], due to the tendency of pregnant women to develop allergies and itchiness after consuming these types of fish. The mama biang also talked about how eating komo fish during pregnancy may cause the babies to have stomach discomfort.
“Komo fish is different for different people, some people develop allergy after eating those, some pregnant women they can also itch from eating those” (Pregnant woman, 31–35 years).
“Komo, papaya, papaya leaves, petatas leaves, all those will cause discomfort in the stomach, so it’s disease. Later when the child is grown, then they [pregnant women] can eat those, after the child has been weaned from breastmilk.” (Mama biang, 61–70 years).
Chili or spicy food
Eight participants (47%) reported that chili and spicy food should be restricted during both pregnancy and breastfeeding. Participants believed consuming chili and spicy food during pregnancy could lead to a range of eye problems, such as eye crusts, red eyes, big eyes, and small eyes. Additionally, chili and spicy food can also be passed through the breastmilk and cause the baby to cough.
“They said it might affect the child’s eyes. Usually… their eyes will be red, even if they’re still closed.” (Pregnant Woman, 31–35 years).
“If the mother has started breastfeeding… Same… if you eat spicy food, your children will have a lot of tai mata (eye crusts)… and they will cough… from the breastmilk…” (Mama biang, ≥ 71 years).
Soda and alcohol
Seven participants (41%) reported that soda or carbonated drinks should be avoided by pregnant women as they may cause disability or miscarriage. The same beliefs are also held by some participants (23%) about alcohol. Both beverages are considered keras (translation: “strong”) and may harm the fetus. The term was used to signify the harm of the beverages toward the fetus.
“I think sopi (traditional alcohol from Eastern Indonesia, made from fermented aren/nira palm fruits)… you can’t drink… Usually if you drink sopi, it could cause miscarriage to the child as well.” (Pregnant woman, 19–25 years).
“You should not eat… drink… like xx, or yy (two famous brands of carbonated soft drinks)… some people said they had miscarriage… maybe the drinks are too hard, doc.” (Pregnant woman, 31–35 years).
Pineapples
Pineapples were mentioned by some participants as the cause of miscarriage (7 participants, 41%). It is implied that pineapples are believed to compromise the womb and trigger miscarriage or affect the fetus directly.
“What they can’t… for pregnant women, some sort of fruits, like pineapples… pregnant women can’t eat pineapples… because the young ones… they affect… I mean…pineapples, if people are… in their young pregnancy, if you eat pineapples… they can destroy the fetus immediately. Then the mother will have a miscarriage.” (Community health volunteer, 30–40 years).
Octopus and squids
Around 35% of participants mentioned that they should not eat octopus and squid, with reasons varying from adversities toward the newborn, difficulty in giving birth, to following elders’ advice. One participant mentioned that eating octopus and squid is restricted due to their tendency of causing high blood pressure, while one stated they might cause the fetus to move a lot inside the womb. A key informant also cited that the elders attributed molar pregnancy (hamil anggur) to eating octopus. One of the participants told the interviewer that eating crabs have the same effects.
“They said for octopus, squid, the child will move forward and backward, so when we push them out, they move forward a bit, and then they will go backward again. That makes it difficult to give birth.” (Pregnant woman, 19–25 years).
Papaya leaves
An equal proportion of participants (35%) also mentioned papaya leaves unsuitable for consumption during pregnancy and breastfeeding period. Papaya leaves are believed to bring potential risks of miscarriage during early stages of pregnancy, high blood pressure for mothers, and ailments for breastfeeding babies.
“If you eat those [papaya leaves], the children will cry easily… cry a lot… then it will be hard for them to sleep at night… then… from breastmilk… Usually the babies’ legs will be tacigi-cigi (jerking), like they’re having seizures.” (Mama biang, 61–70 years).
Food prescribed (recommended) during pregnancy
Participants generally reported that their health providers recommended rice, vegetables, and fish (other than ones mentioned above) as foods that should be consumed during pregnancy. However, some food items are endorsed for more consumption. We present the summary of food prescriptions and the underlying reasons in Table 3 and explain the top findings according to frequency.
Cassava leaves
Embal is often used to describe the flour or food products made from poisonous kasbi (cassava) but is also what the locals call the poisonous cassava itself. Around 59% of the participants said cassava leaves should be consumed when pregnant and after giving birth. Most participants said cassava leaves are highly nutritious and help increase blood (tambah darah), but most importantly, it increases breastmilk production.
“Well… for pregnant women… just cassava leaves right, we have to eat them to prepare, so that our breastmilk would be increased after we give birth, so it’s recommended…” (Pregnant woman, 19–25 years).
Papaya
During pregnancy, papaya is advised for consumption due to its high nutritional value, particularly its vitamin content. Fruit consumption, including papaya, is communicated to pregnant women through their routine check-ups at the local Posyandu, which service is provided monthly. Nine participants (53%) mentioned papaya as a prescribed food item. Papaya was also mentioned to have a cleansing property, for the baby when they are born, and for the insides of the womb.
“For advice, I’ll just say, that the papaya makes the baby’s skin clean… because that’s what I hear from the midwives right… with coconut water too… maybe you shouldn’t eat pineapples because I heard that it affects the womb too, right.” (Community health volunteer, 41–50 years).
Coconut water
Coconut water was mentioned by 53% of the participants because it is said to clear and increase the volume of amniotic fluid, easing labor. In addition, the cleansing attribute of the food is sought after in the hopes of promoting the delivery of a newborn with clean and unblemished skin.
“I regularly drink fresh young coconut water now… Because having fresh coconut is good for your health… My mother told me that consuming young coconuts makes the child clean during labor. I don’t want the baby to look dirty when my baby is born…like being born covered with too much blood.” (Pregnant woman, 19–25 years).
Fish
While komo and momar fish were reported to cause allergies if consumed in large amounts, fish is recommended by 53% of the participants and recognized as an important source of nutrients. However, fish consumption is dependent on the climate and the resulting price in the market. The condition for fishing in Kei Besar is significantly affected by the monsoon winds, causing higher tides and stronger winds during the western (December, January, February) and eastern monsoon periods (June, July, August) compared to the transition period (March, April, May) [27].
“Red fish (red snapper) are good, nutritious. The meat gives… nutrition for the fetus, like that.” (Pregnant woman, 31–35 years).
“If it’s batu-batu fish (fish found around the coral, such as groupers or parrotfish), the ones with many scales, or bubara (trevally) fish, the ones that are meaty, they don’t cause problems. But only when you have it, if you don’t have, you can substitute with eggs.” (Pregnant woman, 26–30 years).
Suggested Dietary Behavior during pregnancy
Dietary behaviors in the community are mainly practiced to prevent adversities for the fetus and ensure safe delivery. There were 11 practices that emerged during the data collection process. We will explain the most frequently found.
Eating for two
Six participants talked about increasing their food intake to feed the fetus. Eating two portions of a meal is believed to be necessary to ensure the fetus grows accordingly and is even endorsed by health providers such as midwives and community health volunteers in Posyandu.
“I always tell them to eat more than one plate because they eat for more than one person, they have to eat many vegetables, many fish, from the 0 month of their pregnancy, they have to eat nutritious food so the child will not be stunted, until two years old, the child has to eat nutritious food.” (Community health volunteer, ≥ 71 years).
Other than the importance of the fetus development, it is also believed that a pregnant woman should eat for two to prepare her to produce more breastmilk.
“They have to eat a lot, more than usual. So that they can have a lot of breastmilk. If they eat less… they will not have enough breastmilk, right, so they have to eat a lot to be able to breastfeed their children.” (Mama biang, 61–70 years).
Using smaller plates
Despite generally agreeing with the idea of eating more than usual during pregnancy, 30% of participants also stated the necessity of eating with smaller containers or plates. Eating with bigger plates is believed to cause the placenta to be large and cause difficulty when delivering the baby later.
“We should not use big plates… we have to use smaller containers… They [older family members] said… they fear that later de pu kaka (literally translated as “the older sibling”, how the locals refer to placenta) will be bigger, so we have to eat using small plates. (Pregnant woman, 31–35 years)
Reducing food and rice intake (Eating Down) in late pregnancy
Furthermore, at some point, pregnant women should stop eating for two. 24% of participants mentioned that when pregnancy enters the third trimester, pregnant women should reduce food and rice intake to prevent giving birth to big babies. Women learned about this practice from the health providers and their community. Interestingly, other food items such as tubers are believed to not cause weight increase in the fetus as much as rice.
“She [The midwife] said we have to reduce the rice intake… because too much rice, the baby will be big, it would be hard to give birth… starting from 8 months of pregnancy or so, reduce your rice consumption… if you have the makanan kebun (food from the field), then eat makanan kebun.” (Pregnant woman, ≥ 36 years).
Portion rationing
The practice of different portion rationing in families was also mentioned by 24% of the participants. It is recognized by participants as customary in the Kei Besar community to put the elderly and the husbands first in terms of food portion rationing, although it may not be widely practiced. There was no specific mention of the children’s portion or when they should be served food.
“Then my husband… we separate his rice, we separate his vegetables… like that. So, we put rice on one plate, and vegetables in a bowl (laughs), that’s just how Kei people are, if we prepare food, we can’t just serve it as we please for our husband. For my husband, or our parents… usually we take separately for them, rice, vegetables, fish… us women, it doesn’t matter, as long as we eat. If… us here, that’s just custom, though, usually people say the head of the fish is important for the husbands (laughs), so there has to be a special fish for husbands… like that.” (Pregnant woman, 26–30 years).
Other practices
Other practices were reported by two participants or less. These include some common practices to avoid ailments, such as washing vegetables before cooking, covering food served on the table, and eating at regular hours. Other practices include: restrictions on eating with cracked plates or drinking with cracked cups, believed to cause the baby to be born with incomplete limbs; serving warm and not hot food, because it would harm the fetus in the womb; and eating until the plate is completely empty so the baby will be clean upon birth.
Foods consumed most commonly by pregnant women
The in-depth interviews with pregnant women included a free list question that asked for the types of food commonly consumed in their ohois. The responses were compiled and analyzed to identify the most frequently mentioned food items, which were deemed as salient (Table 4).
Food groupings of Kei Besar women, free pile sorts
To facilitate further analysis, salient food items were translated into cards containing both the name and picture of the items to be used in the pile sort activity. The pregnant women were asked to sort the cards based on what makes sense for them (free pile sort) and based on the question, “what foods are good for pregnancy?” Pile sort results were analyzed using Visual ANTHROPAC and the resulting multi-dimensional scaling is shown in Fig. 2:
The clusters showed the kinds of food that are considered conceptually similar to each other. Benau vuut (fish) are grouped with the food that they go best with. The tubers and their parts such as leaves are classified as field produce, and with fruits and vegetables grown in the yards, form the group called “Benau Evav,” translated as “food of Kei people.” Rice is not categorized as food from the field or food of Kei people because it was introduced first by the government and not a native plant of Kei Islands. However, it is consumed by almost all Kei people now. This figure illustrates the food eaten by the pregnant women and the diet commonly found among Kei Besar people.
The structural pile sort question yielded two or three piles from each woman, with them grouping food as “good for pregnancy,” “not too good or doesn’t matter,” and “not good for pregnancy.” The second option indicates the food item has no specific effect on pregnancy, except if it is consumed in a large amount, which may pose health risks. We ranked these piles with weights: two for “good” food, one for “not too good” food, and zero for “not good” food, as seen in Table 5.
Five participants mentioned the reason they placed food items under the “good” category is because they heard about the food items’ nutritional benefits from the community health volunteers or Posyandu nutritionist, such as rice helps with development during the early years, or fish makes children smart. This implies that pregnant women will consider a food item “good for pregnancy” if it promotes fetal health. Three other participants mentioned that food in the “not so good” category (embal, kangkong, keladi) may cause an increase in stomach acid and lead to gastritis if consumed too much. The key informants then elaborated that there are food items known as “benau vusin,” which translates to “hard food” and “benau mafun,” which translates as “soft food.” The hard food causes saki ulu hati (epigastric pain) if consumed too much, while the soft food does not. There is also a community belief to not eat too many leafy vegetables since it would lead to an increase in uric acid and knee pains.
Many of the foods that are prohibited in the previous section are not listed by the women in the free list session or listed low down the list and did not make it to the pile sort activity. This indicates that those food items were not consumed daily by the people of Kei Besar Island.
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