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Effects of Postpartum Dietary Restrictions on Maternal Nutritional Status
Meredith Jackson
October 18, 2000
Text: 10 pages
Biblography: 2 pages
Tables and Graphs: in scanner
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Introduction
In indigenous populations around the world, anthropologists have recorded various taboos
and avoidances associated with puerperium and lactation. Food avoidances are one of the more
common associations with these conditions. Reasons dictating these taboos are numerous and
diverse. Townsend (1980) found that among the New Guinea Sago Gatherers a lactating woman
will begin to observe food taboos at the first signs of illness in her infant. The food items to be
avoided might could include wild pig, several common fish species, several snake species,
cassoway, and Polynesian chestnuts. In this society, the mother runs the risk of upsetting spirits
if she doesn’t obey. The diet is restricted for women in Tamilnad, India during the postpartum
period. This is considered to be a pollution period that lasts 40-41 days. The restrictions in this
case are usually of Ayurvedic origin, but can vary from mother to mother (Ferro-Luzzi, 1980).
Many other cultures worldwide practice food avoidances during lactation, including some
populations in Vietnam, Philippines, Malaysia and other countries of southeast Asia (Hart et al.,
1965).
The purpose of this paper is to examine the possible effects of the absence of certain
foods from the maternal diet in several Malaysian populations during the postpartum period and
lactation. Anthropological literature offers a plethora of information regarding the effects of
maternal diet on lactation and milk composition, however, information on the effects of maternal
diet on maternal nutritional status is lacking (Adair, 1992; Mackey et al., 1998). Although not
yet plentiful, the amount of information available on maternal nutritional status has increased
over the past decade. By examining data from several studies involving populations in
Malaysia, I aim to determine if Malaysian mothers observing the food taboos of the 40 day
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puerperium, or the number of days as determined by the mother (Laderman, 1981; 1983), place
themselves at risk of acquiring poor nutritional status and low energy intake.
Maternal Nutritional Status
The National Academy of Sciences Committee on Nutritional Status Subcommittee on
Lactation issued a report in 1991 advising that data are lacking to use in the identification of
lactating women who are at risk of exhausting their nutrient stores. Adequate maternal
nutritional status cannot be determined by evaluating data on infant growth and development
because the maternal nutritional stores can be depleted to maintain sufficient nutrient content in
the breastmilk (National Academy of Sciences, 1991). Adair (1992) points out that most studies
in the past have focused on postpartum anthropometric changes in lactating women, but have not
compared the results with those of nonlactating women.
By the 1990's, researchers had begun using new techniques and tools for assessing
maternal nutritional status. One of these tools is the Body Mass Index (BMI) chart (see Figure 1)
that includes both metric and English units. Body Mass Index is determined by charting weight
and height measurements. Guidelines divide BMI’s into groups of low, normal, high and obese
(Olson, 1994). Adair and Popkin (1992) provide an example of the application of BMI analysis
in studies of postpartum women, specifically in assessing postpartum weight loss. This study
showed that women with a low BMI had mean net weight losses comparable to women with
higher body mass index, indicating that women with low BMI will have higher nutritional stress
since their energy intakes will be smaller.
Other important factors to consider when looking at maternal nutrition are daily energy
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intake and expenditure, and daily dietary intake.
Adair (1992) speculates that lactation is more
likely to affect nutritional status of women in developing countries than in places with higher
incomes because women of low income may not be able to meet the energy and nutrient demands
of lactation by increasing dietary intake. Instead, the body will use its own fat stores, as is shown
by Adair and Popkin (1992) in their findings that lactation has a strong negative effect on weight
loss in Cebu women in the Philippines. To estimate energy requirements for lactating women,
the estimated expenditures of milk synthesis are added to the energy requirements of a
nonpregnant, nonlactating woman. In the United States, the recommendations are for an
additional 500 kcal/day for a total daily allowance of 2700 kcal/day (Doran and Evers, 1997).
Several recent studies that have calculated maternal energy intake have found that the mean
maternal energy intake for their population is less that the Recommended Daily Allowance
(RDA), but without a negative effect on lactation. This indicates that the current RDA may be
too high (Adair and Popkin, 1992; Butte et al., 1984; Doran and Evers, 1997; Mackey et al.,
1998). In addition to this, maternal energy intake has been shown to decrease significantly for at
least the first four months of lactation (Butte et al., 1984).
Food Avoidances during Puerperium and Lactation in Malaysia
Many countries of southeast Asia practice food taboos or avoidances during puerperium,
which, for much of the region, is a 40 day postpartum period (Hart et al., 1965; Laderman, 1981;
1983). As early as the beginning of this century, information about Malay postpartum food
restrictions was being documented as part of the popular religion (Skeat, 1972 [1900]). Wilson
has studied Malaysian dietary practices during pregnancy and lactation and reports that dietary
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intake does not meet the Malaysian RDA for lactating women. All kinds of food restrictions are
referred to as pantang in Malay. These can best be described as guideposts for behavior, leaving
the possibility for cautious experimentation. Pantang have no ruling force behind them, no
punishment or vengeance will fall upon the woman if she doesn't observe the restrictions
(Laderman, 1981; 1983). When a woman has a baby, her body enters into a state of “coolness”,
therefore, she should only eat “hot” foods to help restore balance. The postpartum diet cannot
include any “cool” foods or foods that have “cooling” properties as derived from the Greek
humoral system. This marked category of foods eliminates a large number of items from the diet
temporarily as shown in Table 2 (Wilson, 1980). Skeat (1972[1900]) listed items restricted after
childbirth: things that have a lowering effect on the constitution, such as fruits and vegetables;
things that have a heating effect on the blood; things that have an irritating effect on the skin;
things that are supposed to cause faintness, such as gourds and cucumbers; sugar, chilies, and
coconuts. “In effect she was eating rice, fish roasted over coals, and black pepper, and drinking
coffee,” reports Wilson (1980:68) of a postpartum, lactating mother. Malay diet is centered
around rice. Their ethnic categorizations of food reflect their reliance upon rice as a mainstay.
There are two main recognized categories of food: rice and fish. Vegetable are thought of as
merely additives for improving rice, usually in the form of relishes, and fruits are merely pleasant
treats (Laderman, 1981; 1983).
Laderman
As social scientists have worked feverishly over the past two centuries to document and
record cultural practices from every part of the world, our understanding of traditional lifestyles
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and beliefs has deepened in such a way that modern anthropologists take great measures to
maintain an unbiased level of objectivity in our research. Laderman (1981; 1983) found the
behavior surrounding the food taboos to be quite different than had been recorded by earlier
anthropologists. An important factor in this discrepancy lies between the ideologies as put forth
by previous researchers and the Malays themselves, and the actual behavior of the subjects.
Although fruits had been classified as an unimportant component of the diet, Laderman (1981;
1983) found that in Merchang, the place of her research, fruits are a substantial part of a meal
during peak seasons. Vegetables are considered the basis for relishes, but nonetheless, are still
consumed in rather large quantities: 40-230 grams per meal. Compare this with the average
weight of one day’s intake in an American adult diet: 69.4grams of green beans or 81 grams of
peas and it appears that vegetables are consumed in quantities equal to or greater than the average
American adult. Even though Malays do not consider vegetables an important facet of the diet,
Laderman (1981; 1983) found in her household surveys that 63.5 percent of all households ate a
green or yellow vegetable at least once a day, and 35 percent twice a day. Laderman (1983) also
documented a total of 127 kinds of edible plants eaten in Merchang. Different ecological zones
in Malaysia account for differences in actual diet. Each ecological setting needs to be analyzed
and described in order to produce accurate data on the actual behavioral dietary habits of Malays
(Laderman, 1983). Laderman comprised a detailed list of specific “hot”, “cold”, and
“sederhana”, or neutral, foods listed in Fig. 2.
The Humoral System
Malays use a humoral system to categorize foods, diseases, illness, and treatments. These
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can all be classified according to intrinsic qualities which give it “heating” or “cooling”
properties. Temperature does not affect the humoral qualities of food in Malaysia. The humoral
system came to Malaysia first through trading with China and India and later with the coming of
Arabic medicine and Islam. Malayan aborigines already had beliefs about childbirth that
resemble the new “hot” and “cold” system and probably helped in the spread of its acceptance
(Laderman, 1981). The practice of “roasting” a new mother over a fire is a common tradition
throughout southeast Asia (Hart et al., 1965; Laderman, 1981; 1983). The heat from the fire
treats the “cold” state the mother entered after giving birth, helping to restore balance.
Although Laderman (1981; 1983) found a great deal of agreement on the humoral
classification of foods, ultimately the decision was made by the individual either according to
their own empirical experience, or by the advice of someone else who could better perceive the
qualities intrinsic to a certain food item. Consequently, there exists a great deal of variation
within a single community in the categorization of specific foods (Laderman, 1981; 1983).
“Humoral systems are dynamic rather than taxonomic. They not only admit the possibility of
variation, they incorporate it into the model,” (Laderman, 1981:470). This is characteristic of
Malay beliefs about all aspects of life. Everything can be interpreted differently or can be
individually altered because of the acknowledgment and belief that not only do individuals differ
from one another physically and temperamentally, but that the stages of life, the seasons of the
year, even the hours of the day can have different effects on each individual (Laderman, 1981;
1983). The Malay humoral system also specifies marked and unmarked features. Items that are
“hot” and “cold” are marked items, that is they have been singled out. Food items that fall into
the “sederhana” category are unmarked, they haven’t been specified (Laderman, 1981; 1983).
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The concept of Bisa
Magical power, whether used for evil or good, is considered bisa by Malays. The most
common association made with the concept of bisa is in connection with foods and food
avoidances. The system of food avoidance is not a result of the Malay humoral system, instead
all foods to be avoided are considered bisa foods. However, the humoral characteristics of "hot"
and "cold" could be used to classify a food as bisa. Bisa foods are thought of a "intensifiers of
disharmonies" already present in the body (Laderman, 1981; 1983). In the past, the dynamic list
of bisa foods has been interpreted by social scientists as lacking in structure and being primarily
symbolic, but Laderman (1981; 1983) found that Malays practice the avoidance of bisa foods as
a practical health measure. These proscriptions are firmly grounded in empirical knowledge
gained through experience. Some of these foods categorized as bisa are common knowledge for
most people, but other foods may be bisa for an individual person due to allergies or a past
illness. Symbolism is a factor in the classification of some foods as bisa. For example, a sick
Malay would want to avoid eating cucumbers and watermelon since they are grown close to the
ground and have to be manured. Generally, bisa food avoidances are observed when a person
has entered a state of imbalance, or an "extreme expression of a marked feature" (Laderman,
1981; 1983).
The most misinterpreted bisa food in the Malay diet is fish. During the postpartum
period, Landerman (1981) found that 54 species of fish fall into the bisa category. This
seemingly large group of fish species has alarmed social scientists in regards to maternal
nutrition. Wilson (1980) writes, "the restriction of diets of newly parturient, traditional Malay
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village women to what they consider safe levels would not appear to be physiologically and
nutritionally prudent." Taking this even further, Wilson (1980) postulates that the lowering of
the nutritional status following childbirth may be a contributing factor in infant mortality.
McKay (1980) also feels that beliefs such as the concept of bisa can often result in a restricted
dietary intake of protein, vitamins, or minerals during times of particular physiological need.
Contrary to the assumption of restriction of protein intake as a result of bisa fish
avoidances, Laderman (1981; 1983) found that although there are a large number of fish on the
bisa list (54 agreed upon species), they represent only a small portion of the local fish population.
Most of these fish fall into specific categories that may be harmful anyway, as seen in Table 3.
Laderman (1981; 1983) was able to identify 6 species of fish that everyone agreed upon as being
safe to eat during puerperium, with many people adding 13 others. None of these fish is
scombroid or suspected of toxicity, none are top carnivores, and all are rather small. The bisa list
represents the rarist species while the "safe" list represents the more abundant species. The
"safe" fish can be found at the market on a daily basis, whereas, the bisa fish only occasionally
can be purchased there. Laderman (1981; 1983) concludes that even though the list of bisa fish
is considerably longer, no nutritional sacrifice accompanies the absence of these fish from the
diet, even for extended periods of time.
Evaluation of the Maternal Diet
Laderman (1981;1983) points out the discrepancies in the literature regarding Malaysian
maternal dietary intake. She attributes these discrepancies to differences in stated ideology and
observed behavior. Previous researchers have recorded the Malaysian diet as consisting of rice
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and fish with a little vegetable relish on the side and an occasional fruit as a snack (Laderman
1981;1983; Wilson, 1980; McKay, 1980). However, as previously stated, Laderman (1983)
found that although Malaysians do consider vegetables as additives not absolutely essential for
survival and strength, they have a comparatively adequate portion of vegetables in their daily diet
(40-230 g). During the monsoon season, people bring home large quantities of leafy greens,
daun kayu, on a daily basis which form a significant part of the diet during the season (Laderman,
1983). In Merchang, Laderman (1983) counted 72 varieties of wild plants being consumed, in
addition to 55 varieties of cultivated fruits and vegetables.
Wilson (1980) conducted a study in which 50 married women between the ages of 16
years and approximately 54 years were randomly selected from the village of RuMuda. A
subsample of 6 women were asked to do a dietary recall and a hypothetical diet was devised from
foods "generally accepted as permissible during confinement." The nutritional makeup of
hypothetical diet as compared with the Malaysian RDA's are shown in Table 4. Two women
were chosen to have their dietary intake observed for one day. The results show a large number
of inadequacies when the vitamin and mineral composition is compared with the Malay RDA's,
as shown in Table 5. Wilson (1980) does concede, however, that the woman in Table 4 did not
consume any vegetables on that day, which was an abnormal practice for her.
The hypothetical diet as formulated by Wilson (1980) reveals that a banana is the only
fruit or vegetable consumed in the maternal diet during puerperium. Wilson reported that all
fruits with the exception of cooked bananas and durian are considered "cold" and therefore,
eliminated from the postpartum diet. These findings differ from those of Laderman (1981;1983)
who found that 8 percent of her subjects said all fruits are cold and none believed that all wild
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plants could be categorized en masse. All of her informants agreed that most bananas are
sederhana, but that some are definitely "cold". These "cold" bananas apparently fall under the
description of "slimy". The list of "cold" foods as presented by Laderman (1981;1983) is defined
by only "marked" foods. That is, foods that have been singled out and identified as being "cold".
This list is not exhaustive of all of the wild plants in the region, therefore, implying that all of
the fruits and vegetables that do not fit into the marked categories can be considered safe. The
cause for differing results obtained from asking the same essential questions can be found in the
questions themselves. Wilson's questions (1980) appear to be thorough enough (see Table 6), but
as Laderman (1983) found through informal field observation, more specific questions friendly to
the underlying criteria Malays use for classification were needed to fully account for all of the
dietary restrictions. In light of Laderman's (1981;1983) findings that Malaysian maternal diet is
comprised of sufficient amounts of protein and fruits and vegetables, there appears to be no
negative effect on maternal nutritional status as a result of postpartum dietary restrictions.
Summary
Food avoidances during puerperium and lactation have repeatedly been misinterpreted
and misunderstood in past anthropological literature (Laderman, 1981;1983). In the past, social
scientists have recorded Malaysian postpartum restrictions as being detrimental to the nutritional
status of the lactating mother (McKay, 1980; Wilson, 1980). Unfortunately, data is not currently
available that would allow for the assessment of anthropometric measurements such as body
mass index for lactating mothers in Malaysia, nor is data available on exact maternal daily
intakes for the assessment of energy intake and expenditure. However, by examining existing
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dietary records, including categorized lists of restricted and non-restricted foods, it can be
determined that the dietary components of a lactating mother during puerperium in Malaysia are
sufficient to meet the needs of the infant without having a detrimental effect on maternal
nutritional status (Laderman, 1981;1983).
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