Selling nutrition: Reception & impact of fortified packaged foods, Odisha, India

The efficacy of fortified packaged foods in addressing the issue of micronutrient deficiencies amongst undernourished people is currently not well understood. Fortified foods are celebrated as an example of the market's ability to address the pressing development challenge of malnutrition. However they are also criticized as part of corporate capture of the development agenda, and as a potential gateway to a lifetime dependency on such foods, with attendant health consequences. Furthermore, little is known about how fortified packaged foods are received in practice by poor households, or how these products influence consumers' broader understandings of nutrition and food consumption. Empirical investigation of the intended and unintended consequences of nutrition intervention through fortified foods is urgently needed because of the short time within which the "nutrition transition" may take place. This can occur when people who have been undernourished in the womb and/or early childhood enter food systems dominated by high fat, oil, salt and sugar content; problems of undernutrition can be rapidly replaced with those associated with overweight/obesity as a result.
The research will use critical anthropological and other qualitative methodologies to establish how fortified packaged foods are being received and used in one particular location, Odisha, India. India is a key country experiencing the "double burden" of malnutrition, with one of the highest levels of both undernutrition and obesity/overweight globally. Undernourished Indian consumers are being targeted by numerous multinational food and beverage companies, and the state of Odisha has been the focus of various product launches. A community case study will be built up through household interviews and participant observation, focus groups and key informant interviews. It will be supported by analysis of extant
data and a small community census. The findings will provide development researchers, policy makers and practitioners with grounded insights into the potential and limitations of fortified packaged foods in improving nutrition outcomes in this particular context, while also contributing to wider debates on the role of business in tackling malnutrition.
Research Questions
- How are FPFs marketed to undernourished households?
- How are specific products perceived by target audiences?
- When and why are they adopted (or not) within existing consumption practices?
- What are the other intended and unintended consequences on both food consumption and wider behaviours and beliefs? How is choice/agency regarding food consumption affected?
Research methods
I will conduct a primarily qualitative study of food consumption practices among peri-urban households in Khorda district, Odisha, India. The field of medical anthropology has demonstrated the value of applying an ethnographic method to the predominately medicalized terrain of public health (Pool & Geissler, 2005). In developing a community case study and working with an interpreter, I will draw on the approach of Scott-Villiers et al (2016), including:
- Background/contextual data;
- At least ten in depth household case studies built up through participant observation methodologies and interviews with key household members;
- Focus groups (minimum ten) with relevant occupational and/or social groups; and
- Key informant interviews (minimum 25) with community health practitioners, NGO workers, religious/community leaders, local business people and marketing executives representing key FPF products.
The household case studies will use the 24 hour diet recall and other food recall methodologies adapted by anthropologists (Bernard, 2006) to investigate food preparation/consumption practices, and any impact of FPFs present locally. The food recall interviews will also act as a springboard for broader discussions about consumption practices, knowledge and beliefs.