Balancing expectations amidst limitations: the dynamics of food decision-making in rural Kerala

The demographic characteristics of the participants in the FGDs and individual interviews
are described in Table 1. Only one of the women had formal employment, while many of the others were informally
engaged in fish vending or shop keeping. Four women opted to be interviewed together
with another household member, including: the husband (main interviewee: wife); widowed
mother staying with married daughter (main interviewee) and her family; widowed mother-in-law
staying in her son’s house (main interviewee: daughter-in-law) and daughter who was
staying with her family in her mother’s (main interviewee) house.

Table 1. Characteristics of participants in focus groups and individual interviews

The staple foods of this area are rice or rice-based foods, legumes or pulses, and
fish, particularly along the coastal area where fishing is the major occupation. This
predominantly rural area has both low and middle SES areas, and here the consumption
of branded beverages, meat based products and processed foods is not a regular feature
as in the more affluent or urban areas. Coconut oil is the predominant cooking oil
used and coconut scraping is an ingredient in every meal. The term fruit is almost
synonymous for different types of bananas. There are some locally available fruits
such as guavas and gooseberries, which are available throughout the year, and others
such as jackfruit and mango, which are seasonal. The most common vegetable curry is
called ‘sambar’, which is a mixed vegetable preparation. Though consumption of vegetables is low
in the state, most households have at least one vegetarian dish or curry daily, which
in poorer households may contain only coconut scrapings.

How are food-related decisions made?

The results of the qualitative manifest and latent content analysis are shown in Table 2. The analysis revealed two sub-themes ‘counting and meeting the costs’ and ‘finding
the balance’ and one main theme ‘balancing expectations amidst limitations’. The following
section first describes the sub-themes and categories, while the main theme is summarized
at the end of this description. Each of the categories are also characterized in terms
of a main question (shown within brackets), which is used to construct the decision-tree
(Fig. 1). All quotations are in italics and any text within the quote enclosed by square
brackets have been inserted by the authors.

Table 2. Results of the qualitative content analysis on food decision-making process at the
household level

Fig. 1. Decision tree for the process of prioritization and food decision-making in households.
This decision tree is constructed based on our findings, focusing purchase or procurement
of five dietary components: fruits, vegetables, salt, sugar and oil. It describes
the prioritization process in terms of five key questions to be considered in that
order. Priority was considered as essential based on the disease status or age of household members,
particularly spouse and young children. Preference was based on habit or taste of the more influential members of the household, specifically
spouse and children. We have described only two cost options: ‘high money + high time
and effort cost’ and ‘low money + low time and effort cost’, as these can be clearly
linked to the data. Note that the outcomes described in the table are combinations
of preceding steps, e.g., if a food item comes with high costs, the household is likely
to procure it if it is the preference of spouse or children; and they will definitely
procure it if the food also has a high attributed value, but not if it has a low attributed
value

Sub-theme 1: Counting and meeting the costs

The first sub-theme primarily relates to different types of costs involved in the
procurement and preparation of foods in rural households and how households meet these
costs.

Category 1: Monetary and other costs (What are the costs involved?)

The cost of procuring foods included the direct cost in terms of the market price
of the actual commodity and its transportation; and indirect costs in terms of time
and effort spent on the exercise.

Money costs were found to be the most important and recurring theme through all interviews
and transcripts, and mainly comprised the various expenses involved in procuring the
food, including travel. Here, money was considered in actual monetary terms or in-kind,
particularly related to the produce from land-holdings and neighbourhoods in the form
of wild or locally produced varieties of fruits and vegetables. In most rural areas
in the study district where land was fertile, this meant a source of cheap and readily
available foods, particularly fruits like papaya and jackfruit, and vegetables like
greens and drumsticks, either from one’s own yard or one’s neighbour’s: “In our area, we have mostly used drumstick trees for fencing, so during rains, they
grow. We get drumstick leaves and sometimes the fruits also for different dishes”. (FGD 1; Female; 40 years).

On the other hand, when landholdings were too small; or infertile with unfavourable
terrain and conditions, like coastal areas with salty sand, or water-logged areas,
then it was felt not worthwhile to grow fruits and vegetables. In such circumstances,
the monetary costs of procurement became an important consideration. When the chantha (local market) was close-by, this was mitigated to some extent. These chanthas usually functioned in most localities. There are large chanthas in the towns and cities for fruits and vegetables, fish and meat. Most communities
however, had small wayside chanthas on specific weekdays, mostly for vegetables and fish, where one can get locally grown
produce as well. They also explained that it was more economical to buy a cut vegetable
pack, rather than buy separate vegetables for different dishes. Local markets catered
to this demand by keeping ready-made packs for fixed prices (based on current price)
or putting together such a pack right in front of you. All one had to do was ask for
a 25-or 50-rupee packs, depending on one’s budget and the available pack sizes.

Money costs were however not the only consideration as time and efforts costs were
also described for both food procurement and preparation. However, it was found to
be secondary to money costs as a determining factor for procurement. Participants
in the coastal areas talked about the effort to reach markets: “…sometimes, when we feel we cannot walk, we just decide that there will be no vegetables
on that day”. (FGD 1; Female; 65 years_b) Apart from availability of local markets or locally
grown produce, access to markets is an important factor and depends on the distance
to be travelled and the availability of regular and affordable transport. When access
becomes burdensome, the frequency of visits tends to drop. In difficult and hard-to-access
areas, the nearest market was still too far away, which substantially increased the
cost of food procurement. “Our area is completely coastal. We have extremely salty sand, which prevents any vegetables
from growing. So, all vegetables and fruits have to be purchased. There are also no
local vegetable markets in our locality. If we have to buy any vegetables, we have
to go to the [closest] city by bus”. (FGD 1; Female; 65 years_a) In such areas, the travel expenditure was often higher
than the price of the vegetables. When the balance was skewed with higher money and
effort costs involved in the procurement of fruits and vegetables, the participants
explained that they would limit their efforts to special occasions like festivals.

Some participants also talked about the time and effort involved in food preparation,
which at times rendered the whole exercise pointless. Women working outside the home,
had some extra money but often, no time: “We don’t have much land. We do have a drumstick tree, so we get the leaves, but we
don’t use it. It takes a lot of time to prepare that. I don’t have the time for that
when I come back from work. I just try to make something fast for the children as
they are hungry by then”. (Interview 17; Female; 35 years)

Category 2: Living within our means (Can we afford basic needs?)

Households also had to ‘adjust’ or ‘cope’ with what is available in terms of financial
resources. This type of coping or adjustment itself extracts a cost from those involved
and is a factor in the food decision-making process. However, monetary costs were
found to be the ‘rate-limiting’ factor in the process of food decision-making for
low SES households.

Participants from the low SES, particularly in the first FGD, talked about ‘not spending
what we don’t have’. “Our children live within our financial situations, so their choices reflect this.
Sometimes when we tell them that we cannot make something today, but will make it
another day…they will listen to us”. (FGD 2; Female; 39 years).

A household’s financial capability was often perceived in terms of the occupation
of the various household members. “We have no ‘sambathikam’ [financial resources]. I am a coir worker. I make what money
I can from making coir. I get work only 5 or 6 days in a month. We cannot survive
the rest of the month on that. This is the only work I know. I never studied… Look
at my hands [blistered]. If I had any other way, I will not do this. …My mother is
old and sick. She has pressure [hypertension] and sugar [type 2 diabetes mellitus]
and she is not right in the head [mental illness]. She stays with me and I take care
of her. My son sends me some money whenever he can, so we survive somehow”. (Interview 11; Female; 58 years)

Access to financial resources however, has gendered implications. For women, lack
of income leads to dependence on men for all expenses, loss of independence and negotiating
power and inability to make decisions regarding what can be purchased, due to their
lack of control over the purse strings. Women talked about the difficulty of having
to approach their men to meet every need. As a result, the women’s own needs and those
perceived as luxury, tend to be overlooked in favour of more high priority needs that
cannot be ignored. “…. Earlier, [when there were more manual jobs in road construction for women], if we
wanted to buy something for our children or ourselves, we could do it. Now, we have
to ask money for everything. Or, we have to ask them [men] to buy whatever we want,
even if it is something like food”. (FGD 1; Female; 66 years)

Women from the lower SES, had either no jobs or no regular income to keep the money
coming in and this is a frustrating experience as described by one of the women: “Most people complain that it takes a lot of time and effort to cut vegetables. That
is only for those who don’t have time. Here, we have time, but no vegetables and no
money to buy it”. (FGD 2; Female; 67 years). In such cases, they had to rely on the amounts they
received from their spouses to meet the food needs of the household. While the frequency
of access to this amount varied, there was an observable pattern. In the middle SES
and more affluent households, where the men had regular jobs, the women were often
given a monthly allowance to take care of household and children’s needs, which mainly
included food, and school expenses. In the lower SES, it was more erratic. Often,
they got the money for food on a weekly basis depending on the number of days worked,
while children’s school expenditure money was often given at the beginning of the
term or borrowed by the women from their relatives. Women whose spouses worked in
the Middle East, received money for longer periods, may be two to six months (depending
on the spouse’s job) for household and children’s expenses; and also had greater autonomy
in making day-to day decisions.

Sub-theme 2: Finding the balance

The second sub-theme basically relates to how the benefits are balanced during the
decision-making process.

Category 1: Meeting household needs (Is it a household priority?)

Meeting household needs was found to be a combination of meeting food-related needs,
particularly basic needs; and also understanding and taking care of the differential
needs of its members.

Meeting basic food needs was the main outcome of the food decision-making process.
Even in the lower socio-economic strata, this was very evident, as satisfying hunger,
which is the most basic function of food is somehow managed with whatever means was
available. “Most of the time, our meal would be only rice and fish. Since we are fish vendors,
we have fish during the season…. We use chammanthi [dry coconut chutney] if we don’t
have fish.” (FGD 1; Female; 57 years) At this level, the nutritive value of foods or its effect
on health, play no part in the decision process. When basic needs are perceived to
be unmet, healthy food becomes a luxury that they cannot afford. “How can we buy fruits and vegetables in our house? We will have to decrease something
else. But, there is nothing to decrease. We use ration rice that costs two rupees.
We won’t get anything else for that kind of price. We don’t get vegetables for less
than thirty rupees now, because of the price rise. Shopkeepers refuse to give for
less than thirty rupees. If we buy this pack in our house of seven members, I can
only make one sambar and one aviyal and it will still not be enough for everyone.
That is our situation”. (FGD 2; Female; 67 years)

Household members also had differential needs, and it was important to understand
these needs, which were prioritised and factored into the decision-making process.
These were household priorities and often stemmed from the perceived needs, particularly
for children, whose needs were prioritized in most households. Similarly, based on
disease status, adult members of the household may have special food needs or restrictions.
Households with a member with diabetes or hypertension usually had some routine in
place to deal with food restrictions. Working men were also perceived to have special
needs in terms of energy requirement, particularly those engaged in high intensity
manual jobs, like farming or fishing. “We are fishermen, we work through the night and most of the day. We need rest and
good food…. Usually, we have only rice and fish and may be chammanthi. How will we
work all day if we eat small amounts?” (FGD 3; Male; 41 years)

Category 2: Maximising household satisfaction (What is its value?)

Household satisfaction seemed to be assessed based on the value of the procured or
consumed foodstuffs, as perceived by different household members. Therefore, household
satisfaction was maximised through the procurement of high-value foods.

Participants considered traditional values regarding food choices and practices and
traditional beliefs about certain foods, like plantain and tapioca, as contributing
to health: “Our food habits are traditional…we don’t agree with any of these new habits like eating
meat every day”. (Interview 16; Female; 58 years) Similarly, regular food, mainly rice, and other
traditional rice and legume-based preparations were considered healthy. Food habits
that went against medical advice, health promotion messages or prevalent notions of
healthy food were considered unhealthy. Certain foods like fruits were cold and could
therefore not be consumed during most illnesses; while payar kanji (rice porridge
with green gram and shallots) was ideal as it would both clean your body and provide
enough nourishment.

Adulterated foods or foods believed to have a high probability of being adulterated
or contaminated were considered unhealthy. This included ‘red’ rice, as well as fruits
and vegetables. “Most people use white rice now. Earlier, they used to use only red rice. First of
all, red rice is expensive. On top of that, the red rice you get now is just coloured
white rice. After one or two washes, all the colour comes off……Life is surrounded
by adulterated things. We have to survive in the middle of these things”. (FGD 3; Male; 57 years) The notion that they were paying to ingest harmful poisons
was quite strong and many of the households mentioned pesticides in fruits as a reason
for not buying fruits. “They are full of chemicals. It is so poisonous, that we will get other diseases….” (FGD 3; Male; 62 years). However, they also acknowledged that it was the higher
price of fruits that promoted this unfavourable comparison. “When you consider the price you have to pay for the chemicals in fruits, it is better
not to eat it at all”. (FGD 2; Female; 58 years).

Different foods were also attributed different values, by which they were prioritized.
Some of the foods were considered regular fare and therefore needed no specific label
to describe it. Along similar lines, ‘fruits’ were different types of small bananas.
Most families grow a few banana trees in their own yard. They would purchase fruits
like oranges and grapes, referred to as ‘other fruits’ from local markets only if
they don’t get bananas.

Certain foods were however, attributed higher values based on the impression created
by media advertisements, particularly those portrayed as healthy and necessary for
growing children; often leading to higher than affordable food expenditure. Even among
the low SES households, they would not hesitate to buy some of these more expensive
foodstuffs at the cost of their regular food. “….spend an average four-thousand rupees on food per month [household of seven members,
including four children]… have to spend an extra one-to two-thousand on biscuits and
powder items [health drinks] for small children in the house”. (FGD 1; Female; 65 years_b)

The ability to buy also often imbued ‘good’ qualities to the food purchased, thus
improving their attributed value. “There are four working men in our home so, we can generally afford to buy good food”. (Interview 14; Female; 23 years) The attributes of the job were also de facto transferred
to the things they were able to afford. Government jobs were considered good jobs,
because of the security they provide in terms of a regular income with old-age benefits:
“My son-in-law has a good job [government job] so, they buy only good food”. (Interview 3; Female; 65 years). Consequently, what you got for free was often
undervalued or even ignored: “We had a big papaya tree in our yard. Only I used to eat the papaya from that. I eat
a few pieces and then keep it in the fridge and then throw it away when it gets spoiled.
This is what generally happens. Now it has been cut down”. (Interview 16; Female; 58 years) Similarly, foods that one could not afford on
a regular basis, like restaurant food, were often considered better than the food
they could afford to buy and prepare at home.

Category 3: Matching roles and expectations (Whose preference is more important?)

Household expectations were tightly bound to the preferences and the role and position
of its members in the household hierarchy; as opposed to household satisfaction described
earlier that was linked to the value of the procured or consumed foodstuffs.

Habit, taste and comfort in routines were three attributes many of the participants
described to explain the reason for certain preferences. “… we have habit of seasoning with coconut oil and mustard. … it is unnecessary, but
everyone likes the taste of that”. (FGD 3; Male; 30 years); “….fish is always fried in our house, it tastes better..” (Interview 14; Female; 23 years); “In our house, we have to have tapioca everyday,
except Sunday…”. (Interview 8; Female; 29 years) The importance given to these preferences
and priorities often decided the way certain foods were cooked, based on positions
and expected roles in the household. Preferences of husband and children (and sons-in-law
when the daughter’s family was co-resident), were prioritized in most of the households.
The preferences of the breadwinner of the house was also prioritized, partly because
of a feeling of entitlement; and partly because of perceived needs, especially for
men engaged in manual labour. Women often ignored their own preferences when weighed
against the preferences of their family members. “Only I eat that [vegetable dishes], so, I don’t feel like making it only for myself”. (Interview 1; Female; 36 years)

When perceptions and notions of healthy food were in line with stated preferences
of household members, practising healthy food habits became easier: “….my husband prefers vegetables to meat, so we buy [vegetables] almost everyday”. (Interview 9; Female; 26 years) Women talked about difficulties in this regard,
particularly when there was a mismatch between the two: “… we use lot of oil…difficult to reduce, he [husband] likes lot of fried things…”(Interview 14; Female; 23 years); “….we know that tapioca is not good for sugar, but in our house, it is compulsory”. (Interview 8; Female; 29 years) This made it difficult in some cases, when foods
were prepared to the preferences of one family member, usually the spouse, making
other (s) unhappy (co-resident mother of the wife); leading to tensions in the family:
“If they [daughter and son-in-law] make food with too much salt, that day I only eat
rice. I won’t take anything else”. (Interview 3; Female; 65 years)

Both women and men considered food procurement and preparation as essentially a woman’s
job. There was only one household where a man was routinely involved in these activities.
In their roles as breadwinners, men would get access to luxury foods like snacks,
for fruits like oranges and apples, which were not available in way-side markets,
during special trips or when they receive their pay-packet.

Responsibility for food preparation lay exclusively with women. It imparts a sense
of responsibility to the women to make the food tasty and palatable for the others:
“If we have to make something tasty, we need oil and salt. We know that we should decrease
salt and oil but food won’t be tasty”. (Interview 16; Female; 58 years); and a sense of entitlement and expectation to
their spouse and grown-up children, particularly sons; that the food be prepared to
their taste: “If he [husband] doesn’t like something, he will get angry and he won’t eat….” (Interview 1; Female; 36 years); “When my son comes home, I make whatever he likes…” (Interview 16; Female; 58 years)

Main theme: Balancing expectations amidst limitations

The whole food decision-making process ran like a complex cost-benefit analysis where
the costs of procuring or preparing foods (in terms of money, effort or time) were
balanced within the boundaries set by the household needs, satisfaction and expectations.
However, the burden of making adjustments and balancing this act within the means
available at their disposal fell disproportionately on the women.

The central role of the household as opposed to the individual was also implied throughout
the data. However, the woman of the household, who is the explicitly acknowledged
decision-maker, carried out various activities based on available financial and other
resources and the needs and preferences of the implicit decision-makers (most often,
spouse and children).

The food decision tree: understanding the household prioritization process

Based on the data and the analysis, we constructed a food decision tree to explain
the process and gain further insight into the prioritization process. As the food
decision-making was a complex process, it was also apparent that prioritizations take
place at many levels. Thus the food decision-tree is a schematic representation of
this process (Fig. 1), which usually starts with considering the purchase or procurement of specific foodstuffs,
such as procuring greens from their yard. Based on our understanding, the prioritization
process then involves five questions at different stages in the following order: 1)
Is it the basic minimum they can afford to satisfy essential food needs? 2) Is it
a household priority or preference? 3) What are the costs involved? 4) Whose preference?
and 5) What is its value?

Firstly, if the household could not afford any other foodstuffs of their choice based
on the resources available to them, then they would use it to satisfy their basic
need. Secondly, if it were a priority, i.e. it was considered as essential based on
the disease status or age of household members, particularly spouse and young children,
the answer would again be affirmative. All other outcomes seemed to be cost dependent
with the needs and preferences of spouse and children prioritised over everything
else. Health as a consideration had a very low priority when looking at the procurement
and consumption of fruits and vegetables or reduction in salt, sugar and oil and tended
to be considered only when all other factors were favourable. It was often a by-product
of healthier preferences of the more influential household members.