Characteristic of respondents
The FGD respondents mostly were stay-at- home mothers and were 30–39 years of age, and had 11–15 years of education. All the majority key informants were male and were 40–49 years of age, and had more than 11 years of education (Table 2).
Table 2
Characteristics
|
|
|
|
Focus group discussion (n = 31)
|
Key informant interview
(n = 14)
|
Age group
|
|
|
20–29
|
8
|
0
|
30–39
|
16
|
0
|
40–49
|
7
|
10
|
50–59
|
0
|
4
|
Gender
|
|
|
Male
|
0
|
9
|
Female
|
31
|
5
|
Profession
|
|
|
Stay at home mom
|
24
|
0
|
Service
|
7
|
0
|
Teacher
|
0
|
14
|
Years of schooling
|
|
|
6–10
|
11
|
0
|
11–15
|
20
|
14
|
Mothers’ perceptions of healthy/good foods
When asked what they consider to be “good” food mothers mentioned foods normally cooked at home and fruits and vegetables. Most mothers thought that foods prepared at home were safer than those prepared outside the home. Many mothers mentioned rich foods such as biriyani and meat and polau (pilaf) as good (good to taste or prized) food. Some mothers talked about balanced diets and the need for a variety of foods to arrive at a balanced diet. A few mothers of children studying in medium- and low-tuition schools thought that fast foods such as deep-fried chicken, shawarmas (meat and vegetables wrapped in flatbread) and burgers were good food for their children which lead these mothers to prepare these foods at home when they could not afford to buy them. Most mothers, however, thought that fast foods were popular among children but unhealthy. This perception was also held by teachers, who were very concerned about student nutrition. Some detrimental effects of fast foods mentioned by mothers were stomach problems (diarrhea, dysentery, typhoid) and digestive problems (heart burn, peptic ulcer). Very few mothers associated weight gain with consumption of fast foods; all the teachers mentioned this link, however. No matter how a mother defined good food, it was clear that providing good food to their children was a symbol of love.
My son is the only male in my entire family. He was born after 3 girls. We love him a lot so we keep the best food for him…mainly meats. When we take him to relatives’ house(s) they also try to offer meat-based food (chicken or beef). If meat was not cooked they cook the meat and then the meal is served…never without meat. They do this because they love him. (FGD-2_mother, medium-tuition school)
In the next section of the paper we will discuss the existing food environment in and outside schools that shapes children’s eating patterns.
Schools and food choice
The food environment at school
During our observation of school premises, we found that 10 out of 14 schools had a cafeteria from which children could buy food and drinks during breaks. Some cafeterias had seating arrangements. Based on our observation only at high-tuition schools were all the foods for sale kept in covered displays; in other schools covering foods was sporadic (Table 3). In most schools, food service was contracted out to vendors who prepared the food outside the school premises. Only the high-tuition school cafeterias had space for food preparation.
Table 3
Facilities available in the cafeteria
Facilities available
|
High tuition school (n = 4)
|
Medium tuition school (n = 4)
|
Low tuition school (n = 6)
|
Cafeteria available
|
3
|
3
|
4
|
Food prepared on school premises
|
3
|
0
|
0
|
Foods prepared outside school premises
|
0
|
3
|
4
|
Foods were covered
|
3
|
2
|
1
|
Most school cafeterias sold local snacks, fast foods and sugary, carbonated drinks (Table 4). The foods sold were generally calorie dense and none of the schools provided the option of fresh fruits. Among schools that participated in our study only one (high-tuition) had a policy against selling carbonated drinks.
Table 4
Types of foods available in school cafeterias
Types of foods available
|
High-tuition schools (n = 3)
|
Medium-tuition schools (n = 3)
|
Low-tuition schools (n = 4)
|
Local snacks*
|
2
|
3
|
4
|
Fast foods#
|
3
|
2
|
1
|
Meal packets@
|
2
|
0
|
0
|
Sugary drinks
|
2
|
2
|
2
|
* Singara (Potato deep fried in a dough), somusa (similar to singara), peaju (lentil fritters), chotpoti (boiled chick pea in spiced tamarind sauce), chola (brown gram fried in spices), puffed rice mixed with oil and spices |
#Fried chicken, French fries, burgers, sandwiches, rolls, patties, shawarma (wrap) |
@Tehari, biryani, khichuri |
School policy
None of the schools had specific policies about providing healthy foods and drinks for their students. We found that carbonated drinks (all sugar-sweetened) were sold in the majority of school cafeterias. However, one high-tuition school banned carbonated drinks for concerns about rising rates of overweight and obesity among students. The administrator explained:
We don’t allow (carbonated drinks) in our school. You know that these drinks are the main reason why kids are gaining weight. These are not available in our cafeteria and we do not allow them in our premises. This rule was made only out of health concerns. (KII-7_administrator, high-tuition school)
Pragmatism and choice of foods at schools
During our discussion with school principals we inquired about how decisions were made regarding the types of foods that would be available in the cafeterias. Principals said that student preference was the main driver for the decisions. In some cases attempts had been made to provide healthier food options, but if students had not bought them, the schools had stopped offering. As an administrator at a high-tuition school said:
We know that students prefer fast food and junk food and so we sell these in the canteen. Once we kept some fruits for sale but they did sell. Even if (healthier foods) are available, (students) are interested to buy fried chicken, French fries or singara. Thus, we stopped offering. Our students cannot seem to accept fruits in the school canteen. (KII-7_administrator, high-tuition school)
Profit was an important factor for deciding on the types of foods to be sold in school cafeterias. Most schools leased their cafeterias out to an external company or person and the lease agreements did not have clauses about quality and types of foods that should be provided. The company or person who got the contract was allowed to run the cafeteria and set the menu as they saw fit. So once the cafeteria was leased out, school authorities had little control over the foods offered.
We always tell (the food provider) to make sure good quality food is provided…We tell them to reduce fried food and offer nutritious foods. We can’t make them listen. They have the lease to run (the cafeteria)…They have to make profit. They will have to provide foods that children are interested to buy…We have to see their perspectives too. (KII-3_principal, medium-tuition school)
While school teachers spoke about the importance of student preferences for foods, mothers talked about students being compelled to purchase whatever foods the cafeterias offered. Mothers complained that the availability of unhealthy snacks at school stopped children from eating foods they sent from home.
They offer mostly fast food…foods that are fried such as singara, somucha, sandwich, burger and hotdog. Children get fast food from the canteen daily. If these were not available (children) would have to eat foods that are provided from home. (FGD-1_mother, high-tuition school)
Peer influence on food preferences
Mothers spoke about the strong influence peers had on children’s food preferences. Mothers noticed that after starting school food habits changed and their children often asked for foods that their friends ate at school. Although a few mothers initially resisted their children’s demand for foods they thought were not healthy, they usually gave in to the demands after a few days. Some mothers felt that their children would feel deprived if the preferred foods were not given.
My son said, ‘My friend brought chicken ball. Please give me chicken ball too.’ I resisted his demand for 2 days and give in on the third day. When my son sees other eat this he will feel deprived. [sic] (FGD-1_mother, high-tuition school)
Teachers also observed that the types of foods brought from home have changed based on children’s preferences.
The students do not want to eat roti (flatbread), vegetables or curry at school. If parents provide these foods, he/she refuses to eat it. They have this concept that those foods cannot be eaten at school. They like to eat fried chicken (during recess) instead (KII-5_phys ed teacher, medium-tuition school)
A few mothers were concerned about the teasing and ridicule their children would face if they did not conform to the habits of their peers.
My son does not want to bring food (from home). He thinks that I will give him bread, vegetables and fried eggs to eat. He feels self-conscious about taking these foods to school. When he opens the box, his friends laugh at him. (FGD-6_mother, low-tuition school)
Concerns about hunger
Mothers’ concerns about their children being hungry also resulted in them providing junk foods. Most mothers irrespective of the type of school their children attended told us that their children often skip breakfast, which compounded mothers’ worries about their children not eating during recess. The teachers also observed that many children came to school without eating breakfast. If mothers did not provide foods that their children liked, they worried that their children would not eat. Mothers believed that the lack of food for a long period hurt children’s ability to learn and to stay healthy. These concerns led to the provision of foods that children liked or allowing children to purchase junk foods from school cafeterias.
If I give him homemade food, he does not eat it during recess. The (lunch) box comes home full…If I buy him fried chicken or chicken shawarma (from the shops) or give him money to buy (food), the food is never brought back (home). Sometimes he demands more money than he needs so that he can buy chicken fry in addition to the sandwich. I think that at least his stomach is full…I am compelled (to buy fast food)…He does not eat (food prepared at home). (FGD-1_mother, high-tuition school)
The teachers also observed that when children skipped breakfast they tended to eat more fast food or junk food during recess. A Headmaster explained:
We noticed that most children come to school without eating breakfast. They do not get time to eat (after they come to school). That means that until 10 or 11 o’clock they remain hungry. So when they eat (during recess) they eat a lot and the food is usually junk food or fast food. (KII-7_principal, high-tuition school)
Availability of fast foods around the school
The availability of fast foods near the schools influenced children’s access to them. Mothers spoke about children demanding that their parents purchase foods and soft drinks on the way back from school. The foods available on the streets outside schools are of low quality but many mothers give in to the demands. One mother at a high-tuition school described the situation in the following way:
Every day (my daughter) comes out of (school) and insists on buying food (from the street). There are some fast food shops just outside the school and (she) demands that I buy the fast foods and cold drink. If I refuse she cries and throws a tantrum…It is embarrassing. I am forced…It is a big problem. I live very close to the school and she can come home to eat lunch but everyday she insists on eating these foods. (FGD-4_mother, high-tuition school)
Food choices outside school hours
Beyond the food environment in and near schools, use of ready to use convenience foods, eating out and use of online apps to buy foods has become an important part of the family food ecosystem. While ready to eat and easy to prepare foods at breakfast are driven by school and work schedules, having family meals outside the home has many meanings beyond convenience.
Limited time
Lack of time to prepare foods for children was a common topic of discussion among mothers. In the mornings mothers struggled to prepare breakfast for the family and school snacks for their children. And mothers who worked outside the home struggled to get ready for work, themselves, in addition to helping their families start the day. The limited time available and lack of help meant that mothers used store bought, ready meals that can be prepared fast, such as sausages, nuggets and breads as opposed to more traditional breakfasts. Limited time in the morning also forced mothers to allow children to buy foods from school cafeterias.
I wake up at 5:30am and make breakfast for everyone and tiffin (snacks) for children’s school. I have to take (my daughter) to school so I have to get out of the house by 7am. I have to do a lot of work (within this short time) you understand? Making roti (flatbread) and shobji (vegetables) take time and effort. There are foods (such as) chicken nugget, sausage and ball…they are available frozen at the store…I keep them in the fridge and easily fry them or breakfast. I have to say these foods have made our life easy and children like them. [sic] (FGD-3_mother, medium-tuition school)
Contamination
While acknowledging the importance of fruits, vegetables and fresh home-made foods, all mothers expressed concern about adulterants such as formalin added to raw foods in the markets. Mothers thought chemicals added to foods post-harvest were harmful for health and worried about giving such adulterated foods to their children. The concerns related to food adulteration also encouraged a few mothers to refrain from buying fruits and to favor fast foods.
We want to give (children) nutritious food but we can’t because (the food) has formalin. Formalin causes harm to health. Nowadays there is formalin in fruits and vegetables…We are very scared…Chicken is better. So we depend on fast food. (FGD-3_mothers, medium-tuition school)
Interestingly none of the mothers mentioned health risks related to environmental contaminants or chemicals and pesticides used prior to harvest on fruits, vegetables and feed for livestock.
Purchasing food online
From the mothers with children in high-tuition schools we found that smart phone apps for ordering food online has made it easy for children to order foods from local restaurants and fast food outlets. The ease of ordering and delivery has increased access to and consumption of fast foods. Parents or children no longer have to go out to get the foods they want. As an administrator from a high-tuition school explained:
There is a new trend (in eating food from outside home)…online order. Children can now order themselves. Many (children) go to bed after eating pizza. This was not possible (in the past)…Eating out frequently…you had to go to the restaurants. Now you don’t have to. Food will arrive (at home) within half-an-hour of order. Children ask and parents allow…This is increasing the consumption of fast foods. (KII-7_administrator, high-tuition school)
Eating out
Status symbol
For mothers, particularly many with children in middle-tuition schools and a few with children in low-tuition schools, dining out was a symbol of social status. Mothers equated going to restaurants or fast food outlets with advertising the family’s financial wellbeing. So people went to restaurant to keep up appearances.
Sometimes we eat (out) to maintain social status. I mean if we don’t eat out it feels (as if) we do not belong to a better class…It will feel as if we are not well off (financially)… so we visit restaurants. (FGD-3_mother, medium-tuition school)
Interestingly, none of the mothers with children in high-tuition school mentioned this link between eating out and social status.
Peer pressure
Some mothers talked about peer pressure from their children’s friends leading to requests to go to specific food outlets to try different foods. Children often shared their experience of eating out in terms of specific foods and restaurant ambiance with their friends. The communication between friends inspires others to visit recommended restaurants or to eat recommended foods.
My daughter tells me “my friends go (to restaurants), they eat fast foods. I want to go too”. I know that children talk to each other (about the experience of eating out). They like to talk (about eating out). (FGD-2_mother, medium-tuition school)
However, it was interesting to note that mothers with children in low tuition-fee schools did not mention peer pressure from their children’s friends.
Eating out - a treat
As children were very interested in going out to eat, many mothers used eating at fast food outlets as a reward or treat to encourage or motivate their children to do tasks. One mother with children in a medium tuition-fee school said “I often tell my son that if he finishes reading a certain book chapter, I would take him to his favorite restaurant. These rewards work well.” (FGD-2_mother, medium-tuition school)
Mothers also talked about eating out to celebrate occasions such as birthdays demonstrating that eating out has become an integral part of family recreation.
Safe play space
Some fast food places have play areas for children. Children want to frequent these places to play and interact with other children. Mothers felt that they are good and safe places to take their children to play. However, the use of play areas was only allowed if one bought food. Sometimes even when mothers disliked the food, they brought their children to the fast food places to use the play area and to eat.
We have to take my child to restaurants every week. They (restaurants) have play areas…My child likes to play…He can play with other children. You cannot access the play area just like that, you have to eat. The options are fast food. My child eats these. (FGD 4_mother, high-tuition school)
Mothers with children in low-tuition schools did not mention using restaurant play areas.