Food and nutrition security for Kenya’s urban farmers : perceptions and trends of the urban local food plate in Kisumu

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FOOD AND NUTRITION SECURITY FOR

KENYA’S URBAN FARMERS:

Perceptions and Trends of the urban local food plate in Kisumu

March 2017

Kimberly Loo

MSc International Development Studies

University of Amsterdam

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Cover photo: Sukumawiki plot, Nyalenda Slum, Kisumu, Kenya (Kimberly Loo, 2016)

Food and Nutrition Security for

Kenya’s Urban Farmers:

Perceptions and Trends of the urban local food plate in

Kisumu

University of Amsterdam, Graduate School of Social Sciences International Development Studies

Master Thesis Student: Kimberly Loo Student Number: 10896945

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Supervisor

Dr. Nicky R.M. Pouw

Graduate School of Social Sciences University of Amsterdam Nieuwe Achtergracht 129 1001 NC Amsterdam The Netherlands Phone: +31 (0) 205254105 E-mail: n.r.m.pouw@uva.nl Second Reader

Dr. ir. Y.P.B van Leynseele

Graduate School of Social Sciences University of Amsterdam Nieuwe Achtergracht 129 1001 NC Amsterdam The Netherlands E-mail: y.p.b.vanleynseele@uva.nl Local Supervisor Prof. J.B. Okeyo-Owuor

Victoria Institute for Research on Environment and Development - International Opposite Rabour Police Station

Kisumu Nairobi Road, Kisumu Kenia

Phone: +254 (0) 728303839 E-mail: jbokeyo@gmail.com

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There are a number of people I wish to acknowledge for their contribution to this research who have made it possible for me to pursue a Master’s degree at the University of Amsterdam and allowed me to make to most of my three months stay in Kenya. First and foremost, I would like to thank all of my research participants and residents of Nyalenda for their willingness to participate in my research, for sharing their life stories, opening their homes to me with great hospitality, making me feel welcomed and respected, and for the valuable discussions and interesting interviews. Special thanks goes out to Alice, Joab, and Noman for their extra effort in connecting me to other people and facilitating interviews.

I sincerely thank my thesis supervisor Dr. Nicky Pouw from the University of Amsterdam for all her guidance from the early stages of my research proposal until the final stages of my thesis writing, despite her busy schedule. Her patience and incredibly useful feedback allowed me to develop my work progressively and grow as a researcher and academic writer. Dr. Yves van Leynseele, I thank you for serving as my second reader and I appreciate your willingness to be involved in my work. I would also like to thank Dr. Hannington Odame and Elsie Kangai from the Centre for African Bio-Entrepreneurship (CABE) located in Nairobi, who have helped me with the finalizing stages of the preparation of my research right before entering the field and starting my research.

Moreover, I would like to express my gratitude to Prof. J.B. Okeyo-Owuor from VIRED International who welcomed me to Kenya, was wiling to show his rural home, and provided detailed feedback, support and supervision. I must especially thank my research assistant Mister Dan Abuto for the time he spent with me during my research and for his dedication towards helping me to gain so much knowledge in the field by facilitating many appointments for interviews, focus group discussions and key informants. His natural positive and calm attitude inspired and he was always at hand to enable me to conduct this research in the most efficient manner possible.

I would like to extend my gratitude to Harryzon Otieno, chairmen of the Kibuye market in Kisumu, who was extremely kind to invite me and my friend to his home, allowed us to attend his church and made us feel greatly welcomed during the church ceremony. Furthermore, I would like to thank Sheila for her friendliness, kindness, and hospitality. Likoko Eunice I thank you for all the advice you provided me with before starting this adventure and for the support you were in the field during interviews and focus group discussions. It was great to have you in Kisumu during my final stages of my research. Last but not least, I thank my research peer and friend Madlen, with whom I shared this whole research experience with. Besides your contribution to my research, you have been a great support and friend during our stay in Kenya. And to so many others who have accompanied and supported me during my exceptional adventures time in Kenya and through this fulfilling journey. Asante Sana!

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Food insecurity and malnutrition are major issues, that hinder Kenya from becoming a healthy nation (Mohajan, 2014). The agricultural sector is the mainstay of the Kenyan economy and food and nutrition insecurity are often allowed to the performance of agricultural practices. Especially in the urban informal settlements where arable land is rare and urbanization is causes population growth and high poverty levels, food and nutrition security is far from being reached. For this study food and nutrition security has been conceptualized into availability, access, stability, and utilization, emphasizing the household level and seeking to reveal the perceptions of urban farmers on food and nutrition security. Previous studies have focused more on large scaled food security, and this study aims to recognize the issue of food security as well as nutrition security focusing on the household level of small scaled urban farmers. Leading to the following research question: “How do female urban farmers in the slums of Kisumu, Kenya perceive and acquire food and nutrition security, which barriers do they face in this respect, and what role do social groups play in overcoming some of these barriers?” Field research was conducted in 2016 during 2 months in one of the urban informal settlements of Kisumu, Kenya where the urban population is rapidly increasing and food plates are shifting towards a high-calorie and low-nutrient diet. Data was primarily retrieved through qualitative research methods such as interviews and focus group discussions amongst a population of urban farmers and their community. Findings indicate that the importance of agricultural practices is not valued, and the lack of information on nutrition and farming contribute to food and nutrition insecurity. For future research design, the necessity of including perceptions and social dynamics from the domestic level to the policy level should be valued, with a stronger emphasis on food and nutrition.

Keywords: Food and nutrition security, Kenya, Agriculture, Urban farmers, Urbanization, Nutrition shifts

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~ Foreword ~ ... 5

Abstract ... 6

Table of Contents ... 7

Chapter 1: Introduction ... 11

Chapter 2: Theoretical Framework ... 14

2.1 Food and nutrition (in)security ... 14

2.1.1 Conceptualizing food and nutrition (in)security ... 14

2.1.2 Dietary diversity ... 16

2.1.3 The Nutrition Transition ... 17

2.2 Urbanization and urban agriculture ... 19

2.2.1 Growing urban population ... 19

2.2.2 Urban agriculture and implications on the urban diet ... 20

Significance of urban food production ... 21

2.3 Gender ... 22

2.3.1 Importance of gender ... 22

2.3.2 Gender specific barriers ... 23

Conclusion ... 24

Chapter 3: Research Design ... 25

3.1 Research questions ... 25

3.1.1 Main Research Question ... 25

3.1.2 Subsidiary Research Questions ... 25

3.2 Conceptual scheme ... 26

3.2.1 Studied relationships ... 26

3.3 Key concepts and operationalization ... 27

3.3.1 Female urban farmers in the slum ... 27

3.3.2 Food and nutrition security ... 27

3.3.3.A healthy food plate ... 27

3.3.4 Barriers ... 28

3.3.5 Gender awareness ... 28

3.4 Research Methodology ... 28

3.4.1 Sample selection and research population ... 29

3.4.2 Unstructured observations and informal discussions ... 30

3.4.3 Participatory research ... 30

Seasonal diagram ... 31

Focus group discussions ... 31

Community meetings ... 31

Shadow the farmer ... 32

3.4.4 Structured interviews ... 32

Individual Dietary Diversity Measurement ... 33

3.4.5 Semi-structured interviews ... 33

“I stand before you and the world humbled by this recognition and uplifted by the honor of being the 2004 Nobel Peace Laureate. As the first African woman to receive this prize, I accept it on behalf of the people of Kenya and Africa, and indeed the world. I am especially mindful of women and the girl child. I hope it will encourage them to raise their voices and take more space for leadership.”

― Wangari Maathai (source: Conca & Dabelko, 2014, p.116)

The nutrition and nourishment of people now and the future is greatly influenced by human activity, including deforestation and the deprivation of natural resources, referred to as the Anthropocene (Biermann et al., 2012). In Africa, where many people are subsistence farmers, of which the majority is female, food and nutrition security can be achieved by success in local and political struggle (Maathai, 2011). The issue of food and nutrition security has been on the global agenda for recent decades, as an estimated 805 million people in developing countries are chronically hungry (FAO, 2014b), 165 million children are stunted (WHO, 2011), and around “two billion more people suffer from micronutrient deficiencies” (Fischler et al., 2015, p. 2). According to Kofi Annan, former secretary of the United Nations, these “men, women and children are denied the most basic human right of all: the right to food” (2000, p. 1). This highlights the importance of the issue on a global scale, and also how far the world is from reaching its goals.

According to Kanaya Nwanze, President of the International Fund for Agricultural Development, it is expected that global food security will be among the key concerns of the 21st century (U.N., 2016). This does not only concern issues emanating from food shortages, but also overweight and obesity causing health problems. Presently overweight and obesity are even linked to more deaths worldwide than underweight (WHO, 2016). Moreover, the world is currently facing a potential crisis in terms of food security, and the challenge is to provide the world’s growing population with a secure and sustainable supply of nutritious, affordable and safe high quality food, using less land, with lower inputs, in the context of global environmental changes and utilizing less resources (Godfray et al., 2010). The severe state of food insecurity in many countries all over the world was primarily caused by the global food crisis that caused a substantial rise in food prices, especially staple foods (FAO, 2011a). The increase in food prices had a devastating effect on the marginalized poor people in developing countries, who could not afford it anymore. With soaring food prices, higher demands caused by population growth, and extreme weather events ruining harvest, consumers are often victimized and left with higher prices for basic foods. This has the largest impact on countries with a low GDP per capita and people have a low purchasing power, thus the slightest shift in food prices affects poor households immediately (Zezza et al, 2008). Such as in Kenya where food and nutrition insecurity is a problem, especially with rapid urbanization and a growing population of the urban poor, it is important to understand the contributions of urban farming to improve food and nutrition security at the household and intra-household level (Gallaher et al., 2013). In Kenya, urban farming practices are mainly carried out by women, placing the

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burden on them to provide food that satisfies the nutritional needs of their families, through agricultural farming practices performed (Ibid).

This thesis responds to the newly formulated Sustainable Development Goals by addressing the overall problem of food insecurity, whether the food available is nutritious, and if it sustains a healthy food plate. The SDG’s are part of the 2030 agenda for sustainable development, and consist of 17 goals the 193 Member States of the United Nations have committed to achieve (U.N., 2015). These goals aim for the complete elimination of absolute poverty, and address “the root causes of poverty and the universal need for development that works for all people” (UNDP, 2016, para. 3). Ending hunger and achieving food security and improved nutrition (goal 2) are amongst the main drivers of this research. Eliminating poverty in all it forms everywhere (goal 1) could be an important contributor to achieve food and nutrition security (Martin, 2010). Aiming to ensure healthy lives and promoting well-being for all (goal 3) is the connection with health and nutrition. Furthermore, this research aims to identify gender specific constraints and dynamics faced by female farmers affecting their ability to achieve a healthy food plate, which is in line with goal 5; achieve gender equality and empower all women and girls. Lastly, with the acknowledgement by the United Nations (2014) that urban cities are rapidly expanding, the goal to develop sustainable cities (goal 11) is also connected to the problem statement because this research takes place in an urban setting zooming in on vulnerable population sub-groups. Goals on gender equality, poverty and food security are seen to be mutually reinforcing, and therefore gender equality and women empowerment have both intrinsic and instrumental value for achieving food security.

Data on food and nutrition security retrieved from national surveys in developing countries does not always offer detailed information on the household and individual level, but focusses more on the national level (Akinyele, 2009). There have only been few studies on the contributions of urban farming to household food security (Gallaher et al., 2013). Furthermore, it is important to appreciate the distinctness of nutrition and to focus on it as a separate priority apparent in all sectors dealing with food security. Also, the key question remains how gender factors are intertwined within food and nutrition security discourses; the role of socially constructed gender norms and behavior is often neglected in studies on household food and nutrition security (Morgan, 2009). Lastly, a general lack of knowledge on urban agriculture is often noted in literature as a blank space, more specifically, the importance of urban agriculture as an income producer and the variations across gender and wealth (Magnusson & Bergman, 2014), which is certainly the case for Kenya. In this study, the aim is to capture the perceptions of female urban farmers about food and nutrition security and the role of urban agriculture through data collection methods at the household level.

Food and nutrition security has been widely framed as people having enough food to avoid hunger and malnutrition but it has recently been recognized that food and nutrition cannot be understood in isolation from other systems such as agriculture, culture and social dynamics (FAO, 2013). Drawing on three months of field research in one of the urban slums of Kisumu, Kenya, this study aims to answer the research question: How do female urban farmers in the

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they face in this respect, and what role do social groups play in overcoming some of these barriers? The field research for this thesis took place in Kisumu, where the economy revolves

around agriculture, female urban farmers constitute the majority of the agricultural labor force, rapid urbanization takes place, and 53.4% of the population lives below the food poverty line (Obade, 2016). A qualitative approach was adopted to capture the voices of the urban farmers to understand the relation between the food cultivation practices engaged in and consumption patterns within their household.

The thesis is divided into seven chapters. Following this introductory chapter, Chapter 2 presents an in-depth literature review on food and nutrition security, urbanization and urban agriculture, and gender, and develops an integrated perspective to frame the research. Chapter 3 presents the research questions, the conceptual framework that guided this research, the research methodology, and field research and analytical methods used for the data collection and analysis. Chapter 4 discusses the research context of Kenya, and Kisumu specifically in detail, including national and urban policies on agriculture and gender, socioeconomic characteristics, and the current state of food and nutrition (in)security. Chapters 5 and 6 consist of the data analysis of the main findings. These chapters discuss the perceptions of female urban farmers on a healthy food plate, the role of urban agriculture and social groups in this respect, barriers faced, and lastly, shifts trends in the local food plate. The thesis concludes by answering the main research question, my reflection on the theoretical framework and methodology, research limitations, and policy recommendations and recommendations for future research in Chapter 7.

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The purpose of this chapter is to provide a critical discussion of the literature on food and nutrition security, urbanization, and gender and explain which concepts and relationships are relevant to this research. The chapter is divided into three main sections, each focusing on a key concept or relationship, and a conclusion to bring the concepts and relationships studied together. Section 2.1 discusses the concept of food and nutrition security, dietary diversity and the nutrition transition; section 2.2 unpacks the phenomenon of urbanization and its relation to urban agriculture and food and nutrition security in the urban context; and finally, before concluding, section 2.3 zooms in on gender and gender specific barriers in relation to food and nutrition security in a poor urban environment.

2.1 Food and nutrition (in)security

This section explores the conceptualization of food and nutrition security and how it became to emphasize more the influence of nutrition. The concept ‘dietary diversity’, a tool to measure diversity of the diet, will be discussed, and lastly, the nutrition transition model is explained.

2.1.1 Conceptualizing food and nutrition (in)security

This sub-section presents an overview of the changing conceptualization of food security, and how this concept evolved to include nutrition security. The interrelation with social, cultural, and economic dynamics highlights the multi-factorial nature of the concept (Maxwell et al. 1999), which has led to a great deal of debate on how the issue of food security has to be addressed and how no universal consensus on its definitional parameters has been reached. The initial focus of attention was primarily on assuring the availability of food, but a paradigm shift developed from the availability approach to Sen’s food entitlement approach, that “concentrates on the ability of people to command food through the use of legal means available in society” (Sen, 1981, p.45), and focuses attention on people having or not having enough command over food as distinct from there being enough food available to be eaten (Sen, 1981). In recent times, the acknowledgement that food security cannot be completely distinct from nutrition and sociocultural dimensions has led to a broader conceptualization of food security (Maxwell, 1996; Noack, 2012; Noack & Pouw, 2015). Looking at both adequate food availability and access to food in the 1980s brought about a new understanding of hunger and malnutrition, including micronutrient malnutrition and undernutrition (Barret, 2002). In 1990, UNICEF introduced a Conceptual Framework for Understanding the Causes of Malnutrition which was further elaborated by the 1992 International Conference on Nutrition (ICN) as the first intergovernmental meeting on nutrition that led to the adaptation of the World Declaration and Plan of Action for Nutrition (FAO, 2017), which still serves as a guide for nutrition policies and program development.

In the definition of food security established in 1996 at the World Food Summit the concept “nutrition” is incorporated as it states that food security exists when “all people at all times have access to sufficient, safe, nutritious food to maintain a healthy and active life” (FAO,

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1996, para. 1). The 1996 WFS definition of food security still remains significant and used today because it grounds the concept in three important ways, namely framing “food security in people-centric terms”, being “aspirational in orientation”, and making explicit “an appreciation of food security as being ‘more than calories’” (Pritchard, Ortiz & Shekar, 2016, p.2). However, the conceptualization of food security has become more complex since the 1996 WFS definition with a notable change that the concept has a more complete incorporation of nutrition security. Hence, in its 39th session that took place in October 2012, the United Nations Committee on World Food Security endorsed the terminology ‘food and nutrition security’ as the renewed and preferred indicator in this field, because this term best reflects the conceptual linkages between food security and nutrition security (CFS, 2012). The definition of the Committee on World Food Security (2012) is as follows:

“Food and nutrition security exists when all people at all times have physical, social and economic access to food, which is safe and consumed in sufficient quantity and quality to meet their dietary needs and food preferences, and is supported by an environment of adequate sanitation, health services and care, allowing for a healthy and active life” (CFS, 2012).

For this research the terminology ‘food and nutrition security’ as proposed by the CFS will be referred to, but the four identified intersecting themes of food and nutrition security (FAO, 2008) will form the conceptualization of food and nutrition security for this research, namely availability, access, stability, and utilization (see Figure 1). These themes will serve as guidance for this research, in which the ‘utilization’ theme emphasizes that food and nutrition security is not solely about the caloric consumption of food, but more so the nutritional intake, socioeconomic dynamics, preparation methods, and intra-household distribution.

Themes of Food and Nutrition security

Figure 1: the four pillars of food and nutrition security (Source: modified after FAO, 2008)

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The first theme is food availability, which includes the physical availability of food, and can be determined through factors such as the level of food production, net trade, and stock prices. Access to food, both economical and physical, is the second dimension. According to the FAO’s 2004 final report ‘Agricultural Development and Food Security in Kenya’, 2.8 million of the then total population of 31.5 million Kenyans were considered persistently malnourished as a result of their inability to access food (Gitu, 2004). It cannot be assumed that when there is sufficient food supply at the international and national level that this automatically assures food security on the household level (FAO, 2008). The third dimension of food and nutrition security is food utilization which is commonly understood as “the way the body makes the most of various nutrients in the food” (FAO, 2008, p. 1). The quality of nutrient intake by individuals is influenced by feeding practices, food preparation methods, dietary diversity, and the intra-household distribution of food (FAO, 2008). The final dimension of food and nutrition security is the stability of the previous three dimensions mentioned over time. To illustrate, when there is food available, access to it, and utilized well, you can still be considered food insecure if there is no stability and sustainability over time. For example, stock levels, food preparation, diversity of the diet, adverse weather conditions, political instability or increasing world food prices can each contribute to the instability of food and nutrition security (FAO, 2008). Therefore, in order for a country or household to be considered food secure, all four dimensions must be fulfilled simultaneously.

In this section the theory of the four dimensions of food and nutrition security mentioned above will be interpreted in the context of food and nutrition security in Kenya. The problem of food availability is often not solely caused by supply issues, moreover, at the micro level, food insecurity is highly stimulated by income levels and purchasing power, lack of entitlements and hence poverty (Sen, 1981). An analysis of average food availability in several African countries reveals that in one third of the countries, including Kenya, the average daily caloric intake availability is below the recommended level of 2100 Kcal (FAO, 2006). Kenya has aimed to become self-sufficient in food commodities, however, focusing on solving the food security issue through the supply side and overlooking the demand side, did not accomplish this, especially not regarding food accessibility for vulnerable groups (KIPPRA, 2007). Particularly urban food producers deal with high food prices, market dynamics, and poor transport resources and face severe challenges, which leads to only 2% of the foods consumed in urban areas to be produced within the urban setting, and 98% to be purchased (KIPPRA, 2007). Then again, even when there would be food available and access to it, malnutrition is increasingly prevalent in many African countries as a result of poor food utilization. In Kenya, food utilization is illustrated by high levels of malnourishment, food access is highly influenced by food prices and poor infrastructure, food availability can be linked to production levels of farmers and import rates, and stability over time is counteracted by extreme weather events that occur throughout the year.

2.1.2 Dietary diversity

According to Gross et al. (2000), food needs to be satisfactorily utilized by all individuals at all times. This encompasses the “utilization” dimension of food and nutrition security and

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highlight the nutritional aspect. The utilization of food is divided into three elements, namely, the nutritional value of food, food safety, and the social value of food (Ericksen, 2008). For the purpose of this research, the nutritional value of food, more specifically, the perception of nutritious food is further explored. There is the belief that the incompetency of the poor to feed themselves is one of the root consequences of poverty (Bain et al., 2013). In addition, poverty reduction can alleviate malnutrition because greater incomes at the household level allow families to spend more on food, and increases the option to engulf a more diversified diet (Alderman, Hoogeveen & Rossi, 2006). Dietary diversity relates to the nutrient adequacy of the diet and is meant to reflect, “the economic ability to access a variety of foods” (FAO, 2010b, p. 5). According to the World Health Organization (2015a), a healthy diet consists of the proper quantities and proportions of foods needed to maintain health or growth, and for adults contains; at least 400 grams of fruits and vegetables per day, has less than 10% of the total energy intake come from free sugars and less than 30% from fats, and lastly, the salt consumption is less than 5 grams daily. A universally recognized key component of a healthy diet is dietary diversity which is often measured using simple counts of foods and food groups over a given period of time (Ruel, 2003). It is confirmed by multiple studies done in developing countries that dietary diversity sufficiently represents nutrient adequacy, because of a documented positive relation between the two concepts (Ibid). The FAO (2010b) distinguishes nine food groups to determine individual dietary diversity for women of reproductive age, namely (1) starchy staples, (2) dark green leafy vegetables, (3) other vitamin A rich fruits and vegetables, (4) other fruits and vegetables, (5) organ meat, (6) meat and fish, (7) eggs, (8) legumes, nuts and seeds, and lastly (9) milk and milk products. In Kenya, particularly in Kenya’s urban areas, food habits are shifting from healthy traditional foods to an increased consumption of processed foods and unhealthy snacks, often prepared and sold under unhygienic conditions causing food contamination (Oniang’o, Mutuku & Malaba, 2003). In addition to capturing the perceptions of nutritious and healthy food, this research investigates whether shifts in consumption patterns and food habits have led to a lower level of dietary diversity. This shift towards a consumption of unhealthier foods has also brought several dangerous, life-threatening nutritional related diseases to Africa, such as obesity, diabetes, cardiovascular diseases, cancer, hypertension, and chronic respiratory disorders, which will be touched upon in the next section when discussing the nutrition transition (Ibid).

2.1.3 The Nutrition Transition

Over the past decade, the structure of dietary intakes and the prevalence of obesity around the developing world has been changing at an accelerating pace following current food trends in the global north, towards high-energy and low-nutrient ‘western diets’ (Popkin, 2006; Popkin & Gordon-Larsen, 2004), often associated with urban-industrial lifestyles (Olshansky & Ault, 1986). Barry Popkin in his article Nutritional Patterns and Transitions explored the relation between social, economic, health, and demographic impacts on nutritional changes, and referred to these shifts in dietary consumption and energy expenditure as the ‘nutrition transition’ (1993). The nutrition transition often coincides with shifting lifestyles, economic growth, urbanization, technological changes, and globalization (Popkin, 2004; Popkin, 2001; Chopra, Galbraith & Darnton-Hill, 2002). The shift towards a diet high in saturated fats, sugars,

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and refined foods, but low in fiber, vegetables and fruits often occurs congruent with the demographic transition; the shift from a pattern of high fertility and mortality to one of low fertility and mortality (Popkin, 2002), and the epidemiologic transition; the shift from a pattern of high prevalence of infectious disease to one of high prevalence of chronic and degenerative disease (Omran, 1971). These dynamically influenced transitions share an emphasis on the ways populations move from one pattern to the other and are summarized into five patterns by Popkin (1993) in the nutrition transition model (see Figure 2). These patterns largely appear chronological, but are not restricted to particular periods of human history, however still characterize certain geographic and socioeconomic subpopulations (Popkin, 1999).

The Nutrition Transition Model

Figure 2: five patterns of the nutrition transition (Source: Popkin, 2002)

The negative implications of these changes began to be noticeable primarily in the low- and middle-income populations in the early 1990s but did not become clearly recognized until noncommunicable diseases began to dominate the global health situation (Popkin, Adair & Ng, 2012). Presently rapid increases in the rates of overweight and obesity are being documented on a wide scale, from both urban and rural areas in the poorest countries of Africa and Asia to populations in western developed countries (idem). Despite the implications of the nutrition transition on a global scale, the urban populations in low- and middle-income countries are stated to be most vulnerable with large changes in diet, body composition and high levels of obesity (Popkin, 1999), as well as reductions in physical activity and increasing sedentary behavior (Popkin, Adair & Ng, 2012). As others have shown, many rapidly increasing urban populations in the world face growing poverty and food insecurity rates together with the implications and related problems (FAO, 2009; Cohen & Garett, 2010). However, in these

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same populations where undernutriton and food insecurity is found people suffer from dietary excess and obesity. This complex entwining of socioeconomic influences offers major challenges for food and nutrition policy implications (Popkin, 1999).

Despite being one of the most developed nations in Sub-Saharan Africa, in Kenya one out of two people suffer from food insecurity and an average Kenyan consumes only 1,690 calories per day (World Bank, 2013). High levels of malnutrition and severe public health issues are aggravated by chronic levels of food insecurity (Mohajan, 2014), and linked to high levels of gender inequality in Kenya, where women are considered one of the food insecure vulnerable groups (Kenya Food Security Steering Group, 2000). Simultaneously, Kenya is recently experiencing an increase in noncommunicable, diet related diseases in line with pattern 4 of the nutrition transition model, which can be attributed to the consumption of food low in fiber and high in fats and sugars, insufficient physical activity, tobacco use, and harmful drinking (WHO, 2015b). In addition, urbanization and associated lifestyle changes may increase the prevalence of risk factors for cardiovascular disease such as overweight, obesity, and physical inactivity (Ettarh, van de Vijver, Oti & Kyobutungi, 2013). These two opposing heavy burdens make malnutrition complex and no longer just a health problem, but also influenced by sociocultural aspects. The local food plate in Kenya is strongly affected by socio-relational dimensions and cultural influences, and the potential of integrating these dimensions can be huge for eliminating food and nutrition insecurity (Noack & Pouw, 2015). Cultural customs and beliefs can have a significant influence on the families’ dimensions and nutritional well-being, cultural food beliefs for example are often connected to animal products affecting primarily women’s and children’s food plates (Oniang’o, Mutuku & Malaba, 2003). Other cultural influences on food plates may include attitudes towards certain foods, preferred preparations methods, and breast-feeding and infant feeding practices (Ibid).

2.2 Urbanization and urban agriculture

This section will unpack the concept ‘urbanization’ in the context of this research and discuss the importance of urban agriculture for food and nutrition security both at the household and community level.

2.2.1 Growing urban population

The urban population in the whole of Africa is expected to grow faster than in any other region (see Figure 3). It is expected that at then end of 2019, a large majority of the world fastest growing cities will be African cities (FAO, 2012). In Sub-Saharan Africa specifically the urban population is expected to double to 720 million by 2030 (UN-Habitat, 2008). Urbanization creates enormous social, economic and environmental changes, and the current rapid rate of urbanization is causing immense problems for African cities, with often more than half of the population living in overcrowded slums under unhealthy and unhygienic circumstances, and an equal possibility for children to be malnourished in urban compared to rural areas (Fotso, 2007). Despite the strong economic growth many African countries have achieved over the past decade, fast urban development also causes major concerns when city authorities lack the

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capacity to cope with increasing demands to meet economic and social needs of the urban population (Ooi & Phua, 2007). Seven out of the ten world’s fastest growing economies are African, however, urban inequality, food insecurity, and poverty are caused by rapidly increasing slum populations in Africa (FAO, 2012). To steer urbanization from its current destructive path towards cities in which food and nutrition security can be ensured and a clean environment for all residents can be achieved, urban agriculture should be exploited further (FAO, 2012). So can cities grow greener through an increase in the production of fruits and vegetables in and around urban areas to supply the urban population with fresh and nutritious produce, generate local employment, and reduce food transport costs and pollution.

Figure 3: Africa’s urban population (Source: FAO, 2012)

2.2.2 Urban agriculture and implications on the urban diet

Urbanization is causing a rapid growth of cities in developing countries placing enormous demands on the urban food supply systems. It is expected that by 2030 60% of the world’s population lives in cities, resulting in more food insecurity and poverty in these urban centers (FAO, 2009). The definition of urban agriculture (UA) applied in this paper is “the production of crop and livestock goods by urban residents within cities and towns” (Zezza & Tasciotti, 2010, p. 265), emphasizing that both the household and the agricultural production resides in the urban space. With many people moving towards urban centers, urban agriculture is becoming an important tool to create food and nutrition security. It is estimated by the FAO (2017) that urban agriculture is practiced by 800 million people worldwide. The importance of urban food production was firstly recognized at an international level by the International Development Research Centre (IDRC) in the mid-1990s as the subject of research and public policy (Mougeot, 2000). This led to the UNDP acknowledging the current and potential contribution of urban agriculture to the multiple goals of employment, urban food security, and environmental management (UNDP, 1996). Urban agriculture can provide the supply of fresh food, generate employment opportunities, recycle urban wastes, create greenbelts, and strengthen a city’s resilience to climate change (FAO, 2009), however a lack of awareness of the socioeconomic and environmental role of urban agriculture, a lack of clear government responsibility, resistant attitudes, cultural norms, and a lack of resources, financial and

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technical support counteract the potential of urban agriculture (Mougeot, 2000). Significance of urban food production

One major theme in literature on urban agriculture is the discussion of how it can contribute to food and nutrition security within the urban space including the households that are engaged in urban agriculture. Firstly, a distinction is made between the extent to which urban farmers have some degree of market orientation or whether they are purely producing for own-consumption. According to a study examining urban agriculture in East Africa, data supports the importance of urban food production for both income and consumption, and while most food is grown for consumption, only 25% claims that they cannot survive without their own produced food (Egziabher, 1994). Another study also emphasizes that the direct food security purpose prevails, but a considerable number of farmers sell their produce on local markets (Maxwell, 2003). At the household level, the impact of urban farming is a combination of three factors: income, food security, and nutritional status (Maxwell, 1995). There are various ways through which urban agriculture can have an impact on household food security and nutrition security; it can be a source of income (Zezza & Tasciotti, 2010); it can provide direct excess to a larger number of nutritious foods (Maxwell, 2003); and it can increase the stability of food supply over time (Maxwell et al., 1999; Maxwell, 2003). The amount of quantitative studies that focus on the link between urban agriculture and food and nutrition security is limited. Only one study was found wherein Maxwell (1995), based on data retrieved from Kampala, indicated a strong and significant association between urban agriculture and improved child nutritional status, especially in the low income groups.

Moving beyond the household level to a more aggregate level, urban agriculture can account for an important share of the production of some foods, particularly the more perishable ones such as milk and vegetables (Nugent, 2001). However, “the primary motive of urban farmers is to secure a non-market source of food for the household or family of the farmer” (Maxwell, 1995, p. 1672), causing food supply for the urban population to be limited and to rely more on food supply from rural areas and imports (Nugent, 2001). Also, urban agriculture creates employment in the informal sector however it only provides little economic injection into the local economy because production costs are low and inputs used minimal (Idem). These are the primary reasons that the poor households are mostly engaged in urban agriculture, although not necessarily the poorest who might lack access to land (Ruel et al., 1998). Furthermore, urban agriculture can contribute to the environmental sustainability of the urban space by for example recycling organic wastes to create fertilizers, and to avoid costs of waste disposal (Drechsel & Kunze, 1999). Lastly, a contribution made by urban agriculture includes gender disaggregation (Duchin & Sinha, 1999), because urban farmers are overwhelmingly women (Maxwell, 1995). The role gender plays in urban agricultural and food production will be discussed more in detail in the next section, including gender specific barriers female urban farmers face.

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2.3 Gender

This section touches upon gender dynamics, the effect of gender inequalities on food and nutrition security, and presents gender specific barriers to achieve food and nutrition security in the context of this research.

2.3.1 Importance of gender

Gender is an important parameter in development studies, and crucial to consider for social and economic analysis (Sen, 1987). Empirical research in recent years has clearly illustrated the extent to which women occupy disadvantaged positions in traditional social and economic arrangements. For the purpose of this research, the nature of gender inequality, specifically women’s social roles and gender specific barriers to achieve food and nutrition security are researched. According to Sen (2001) the issue of gender inequalities is ultimately one of disparate freedoms and a collection of inter-linked problems. Furthermore, Sen states that besides the presence of gender inequalities in Europe and North America, “in some fields women’s relative deprivation is much more accurate in many parts of the ‘Third World’” (p. 259). Ownership inequality and household inequality exemplify some of the disparities between genders (Sen, 2001). The ownership of basic assets such as land and homes can be very unequally distributed, and the absence of claims to property can be a barrier for women to enter into economic or commercial activities as well as reduce the voice of women. In terms of family arrangements, there are often inequalities in gender relations and commonly the burden of housework and childcare is unequally shared.

Throughout decades the value of gender equality is being recognized at the international level and research on gender issues within the international development framework is becoming an important consideration in development. Currently gender has been expressed in goal 5 of the SDG’s; achieve gender equality and empower all women and girls (UN, 2016). In the next decade and a half international agreements are expected to shape the world for women, which can serve as a great entry point towards equal rights and social justice, and towards unified involvement to fight poverty and inequality. According to the World Health Organization gender refers to “socially constructed roles, behaviors, activities and attributes that a given society considers appropriate for men and women” (2017). The term distinguishes the socially constructed from the biologically determined aspects and emphasizes gender roles and power relations as a social construct; they can vary through time and across different cultures and thus are amenable to change (MWIA, 2002). Distinct roles and relationships between women and men may bring about gender inequalities; differences between genders that regularly disadvantage one sex. Feminist scholarship has put the strive for gender equality high on the international agenda since the 1960s when feminist scholars began to question original assumptions regarding women’s and men’s attributes. As a result of the increasing emphasis on gender perspectives women’s empowerment is being improved and opportunities for economic development developed.

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2.3.2 Gender specific barriers

This section will unpack the gender specific barriers touched upon by the literature discussed in the previous section in the context of this research. Female farmers have traditionally been responsible for food production in Sub-Saharan Africa with an estimation of more than half the labor required to produce the food consumed in the developing world being provided by women, which goes up to 75% in Sub-Saharan Africa (FAO, 2011b). However, among one of the reasons agriculture is severely underperforming is the lack of resources, improved technologies, and opportunities women need to reach high productivity levels. This does not only affect local productivity and food security on the household level, but also intervenes with the achievement of broader economic and social development goals (FAO, 2011b). Despite findings that closing the gender gap in agriculture is key to reducing poverty and to improve food and nutrition security, women in many countries face social and legal barriers preventing them from owning or inheriting assets or accessing credit on their own (WHO, 2016). Also, women often do not get the same opportunities men do (World Bank, 2016b). This featured story published by the World Bank puts in light the oppression by gender inequalities women farmers have to deal with, even though these women are considered to have the capabilities to become agents of change in the agricultural sector with possibly a great future impact on poverty rates and food security (World Bank, 2016b).

Despite the important role women fulfill in the agricultural sector to fight food and nutrition insecurity, many gender related difficulties challenge this role. One barrier are women’s disadvantages with regard to the right to land, which evidently illustrates clear gender inequalities, with women representing only 15 per cent of land holdings in Sub-Saharan Africa (FAO, 2010a). The Social Institutions and Gender Index (SIGI) developed by the Organization for Economic Co-operation and Development (OECD) measures discrimination against women in social institutions, with gender inequalities and gender gaps in development areas as underlying drivers. In Kenya, the SIGI indicates restricted physical integrity and restriction on resources and assets, such as the access to, control of, and ownership of land, to be the root causes behind gender inequalities (OECD, 2017). The barriers created for women concerning the right to land persists because of legal, social, and institutional factors. In Sub-Saharan Africa, where women are mostly in charge of food production, they are limited to only user rights to land with the consent of a male relative (Quisumbing, Brown, Sims-Feldstein, Haddad, & Pena, 1995). When these women do not have access to and control over land, access to financial support becomes more difficult (World Bank, 2016b), and the likelihood to invest time and resources in the land, or adapt sustainable farming practices decreases (Quisumbing et al., 1995). Aggregate data suggests that women are involved in a high variety of tasks namely processing food crops, providing water for the household, working on food storage and transportation, hoeing and weeding, harvesting, and finally marketing (World Bank, 1989; FAO, 2011b). Often women have to combine the agricultural related workload with household tasks and taking care of the children and themselves leading to ‘time poverty’ (World Bank, 2016b). Health challenges related to the high workload can more so increase the overall vulnerability to HIV/AIDS (Izugbara & Ngilangwa, 2010) which in turn can decline labor productivity, increases dependency and often leads to a loss of income.

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Conclusion

Despite many varying definitions available and food security not being distinct from nutrition security, the preferred indicator in the field is food and nutrition security (CFS, 2012) emphasizing the nutritional value and health aspect of food. Recognizing the complexity of this definition and its overarching impact, this research will in practice regard the concept more simplified, because of restrictions in time and resources. Focusing on nutrition and dietary diversity, the ‘utilization’ dimension is accentuated in this research. Over the past centuries, the pace of dietary changes appears to have accelerated not only in the developed world, but also in fast growing urban centers in developing countries. Dietary and activity changes parallel major changes in health status as well as socioeconomic changes (Popkin, 2002). Urbanization is causing many African cities to follow the path of western diets high in fat and sugar, while low in fiber and nutrients, following the nutrition transition (Fotso, 2007). Agriculture is a not negligible reality for the urban population, involving a majority of the urban poor households, with primarily positive affects on food and nutrition security. In terms of income generation at the community level, though, the role of urban agriculture appears to be much more limited. The urban farmers involved in urban agriculture face barriers that go beyond the lack of farm intensification, and are more distinct due to sociocultural constraints and gender inequalities affecting their ability to improve their livelihood and household conditions (Mikalitsa, 2010). These concepts all come together in the context of the urban slum areas of Kisumu where this research took place. The relevance of studying the topic of food and nutrition security in relation to food trends, dietary diversity, and urban agriculture in this research location is evident. Firstly, because the majority of the urban poor that work in the agricultural sector are women (Maxwell, 2003). Also, many African cities face the continuous stream of urbanization, with urban agriculture playing an essential role to provide food and nutrition security for the growing urban population. Furthermore, it is recognized by governments, donors, and development practitioners that agriculture is central to economic growth and food and nutrition security, especially in Kenya where a significant share of the population depends on the agricultural sector (FAO, 2011b). The aim of this research is to unpack, within the context of the urban slums of Kisumu, the perceptions of female urban farmers on nutritious food, the barriers they face to achieve this, and to discuss some of the changes and trends associated with a changing food plate in the urban area of Kisumu in West Kenya. The conceptual scheme illustrated in the next chapter (see Chapter 3.2, Figure 4) depicts the linkages between the concepts that guided this research to form the concrete structure of this research.

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This chapter is divided into 7 sections explaining the research methodology. Firstly, section 3.1 presents the main research question as well as the five sub-questions; 3.2 outlines how the key concepts relate to each other demonstrated in the conceptual scheme; 3.3 discusses the key concepts as well as their operationalization; 3.4 describes the research methodology and offers a brief description of the research population and the sampling methods used; 3.5 explains how access to the field was acquired;3.6 presents the methods of analysis applied; and lastly, before concluding, section 3.7 covers the ethical considerations and limitations.

3.1 Research questions

This research aims to explore the perceptions of female urban farmers on food and nutrition security and demonstrate how agricultural practices relate to consumption patterns of urban farmers.

3.1.1 Main Research Question The main research question is:

How do female urban farmers in the slums of Kisumu, Kenya perceive and acquire food and nutrition security, which barriers do they face in this respect, and what role do social groups play in overcoming some of these barriers?

3.1.2 Subsidiary Research Questions

To answer this main question, the following five supporting questions are formulated: 1. What constitutes a healthy food plate according to female farmers’ own perceptions?

2. How do agricultural practices performed by female farmers relate to the consumption patterns within their households?

3. What barriers do female farmers face to maintain a healthy diet as well as provide this for their household?

4. How have urban food plates changed in recent years and what factors drove these changes?

5. What role can social groups play in achieving food and nutrition security for female urban farmers?

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3.2 Conceptual scheme

This section presents the key concepts that merged from the literature analysis illustrated in the conceptual scheme as well as their studied relationships. Figure 4 illustrates the interconnection of the concepts discussed in literature. Explanations of the correlations follow the schematic.

Conceptual Scheme

Figure 4: Conceptual scheme

3.2.1 Studied relationships

The above conceptual scheme depicts how the main focus of this study ‘a healthy food plate’ derives from the ‘utilization’ dimension of food and nutrition security. As can be understood by the yellow arrows, female urban farmers face multiple barriers, including gender specific barriers, to acquire a healthy food plate, both at the household level and at the community level. The local food plate is not only determined by the urban agricultural produce, but also influenced by sociocultural norms, urbanization, the nutrition transition, and economic influences. Chapter 5 and 6 provide empirical evidence to support the interconnections between the concepts as proposed in the conceptual model derived from the literature analysis.

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3.3 Key concepts and operationalization

In order to answer the main research question satisfactorily the concepts illustrated above in the conceptual scheme are described and operationalized in the following section (see appendix III for the operationalization table).

3.3.1 Female urban farmers in the slum

The targeted research population is female urban farmers practicing urban agriculture in the Nyalenda slum of Kisumu. To answer the main research question it is also necessary to explore other sources of information. Having a solid understanding of the role these female farmers fulfill in the urban slum will hopefully also allow me to place their interpretations and perceptions in a wider context. Not all urban farmers in the slum work fulltime in the farm, but create other business opportunities to increase income generation. Besides mainly focusing on female farmers, male farmers were also included in the data collection to add their input about the topics concerned and create a more comprehensive bottom-up picture of the situation.

3.3.2 Food and nutrition security

Food and nutrition security can be divided into four dimensions that together constitute both food security and nutrition security aspect (FAO, 2008). As discussed in Chapter 2.1, these dimensions are: access, availability, utilizations, and stability.

o The access to food is usually measured by food intake and consumption. Measuring this quantitatively is not the aim of this research, but this dimension is assessed by the means of qualitative methods. Factors leading to the inability to access food are poverty, lack of resources, and geographical location.

o Availability relates to the supply of food through production, distribution, and exchange. Food production is determined by factors such as land ownership, agricultural performances, and extreme weather events. These aspects influence the seasonal supply of food and diversity in food types available in markets.

o Utilization is often linked to nutrition security and requires an adequate diet and a healthy physical environment. This strongly depends on socioeconomic aspects determined by knowledge and habits, such as household dynamics, food preparation methods, and social rituals.

o Food stability refers to the ability to obtain food over time, which is affected by fluctuations of the above mentioned dimensions over time. Extreme droughts or rains cause food production to decrease, instable market dynamics cause rising food prices, but also unemployment or severe illness can lead to food and nutrition insecurity.

3.3.3.A healthy food plate

The concept ‘a healthy food plate’ is derived from the ‘utilization’ dimension of food and nutrition security and portrays an adequate diet. This is measured through assessing dietary

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diversity levels of the urban farmers and discussing perceptions about what constitutes a healthy food plate, how these have changed over time, and what factors cause these changes. Furthermore, in a focus group discussion with community health workers, the trends regarding food related diseases, vulnerabilities to nutrition insecurity, and the changing physical environment are addressed to reveal the health related aspects of a healthy food plate. The concepts ‘a healthy food plate’ and ‘nutritious food’ are used interchangeably in this thesis. The concept ‘a healthy food plate’ is chosen because of its simplicity and communicative strength, because many interviewees could not identify with the term ‘nutritious’.

3.3.4 Barriers

As already discussed in Chapter 2.3, gender inequalities exist in the poor urban slums in Kenya. The barriers that female farmers face to acquire a healthy food plate for their household as well as to affect the food and nutrition security situation in the community are emphasized. For the analysis of this research, the barriers are divided into nonagricultural related barriers and agricultural related barriers. Gender specific barriers are represented in both agricultural related barriers, such as limited access to agricultural technologies, and nonagricultural related barriers, such as institutionalized barriers to credit.

3.3.5 Gender awareness

The incentive of this research is to delve into the lives of female farmers in the urban slums of Kisumu to reveal their role and perceptions of food and nutrition security at the household and community level. The topic of gender is addressed in all data collecting methods and refers either to gender in the household setting or within the slum area. Within the household, gender is addressed in terms of the division of tasks and roles appointed, and within the community level, the current and future role of women is explored. The topic of gender is discussed mostly in a women-only environment but also in group discussion and interviews with men to include their perceptions of gender roles and inequalities.

3.4 Research Methodology

This section presents an understanding of the research methodology this research is derived from, an overview of the sampling selection procedure, and an explanation of the research methods used for the collection of data.

The research methodology is a qualitative approach and only qualitative research methods are applied for data collection and analysis, because this study aims to capture changing patterns and the perceptions and voices of female urban farmers about agriculture and food and nutrition security, changing food trends, and barriers faced. A combined use of inductive and deductive techniques was adopted to on the one hand enable the female farmers to voice their opinions and own experiences, which created space for social, environmental, cultural, and economic dynamics affecting food and nutrition to surface. On the other hand, the conceptualization of food and nutrition security discussed in theory led me to use dietary diversity as a qualitative measure of nutritious food consumption. For this study I aim to increase my understanding of

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the social world through an examination of the interpretation of that world by its participants, which is stressed by a qualitative research methodology (Bryman, 2012). Blumer (1954) emphasizes that concepts developed for qualitative research are not fixed, but adaptable to the social world, provide “a general sense of reference and guidance in approaching empirical instances” (p.7), and concepts act as a means to uncover the variety of forms that the phenomena can assume. This is why the operationalization of the concepts for this study was adapted throughout the course of the research.

There is considerable variability in the collection of data in a research based on qualitative methods. Qualitative research subsumes multiple diverse research methods that differ from each other considerably (Bryman, 2012, p. 383). For this study, a variety of qualitative methods is used, which supports the concept of triangulation and helps to get a better understanding of the complexity of the issue. Within the structure of development studies this is extremely useful since the concept studied can be complex especially because of the large cultural, social, and linguistic differences that are involved (Bryman, 2012). The research methods deployed during the course of the fieldwork mainly consisted of structured interviews, focus group discussions, and semi-structured interviews. The structured interviews with female urban farmers primarily aimed to retrieve data to answer sub-questions 1, 2, and 3, which all emphasize the farmers’ perceptions, agricultural practices, and barriers experienced. Sub-question 4 was answered by a combination of structured interviews and focus group discussions, which aimed to fuel more conversation after already having addressed the topics in some of the structured interviews. This data then was complemented by semi-structured interviews with key informants and a focus group discussion with community health volunteers to include health implications. Also, the method of creating a seasonal timeline was used to unpack the implications of climate change on the local food plate. Sub-question 5 was adjusted to include the role of social groups during fieldwork, because many farmers highlighted the importance during interviews. In addition, a focus group discussion with female traders was attended to increase knowledge on the dynamics of such social groups.

By applying various methods in order to answer the main research question, and using multiple methods per sub-question, guarantees an increase in validity and allows to collect more well-founded data with a higher reliability and generalizability (Summer & Tribe, 2008). Research was primarily conducted with female urban farmers in Nyalenda who are at the start of the local food chain as food producers and thus fulfill a crucial role regarding food and nutrition security. Besides the farmers, research was also conducted with food traders and marketers to get a better understanding of the complete food chain and processes affiliated with it.

3.4.1 Sample selection and research population

The selection of participants for data collection was attained in close coordination with VIRED International. As a local organization they have been in close contact with the community for several projects in the area, resulting in well sustained relationships with local urban farmers and people within the community.

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Convenience sampling, a type of non-probability sampling, was used to attain an accurate sample size, because a form of probability sampling did not turn out to be feasible due to a lack of knowledge about the population and minimum resources available. Further into the research process a high percentage of the farmers being active in this community were approached, leading to these participants representing the female urban farmers of this community (Nyalenda A). The focus group discussions were organized based on already existing contacts with participants made during interviews or via the connections of VIRED. This person would then gather a group of relevant participants for the focus group via his/her contacts within the community. Interviewing as many key informants relating to my research as possible was realized by using snowball sampling. Since the community is rather small, most key informants were able to direct me to another person or organization relevant to my research. The aim of interviewing the key informants is not to draw a random sample in order to generalize the findings but rather to increase knowledge about the community, relevant projects being implemented in the area, or government’s plans for policy implementation.

The unit of analysis for this research is primarily the female urban farmers who live in the Nyalenda slum and practice urban agriculture, meaning that both the household and the agricultural production resides in the urban space. The community where the female urban farmers live and work in is also included to gain an overview of the area and to evaluate their impact on the community as urban farmers and the effects on local food and nutrition security levels.

3.4.2 Unstructured observations and informal discussions

In order to retrieve and absorb as much relevant information during my time in the field, it was essential to understand the local dynamics, people’s usual rhythms of the day, and also when it is appropriate to request people’s time for interviews and talks, and how they like to be addressed. Furthermore, it was important to understand the physical map of the area, such as the locations of the markets, the distances between locations, and the layout of the different slums. Identify whether there are more people involved in urban agriculture besides the area I am researching, and compare these.

The interactions, talks and observations I engaged in during visits to the markets, when commuting between places, or at social gatherings, offered a great deal of contextual information and provided an inside into the daily routines of people, their usual agricultural performances, and the norms and values they value. Furthermore, during this period I learnt how I was perceived by the local community, which made me aware that many automatically placed me into a certain position, of caregiver and connected to aid organizations.

3.4.3 Participatory research

Participatory methods were utilized at the beginning stages of my research and continued throughout in order to triangulate data retrieved during observations and other research methods. Methods used include an exercise mapping a seasonal calendar, focus group