Background
Food insecurity is a pressing global issue and contributes to malnutrition in all its forms (undernutrition, micronutrient deficiency, and overweight and obesity) through the complex interplay of food and non-food factors that affect a person’s nutritional status [
39]. In 2018 an estimated 820 million people were classified as undernourished and two billion people were affected by micronutrient deficiency or ‘hidden hunger’ [
40]. “Hidden hunger occurs when the quality of food people eat does not meet their nutrient requirements, so the food is deficient in micronutrients such as the vitamins and minerals that they need for their growth and development” [
100]. Hidden hunger can occur in those consuming too little food or in those consuming too much energy-dense nutrient poor food. Globally, undernutrition was the underlying factor in 45% of all deaths of children under 5 years of age in 2011 [
7], and suboptimal diets are responsible for more adult deaths than any other risks [
44]. The most common nutritional deficiencies are of iron, zinc and vitamin A, and multiple micronutrient deficiencies can occur together in the same population [
78]. The WHO [
101] recommends consumption of a healthy diet to avoid nutritional deficiencies and non-communicable diseases. A healthy diet comprises an appropriate energy intake, increased intake of fruits, vegetables, legumes, nuts and wholegrains, moderate intake of animal-source foods such as fish, and reduced intake of ultra-processed foods, to meet the nutrient requirements of all age groups, including those with special nutrition needs, and is adapted to the local context and culture [
77,
101,
104]. Ultra-processed foods “are typically high-energy-dense products, high in sugar, unhealthy fats and salt, and low in dietary fiber, protein, vitamins and minerals” ([
76], p.1). They are generally manufactured in an industrial setting, and in developing countries are widely available as single-serve packaged sweet or savory snack foods. In the context of the multiple burden of malnutrition, and the complex challenges of a growing global population and climate change, there is growing recognition that healthy diets must also be produced by sustainable food systems so as to ensure food and nutrition security for present and future generations [
36,
52,
54,
104].
Fish, and other edible marine resources (e.g. bêche-de-mer, octopus, sea shells, shrimp; hereafter “fish”), have largely been overlooked in discussions of food-based strategies to address malnutrition in the context of sustainable food systems [
10,
53,
62,
63,
68,
91]. Fish are a nutrient-dense animal-source food which provides 3.2 billion people with almost 20% of their average per capita intake of animal protein, with consumption higher in Indigenous fishing communities and small-island developing States [
17,
22,
38]. However, the nutritional value of fish extends beyond protein, encompassing long-chain polyunsaturated fatty acids, micronutrients such as vitamins A, B12 and D, and minerals including calcium, phosphorous, iodine, zinc, bioavailable heme iron, and selenium [
5,
11,
85]. Fish are an invaluable addition to plant-based diets because they enhance the bioavailability of non-heme iron and zinc from other foods consumed in the same meal [
69,
70]. In developing countries, the small-scale fisheries sector, operating across marine, inland and aquaculture systems, employs an estimated 33.1 million fishers on a full- or part-time basis, with an additional 2–3 people for every fisher employed in postharvest activities; half of these workers are women [
72]. The sector provides a safety net function, with countless others engaged in fishing activity on an occasional and seasonal basis [
6]. These activities contribute directly to food and nutrition security through the provision of fish for home consumption and indirectly through the generation of income which can be used to purchase other foods, including staples and lower-value fish, and to pay for other goods and services.
‘Fish as food’ is an important lens for thinking about the sustainability of fisheries and fishing communities [
5,
63]. Studies at a global scale indicate that in some countries with a high malnutrition burden redirecting a small portion of marine finfish landings to local rather than export markets could have a meaningful impact on the nutritional value of local diets, especially for children under the age of five [
51]. Studies at a local scale tend to focus on the apparent availability of fish, particularly in the context of marine governance and sustainability innovations, rather than on how fishing contributes to food and nutrition security within local fishing communities. Kawarazuka and Bene [
58] mapped evidence of these contributions across three pathways (income, consumption and distribution), but noted that more research was required to quantify the linkages between fish-related livelihoods and nutrition. Moreover, fishing households face heightened risk of food insecurity as they are at risk of direct and trading entitlement failures because their food and nutrition security depends on the consumption of the food they produce (i.e. fish)
and its sale to obtain other foods [
14]. These risks may be higher in specialised fishing households and communities that are constrained by limitations of access to productive resources, infrastructure, economic and institutional capacity, and where the socio-cultural ties to fishing as a way of life are strong [
20,
34,
60].
In this paper, we present and analyze empirical data from a mixed methods exploratory case study of food and nutrition security in three specialised fishing communities in eastern Indonesia. We use food consumption frequency data to assess nutritional quality of diets at the household level, assess the prevalence and severity of food insecurity (access), and identify strategies used by households to manage during times of food insufficiency. The study contributes to the literature by identifying the vulnerability of specialised fishing households to chronic food insecurity and the need for cross-sectoral nutrition-sensitive programmes to improve food security in similar communities in the tropical coastal seascape.
Discussion
This study presents findings from an exploratory assessment of food and nutrition security in three specialised fishing communities in Komodo District, NTT, eastern Indonesia. We found that households appear at first to have adequate access to consumption of diverse food. However, the typical household dietary pattern comprised frequent consumption of the staple rice and regular consumption of fish, and only occasional consumption of vitamin A rich foods and fruits and vegetables in general. Fish were the primary dietary source of protein and heme iron; a wide range of fish were consumed, including reef-associated finfish such as emperor, rabbitfish and grouper, and small pelagics such as anchovy and sardines. Studies indicate that fish can be an important dietary source of vitamin A [
11,
85]. However fish are not included in the ‘vitamin A rich food group’ used to construct the Food Consumption Score for nutritional quality analysis, perhaps reflecting the indicator’s historical development in Sub-Saharan Africa where per capita fish consumption is among the lowest in the world [
38]. The inclusion of fish is hampered by complexity arising due to the form, content and bioavailability of vitamin A differing among fish species and also affected by a range of ecological processes [
16,
84]. Despite recent efforts in other countries [
11,
79,
83], there is limited nutritional data available for commonly consumed fish in Indonesia. The
Food Composition Table for Indonesian lacks sufficient detail, listing only a handful of fish (for example ‘anchovy’, ‘fish’, ‘fish, sea’ and ‘fish, tuna’) and fish dishes, although over 870 species of bony fish are marketed [
89,
99]. This lack of information, applying equally to other key micronutrients and minerals such as iron and zinc, is compounded by limited understanding of the impact of post-harvest handling and processing and cooking methods on the nutrition quality of fish. In the case study communities, fish were observed being processed using methods that raised food safety concerns, further highlighting the complex interplay of factors associated with ensuring access to adequate, nutritious and safe foods for all.
Household consumption of fruits and vegetables in the communities studied varied seasonally in accordance with local availability and corresponding affordability. A small number of nutrient-dense moringa trees (
Moringa oleifera,
kelor) were grown by individual households in each community. Moringa appear to be underutilized as a versatile and nutrient-dense food source, particularly given that little else was successfully cultivated locally. Fruits were considered as a snack food whereas vegetables were typically consumed in small portions as a side dish or incorporated sparingly in stir-fried dishes or soups. This appears consistent with other dietary patterns across Indonesia, with data at the national level indicating that Indonesians consume less than half the recommended daily amount of fruits and vegetables [
9,
94]. Infrequent consumption of fruits and vegetables were also evident in the 24-h recall dietary quality data we collected for women of reproductive age and infants and young children [
45]. Analysis of this data found that both the mother and child in one half of mother-child pairs surveyed had consumed fruits and vegetables in the 24-h recall periods (53% in the wet season and 49% in the dry season) and, that in 88% of mother-child pairs neither the mother nor child had consumed vitamin A rich fruits or vegetables. Other studies from Indonesia have shown that diets lacking diversity increase the risk of vitamin A and iron deficiency for infants and young children, female adolescents, and women of reproductive age, suggesting that women and children may be susceptible to micronutrient deficiencies despite the frequent consumption of fish [
8,
64,
86]. Moreover, as is also observed in Albert et al. [
1]‘s study in the Solomon Islands, the dietary quality data contrast with the initial impression given by the Food Consumption Score. This suggests that the cutoff scores used for poor, borderline and acceptable diets in contexts where there is frequent consumption of fish (and other protein foods) should be adjusted further upwards. This anomaly reinforces the importance of selecting an appropriate combination of food and nutrition security indicators, depending on the purpose of the study and feasibility of data collection given available resources and other constraints [
37,
61].
A healthy diet encompasses a balanced, diverse and appropriate selection of foods, ensuring that the need for macro- and micronutrients are met given a person’s gender, age, physical activity level and physiological state [
40]. Increasing dietary diversity is one of the core messages of Indonesia’s revised dietary guidelines [
75] and is included as an objective of the food-related policy framework (
National Medium-Term Development Plan 2015–2019,
Strategic Policy for Food and Nutrition 2015–2019,
National Action Plan for Food and Nutrition 2017–2019). While recent progress has been made with respect to increasing the consumption of fish [
2], consumption of fruits and vegetables declined by around 4 % between 2012 and 2016 and continues to fall, in line with dietary transitions occurring in many low- and middle-income countries [
94]. There is a substantial difference in the frequency of consumption of fruits and vegetables between Indonesian households in the lowest and highest income quintiles [
94]. A recent assessment found that 38% of Indonesian households could not afford a staple-adjusted nutritious diet, increasing to 68% of households in NTT Province where nearly 60% of rural households’ monthly expenditure is on food [
12,
98]. Low levels of fruit and vegetable consumption have been reported in small island developing states across the Indo-Pacific region, largely due to cost and affordability but also changing taste preferences, convenience and environmental challenges [
1,
19,
33,
57]. Availability and affordability are key factors influencing household purchasing decisions, with low income households tending to focus on consumption of sufficient energy-dense staple foods to meet calorie needs [
88]. Efforts to increase dietary diversity are also influenced by taste preferences, food habits and taboos, low nutritional awareness, convenience, food safety concerns and changing lifestyles [
56,
88]. We also found that women served other members of their household before themselves and relied upon the advice of women elders and traditional midwives rather that community health personnel [
45]. These factors can lead to inequalities in intra-household distribution of nutrient-dense foods, which can be masked by studies at the household level [
49]. There is thus a critical need to further explore and address the barriers to consumption of nutrient-dense foods in the communities in this study area.
The households included in our study reported high levels of perceived food insecurity, with household perceptions of food security significantly higher in the dry season. Food insecurity was likely higher in the wet season due to poor weather conditions which kept fishers ashore resulting in there being less fish harvested for subsistence consumption or sold for income. Poor weather also meant that small fruit and vegetable vendors could not travel between the islands and mainland markets. Only a small proportion of households reported the more severe food insecurity condition experiences, such as ‘not having food of any kind in the household’ and ‘going a whole day and night without eating’, although these were rare occurrences. Fabinyi et al. [
35] identified similar experiences in fishing communities in the Philippines. A higher level of food insecurity was associated with a low level of maternal education and lower material styles of life score, a proxy for household wealth. These factors have previously been identified as risk factors for food insecurity and children’s micronutrient deficiencies [
48,
90]. Empowering women through education is argued to be the single most important determinant of food security, with women with higher levels of education likely to delay having children, have increased opportunity to participate in the work force, greater decision-making capability and the ability to influence household purchasing to support improved nutrition outcomes [
55,
90]. Darling [
27] and Fiorella et al. [
43] found household wealth was associated with higher levels of food security in inland and coastal fishing communities in Kenya respectively, irrespective of the household pursuing fishing livelihoods.
In these specialised fishing communities, food insecurity was a cyclical and seasonal phenomenon, with the flow of fish, income and food linked to the type of fishing activity pursued. For many households, food insecurity reflected the lunar cycle, with night fishing practices such as spearfishing and lift-net fishing significantly reduced or ceasing during each full moon phase. Households employed a range of consumption and non-consumption strategies to manage through times of food insecurity; these include four commonly identified coping strategies: dietary change, food-seeking (including borrowing, purchasing on credit and reliance on wild foods), household structure, and rationing [
65,
66]. However the strategies were not “short-term responses to an immediate and inhabitual decline in access to food” [
28], but rather routine insurance and adaptive strategies in response to the vagaries of the small-scale fisheries activities pursued and the broader socio-economic context. The income generated by fishing, particularly for poorer fishing households without fishing capital (boats, engines, gear), was too low to allow for savings, leaving the fisher and his household reliant on patron boat owners for work and other support such as loans to cover food or medical expenses [
35,
41,
73]. While numerous studies have noted the importance of livelihood diversification strategies in increasing household resilience [
47,
71], such options are limited in specialised fishing communities by the pervasiveness of patron-client relationships, geography, community size and cultural identity associated with fishing as a ‘way of life’ [
67]. None of the households in the study communities engaged in cropping, kitchen gardens were uncommon, soils were poor and fresh water limited. Some fisher-wives created small food-based or petty-trade businesses, however, the vagaries of fishing and the flow of money within the communities impacted these businesses too, leaving the women vulnerable to debt. The range of strategies pursued by households highlights their high level of risk to entitlement failure, and vulnerability to continued food insecurity.
Strengths and limitations
This research places a spotlight on the experiences of food and nutrition security in remote rural specialised fishing communities, a vulnerable group which has been overshadowed by a consistent focus on food security in agricultural small-holder households. Several limitations should be considered. As a small cross-sectional case study, the results relate to households in these communities comprising a woman of reproductive age and a child aged between 6 months and 5 years, and therefore may not be generalizable to the wider Indonesian population. The analysis drew on maternal-reported food consumption and experience of food insecurity data which may be subject to recall error and, despite careful explanation of the purpose of the study, social desirability bias. Consumption of fruits and vegetables are driven by seasonal availability and greater access due to lower prices. While we collected data in periods covering the major seasons from a fisheries perspective, neither survey period coincided with the local mango season which occurs from October to December. A repeat survey during that period may have produced elevated food consumption and dietary diversity scores due to more frequent consumption of mango, a vitamin A rich fruit. We acknowledge that the quality of food consumption data collected using questionnaires is imperfect and that quantitative dietary assessment with additional biochemical measures would allow for a more accurate assessment of nutrition status. Finally, research activities were undertaken by a multi-lingual field research team, so our methodology incorporated frequent cross-checking and the use of probing questions to clarify understanding and further explore responses. Transcripts were transcribed verbatim and checked for correspondence with contemporaneous notes, but unfortunately resources and timing did not allow for rechecking of transcribed material with research participants. While data were not co-coded, regular and reflexive debriefing supported bracketing.
Publisher’s Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.