Solid fuel use and cooking technologies

Solid fuels are used extensively for cooking and home heating in developing countries, especially in rural areas. According to recent estimates, in Mexico, there are 16.8 million exclusive fuelwood users and 5.8 million mixed users (around 20% of the population) mainly in the rural and indigenous areas [1]. The traditional use of solid fuels in inefficient devices results in excess fuel use and the release of products of incomplete combustion. Health impacts are driven by indoor exposures mainly during cooking, which disproportionately affect women and small children [2]. There has been a global focus on improved cookstoves (ICSs) and clean fuels based on their potential benefits in three areas: health of household members, local environmental quality, and regional climate benefits. However, ICS and clean fuel dissemination programs have presented low uptake rates [3–5]. Introduction of new cooking fuels and stoves in many areas has been best described as a “stacking” process: New stoves and fuels do not usually substitute 100% for traditional ones, but rather are initially used for certain cooking tasks. An in depth understanding of the household energy use and how the new stoves and fuels can displace older devices across all household energy tasks is critical to achieve the expected health benefits by such programs [6–8].

The kitchen is a complex social space that is both critical to the material well-being of the household and imbued with deep cultural meaning, which raises a unique set of characteristics in the intersection of the culture, environment, and fuel access [4, 7–11]. The stacking has strong implications in terms of the long-term impacts of interventions [8], precludes adequate reduction in exposure levels [12] and therefore the health benefits have been less than expected.

The World Health Organization published indoor air quality guidelines regarding household fuel combustion which include recommendations on emission rate targets from household energy fuels and technologies that pose minimal health risks [13]. Few households worldwide can achieve the air quality standards without displacing the polluting traditional open fire with modern technologies [8, 14].

Studies across the world have identified a wide variety of contextual factors which influence the process of ICS uptake. For instance, after reviewing 137 ICS programs in 47 developing countries, the World Bank reported that efforts tend to fail [15] if any of the following conditions apply: cookstoves and fuels cannot be purchased or easily obtained; those who determine that the ICS is required are outside “experts”, the ICSs are provided as part of a technical package without taking user preferences into account, the design does not resemble that of traditional stoves, the ICS is difficult to light and requires pellets, and finally, monitoring and evaluation are not designed and budgeted as part of the program. More recent studies have identified the following social determinants increasing the uptake processes: higher income and schooling [9, 16–18], fuelwood price, household size and credit access [16], house ownership [9], previously owned and used LPG stove [10], exposure to messages about the benefits of improved cookstoves [18] and the agreement between the technical characteristics of the stove with the social and cultural needs and expectations [9, 16–19].

Over the past 30 years, the international community has gradually shifted the focus of analysis towards the sociocultural contexts of users. Several studies have explored the sociocultural factors related to the user decision to choose a new cooking technology or to fulfill other household energy needs. Due to its importance, these issues are still under research. As mentioned by Pine et al (2011) [20], “many programs to promote these improved technologies have failed in the long run because they did not take variations in cultural preferences, local cooking needs, patterns of household fuel use, and other social and economic factors into account”. Some of the studies under this perspective have been carried out in Guatemala [21]; in Mexico [4, 22]; in Mozambique [23]; in Bangladesh [24]; in Kenya [25][26]; in India [27]; in Mongolia [28]; and in Sudan [18]. Some other studies have explored the influence of gender on the adoption and use of ICS [29, 30].

The study in Sudan indicated that traditional ways of cooking cover a large number of sociocultural functions and practices that have not been considered by ICS programs [18]. In addition, a systematic review study showed that indigenous and other regional ethnic groups are not likely to adopt clean fuel and ICSs because of the intrinsic value that traditional cooking techniques represent [16]. Similarly, a study in Peru, Nepal and Kenya analyzing contributing factors for rendering ICS interventions more effective pointed out that both general similarities and locally distinct practices and norms can be identified in traditional stove usage across regions. Traditional stoves accommodate not only specific cooking styles, but also fuel types and resources available for their maintenance and renovation. They allow users to cook their local dishes and repair their stoves easily. The authors concluded that ICS designs need to take into account the diversity of values and necessities of potential users; as a consequence, a single design for different regions is not advisable because it cannot cover diverse cooking practices and other household energy needs, or respond to local resource restrictions [31]. In this context, stacking becomes important, given that each combination of technologies and fuels covers a niche of specific tasks according to the needs and preferences of the users [7].

After analyzing the factors behind ICS uptake in Africa, Asia, Central America and the Caribbean [15, 19], studies have concluded that programs incorporating the needs and preferences of users are more likely to be successful. According to these studies [19], women attach greater value to features other than fuel savings (e.g., the time stoves take to warm up, aesthetics and the social status of possessing improved technology). ICSs must therefore be competitive vis-a-vis the traditional ones in numerous ways (i.e., ease of operation, safety and time savings) for users to clearly perceive their benefits. Few studies have adopted a user’s perspective to analyze the factors in the selection among different cooking technologies [32], nor have they followed up on ICS implementation to investigate sustained usage and to identify the factors underlying the uptake process.

Studies in Mexico

A study on fuelwood use and management strategies in the Altos de Chiapas region, showed how sociocultural, economic, climatic and technical factors pose barriers to the acceptance of technological changes [33].

The rural household energy program with the development and dissemination of the ICS Patsari is a well-documented project in Mexico [34]. The Patsari stove is an efficient multipot wood-burning stove built in situ with the help of a mold and local materials, including a big flat pan or comal, a chimney and/or two secondary pots. The size and inner dimensions of the stove were optimized to produce a cleaner combustion. The implementation of the program in this case included the installation of the ICS and an initial training with a short follow up during one year as part of the study, but the supply chain for spare parts was not assured and people had to rely on themselves for stove operation and maintenance [17].

Use of the Patsari cookstove in actual field conditions, has been shown to achieve average reductions of 70% in indoor air pollution concentrations [35, 36], of 56% in household fuel consumption [37], and of 74% in greenhouse gas emissions [38] compared with open fires. A health impact assessment showed that the actual use of the Patsari stove, as reported during field worker visits, was significantly associated with a reduction of symptoms related to wood smoke and of lung function decline over 1 year of follow-up in women [5] and a protective effect mainly on the upper and lower respiratory infection duration in children [39]. It has been documented that the processes of ICS uptake are driven by both household and community components [20]. The adoption of a cookstove should not be regarded as an isolated event, but rather as a complex process where cooking practices depend on specific user-technology-fuel interactions [40]. From the perspective of users in the Purepecha Meseta region, it is clear that these processes are permeated by social, cultural and environmental issues [4].

In order to better understand the individual and sociocultural factors underlying the adoption and sustained use of ICSs in the Mexican Purepecha region, the aim of this study was to analyze the factors enabling/limiting the use of improved cookstoves among rural fuel wood users from one mestizo and two indigenous communities eight years after an intervention in the state of Michoacan, in Mexico.

Study population

The Purepecha Meseta region of the Mexican state of Michoacan, sitting over 2,400 meters above sea level, is dominated by pine and oak forests with a temperate weather with large diurnal variation, particularly in winter. The household solid fuel use is highly prevalent and there is a seasonal space heating need. The access and use of LPG is low. The region is inhabited by Purepecha indigenous communities of pre-Hispanic origin, and more recently settled mestizo rural communities [41].

A randomized community trial was conducted in six communities, from the Purepecha region to evaluate the impact of a Patsari ICS program implementation on women and children health. Among 889 households complying with the inclusion criteria (using open wood fires and having a child under 5 years old), 668 agreed to participate and were randomized to receive the stove at the beginning (early 2005) or end (mid 2006) of the study [5, 39]. Maximum ICS utilization (around 70%) was documented four months after installation and then declined steadily from the eight month (55%) onwards [20]. A follow up study was conducted among the cohort of rural women in four communities established during this community trial in 2012/13 to assess health outcomes (lung function) and learn about the household fuel use during the period. Two communities were excluded from this follow up because of logistic issues and insecurity. From a total of 257 participants in 2012, only 15.5% (n = 40) of the women still used the Patsari ICS, 15.5% (n = 40) still possessed it but did not use it, and 69% (n = 177) had dismantled it [42]. A subsample of participants was selected from three communities to participate in the qualitative study presented here.

Study design

We used a qualitative design with an ethnographic perspective based on semi-structured interviews with the adult women participating in the Patsari follow-up study [42]. Our report was formulated according to the qualitative research reporting criteria [43]. Our selection of an ethnographic theoretical perspective arose from our interest in the behavior and perceptions of the social actors related with the adoption and use of the ICS in their particular sociocultural context. Our study sought answers to the following questions: What factors enabled/limited ICS adoption and use? And specifically with regard to the Patsari participants who had not adopted or were not using the ICS, why did they reject the new technology? We used semi-structured interviews because they allowed for understanding how the women perceived their own practices and experiences as well as the significance they attributed to adopting and utilizing an ICS in their homes. The study was approved by the Science and Bioethics Committee of the National Institute of Respiratory Diseases of Mexico (INER by its Spanish initials) under protocol number S02-14 as a minimal risk study with an oral informed consent for the interviews and its audio recording.

Selection of participants

The interviews were conducted in three communities—one mestizo (La Mojonera) and two indigenous (Quinceo and Turicuaro)—of the Mexican Purepecha region (Fig 1). Participants were selected by means of snowball sampling from the Patsari follow-up study cohort [42].

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Fig 1. Map of the three participating rural communities located in the Mexican state of Michoacan.

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As part of the Patsari follow-up study, our participants were classified according to the status of the ICSs installed in their communities in 2005 and 2006, namely whether they were in use, disused or nonexistent (dismantled). The number of interviews was determined according to the theoretical saturation criterion; that is, interviews were suspended when they ceased to provide new elements for a more in-depth understanding of the object of our study [44]. A total of 62 interviews were carried out: 15 from Quinceo, 22 from Turicuaro and 25 from La Mojonera. The participants were personally invited at their homes. The rural health assistant in the two indigenous communities served as the link between the researcher and study participants; at times, she also served as interpreter, since the women spoke the Purepecha language. In the mestizo community, the nurse at the health center assisted in contacting participants but was not present during the interviews.

Piloting

We designed the interview guide on the basis of a literature review focused on the topic of our study, placing special emphasis on the sociocultural characteristics of our sample population such as its attachment to traditional cooking technologies and practices. The interview script was tested on a group of four women from Quinceo and was subsequently redesigned as regards the introduction, sequence of its items and duration of the interviews.

Procedure

First, we presented the study to the local, civil, agrarian and health authorities. Subsequently, we carried out three field trips across the study communities in order to become acquainted with the residents, observe their daily routines and locate the homes of potential participants. Two visits were made to each prospect: the first to present the study, the purposes and approximate duration of the interview, the confidentiality of the information provided and the most convenient timing for the interview. Those who expressed an interest in participating were then asked to give their oral informed consent to the interview and its audio recording. During the second visit, we conducted the interview and inquired about housing conditions, including the kitchen characteristics. All interviews were carried out by the principal investigator (MCV), a researcher with experience in qualitative studies of women from indigenous and marginalized communities, who had participated in the Patsari follow-up study but not established contact with the interviewees. Conducted face to face in the homes of the women, the interviews lasted approximately 40 minutes each and ran from September 2013 to April 2014. The rural health assistant in the two indigenous communities served as interpreter when the participating women did not speak Spanish fluently.

In order to understand the factors influencing women’s decision to adopt and utilize the ICS, we explored a combination of sociocultural determinants and characteristics including gender, social class, ethnicity, age group, the mother-wife condition, knowledge, customs and traditions [32, 45]. Our interview script identified four relevant topics: (1) family and everyday life, especially the type and composition of family, the occupation and health of its members and various aspects of women’s everyday lives; (2) social representations on being a woman, specifically, community images of what a woman should be, including the knowledge that mothers transfer to their daughters; (3) technologies used for cooking and other domestic tasks. We asked respondents at what age they had learned how to use the traditional open fire, what domestic tasks they used it for and what advantages and/or disadvantages they attributed to traditional technology. We asked also what the history of the ICS stove was and whether or not they still kept and used it. Those who answered positively were asked what tasks they used it for and what advantages and/or problems derived from its use. Those who answered negatively were asked to explain why they had abandoned the stove; and (4) health risks attributed to woodsmoke and the effects, if any, that the respondent, family members or community residents had experienced as a result of inhaling woodsmoke from the traditional open fire.

We conducted the interviews mainly in the kitchen, some of them while the respondent performed one of her cooking activities. We recorded the information in a notebook adapted as an ethnographic register and audiotaped the conversation. The sessions occurred without the presence of other researchers and only occasionally in the company of a family member. During the interview visit, we registered the location of the kitchen (in/outside the dwelling), its type of construction (traditional/modern), the status and location of the Patsari ICS, and the location of the traditional open fire and other furniture. All of these elements provided useful information for the interpretation of the study results, particularly those related to cooking technologies.

Data analysis

We transcribed the audios using a word processor designed for professionals in the INER Epidemiology and Social Science Research Department, with transcriptions verified by MCV. Based on the method proposed by Taylor & Bogdan [46], data analysis was performed along the following stages: (1) repeated readings of transcripts; (2) definition and elaboration of a codebook according to the categories in the interview guide themes; (3) identification of emerging themes; (4) coding of linguistic material using Atlas-ti software (versions 5.2); and (5) data editing, description and analysis. Coding of texts was defined according to an initial draft which was progressively refined through discussion and consensus.

Characteristics of the study communities

Of pre-Hispanic origin, the indigenous communities of Turicuaro and Quinceo lie in the municipalities of Nahuatzen and Paracho, respectively. La Mojonera, a mestizo community formed after the Mexican Revolution, lies in the Nahuatzen municipality, with its cooperative land tenure established in 1934 [41]. Table 1 illustrates the demographic, economic, educational and household characteristics of the three sample communities. La Mojonera presented the lowest number of illiterate women and the economically active population was integrated by 11–13% of its female population. The three sites shared the same proportion (roughly 14%) of female-headed households. Dwellings with dirt floors were found throughout the three sites but prevailed in the indigenous communities: 48% in Turicuaro and 65% in Quinceo. La Mojonera showed a lower prevalence of piped water (36%) than the other two communities [47].

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Table 1. Profile of the study communities according to the 2010 National Census.

https://doi.org/10.1371/journal.pone.0193238.t001

Participant characteristics and household fuel use

Table 2 illustrates the characteristics of the study population groups and their ICS and other cooking devices status. On average, the women in the indigenous communities were younger (33.1 vs. 36.5 years) and had two years less schooling (a total of 4.5 years) than those in the mestizo community. Practically all of the women in the study population were married. The indigenous communities obtained their water mainly from a well, whereas La Mojonera used jug water.

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Table 2. Characteristics of participants by ethnic group.

https://doi.org/10.1371/journal.pone.0193238.t002

In all three communities, kitchens of planks and gabled tin roofs were mainly built separately from the other rooms around a common patio. Previous publications on our study contain photographs of the typical described household and kitchen characteristics [5, 35]. The “Piso firme” Program, a large-scale government initiative for replacing dirt floors by cement floors, was implemented after the introduction of the Patsari cookstoves in this region.

As shown in Table 2 and Fig 2, a traditional open fire, generally U shaped and built at floor level with overlapping bricks laid in the center of all indigenous kitchens. Twenty eight of the indigenous women still cooked exclusively on the traditional open fire; 22 of them had dismantled the ICS and in 6 cases the stove was abandoned, while the other 9 had the ICS in use combined with the open fire.

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Fig 2. Household fuel use on a regular basis by study community (number of women in each category).

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In contrast, the ICS was present in the entire mestizo kitchens; 23 women were using only the ICS and 2 women combined it with an open fire for some cooking tasks. LPG stoves were present in 4 indigenous kitchens, but only one woman used it regularly in combination with the open fire. Although the LPG stove was present in 8 kitchens from La Mojonera, none of the women used it regularly.

Contextual use of the ICS (families and their everyday activities)

Twenty of our 37 Purepecha participants belonged to extended families including as many as 13 individuals from different generations. In 16 of the 20 interviews, we noted that the women cooked together. Although the nuclear families in the indigenous communities performed their daily cooking in their own homes, they joined their maternal or paternal families to cook for their frequent celebrations and social events. The husbands of the indigenous women were involved in agriculture or the wood industry or worked in a trade as masons or musicians.

By contrast, the mestizo community was composed mostly of nuclear families (n = 21) where women joined in family cooking activities on only four occasions. Most of the husbands of respondents were engaged in agriculture (cultivating oats and corn) while the rest worked at the community sawmill or took temporary jobs.

As part of their everyday activities, the indigenous women (1) prepared meals: took the nixtamal (corn cooked in limewater and then ground to make dough for the tortillas) to the mill in the morning and afternoon, made tortillas once or twice a day, prepared breakfast and lunch, served the family meals, took their husbands a snack in the cornfields or wood sites, and prepared the nixtamal for the following day; (2) did housework: swept the kitchen and patio floors, washed the dishes and cooking utensils and washed and ironed clothes for the entire family; (3) made handicrafts: weaved or knitted traditional clothing such as jackets, blouses, skirts and shawls as well as napkins for their own use or for sale in/outside the community; and (4) worked on the farm fields: sowed, cleaned, harvested the crops and collected firewood. Respondents related that gathering firewood from the fields was a pleasant activity because it drew them out of their everyday routine and allowed them the opportunity to walk and do exercise.

The mestizo women performed the same activities as their indigenous counterparts, except they made tortillas only twice or three times weekly. Some respondents even reported making tortillas for the entire week, either because their families were small or simply because they had grown tired of making tortillas day after day. They also reported not making handicrafts or having to go to the fields for firewood because they obtained their supply from the community sawmill.

Both in the indigenous and mestizo communities, the women agreed that of all their daily tasks, doing the laundry for the entire family was the most burdensome because of the physical effort and time required to wash such a large amount of clothes by hand.

“The heaviest work is doing the laundry, …yeah, it’s really heavy. I get more tired from washing clothes; no, the rest isn’t that tiring, -as for making tortillas- no, because I make two and a half kilos of dough. I knead it with my own hands.”

(49-year-old female, ICS in use, Quinceo).

Preparing a large number of tortillas for an extended family, even a couple times a day, is not perceived as a heavy task, which can be a barrier to change the practice of this activity using the traditional open fire.

Enablers and barriers for ICS use

Six themes relevant to ICS use emerged during data analysis: (1) the social representation on the role of women preparing nixtamal and tortillas on the traditional open fire; (2) the uses, advantages and disadvantages of the traditional stove; (3) the uses and advantages of the ICS; (4) reasons for abandoning the ICS; (5) reasons for not keeping the ICS; and (6) woodsmoke as a health risk. Table 3 summarizes the themes and subthemes identified during thematic analysis, classifying them as enablers or barriers for the sustained use of ICSs by ethnic group.

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Table 3. Enablers and barriers for sustained use of the ICS by ethnic group.

https://doi.org/10.1371/journal.pone.0193238.t003

Women, the traditional stove, the nixtamal and tortillas (gender roles)

Adoption and use of traditional over improved stoves were largely conditional on gender roles. As documented in the previous section on everyday life, the indigenous sample communities regarded all domestic tasks, particularly cooking and related activities, as the responsibility of women. The respondents related that, in order to fulfill the norms and expectations of Purepecha society, women taught their daughters how to light the traditional open fire, prepare the nixtamal and make tortillas from an early age (between eight and ten years). These tasks were considered of great importance from a domestic viewpoint. Girls progressively acquired the knowledge and skills specific to their gender role and learned to play their wife-mother role as a fundamental condition for getting married (which, according to reports, occurred between the ages of 13 and 14 years).

“She’d tell me [referring to her mother], ‘dear, learn to make tortillas, because one day you’ll get married and you won’t know anything about making tortillas. You’ll get scolded if you don’t know.’ So I used to help her, like that, little by little (one step at a time) and I learned.”

(female, 36 years old, ICS nonexistent, Quinceo)

Women who did not acquire this knowledge and did not assume this role faced social disapproval, particularly by their husbands and in-laws. In the words of a participant:

“The mothers-in-law are angry all the time and say that you don’t know how to do anything. Sometimes they even say (they tell the husband), ‘Get rid of that woman. What do I want her around here for?”

(36-year-old woman, ICS nonexistent, Quinceo).

The early socialization about the traditional cooking practices using an open fire limits the adoption and use of the ICS.

Gender in these communities implies a series of man-woman inequalities reflected in decision making, for instance, in the adoption of new technology. Within the scope of our study, the majority of indigenous women were required to ask their husbands or in-laws for permission to participate in the Patsari ICS program. In some cases, a negative opinion from their male relatives was decisive in abandoning or destroying the stove.

Furthermore, men demanded that women use the traditional open fire for daily cooking. Being the principal household providers, responsible for the agricultural and woodworking activities in the community, their opinion was conclusive:

“My dad comes and says, ‘Give them something to eat, quick (referring to the wood workers)…’ yeah, that’s why we do it here (on the traditional open fire) or over there, on the other traditional stove, real fast”

(35-year-old woman, ICS nonexistent, Quinceo)

Another significant factor behind technology uptake was the fact that several steps of the program for example stove manufacturing and maintenance was implemented by men. The respondents reported that, owing to Purepecha customs and traditions, they felt uncomfortable when a man entered their homes while they were alone, and anticipated a potential conflict with their husbands.

In the mestizo community, however, gender relations were expressed differently: the majority of women accepted ICS installation on their own, that is, without needing the consent of their husbands. In some cases, the husbands and/or in-laws even encouraged the women to enroll in the program and advised them to stay calm and patient while learning how to operate the new stove. Although women in this community were also required to learn how to perform domestic tasks from a very early age, none of them mentioned that being able to use the traditional open fire was a fundamental part of their knowledge. In fact, respondents from this community related that, when they were children, the traditional three-stone or floor-level stoves were already obsolete and had been replaced by raised stoves, often mounted on a metal drum referred to as a “tambo”.

Uses, advantages and disadvantages of the traditional stove

Although all of the sample women were using traditional open fire at the time of the study, usage varied according to their ICS status. Some women who had begun using the ICS continued using their traditional stove for preparing the nixtamal (once or twice a week), for heating bathwater for the family and for making tortillas during the planting and harvesting seasons. They also preferred the traditional stove for preparing food in a hurry or under pressure.

“I use the big stove to make pozole, sometimes [to prepare] the nixtamal and sometimes when it’s very cold. But I use the chimney stove to cook and to make tortillas. When there’s a need to make pozole, when my girls have a birthday or want to invite friends over to eat, I do it down there. Or when there’s corn you have to roast it and you have to do it down there. You can’t do it at the chimney stove… It’s not every day. It’s almost only once a week.”

(29-year-old female, ICS in use, Quinceo)

The women who had stopped using or had dismantled the ICS, used their traditional stoves for all their cooking activities, to heat the bathwater for the family and water to wash the dishes.

All the indigenous women in our sample, whether or not they still kept and were using the ICS, commonly resorted to the traditional stove for making large volumes of tortillas or food in pans, vats, pots or drums. Extensive cooking took place during traditional community celebrations and/or family events such as weddings, 15th birthday celebration and other birthdays, religious festivities and graduations. In one single day of celebration, they may prepare food for over 200 guests in only one house. Preparation was carried out by over 30 women using as many as six floor-level open fires. Respondents explained that some comales (a clay or metal disk used for cooking corn tortillas and for toasting coffee beans or cocoa) were so large that five women could use them simultaneously for making tortillas. The ICS was not viable for those cooking practices.

All of the indigenous women, whether or not they had kept and were using the improved stove, remarked that the traditional open fire generated intense heat, could be loaded with abundant firewood and allowed for cooking and making tortillas more rapidly than the ICS. The “speed” and “practicality” of the traditional stove were of primary importance for extended families needing to prepare food for many people or to make breakfast very early in the day for schoolchildren, husbands or other relatives working in the farm fields or wood sites.

Because of these characteristics, the traditional stove was highly valued and regarded as an indispensable asset by the indigenous women in the sample.

Interpreter: “Yes, the lady decided to dismantle it [the ICS]. Down there you can cook faster, even though there’s smoke and the flame is big. The woman says the traditional stove is better than the Patsari. She says that’s why, because it has a bigger flame. That’s why it’s more valuable than the Patsari.”

(26-year-old woman, ICS nonexistent, Turícuaro)

Furthermore, they commented that the traditional open fire could be lit with green firewood and logs of all sizes, a big advantage to them. In general, the fire was regarded as an important part of the kitchen, the space most commonly used for socializing. All family members can gather around the stove, sitting directly on the floor or on small wooden chairs.

Likewise, the women commented that making tortillas while sitting or kneeling—an activity which they referred to as tortear–made them feel as if they were resting, and allowed them to exert more strength while regrinding the dough—a feeling completely different from performing the same activity while standing. They reported being accustomed to the traditional stove at floor level because many of their daily activities were performed in a sitting or kneeling position: regrinding dough, making tortillas, preparing atole (a thin porridge-like drink), cooking, grinding chili peppers, doing the dishes and washing clothes. One of the respondents suggested that the ICSs should be installed lower, at floor level.

“… when we finally sit down, we rest a little, for a little while. Here, we get tired of standing… Sometimes it feels heavy on the knees and here. Over there we sit for a little while and make tortillas.”

(32-year-old female, ICS abandoned, Quinceo)

Even though the indigenous respondents saw numerous advantages in the traditional stove, they also recognized certain characteristics that they either disliked or perceived as disadvantages. ICS users mentioned that the traditional stove stained and smudged their hands and dishes, used an excessive amount of firewood and produced a great deal of smoke, thereby smoking up the entire kitchen and damaging or leaving their clothing dingy. Moreover they mentioned that the open stove emitted sparks everywhere, representing a danger for the children and for themselves. They also related that the smoke caused a burning of the eyes and a sore throat.

Within the group of women who had either abandoned the use of the ICS or had disposed of it altogether, there were those who recognized the traditional stove as a source of danger exposing users to accidents and noxious smoke. Nonetheless, while concerned about these things, they felt that the traditional stove was preferable simply for the tremendous heat it generated. Some participants saw no disadvantages whatsoever to traditional technology.

Although women in the mestizo community were familiar with the traditional open fire, they no longer used it in their daily cooking, with eight of them recurring to it very few times a year: at family celebrations and in the community festival. Only two participants continued to use it occasionally for heating bathwater and for preparing the nixtamal.

Unlike the indigenous women, mestizo women commented that they saw no advantage in using the traditional stove, observing moreover that woodsmoke caused headaches and irritation of the eyes, and that the sparks from the stove could lead to burns.

Uses and advantages/benefits of the ICS

In the indigenous communities, eight of the nine ICS users employed the stove on a daily basis to prepare meals, five also used it to make tortillas, two to prepare the nixtamal and beans, and one to heat water. Among the multiple advantages associated by respondents with the new technology, the ones most frequently cited concerned ICS design: it required less firewood, did not produce smoke in the kitchen (a user from Quinceo even compared it with the gas stove), allowed for performing a number of tasks simultaneously (e.g., cooking meals and making tortillas), did not dirty or blacken pots, and remained hot for a long time, keeping the food hot until the moment it was served:

“You can prepare meals and tortillas at the same time and they [the ISCs] heat quickly and use less firewood. And the advantage is that the smoke no longer comes into the kitchen. Now the smoke goes directly outside. There’s no more smoke. If you´re cooking, it’s as if you were cooking with a gas stove. There’s no smoke, and if there is smoke, it’s very little.”

(29-year-old woman, ICS nonexistent, Quinceo)

Regarding health effects, ICS users from the indigenous communities reported no longer breathing smoke, suffering from watery eyes, burning their hands while making tortillas, or worrying about their children getting burned.

Those with abandoned or nonexistent ICSs still acknowledged some advantages of the new technology principally that it eliminated exposure to smoke.

The ICS users in the mestizo community commended the advantages of the new technology even more than did the indigenous users. Most frequently, they mentioned that it could be used for almost all of their daily activities: to cook meals, prepare the nixtamal and heat water for bathing; in their own words: “We use it for everything.” This multiplicity of functions led mestizo women to view their new stoves as a “necessary or indispensable” asset. They commented that the ICS cooked food more quickly, allowed for preparing several dishes simultaneously, maintained its heat for a long time allowing the food to stay warm until serving time, used less firewood than the traditional stoves, did not expose children to accidents, did not dirty their clothes while they cooked or made tortillas, improved the flavor of the food, as it no longer tasted like smoke, and prevented respiratory diseases in the children and in themselves. They highlighted that ICS use entailed health benefits for the entire family because the units were enclosed and people no longer inhaled smoke.

“I think it helps us [women] as much as it does the family and the children, because in fact there was a lot of smoke with the ‘tambo’ and we absorbed as much of it as the children and everyone else, because we were always shut up inside.”

(29-year-old woman, ICS in use, La Mojonera)

In some cases, women referred to the Patsari implementation program as “my program,” arguing that some family members had “become very fond of” the new stove. One of the respondents mentioned that her daughter referred to the stove as “my tongue” owing to the small size of the flame. Respondents commented that the stove had brought them many benefits, and their daily lives had changed significantly as a result of using the Patsari ICS. As reported by the La Mojonera health center nurse, 90% of the 464 families in the community had adopted an ICS from the Patsari or another program and those who had not obtained a Patsari either desired or were looking for one.

Reasons for abandoning use of the ICS

In the indigenous communities, two participants reported having changed the location of their kitchens: one because the previous space was insufficient for their growing family; the other because they joined the aforementioned “Piso firme” program. In both cases, their ICSs had been exposed to the elements and could no longer be used. In other cases, the ICS had been installed somewhere other than the kitchen. Finally, two participants commented that they were not using the new stove because they had no dry firewood or adequate-sized logs. They also noted that the ICS griddles were deteriorating—the iron was peeling and adhering to the tortillas—and the stove could not be used for preparing large amounts of food.

In the mestizo community all the installed ICS were present and in use except for two abandoned stoves. One of the two women who had abandoned use of the ICS explained that she no longer lived where the stove had been installed; the other one reported that the stove had broken and she had been unable to repair it.

Reasons for dismantling or disposing of the ICS

Likewise, the indigenous women who no longer used the stove (22) adduced numerous reasons for this, many of them interrelated. Some mentioned that the wooden base had burned or rotted or the flame tended to go out causing a great deal of smoke. This had led them to remove the stove from the kitchen or abandon its use to the point where it was ruined. Others mentioned that rain had entered through the stovepipe and had destroyed the stove, or the kitchen roof had fallen in and had crushed the stove. In other cases the respondents felt that the stove did not provide sufficient heat for cooking, leading them to progressively widen the combustion chamber until the stove was completely destroyed.

Additional reasons pertained to household/community characteristics. Six respondents reported having removed the ICS to make room for a bedroom; four destroyed the stove because they moved from their in-laws’ house to their own in order to leave the space for another member of the family (a man who had just gotten married). Others moved the kitchen to another location within the house, either because the family had grown or simply because they no longer liked the former location for the kitchen. In another case, the father-in-law destroyed the ICS of a couple who had migrated to the United States to work.

All three groups pointed to issues concerning ICS program implementation. Some respondents considered the follow-up as inadequate, and didn’t know where to turn to when they had questions about the functioning of the stove or when it needed spare parts.

It is important to bear in mind that various factors may influence the decision to dismantle or abandon use of the ICS. For example one participant from Quinceo did not know how to light the stove: the flame would die out and produce a great deal of smoke; she had neither small pieces of firewood nor a hatchet with which to cut the logs. In this case, both the ICS and the traditional stove were in the kitchen and, because the family needed to use that space as a bedroom, the husband of the participant decided to do away with the ICS arguing that it didn’t work properly.

Woodsmoke as a health risk

When the indigenous ICS users were asked if woodsmoke could damage health, they responded that smoke could definitely have an effect on health, that it could cause coughing and hurt the lungs or respiratory tract. They emphasized that women and children were the most affected because they spent the most time in the kitchen. One of the participants mentioned that her father-in-law had died from the effects of woodsmoke, while another mentioned knowing people who had died of lung cancer as a result of cooking with firewood.

“I feel that yes, mostly for this reason….through the airways, lung infection and all of that….like, for example, when…there are a lot of people who smoke, their lungs are affected for the same reason, because smoke gets into them. I say it’s the same with firewood, right?”

(26-year-old woman, ICS in use, Turicuaro).

Among the group of women who had abandoned use or disposed of the ICSs, some were aware that smoke could damage the lungs but were unsure whether they themselves could become ill. Even knowing that the traditional stove could cause harm, they lit it because it was quicker for cooking and because they couldn’t “do everything” on the Patsari. One of the participants was aware that smoke was harmful to health, but noted that the decision to stop using the stove did not depend on her. Women who had disposed of the ICS mentioned that they had received information about harm to health from the community clinic and from the people who made the improved cookstove.

In the mestizo community, all the women agreed that woodsmoke could affect health. They had learned this in part through the community health center, but also from knowing family members or acquaintances who had lung diseases as a result of exposure to woodsmoke. The respondents used phrases such as “s/he has smoke in the lungs,” “smoke plugs the lungs” or “their lungs are damaged,” and compared woodsmoke to cigarette smoke in terms of harm. They perceived woodsmoke as a risk to which they had been exposed since birth, and could even identify diseases such as cancer and COPD. All the women agreed that they were more vulnerable to damage from smoke as a result of cooking on the traditional stove.

“…since birth, you’re exposed to smoke…because, well, from the time you’re born, your parents pull you near the fire or the stove. Before, well, there were none of these burners. There’s a neighbor, her lungs are already really blocked and she already receives oxygen. At night she uses it. And I also know another woman, a sister of my mother-in-law, she also gets oxygen at night because of all the smoke she breathed her whole life, and her lungs are already damaged…”

(38-year-old woman, ICS in use, La Mojonera)

Perceived ICS benefits related mainly to matters of health: “You don’t inhale smoke anymore;” “It helps protect the family’s health, especially the children;” and “It prevents respiratory diseases like the flu or cough.” The women felt that they were particularly at risk because they spent more time in the kitchen than did the men. They had a high-risk perception of woodsmoke based on the following link: ICS = less exposure to smoke = lower health risk.