INTRODUCTION

The overlapping of hunger, food insecurity, overweight, and obesity are the main health public health problems, violating the human right to health and to nutrition.¹⁾ There are serious malnutrition problems²⁾ associated with climate change like “global syndemic,” a synergy of epidemics sharing common causes resulting from present-day unhealthy and minimally regulated food systems^3,4) that are represented in obesogenic environments,^5,6,7,8) adversely affecting the protection of the right to adequate nutrition.^9,10) It is under this scenario where global syndemic and COVID-19 pandemic are developed, accentuating inequality and vulnerability situations.¹¹⁾ ECLAC’s Special Report COVID-19 No. 3 warns about the increase in income-based poverty and vulnerability in people having informal jobs under conditions of scarcity, who reside in peripheral areas, suffer from some form of disability or are migrants, living in the streets, micro and small-sized enterprises, and women having precarious employment.¹²

This study was conducted at a time when poverty in Argentina accounted for 40.9% of the people, of whom 10.5% were classified as indigent, and among children aged 15 or younger, 56.3% were living in total poverty, whereas 15.6% were considered indigent.¹³ These data worsened by the second semester of 2020, with 57.7% of people aged 0 to 14 living in poverty.¹⁴ The year-on-year variation of the monthly valorization of the basic food basket and of the total basic basket for a four-member household based in Greater Buenos Aires, between May 2019 and May 2020, had increased 47.9% and 42% respectively.¹⁵ During the conduct of this study, the pronounced rise in prices of foods and other basic items was aggravated by the epidemiologic, social and health situation affecting the population in general and, especially, the child population.¹⁶

The food and nutritional situation affecting the population was complex already, the prevalence of overweight, albeit affecting all age groups and income quintiles, the lower-income social groups evidenced higher rates of excess weight, with a 21% higher in the lower-income quintile against the highest quintile,¹⁷⁾ which aggravated due to the impact of COVID-19, violating human rights even more.^18,19,20) This study was accomplished applying a qualitative approach that assumes food processes from a holistic perspective,^21,22) marked by power relations that have an effect on the meanings that people attribute to foods.²³⁾ Attention was paid to the relationships between malnutrition due to excess and the role of women. It should be noted that, although in Argentina the largest prevalence of overweight is found in men (37.5%), as for women (31.1%),²⁴⁾ the trend in the increase of obesity has had a disproportionate impact on women across Latin America and the Caribbean: in more than 20 countries in the region the rate of female obesity is almost ten percentage points higher than that of men.²⁵⁾ Similarly, the prevalence of food insecurity is higher in women than in men, which places Argentina among the countries that maintain wider gaps between men and women.¹⁹⁾ These statistics reinforce the importance of considering a gender perspective, which helps to visibilize the fact that women assume the greater part of the burden of social reproductive work, including “responsibilities” concerning nutrition, which reproduce inequality and power structures.^26,27) Women are found among the most vulnerable groups in terms of gender-based discrimination; of social, legal, and cultural constraints; they have a more limited access than men to employment opportunities, productive, and financial resources, education, decision making and labor markets.²⁷⁾ In this context, the cross-sectoral approach is crucial to describe how groups of people are at a disadvantage due to multiple sources of prejudices and discrimination, based on their overlapped identities and experiences, such as, inter alia, race, class, gender identity.²⁸⁾ The notion of race refers to the existence of historically excluded groups amid a colonial structure and matrix of racialized and hierarchized power, with white and “whitened” people at the top but the other peoples (indigenous, peasants, afro-descendants, among others) in the lower strata.²⁹⁾ This structure is linked to stigmatization processes relative to “the poor” and “their culture,”³⁰⁾ which reinforce preexisting prejudices toward those who belong to most disadvantaged sectors,³¹⁾ and are shown in racist and xenophobic discourses, within which residents of bordering countries are included.³²

Account was taken of the care needs as something that affects all human beings in stages of the human lifecycle and as an essential part of social reproduction, which help to visualize how care is distributed among genders, generations, family, government, and market. This argument makes it possible to delve into relations and tensions among inequalities between men and women in the field of nutrition and malnutrition due to excess, in particular.²⁴

This article describes aspects and significances that have an effect on food access and consumption, with a focus on ultra-processed products, on the part of domestic groups in the context of COVID-19 pandemic, in Villa 21-24 (hereinafter, neighborhood 21/24) of the Autonomous City of Buenos Aires (CABA) [Ciudad Autónoma de Buenos Aires], during the months of April and June 2020. The aspects analyzed here include, inter alia, channels of access to food and meals, identification of individuals in charge of nutrition inside the household, criteria for food purchasing, consideration of the most important foods, and possible obstacles that have an effect on their purchase, preparation, and consumption.

METHODOLOGICAL ASPECTS

This work results from a larger participant-observation, descriptive, and cross-sectional study, with a quantitative and quantitative approach, which describes aspects of environments, domestic units within the Metropolitan Area of Buenos Aires, and the relationship with the nutritional state of their members. Said study falls within the project “Alimentación y entornos obesogénicos: Estudio desde una mirada multidisciplinaria en contextos urbanos y periurbanos de Buenos Aires” [Food and obesogenic environments: A study from a multidisciplinary perspective in urban and peri-urbans contexts in Buenos Aires] (UBACyT 2018-2020 and research financial aid Beca Salud Investiga Dr. Abraam Sonis for multi-centric research studies 2018). The study, conducted between 2018 and 2019, included a population living in unfavorable socioeconomic conditions, residing in the Metropolitan Area of Buenos Aires, such as, neighborhood 21/24, located in Commune 4 of the Autonomous City of Buenos Aires. Some of their characteristics include, inter alia, high crowding levels, lack of gas, sewage and drinking water supply networks in a lot of households, and, in the case of gas, the population used bottled gas mainly. Most of the adult people had non-registered employment.^33,34,35) Another characteristic was the overwhelming presence of migrants coming from Paraguay. Although there are no official data, the existence of multiple institutions could be observed as well as of food posts and regional products.

We worked with households made up of adult people and at least one child or adolescent, aged 5 to 19 years that attended one of the self-managed tea community centers, whose figurehead we had previously met. We included domestic units in which the information was provided by the person responsible for purchasing foods and lived at least with one child and/or adolescent aged 5 and 19 years. We discarded from the study adult people that had a disease that prevented them from responding and/or completing the study phases. The domestic units were selected by a convenience, non-probability sampling. In-depth interviews were performed, alternating such techniques as informal interviews and participant observation.³⁶

The study complies with all ethical requirements of autonomy, beneficence, and justice.³⁷ It was evaluated and accepted by the committee of ethics at the Hospital “Prof. Dr. John P. Garrahan”. Each individual that took part in the study signed the relevant informed consent. The original names were changed to protect confidentiality of the respondents and the data obtained.

At the start of the pandemic, another study was proposed, accomplished with the support of UNICEF Argentina, applying an exclusively qualitative approach and phenomenological interpretation, titled “Prácticas alimentarias, obesidad y COVID-19 en contextos de pobreza urbana: Villa 21-24, Ciudad de Buenos Aires, Argentina, 2020” [“Food practices, obesity and COVID-19 in contexts of urban poverty: Villa 21-24, City of Buenos Aires, Argentina, 2020”.] For this study, we once again contacted the figurehead in charge of tea community center located in the neighborhood as well as 17 women that participated in the domestic groups of neighborhood 21/24, with whom we had worked before and with whom we were still in contact. All of these women lived with at least one child and/or adolescent, who attended the abovementioned tea community center. In-depth interviews were conducted, which lasted about one hour, between April and June 2020 through calls made to the women’s personal cellular phone. Although the qualitative methodology is traditionally based on face-to-face relationships,³⁸⁾ due to the mandatory lockdown, it was the only possible solution. Interviews were audio-recorded. After their transcription and reading, we elaborated qualitative matrixes with the analysis of the fragments included in the categories to establish conceptual topics and text construction.

RESULTS

DISCUSSION

In this section we will discuss the main findings by organizing them in four thematic areas: access to foods, food consumption, women’s role linked to tasks of care and family nutrition, and the relevance of civil society organizations. All these areas are marked by living conditions and impoverishment. These conditions were intensified by the social and health situation caused by the pandemic.³⁴ We should add the continuous rise in food prices, unemployment, and impossibility in many cases to go to work with the ensuing decrease in or loss of monetary income in the household.^19,44 In this context, access to foods, according to the voices of the interviewees, reveal the impact of the little competitive retail prices and the competition from supermarket networks in this sense, which control the distribution of foods, mainly of bottled products and already chopped-up meat, in order to maintain offers and promotions,⁴⁵ which put retailers at a disadvantage, who yet managed “to survive.” Another aspect that is revealed by the power of companies or suppliers within the governmental sphere is that food modules are partially made up of ultra-processed products (as dairy desserts) high in critical nutrients. Interviews account for the positive incidence of the measures adopted by the federal government, through the monetary programs such as the Emergency Family Income (IFE)⁴⁰⁾ - the first payments were made while we were conducting our field work -, and the measures adopted by the municipal government of the Autonomous City of Buenos Aires, with the delivery of school food modules. These measures helped households to have minimal access to foods although, due to the rise in prices, the purchase was limited to items considered basic: flour, oil, potatoes, onions, and meat.

The relationship between the school food environment and its impact on food access, behavior, and consumption by children and adolescents proved to be an emerging dimension in our research study. Although the importance attributed to the direct food assistance offered by schools in general is clearly highlighted, the notion that “without schools, children eat better” is also expressed, arguing that, owing to lockdown measures, they are not exposed to the range of products of sweet shops, street sellers, and street advertising that promote the consumption of food products high in critical nutrients within the school environment. The 2nd National Survey of Nutrition and Health (ENNyS 2)¹⁷⁾ reveals that 71.2% of children and adolescents going to school sometimes or always receive from their schools rolls and croissants, pastry products, cookies, and/or cereals with sugar; whereas only 2 out of 10 students reported that their institution always supplies fresh fruits. We also observed that 6 out of 10 children and adolescents going to school aged 6 to 17 years had bought sweets from a sweet shop or cafeteria located within the school building during the last week. This shows the need to apply a regulatory scheme in school environments, for instance the newly passed Act No. 27642 for the Promotion of Healthy Nutrition,⁴⁶ for children and adolescents to have food environments guaranteeing their right to adequate nutrition.⁴⁷ In turn, the need to regulate food donations is observed, mainly, those centered on the delivery of ultra-processed products, which reinforce the industrialized food pattern described above.

The relationship between food access and consumption is close. In this sense, although meat is highly valued,⁴⁸ as there are constraints on its purchase, it remains in a peripheral place in terms of elaborations as regards quantity and quality (there are plenty of fatty cuts). The same situation applies for fruits - they are highly praised, but interviewees insist on the fact that their purchase becomes relegated. This is in line with the fact that the population belonging to the lower quintiles has a consumption pattern that drops to a half in relation to the highest value, 22.8% versus 45.3%, respectively.¹⁷ Among other consumptions valued by the interviewees as being “prestigious,” they mention yoghurt, cookies, artificially sweetened beverages, and aperitif products (potato chips, cheese puffs, salty little sticks, among others), associated with the search of satisfying the likes and whims of their children and adolescents, and other members of the family. It should be noted that the consumption of artificial beverages with sugar and aperitif products in the survey ENNyS No. 2 proves to be twice higher in the lower quintiles than in the highest ones.

Food access and food consumption are influenced by the characteristics of obesogenic environments marked by an increase in the consumption of ultra-processed products,^49,50 triggered by non-regulated marketing strategies that “tempt your palate,” targeted at child population.⁵¹ We could find connections between the increase in available ultra-processed products,^(7.52) the configuration of the present-day hegemonic agro-food system,⁵³⁾ and a lack or inexistence of public policies that can increasingly shape healthier and sustainable food environments⁵² for the general population and for the child population in particular. This coincides with the local research studies that reveal an increase in the purchase⁷⁾ and consumption⁵⁴⁾ of these products across Argentina. The weight of the agro-industrial chain within the global market economy is important.^55,56) Another aspect is related to homemade elaborations in households, marked by unequal pleasure to cook, having cooking abilities and knowledge, material resources (gas, water, furniture, among others), access to the wide range of fresh and natural foods. As a result, spending lockdown at homes acquires different meanings: while to wealthier sectors it could entail having more time to cook and to eat “better,” to the interviewees participating in our study this possibility was limited.

All testimonies show women’s central role as much in the food responsibility inside their homes, as in the management of community resources to have access to foods outside their homes. We agree with research studies that highlight an excessive emphasis on individual responsibility in contexts of social and food precarization, where the right to nutrition is violated.⁵³ But responsibility is placed with more emphasis on women, showing how the patriarchal model and the configuration of the present-day food system take advantage from care tasks that are naturally assumed, and that prove to be essential. It is important to visibilize the non-remunerated social reproductive work that is yet to be socially recognized.^27,57,58,59) That way, the close relationship between the role of women and the intra-household food management shows that the ones that assume the burden of hunger are women.

It was possible to observe the relevance of civil society organizations, traditionally key social actors that strengthen availability and access to foods and meals in contexts of impoverishment.⁶⁰ This network of civil society organizations, together with social and food programs established within governmental spheres, actions by self-organized neighbors, contribute to improving food availability in the neighborhood. Through the testimonies, interviewees describe the role played by these organizations in the context of pandemic, still with scarce care infrastructure and minimal financial resources, a precarious level of institutionalization or formalization. Foods that are mainly available, albeit abundant, are mostly foods high in critical nutrients, which in turn contribute to reproducing poverty and malnutrition, thus intensifying social and biological vulnerability in the context of pandemic. This situation becomes especially significant in the population of children and adolescents, the main hidden victims hit by the pandemic.^19,44

There is no criticism of the types of foods that are distributed, even knowing the importance of consuming fresh food on a daily basis, as recommended by the Food-Based Dietary Guidelines for Argentina,⁶¹ mainly in epidemiologic situations where a good nutritional status is essential. This leads us to reflect on the lack of appropriation on the part of some population sectors of their condition as rights-bearing subjects. In the representations, “hunger” means not having foods available to eat. However, having no other choice but to stuff oneself with flours and stews through assistance and reassurance networks seem to be naturalized. Although, when asked to define good nutrition habits, some interviewees describe fresh foods as the most difficult foods to have access to, they are silent about this aspect in their discourses. The question about the importance of likes as a dimension separate from the right to nutrition is posed, because when nutrition and poverty are associated, what prevails is need but not taste, resorting to an optimization logic to explain poor people’s consuming behavior.⁶² This is reflected in the stigma of regarding oneself as a poor individual, with the shame this involves, in some cases, when having to go out and manage food resources, or, in other cases, when admitting that sometimes there is no other choice but to feed oneself during weeks off fried dough. This is why some women explained that in their homes they eat fried dough “only when it rains, as tradition says.” Another stigma has to do with being migrants from bordering countries and having a peasant origin when they refer to regional elaborations, by using adjectives like “heavy” and “greasy” when describing them. When this is also true for other preparations associated to Argentine middle classes, such as fast food or semi-elaborated foods. This shows that social inequality and discrimination against underprivileged and racism underlie malnutrition problems. Various research studies analyze the relationship between food insecurity, inequality, race, ethnicity, and gender,⁶³ revealing that “otherness” is a marginalization tool. The voices of Paraguayan women are delegitimized and silenced in terms of their practices, abilities, and cooking knowledge.^64,65 Another aspect to highlight is that it is important that in the decision-making spheres they address ethnicity in strategies aimed at overcoming food security and nutrition. This means leaving behind visions that conceive underprivileged populations as passive actors, to begin validating their systems of knowledge, which are key to improve nutrition, to strengthen cultural diversity and the construction of societies with no discriminatory and exclusion behaviors.¹⁹

FINDINGS

This pandemic poses a social and health emergency with direct and indirect impacts on malnutrition due to excess, even more in children and adolescents, and vulnerable groups, where inequality, impoverishment, gender discrimination, the dimensions of impoverished groups and identity, and obsesogenic food environments intermingle and are ultimately determined. The different channels to access foods are through a direct purchase or through food assistance networks, whether official and/or by civil society organizations, as well as self-managed neighbors and food donations. In all cases the foods that prevail are highly industrialized and ultra-processed products, or items that are high in critical nutrients that reproduce malnutrition. Women’s role in food management inside and outside the household is clear, since they are the ones assuming the burden of hunger. Despite the fact that malnutrition indicates its link with excess, the main concern is not suffering from hunger, while the quality of foods to which they can have access through different channels is not questioned. A spiral is identified that deserves better investigation, into which concern about hunger in the context of a purported availability of foods is expressed. The problem is that these are foods whose consumption relates with health deterioration and a lack of elements on the part of the population to demand, under the law, healthier and more adequate foods, which results in the invisibilization of malnutrition due to excess. In this obesogenic spiral, we can see a combination of individual responsibility, impoverishment, the condition of impoverished and underprivileged sectors, gender and ethnicity, which are perceived as a stigma that ends up embarrassing them. At the time of the study, in the context of lockdown due to COVID-19 pandemic, it was clear that there were no regulatory and statutory frameworks that could transform obesogenic environments and configure food systems aimed at promoting access to healthy nutrition. Systemic changes based on human rights are necessary to address parallel foods crisis, pandemic, and living resources. It is also necessary to adopt public policies to promote fairer, more environmentally sustainable food systems, in order to democratize productive resources with short distribution channels. Only that way will it be possible to achieve greater equality and access to fresh foods.