Discussion
This study has explored the uses and perceptions of geophagy among women of childbearing age in Tshwane District, Gauteng Province. The women of childbearing age who participated in this study perceived addiction and cravings, lack of proper knowledge and understanding of dangers associated with geophagy, boredom, fun and entertainment, pregnancy, influence from family members and peer pressure, and social acceptability and accessibility to be some of the causes, reasons, motivations and uses of geophagy among women of childbearing age. Studies found that curbing morning sicknesses, nausea, mineral deficiency, satisfying cravings and life-sustaining beliefs are some of the reasons for clay soil ingestion among women of childbearing age.4 15 19 20 32–34
Women of childbearing age who took part in this study expressed their views that people practise geophagy due to iron deficiency, addiction and cravings. Similar studies also confirm that women of childbearing age practise geophagy due to iron deficiency to feed their addiction and cravings.4 5 16 25 35–37 The cravings of clay soil, related earthly materials and strange food items during pregnancy are mostly caused by iron deficiency and imbalanced hormones, respectively. Women of childbearing age practise geophagy to supplement their need for iron. The smell of rain triggers various people to start craving and ingesting clay soil continuously, leading to addiction.
Geophagy is perceived as a sign or confirmation of pregnancy by women of childbearing age who participated in this study. Numerous studies conducted across countries also confirm that most women practised geophagy when pregnant.4 9 13 15–17 19 20 25 38 Participants have indicated that they associate geophagy with pregnancy. Some participants indicated that they use clay soil during pregnancy to soothe morning sicknesses and nausea. Similar studies found that most women of childbearing age practise geophagy when they experience morning sicknesses and nausea during gestation period.4 19 32 39 40
Influence from family members and peer pressure were also perceived by participants to be some of the major motivations behind the use of clay soil through the practice of geophagy. Most women of childbearing age who took part in this study indicated that they started consuming clay soil after been recruited by or introduced by their close relatives, friends and family members; meanwhile, others were given a small portion of clay soil to try it by their peers. Geophagy was perceived by participants as a practice that is mostly learnt and passed on by closely related people and loved ones. A similar study also found that the practice of geophagy among geophagists originated from a friend, sister and mother, although some learnt the practice of geophagy on their own.19 Keeping a company of clay soil consumers makes one to be vulnerable to want to explore the practice. The curiosity to want to taste clay soil due to fear of missing out on what others are feeling is what has also led many to practise geophagy.
Lack of proper knowledge and understanding regarding the dangers associated with the practice of geophagy are some of the causes and reasons facilitating the practice of geophagy among women of childbearing age as perceived by participants. Some participants indicated that they were not aware that soil-eating practice is harmful to their health because of the toxic chemical constituents that are contained in clay soil. They further revealed that they perceive geophagy as a harmless practice that offers many great benefits, with no repercussions. Studies found that most geophagic women of childbearing age do not understand the dangers of practising geophagy, as well as the potential health risks associated with the practice of geophagy.2 6 19 20 24 41 42 The misinformation and misconceptions that the participants have regarding the benefits of geophagy are strongly recognised as a major concern.
Some participants perceived geophagy among women of childbearing age as a habit that people indulge in because of boredom, fun and entertainment. A study conducted in Limpopo found that geophagic women crave soil due to boredom, pregnancy, after every meal, on seeing it and when feeling weak.4 When people are bored and idling, they tend to engage in risky behaviours such as geophagic practice to pass time, for fun and entertainment. Other participants have expressed the view that they prefer eating clay soil as compared with other types of soil due to its perceived taste, smell, crunchiness, stickiness, muddiness, cleanness and its effect after consumption. On the contrary, a study conducted in Limpopo found that clay soil was the least preferred and consumed type of soil by geophagic women of childbearing age.4 Similarly, studies reported that kaolin is the most consumed geophagic material among women.19 43 These variations may be caused by lack of accessibility of clay soil in specific geophagic locations.
Participants revealed that they practise geophagy as a traditional and cultural custom that is socially acceptable; however, some participants indicated that they get tempted to purchase clay soil on seeing it in the open markets, street vendors, taxi ranks and spaza shops because of easy accessibility. Studies confirm that geophagy is a common cultural practice that is socially acceptable by many people across nations.4 15 19 32 Social acceptability and easy accessibility of clay soil add to the high number of people who practise geophagy. The level of acceptability for geophagy practice among communities makes it difficult for consumers to see it as a dangerous practice that needs to be condemned. Furthermore, for as long as clay soil is still easily accessible to consumers in public spaces, it will be difficult to curb the practice of geophagy.
The practice of geophagy among women of childbearing age remains a major public health problem that requires serious consideration by the government. Despite the available interventions aimed at curbing the practice of geophagy among women of childbearing age, such as administration of iron supplements and folic acid, studies have discovered poor adherence and uptake of iron supplements and folic acid among women of childbearing age across countries citing challenges such as nasty taste, nausea, vomiting and weight gain as some of their reasons for defaulting.44–47 Some of the limitations of this study included the setting type and participants selection, since conducting a study in the healthcare facilities has the potential to hinder some participants from sharing their views freely and openly, out of fear of the healthcare workers. This study included only women of childbearing age who were consulting in the family planning units and antenatal care units, without any consideration for all women of childbearing age. Some of the study participants were above the age of 50 years, although we confirmed with them their ability to conceive a child, we are speculating that some were perhaps consulting due to reproductive health problems encountered postreproductive age; since participation was free and voluntary, they participated due to fear of missing out and excitement.
Conclusions
It is concluded that the practice of geophagy is accelerated by addiction and cravings, pregnancy, social acceptability and accessibility, boredom, fun and entertainment. Influence from family members and peer pressure play a significant role when it comes to the practice of geophagy. Lack of proper knowledge and understanding regarding the dangers of geophagy are some of the reasons behind the use of clay soil. Most women of childbearing age use geophagy as method of soothing nausea and morning sicknesses during pregnancy.
Recommendations
Geophagy must be included in the school’s curriculum and maternity package to facilitate geophagy health education and promotion. Support groups and rehabilitation centres for people who practise geophagy must be established. Geophagy public health surveillance system must be established. Further research needs to be conducted to understand the aetiologies, toxic elements and health effects of geophagy phenomenon.
Limitations and strengths of the study
The study was conducted in the healthcare facilities which serves as a study limitation, as some of the participants might have not shared the views freely due to the nature of the setting in fear of healthcare workers.