Our work in India has shown that mothers with low intakes of micronutrient rich foods had babies with lower birth weights, and higher insulin resistance in childhood. Fruit and green leafy vegetables are micronutrient rich and culturally acceptable foods in India but in rural settings the consumption is low and the reasons for this are not clear. We therefore designed a qualitative study with the aim of identifying modifiable constraints and facilitators to fruit and green leafy vegetable intake, and, in the longer term, to design interventions to increase consumption of these foods.


This qualitative study comprised a ‘value chain analysis’ of selected exemplar fruit and green leafy vegetables in settings in the state of Maharashtra, India. The study involved agricultural scientists, economists and social scientists. We held workshops with stakeholders including policy makers and representatives of farmer and vendor groups (Figure 1), and interviews and focus group discussions with landowners, farmers, wholesalers and consumers (Figure 2). The work was led by Sarah Kehoe in conjunction with the Centre for the Study of Social Change (CSSC), MS Swaminathan Research Foundation (MSSRF), and the International Food Policy Research Institute (IFPRI).

Figure 1: Stakeholder workshop in Mumbai
Figure 2: Focus group discussion with women consumers

A ‘value chain’ refers to the addition of value along the food supply chain for actors at different stages. Central to the approach is identifying opportunities whereby actors can benefit economically from marketing agricultural products of higher nutritional value (figure 3).

Results: From thematic analysis of the focus group discussions with women consumers living in the villages outside the city of Wardha in Maharashtra, India we identified the following barriers to consumption of fruit and vegetables:

Personal FactorsDislikes of the taste of certain green leafy vegetables.
Household DynamicsWomen often have no say in which foods are purchased for the family.
Social and Cultural NormsBeliefs about the harms associated with consumption of certain foods during pregnancy (such as papaya).
WorkloadWomen reported being too tired to spend time on preparing and eating food.
Time pressuresMost women worked in agriculture and had to balance this with childcare, they had little time to prepare and eat food.
Environmental FactorsFor women living in several villages there was no market close by. They could only purchase fruit when they travelled long distances to the city. They did this infrequently due to time and cost pressures.
CostThe cost of fruit and vegetables sold in the villages was often prohibitive, particularly for fruit.

In addition to the perspectives of the women in the villages we obtained the views of farmers, wholesalers and vendors (Figure 4) to understand the constraints to availability of fruit and vegetable in the villages. Farmers told us that there were difficulties for them in obtaining resources and assets due to lack of finance, also that they struggled with unpredictable rainfall and pests destroying crops. In some cases this led to farmers growing cash crops such as cotton rather than fruit and vegetables. Wholesalers and vendors described the challenges of storing and transporting fruit and vegetables in the hot climate. They said that it was more profitable to sell produce in the city than the villages and there was greater demand in the city.

Figure 4: Interview with village fruit vendor

We plan to conduct similar studies in other settings within India as the constraints are likely to be context specific.

Based on our findings we plan to develop interventions to address the constraints to consumption of fruit and vegetables in these settings.

Recent Publications

  • Kehoe S, Dhurde, V, Bhaise S, Kale R, Kumaran K, Gelli A, Rengalakshmi, R, Lawrence W, Bloom I, Sahariah SA, Potdar RD, Fall C. Barriers and facilitators to fruit and vegetable consumption among rural Indian women of reproductive age. Food Nutrition Bulletin 2019; 40: 87-98. PMID: 30974984.
  • Kehoe SH, Dhurde V, Bhaise S, Kale R, Kumaran K, Gelli A, Rengalakshmi, Sahariah SA, Potdar RD, Fall CHD. How do fruit and vegetable markets operate in rural India? A qualitative study of the impact of supply and demand on nutrition security. Food and Nutrition Bulletin 2019; doi: 10.1177/0379572119846809 (e-pub) PMID: 31167553.