Antenatal Food Avoidances in Madagascar Suggest an Evolutionary Link Between Subsistence Patterns, Carbohydrate Consumption, and Determinants of Obstructed Labor

Food avoidances during pregnancy among Malagasy agriculturalists and fishers differ in targets and reasons. Avoided foods reflect staple diets, while the fear of difficult labor due to large infant size in relation to carbohydrate-rich foods among agriculturalists overlaps with a high incidence of obstructed labor in agricultural regions. Therefore, different subsistence modes affect antenatal behavior priorities differently. Taboos and sources of advice on maternal diet are fluid systems. We highlight the urgent need to better understand the determinants of obstructed labor and the patterns of spread of antenatal practices in Madagascar.