The role of dairy in healthy and sustainable food systems: community voices from India | BMC Public Health

Three main themes were identified: 1) Quality and value matters to producers and consumers; 2) The need to adapt to sustain dairy farmer livelihoods in water scarce areas; 3) It’s not only about health. Results are presented below by theme, using illustrative quotes from workshop transcripts, as well as displaying the photographs and captions, which elicited particular discussions (labeled urban or rural).

Quality and value matters to producers and consumers

Quality and value were mentioned throughout the discussions, by both urban and rural participants, and in relation to all parts of the milk food supply chain (production, retail, and consumption). Urban participants, a minority of whom were involved in milk production, discussed quality as an end-user / consumer in terms of trust in the quality of milk produced. The rural participants, a large number of whom were involved in producing milk, discussed the value of producing a high quality milk product. Both groups discussed the value to local communities of dairy production as a traditional livelihood and dairy consumption as a traditional pastime.

Value of producing high quality milk

Rural participants referred to the value of producing high quality milk to improve livelihoods ie, aiming for a higher quality product, with a higher fat content, to achieve a higher price at milk collection centers and receive greater benefits to the wider community. Figure 1 refers to a low risk of adulteration or poor quality products at milk collection centers. This photograph elicited discussions about the value of high quality milk production and practices to increase milk quality, such as milking in the morning, good animal husbandry, and avoiding milking when animals are in ill-health. Value in terms of the greater number of milk products that could be made from a higher quality (high fat) milk product was also discussed.

“We get more money if the butterfat volume in the milk is more. We get less money if there is lesser butterfat volume. ” [SHG 2, rural]

“Even in terms of quality, more ghee and butter come from the milk because it is extracted early in the morning. Lesser butter and ghee come from the milk extracted during the nights. ” [SHG 2, rural]

Fig. 1
figure 1

We buy milk from milk centers. Clean and unadulterated milk is available there which is good for health [SHG 2, rural]

The value of being part of a co-operative dairy was discussed at length with rural participants, and how benefits were distributed dependent on the quality and quantity of milk sold to dairy. Bonuses would be given throughout the year (eg, at the Sankranthi harvest festival celebrated in January and prior to the start of the academic year). This was on top of access to free veterinary care (medicines to be paid in advance, veterinary time and expertise provided by dairy), family healthcare provision, health insurance for family members, interest free loans, and contributions to community facilities such as schools , producing wider community benefits “for children, scholarships, and health care at community clinics”.

“It depends on the milk we sell. Sir, you have certain deductions when you draw a salary, the same way they deduct a certain amount depending on how much milk we supply to them and that is given as a bonus. ” [SHG 2, rural]

Value of trusting the quality of milk purchased

Trust was a key factor in judging the quality of milk purchased. A higher quality product was considered to be tastier and unadulterated due to its higher fat content ie, not watered down. Figure 2 elicited a long discussion in the urban group on the adulteration of milk and a preference for purchasing fresh milk directly from a farmer at the time of milking. The photographer explained they bought milk from a familiar farm, one they trusted, somewhere their family have bought milk since they were a child.

Fig. 2
figure 2

We are buying milk from him since childhood. We trust the milk that he supplies. So, I have clicked his picture [SHG 1, urban]

Other participants remarked that they would go out of their way (early in the morning or a distance) to collect milk from someone they trusted, where they could be confident water had not been added to the raw milk “that is the reason we go even before they could extract the milk ”. This was preferred over the convenience of having milk delivered to their home, as if “they deliver it to our home but then we would not be able to trust” and “once it changes hands, anything can happen”.

Participants generally preferred to receive ‘trusted’ raw (cow / buffalo) milk or “fresh milk that comes daily”, over milk available in plastic packets or Tetra Paks. They were aware that raw milk needed to be boiled before consumption to remove pathogens, whereas packaged milk had already been pasteurized or processed at ultra-high temperatures (UHT milk) and “stays fresh for a longer time”. Nevertheless, boiling milk was habitual and often used as a way to test whether a product was fresh (Fig. 3).

“You get vomiting if you drink raw milk. So we boil it and drink. ” [SHG 2, urban]

“…[milk] from the cow curdles if we keep it at room temperature for a day. This [packet] milk does not spoil for a day even after opening ”. [SHG 2, rural]

Fig. 3
figure 3

Milk should be boiled before consumption. This will ensure that harmful bacteria are killed. We also come to know if the milk is fresh or not [SHG 1, urban]

Tetra Paks have been described as having several advantages, such as being convenient when away from home, where boiling on site would be difficult, and / or catering for large numbers such as “they are useful when you go camping and such”. The process to preserve the milk, however, was thought to alter the taste and fresh raw milk was still preferred.

“It is preserved for a long period, right and it is not as tasty.” [SHG 1, urban].

All participants discussed the preparation of milk products and milk dishes at home (eg, yogurt / curd, buttermilk, and clarified butter / ghee; Payasam / Semya / khova, tea and coffee), as well as situations when they would prefer to purchase milk products from stores or dairies (eg, milk sweets such as paneer jalebis, as well as ice-cream, lassi, and chocolate).

Products made at home were considered more hygienic, although store-bought products were necessary for large amounts of food at festivals, family occasions, or celebrations. There was also a reference to the greater choice of stores / products available to urban participants, the greater availability of raw milk products to rural participants, and / or the cooking skills / knowledge of particular participants, which would inform whether products were made at home or purchased.

“When we make it at home, we make it on ourselves, it is hygienic. We make it with our very hands we know what we are using what we are not using. ” [SHG 2, rural]

“These days, there is nothing that is not available outside. You get everything. ” [SHG 1, urban]

“If they have in surplus, they sell it, sir. If they need it, large quantities for a party or for a wedding, they buy it from others. ” [SHG 2, rural]

Urban participants preferred to buy certain products directly from the dairy, whilst others could be bought in local small stores (Kirana) or larger mini supermarkets. When buying in a store, participants mentioned brand preferences and a common practice of testing milk product samples, to check the freshness, before purchasing.

“The brand X is good. We also look at the expiry date. We look at the manufacturing date and the expiry date. ” [SHG 1, urban]

“Anything [sweets made out of milk] we buy, we test it, and then we buy. ” [SHG 1, urban]

The need to adapt to sustain dairy farmer livelihoods in water scarce areas

Concerns regarding dairy production livelihoods were identified; however, these were subtle, and related to promoting dairying as a viable livelihood and adapting to changes in the environment, predominantly due to water scarcity or irregular rains. Two photographs in the rural group represented the benefits to the community of a green and natural environment. One of these (Fig. 4) led to a substantial discussion on feed for cows and buffalos and how this has changed over the years to adapt to the lack of water in the region.

Fig. 4
figure 4

Green grass is the food for animals. Grow trees to keep the environment clean and protect health. Greenery is because of the farmer. Food is available only because of the farmer [SHG 2, rural]

Participants mentioned the use of different feed (boiled broken rice and rice husk powder, peels and husk of pulses, hay) used to supplement the grass either fed to or grazed by cows / buffalos. They discussed the convenience of using a newer type of dairy grass and how this has led to a new generation of dairy farmers. This grass was described as beneficial as it required less water, grew quickly, and was less labor intensive. It was considered more economic than “natural grass” and part of why the dairy industry was becoming a more popular livelihood.

“The [natural] grass also does not grow because there are no rains. ” [SHG 2, rural].

“Earlier there was no dairy grass. Now there is no water, so that grass is not growing. This grows if you just water the soil. That grass does not grow. So, we are used to using this. For it to grow soon urea is used. It grows in 15 days. It is easy for us, so we are cutting it and we feed it. ” [SHG 2, rural]

“Earlier this grass was not there so no one was into farming. But now even people who are [not from traditional farming communities] can do it with this grass. As a result, cows are also more in numbers. ” [SHG 2, rural]

The only explicitly negative association with dairy grass was the reaction to using urea, a fertilizer high in synthetic nitrogen. Urea was seen as a means to an end, and a common practice necessary due to the lack of water in the region; however, participants were uncomfortable with using chemicals and believed they would impact their health either directly or via the milk produced.

“The cattle are affected and in turn the milk coming from them is also affected.” [SHG 2, rural]

It’s not only about health

Participants in both the urban and rural groups referred to the enjoyment in cultural practices of offering and consuming milk and milk products. This was discussed as part of everyday customs as “It is customary to serve tea or coffee (with milk added) to the guests.”; as well as for family celebrations where “Sweets made out of milk are required to be served in functions. It is good if these sweets are served to the guests. ”; and also for many religious festivals (Fig. 5).

“Semiya payasam is offered to God. It is also liked by my children. ” [SHG 1, urban].

Fig. 5
figure 5

Payasam (vermicelli and milk dessert) is prepared on birthdays and festivals. All my family members like it [SHG 2, rural]

The health benefits of consuming milk were clearly discussed among all participants, in particular for the health of children because “milk has calcium” and “it strengthens bones, too” (Fig. 6). Many participants, however, stated that health was not always the main reason for consuming milk and milk products. They spoke of preferences and liking the taste of a number of milk-based foods and drinks (eg, ice cream, ghee, tea), whilst also recognizing that should be consumed in moderation for health reasons (eg, to moderate energy / fat intake ) (Fig. 7).

“Chocolate, sir. It is made from milk. Children like it. Not only children but also adults enjoy it. ” [SHG 1, urban]

Fig. 6
figure 6

This is healthy for all and makes bones strong [SHG 1, urban]

Fig. 7
figure 7

Ice cream is liked by children and adults alike. But too much ice cream is not good for health [SHG 2, rural]

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