Understanding the traditional values and use of okra among pregnant women in western Ethiopia: a qualitative study

**Background:** Malnutrition among women in developing countries is driven by limited dietary diversity. Indigenous plants like okra (Abelmoschus esculentus), which originated in Ethiopia, are rich in essential nutrients including folate, fiber, proteins, and antioxidants. Despite okra's potential to address food insecurity and micronutrient deficiencies, evidence on its traditional use among pregnant women in resource-limited settings like western Ethiopia is limited. This study aimed to explore the traditional values, beliefs, and utilization patterns of okra among pregnant women in western Ethiopia.

**Methods:** A qualitative study was conducted from June 1 to June 30, 2020, in the Sherkole and Assosa districts of the Benishangul-Gumuz regional state, western Ethiopia. One kebele (smallest administrative unit) was purposively selected from each district. Pregnant women were identified using health post registry books. Purposive sampling was used to recruit 86 participants: 72 for focus group discussions (FGDs; 7 groups of 8–12 participants each) and 14 for in-depth interviews (IDIs). Data were collected by six trained nursing professionals using semi-structured guides in the local language (Rutanegna). FGDs lasted 45–50 minutes and IDIs 25–30 minutes. Data were audio-recorded, transcribed verbatim, translated into English, and analyzed using thematic analysis with an inductive approach. Trustworthiness was ensured through pretesting, triangulation of FGD and IDI data, and team-based coding.

**Key Results:** Three themes and six subthemes emerged. (1) Consumption of okra: All participants reported using only okra pods as food; other parts (leaves, seeds, stems) were not consumed. Participants valued okra pods for their mucilaginous texture, which increased palatability. Knowledge about the nutritional value of other plant parts was absent. (2) Cultural practices: Okra pods were prepared alone or with other foods, and were preserved by drying and powdering for long-term storage. Pods were harvested before drying to maintain palatability. (3) Traditional and health benefits: Participants reported that okra relieves gastritis pain, neutralizes stomach acid, improves strength, increases life expectancy, and serves as a source of income. Cultural beliefs included using okra to express happiness and belongingness. Sociodemographically, 97.2% of FGD participants were Muslim; 68.8% of FGD participants had no formal education; 81.9% of FGD participants were aged ≤31 years.

**Clinical Implications:** The study highlights a critical gap in the utilization of nutrient-dense parts of the okra plant among pregnant women in western Ethiopia, driven by lack of awareness rather than availability. Okra pods are rich in folate (preventing neural tube defects), dietary fiber (preventing constipation), and antioxidants. Other parts—leaves (high in carbohydrates, fiber, protein, minerals) and seeds (22.14% protein, 14.01% lipids, high unsaturated fatty acids)—remain underused. The traditional belief that okra relieves gastritis is supported by evidence of antiadhesive compounds against Helicobacter pylori and gastroprotective effects comparable to omeprazole. Antifatigue effects are attributed to ethanol extracts and polysaccharides in okra seeds. The study recommends behavioral change communication interventions to promote utilization of all okra plant parts, which could contribute to food security, improved maternal nutrition, and progress toward Sustainable Development Goal 2 (zero hunger). Limitations include potential interviewer and social desirability bias, and lack of exploration of taboos related to okra.