Marital transition is associated with food insecurity, low dietary diversity, and overweight in a female population in rural Ghana

Abstract

Research from high-income countries shows that marital transition affects individuals’ nutrition outcomes. Yet, little is known about its effect on women’s food security status and nutrition outcomes in Sub-Saharan Africa. Moreover, most published studies merge cohabitation and marriage into one category, but these statuses might have a distinct effect on nutrition outcomes in different settings. This study examined the association between the marital transition of women living in a rural district in Ghana and their food security status, minimum dietary diversity, and overweight (body mass index (BMI) ≥ 25 kg/m2). This analysis used representative data from women with a child less than 12 months from the Upper Manya Krobo District, which was collected for the 2014 baseline of the Nutrition Links project in 137 villages (clinicaltrials.gov NCT01985243). Women’s marital transition was assessed by merging their current and previous marital status into five categories: i) continuously married; ii) remarried; iii) cohabitating with a previous union; iv) cohabitating with no previous union; v) single (majority never previously married). The adjusted logistic regression showed that, compared to women who were continuously married, those cohabitating—with or without a previous union—and those who were single were more likely to be food insecure (aOR = 2.49; 95% CI [1.31, 4.72], aOR = 2.01; 95% CI [1.13, 3.58], and aOR = 1.85; 95% CI [1.02, 3.38], respectively). Women who were cohabitating—with or without a previous union—were more likely not to meet the minimum dietary diversity than those who were continuously married (aOR = 1.82; 95% CI [0.98, 3.38] and aOR = 1.78; 95% CI [1.01, 3.12], respectively). Finally, compared to the continuously married group, cohabitating women with no previous union were less likely to be overweight (aOR = 0.40; 95% CI [0.22, 0.74]). These results are consistent with previous publications that showed married women were wealthier and more overweight. Moreover, these results indicate that cohabitation affects nutrition-related outcomes differently compared to marriage in a sub-Saharan setting. More attention must be placed on better understanding the social aspects that link women’s marital transition to diet and nutrition outcomes. Key words: Marriage, marital status, food security, diet, overweight, women, Ghana, Africa