Perceived Causes and Consequences of Food Insecurity During Pregnancy and Lactation among Kenyan Women of Mixed HIV Status

Abstract

Food insecurity (FI) has been associated with poor maternal and infant health in high-income countries. However, little is known about the determinants or consequences of FI during pregnancy and lactation (P&L) in resource-poor settings or in the context of HIV. We explored these relationships in Nyanza, Kenya, through in-depth interviews with 39 P&L women (46.2% HIV+), household members (n=14), and key community members (n=10). Transcript coding was informed by the ecological mode and completed using the software Dedoose. The bulk of the perceived causes of FI were at the household and individual levels, though factors at every ecological level were reported. Cultural and individual (mis)perceptions about nutrition needs during P&L, prioritization of nutrition needs of other household members, and dependency on husband were the most common modifiable determinants of FI. Consequences of FI for mothers included self-deprivation of food, reduced ART adherence, and psychological duress. For infants, suboptimal infant feeding and duress were the most commonly reported. These data suggest several potential causes of FI unique to the perinatal period, and multiple mechanisms by which FI may be deleterious. Some potential sequelae (reduced ART adherence, early cessation of exclusive breastfeeding) may increase the risk of vertical transmission of HIV. Longitudinal data are required to quantitatively test these pathways and to design appropriate interventions.