Abstract
Background/objectivesUnderstanding of the patterns and predictors of intra-household food allocation could enable nutrition programmes to better target nutritionally vulnerable individuals. This study aims to characterise the status and determinants of intra-household food and nutrient allocation in Nepal.Subjects/methodsPregnant women, their mothers-in-law and male household heads from Dhanusha and Mahottari districts in Nepal responded to 24-h dietary recalls, thrice repeated on non-consecutive days (n = 150 households; 1278 individual recalls). Intra-household inequity was measured using ratios between household members in food intakes (food shares); food-energy intake proportions (‘food shares-to-energy shares’, FS:ES); calorie-requirement proportions (‘relative dietary energy adequacy ratios’, RDEARs) and mean probability of adequacy for 11 micronutrients (MPA ratios). Hypothesised determinants were collected during the recalls, and their associations with the outcomes were tested using multivariable mixed-effects linear regression models.ResultsWomen’s diets (pregnant women and mothers-in-law) consisted of larger FS:ES of starchy foods, pulses, fruits and vegetables than male household heads, whereas men had larger FS:ES of animal-source foods. Pregnant women had the lowest MPA (37%) followed by their mothers-in-law (52%), and male household heads (57%). RDEARs between pregnant women and household heads were 31% higher (log-RDEAR coeff=0.27 (95% CI 0.12, 0.42), P < 0.001) when pregnant women earned more or the same as their spouse, and log-MPA ratios between pregnant women and mothers-in-law were positively associated with household-level calorie intakes (coeff=0.43 (0.23, 0.63), P < 0.001, per 1000 kcal).ConclusionsPregnant women receive inequitably lower shares of food and nutrients, but this could be improved by increasing pregnant women’s cash earnings and household food security.
Highlights
Pregnant women in South Asia have inadequate intakes of many micronutrients [1, 2], and this can translate intoLondon, UK 3 Mother and Infant Research Activities, Kathmandu, Nepal 4 Maternal Child and Adolescent Health, World HealthOrganization, Geneva, Switzerland 5 Great Ormond Street Institute of Child Health, University CollegeLondon, London, UK comorbidities of multiple micronutrient deficiencies [3]
Inadequate diets during pregnancy are problematic because inadequate weight gain and micronutrient intakes are associated with higher risk of adverse health outcomes, including low birth weight [4] and maternal mortality [5]
The pre-specified sampling frame included all maleheaded households, with a pregnant woman in their third trimester who was living with their mother-in-law and enroled in a cluster-randomised controlled trial: the Low Birth Weight South Asia Trial (LBWSAT; http://www. controlled-trials.com/ISRCTN75964374) [19, 20] between June and September 2015
Summary
Inadequate diets during pregnancy are problematic because inadequate weight gain and micronutrient intakes are associated with higher risk of adverse health outcomes, including low birth weight [4] and maternal mortality [5]. Women [7, 8], pregnant women [9], are discriminated against the allocation of food within households—a trend that is more prominent in South Asia than elsewhere [9]. This may be explained by food insecurity [10] or sociocultural factors [7]. During pregnancy, women have higher nutritional requirements but often have other pregnancy-specific food restrictions [7]
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