Screening Food Insecure during Pregnancy: Pilot Testing an Effective Brief Tool for Use in an Australian Antenatal Care Setting

Abstract

The purpose of this research is: (1) to determine the prevalence of food insecurity among pregnant people using the 10-, 6-, and 2-item iterations of the USA Household Food Security Survey Module (HFSSM) and the single item measure, and (2) identify an appropriate combination of questions that could be used to identify food insecurity in a clinical setting for a population of people who are pregnant in Australia. Cross-sectional survey collecting self-reported data from pregnant people in Australia (open May 2021 to March 2022). Survey included demographic characteristics, including income/welfare use, education, age, pregnancy information, household size and composition, and two measures of food insecurity. In total, 303 participants were included in the analysis. Sensitivity and specificity of the various combinations of questions were conducted. Food insecurity was estimated using the single item, and the 2-item, 6-item, and 10-item versions of the HFSSM, food insecurity was 6.2%, 11.4%, 11.7%, and 14.3% respectively. Respondents who were living in households that were food insecure answered affirmatively to question one, two, or three of the HFSSM, with the combination of questions one and three showing the best sensitivity and specificity for the whole sample, as well as for those who have characteristics likely to lead to food insecurity. Further testing of the 2-items, comprised of items one and three from the HFSSM, need to be conducted with a larger and more diverse sample to determine if this is an appropriate screening tool in an antenatal clinical setting to determine food insecurity during pregnancy.

Could commercial meal kits be part of the solution to food insecurity during pregnancy? An Australian exploratory study

“…Clinicians working with pregnant women report not having clear guidelines surrounding how to assist their patients when hungry or food insecure, 60,61 while services that provide emergency assistance for people who are hungry and food insecure are not always able to assist them to meet their nutritional requirements. 47 Providing meal kits to households with a pregnant member who is hungry or food insecure may be a useful way to provide some nutrition during this important period for both parent and offspring. Research suggests that during their pregnancy, women in high income countries can find maintaining adequate nutrition challenging.…”

“…Agencies who are responsible for providing assistance to people who are food insecure and hungry are reporting an increase in the number of people who are in need, 57–59 with recent research suggesting that more than 1 in 10 pregnant women in Australia are food insecure, the number of pregnant women and in need is also likely to increase. Clinicians working with pregnant women report not having clear guidelines surrounding how to assist their patients when hungry or food insecure, 60,61 while services that provide emergency assistance for people who are hungry and food insecure are not always able to assist them to meet their nutritional requirements 47 …”

“…Food insecurity during pregnancy has short‐ and long‐term implications for the health for both parent and child 42–46 . Approximately, one in 10 pregnant women in Australia are food insecure, however, in Australia, few services exist that are able to specifically assist pregnant women to meet their nutritional requirements 47 . Meal kits may be useful as they can remove two of the main barriers to adequate nutrition during pregnancy; time and money, while also having the potential to have an educative impact thanks to recipe cards and instructional videos.…”

“…[42][43][44][45][46] Approximately, one in 10 pregnant women in Australia are food insecure, however, in Australia, few services exist that are able to specifically assist pregnant women to meet their nutritional requirements. 47 Meal kits may be useful as they can remove two of the main barriers to adequate nutrition during pregnancy; time and money, while also having the potential to have an educative impact thanks to recipe cards and instructional videos. Pilot work from the USA suggests that providing pregnant women with meal kits from the time of enrolment to 60 days postpartum can lead to a reduction in food insecurity and a significant reduction in severity of postpartum depressive symptoms, 48 however, more work is needed to explore the possibility that meal kits could be employed as a health promoting activity during pregnancy.…”

Views and preferences of food‐insecure pregnant women regarding food insecurity screening and support within routine antenatal care

“…This relationship is in part due to food insecurity contributing to disordered eating patterns induced by the stress of food scarcity 6 and restricted access to a nutritionally adequate diet during pregnancy 3 . Approximately 14% of Australian pregnant women experience food insecurity, 7 with similar rates reported in other high‐income countries 8,9 …”