Status and determinants of intra-household food allocation in rural Nepal

Abstract

Background/ObjectivesUnderstanding of the patterns and predictors of intra-household food allocation could enable nutrition programs 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 households heads from Dhanusha and Mahottari districts in Nepal responded to 24-hour 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.

Impact on birth weight and child growth of Participatory Learning and Action women’s groups with and without transfers of food or cash during pregnancy: Findings of the low birth weight South Asia cluster-randomised controlled trial (LBWSAT) in Nepal

“…It seems that regular consumption of fortified balanced protein-energy super cereal (during the earlier time of the study when birthweight was being measured) was more effective at improving birthweight than regular consumption of extra milk, as occurred in the cash arm. In this context, gender disparity in earned cash income is a stronger predictor of intra-household calorie allocation than household food security, whereas household food security is a stronger predictor of micronutrient allocation [ 54 ]. Yet, intra-household allocation of dairy was more equitable in the PLA plus cash arm than the control, and intra-household allocation of energy was more equitable in the PLA plus food arm, suggesting that the additional dairy purchased with the cash and the additional energy from Super Cereal in these transfer arms were channelled to the pregnant women (51).…”

Greater household food insecurity is associated with lower breast milk intake among infants in western Kenya

“…Strengths of our study include its longitudinal design, large sample size, multiple objective measurements of breastfeeding behaviour, and use of stable isotopes to measure breast milk intake. Future studies could expand upon this work by measuring breast milk intake at multiple time points and using an individually focused food insecurity scale; our examination of household food insecurity may obscure intrahousehold differences in food access and intake (Akerele, ; Harris‐Fry et al, ). Examination of breast milk macro and micronutrient quality in relation to maternal food insecurity would also be informative.…”

How Much Education Is Needed to Delay Women's Age at Marriage and First Pregnancy?

“…Maithilispeaking women of reproductive age, especially young and newly married wives generally have limited mobility outside their homes because of cultural norms restricting socialization with outside men (37)(38)(39). They tend to have less access to nutritious foods during pregnancy (40) and little decision-making power over when and what they eat (41).…”