Elevating mothers’ and women’s nutrition

Mother’s Day in the United States is celebrated on May 9th this year. While Mother’s Day may look a little different than usual (again), due to the COVID-19 pandemic, many families in the U.S. show gratitude to their mothers through food. Partners and children serve them breakfast in bed or pick up brunch. Mothers in the U.S. and around the world are often responsible for feeding their families each day, an act which provides nourishment and shows love and care for their family.

On Mother’s Day, we “flip the table” with this simple act by taking the responsibility of feeding off mothers’ plates and showing them love and care through food.

Yet, this act of gratitude and love is also a reminder of a mothers’ routine responsibility for feeding their families; mothers often focus on the nutritional needs and food preferences of her family, aiming to satisfy, please, and nourish. As the one who provides rather than receives family meals, mothers’ nutritional needs and food preferences can be easily overlooked.

The public health community also tends to focus only on mothers’, and indeed women’s, nutrition during reproductive periods of pregnancy and lactation, and not throughout their lives.

Diets and nutrition are critical for mothers’ health and directly influence the health of their children. A paper in the 2021 Lancet Series on Maternal and Child Undernutrition highlights the continued prevalence of maternal undernutrition and micronutrient deficiencies, which are caused, in part, by diets of insufficient quantity and quality. While rates of maternal underweight and short height status have declined globally, progress has been more limited in low-and-middle income countries (LMICs) and for low-income populations within those countries. Rates of underweight have remained stagnant for adolescent girls aged 15-19 years in LMICs. Maternal underweight and short height and anemia during pregnancy contribute to increased risk of maternal morbidity and poor birth outcomes especially delivery of low birth-weight babies. The prevalence of maternal overweight and obesity in LMICs is increasing, particularly in urban areas, which is associated with maternal morbidity, preterm birth, and increased infant mortality as reported in the Lancet.

Unequal burden of undernutrition                           

The COVID-19 pandemic has laid bare the deepening inequalities, showing significant impacts on people’s health and well-being. IFPRI’s 2021 Global Food Policy report finds that food insecurity has rapidly risen and diet quality has worsened during the pandemic. However, not everyone has faced these risks equally. The report states that during the pandemic, “Women have been more likely to experience increased domestic violence and food insecurity, reduced autonomy, and loss of income” (p. 54).

These dynamics are not new. Women too often experience unequal intrahousehold food allocation, or an unequal share of available food. A study by the World Bank on poverty and nutrition in 30 sub-Saharan African countries found that nearly 75 percent of underweight women live in households with a male head who is not underweight and nearly 75 percent of underweight women and undernourished children do not live in the poorest 20 percent of households. These findings support evidence that there is substantial intrahousehold inequality that affects women’s diets and nutrition, and that women’s undernutrition is not solely due to impoverishment.

Women’s nutrition is also influenced by the environment in which they live. A review, Albertha Nyaku, R4D’s nutrition program director, conducted with Lindsay Jaacks, Justine Kavle, and Abigail Perry shows that food, education, and health systems often do not sufficiently support healthy diets, which contributes to the prevalence of maternal overweight and obesity.

Within households that face food scarcity and insecurity, girls and women considered as having lower status in households (e.g., adolescent girls, young mothers) most often bear the brunt of food scarcity and first reduce the quality and quantity of what they consume before others in the household have to do so. They often make decisions about food preparation and intrahousehold allocation with “burdened agency,” a term Professor Erin Lentz applies in a study about how women navigate food and nutrition insecurity and domestic violence in rural Bangladesh. While the female participants in the study are not entirely powerless, they have limited food choices in a reality in which impoverishment, seasonal hunger, and strict patriarchy are common. At times, they eat lower quality or lower quantities of food to avoid familial conflict and violence, knowing that this has negative consequences for their own nutrition and health. While further research is needed to understand the dynamics between food practices, gender norms, and intrahousehold power relations in other contexts, it is clear that girls’ and women’s nutrition is negatively impacted by socio-economic inequality.

Building evidence on women’s empowerment interventions

In the wake of the pandemic and in the face of continued maternal nutrition challenges, how can the international public health community better support mothers’ diets and nutrition?

As the pandemic and existing evidence show, differential food allocation and nutrition outcomes for women is affected by women’s socio-cultural and economic vulnerability. Therefore, part of addressing maternal nutrition requires taking a more comprehensive view of women’s status and empowerment, including gender norms, women’s access to and control over resources, and other factors influencing vulnerability and marginalization like race, ethnicity, and disability. As Dr. Isabel Madzorera and Professor Wafaie Fawzi argue in a Lancet commentary, we need to place greater emphasis on 1) implementing nutrition-sensitive interventions that seek to address women’s empowerment along with nutrition and 2) addressing research and evidence gaps related to women’s empowerment and nutrition.

There is growing evidence that nutrition-sensitive interventions can be more effective when they are combined with those seeking to address women’s empowerment. A paper in the 2021 Lancet Series on Maternal and Child Undernutrition reports this in the cases of nutrition-sensitive agriculture and social protection interventions. In addition, recent randomized controlled trials in India and Bangladesh have found that the packages of nutrition-sensitive agriculture interventions that included women’s empowerment interventions were more successful compared to those only delivering nutrition-sensitive agriculture interventions.

More information is needed about what types of women’s empowerment interventions are most effective for improving diets and nutrition and how they should be delivered. Results for Development, as a consortium partner on USAID Advancing Nutrition, is helping to fill these information gaps through multisectoral literature reviews and by generating evidence and learning. USAID Advancing Nutrition’s efforts have included the following:

• Conducted a systematic review of evidence on behavioral interventions that engage family members to support maternal and child nutrition.
• Developed program guidance on how to involve family members, including men, in supporting women’s nutrition.
• Launched the Adolescent Nutrition Resource Bank to bring together resources on adolescent nutrition given the nutrition challenges faced by this age group.
• Developed a learning agenda on women’s diets that aims to synthesize evidence and learning across the project’s multisectoral portfolio to build the evidence base on how to improve women’s diets, including through food market environments, family diets, and health service delivery, to inform the design and implementation of nutrition programs and interventions.

The international public health field must continue to build the evidence base on how to improve women’s and adolescent girls’ nutrition in LMICs. And these efforts should be done in a way that addresses the limited power and agency that contribute to their malnutrition. The women responsible for feeding the families of our world must also be nourished themselves.

Photo © Morgana Wingard/USAID