Intra-household food allocation in rural Nepal

• Main Author: Harris-Fry, H. A.
• Published: University College London (University of London) 2017
• Online Access: https://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.746410

Background: It is often assumed that pregnant women are discriminated against in the allocation of food in South Asian households. Better understanding of food allocation trends and determinants could inform how nutrition programs can reduce intrahousehold inequity and improve maternal and child nutritional outcomes. Objectives: Measure and explain inequity in intra-household food allocation in rural Nepal by (1) testing for differences in calorie adequacy ratios between household members, (2) identifying determinants of Relative Dietary Energy Adequacy Ratios (RDEARs) – a measure of intra-household food allocation, and (3) testing the effects of ‘Participatory Learning and Action’ (PLA) women’s groups, PLA with food transfers, and PLA with cash transfers, on RDEARs and other dietary outcomes. Methods: Interventions were tested in a four-arm cluster-randomised controlled trial in 80 clusters in Dhanusha and Mahottari districts, Nepal. In 805 rural households across the trial arms, pregnant women, mothers-in-law, and male household heads responded to between one and three 24-hour dietary recalls each. Effects were analysed by fitting multivariable linear and logit regressions. Results: Pregnant women had lower calorie adequacy ratios (median=0.84) than their mothers-in-law (0.97; z=3.80, p < 0.001) and male household heads (1.07; z=5.39, p < 0.001). The biggest predictor of RDEARs was pregnant women’s relative income; RDEARs between pregnant women and household heads were 30% higher if she earned the same or more than her spouse. Compared with the control, RDEARs between pregnant women and their mothers-in-law were 12% higher in the PLA plus food arm (log-RDEAR β 0.12 (95%CI 0.02, 0.21), p=0.014) but RDEARs between pregnant women and household heads were lower in the PLA only arm (-0.11 (-0.19, -0.02), p=0.020). Conclusions: Food is allocated inequitably, and programs should deliberately target women to improve nutritional outcomes. Food transfer programs should consider household members’ preferences for different foods; other programs could improve nutrition by increasing women’s employment opportunities.