Women's vulnerability to food insecurity and malnutrition

Despite increased attention and strides in global nutrition efforts, women remain disproportionately vulnerable to food insecurity and malnutrition compared to men. This disparity stems from biological differences in needs but also frequent gender-based social norms limiting their access to nutritious foods (1). Studies estimate that close to three-quarters of women of reproductive age globally suffer from deficiencies in micronutrients such as iron, zinc or folate, especially in Sub-Saharan Africa (80%) and the Asia-Pacific (73%) (2). These deficiencies can cause anaemia, cognitive impairment, infections, slow recovery from illness, and stunted growth of children during pregnancy and breastfeeding (3).

This then leads to increased morbidity and mortality, affecting health and economic opportunities across generations and societies (4). The COVID-19 pandemic further highlighted the extent to which social and cultural factors may limit women's ability to secure a healthy diet due to lower income, limited mobility, and less financial control than men, underscoring the need for multi-sectoral, holistic action to achieve the Sustainable Development Goals (SDGs) by 2030 (5–7).

Women’s personal agency

In our recent work on women’s food environments (8,9) and effective nutrition interventions in the West African Sahel (10), we have found that women's personal agency and autonomy are central in determining food acquisition and dietary quality, as they influence financial, social, temporal, and spatial factors, often inadequately addressed. The barriers faced by women of reproductive age (especially of younger age) include limited autonomy in managing financial resources and decision-making, time poverty due to disproportionately high engagement in unpaid work, and mobility constraints.

Conversely, social networks often help women overcome challenges in food procurement and preparation by enabling the sharing of resources, labour, knowledge and skills. For example, women of reproductive age with strong positive social networks nearby (e.g. family, friends and neighbours) often experience improved dietary quality because individuals within the social network may share the time burden of procuring and cooking food and caring for children.

Policy and programme implications

Our research indicates that personal agency is a critical lever for food environment and nutrition interventions to improve women’s dietary quality. Additionally, gender-sensitive agricultural policies must address barriers to women's decision-making power and control over income to ensure they benefit directly from increased production and income (11,12) and avoid negative side effects (13).

When designing multi-sectoral nutrition programmes or making infrastructure decisions, it is critical that policymakers consider women’s time burdens, such as unpaid work commitments, and barriers to women’s mobility, including cultural norms and the walkability of roads (11,13,14). Context-specific policies and programmes are essential since the relative importance of different barriers varies based on geographic, socioeconomic and cultural factors (15). Given that decision-making power is often concentrated in the hands of men and older women in highly gendered patriarchal societies, our research reinforces the need for an inclusive whole-of-community approach, which would also promote co-responsibility for nutrition (11).

Our findings reinforce the importance of working with the community to co-design programmes (15,16) and conducting mixed-method evaluations to ensure that interventions monitor and mitigate unintended consequences (17). This is especially important when targeting complex long-chain impact pathways such as women’s decision-making power and control over income (12,18). Our work on expanded food environment frameworks (8) and the effectiveness of nutrition intervention designs in the West African Sahel (10)  is based on empirical research about the factors which shape food access and consumption. Although this research is focussed on women of reproductive age and their children, it also offers insights for other vulnerable groups, such as youth, elderly people, and people with disabilities living in precarious conditions such as poverty or insecure employment, disempowerment, or stigma.

References:

1.          Fox EL, Davis C, Downs SM, Schultink W, Fanzo J. Who is the Woman in Women’s Nutrition? A Narrative Review of Evidence and Actions to Support Women’s Nutrition throughout Life. Curr Dev Nutr. 2019;3(1):1–22.

2.          Stevens GA, Beal T, Mbuya MNN, Luo H, Neufeld LM, Global Micronutrient Deficiencies Research Group. Micronutrient deficiencies among preschool-aged children and women of reproductive age worldwide: a pooled analysis of individual-level data from population-representative surveys. Lancet Glob Health [Internet]. 2022;10(11):e1590–9. Available from: http://www.ncbi.nlm.nih.gov/pubmed/36240826

3.          Bailey RL, West Jr. KP, Black RE. The Epidemiology of Global Micronutrient Deficiencies. Ann Nutr Metab. 2015;66(Suppl. 2):22–33.

4.          Victora CG, Christian P, Vidaletti LP, Gatica-Domínguez G, Menon P, Black RE. Revisiting maternal and child undernutrition in low-income and middle-income countries: variable progress towards an unfinished agenda. Lancet [Internet]. 2021;6736(21). Available from: http://www.ncbi.nlm.nih.gov/pubmed/33691094

5.          FAO/IFAD/UNICEF/WFP/WHO. The State of Food Security and Nutrition in the World 2022. Repurposing food and agricultural policies to make healthy diets more affordable. The State of Food Security and Nutrition in the World 2022. FAO; 2022 Jul.

6.          O’Meara L, Turner C, Coitinho DC, Oenema S. Consumer experiences of food environments during the Covid-19 pandemic: Global insights from a rapid online survey of individuals from 119 countries. Glob Food Sec [Internet]. 2022;32:100594. Available from: https://doi.org/10.1016/j.gfs.2021.100594

7.          O’Meara L, Sison C, Isarabhakdi P, Turner C, Harris J. ''Whatever we have is what we eat": How marginalised urban groups in the Philippines and Thailand experienced their food environments through Covid-19. Health and Place (under review). 2024;

8.          O’Meara L, De Bruyn J, Dominguez-Salas P, Hope T, Turner C, Stoynova M, et al. Characteristics of food environments that influence food acquisition and diets of women in low- and middle-income countries: a scoping review protocol. Vol. 21, JBI Evidence Synthesis. Lippincott Williams and Wilkins; 2023. p. 1270–9.

9.          O’Meara L, de Bruyn J, Hope T, Fajó-Pascual M, Hodge R, Turner C, et al. Conceptual framework of women’s food environments in low- and middle-income countries: a systematic scoping review . (forthcoming).

10.        Dominguez-Salas P, O’Meara L, Bechoff A, Byrd K. Understanding Persistence of Malnutrition in the Sahel. Study B: Assessing Designs of Nutrition Initiatives. Nutrition Research Facility, Belgium; (forthcoming);

11.        Farhall K, Rickards L. The “Gender Agenda” in Agriculture for Development and Its (Lack of) Alignment With Feminist Scholarship. Front Sustain Food Syst. 2021 Feb 10;5.

12.        Sharma IK, Di Prima S, Essink D, Broerse JEW. Nutrition-Sensitive Agriculture: A Systematic Review of Impact Pathways to Nutrition Outcomes. Vol. 12, Advances in Nutrition. Oxford University Press; 2021. p. 251–75.

13.        van der Harst M, Koch DJ, van den Brink M. A review of the unintended gender effects of international development efforts. Vol. 43, Public Administration and Development. John Wiley and Sons Ltd; 2023. p. 280–92.

14.        Davies SE, Harman S, Manjoo R, Tanyag M, Wenham C. Why it must be a feminist global health agenda. Vol. 393, The Lancet. Lancet Publishing Group; 2019. p. 601–3.

15.        Vercillo S, Rao S, Ragetlie R, Vansteenkiste J. Nourishing the Nexus: A Feminist Analysis of Gender, Nutrition and Agri-food Development Policies and Practices. European Journal of Development Research. 2023 Dec 1;35(6):1261–93.

16.        Leung L, Miedema S, Warner X, Homan S, Fulu E. Making feminism count: integrating feminist research principles in large-scale quantitative research on violence against women and girls. Gend Dev. 2019 Sep 2;27(3):427–47.

17.        Bamberger M, Tarsilla M, Hesse-Biber S. Why so many “rigorous” evaluations fail to identify unintended consequences of development programs: How mixed methods can contribute. Eval Program Plann. 2016 Apr 1;55:155–62.

18.        Leight J, Pedehombga A, Ganaba R, Gelli A. Women’s empowerment, maternal depression, and stress: Evidence from rural Burkina Faso. SSM - Mental Health. 2022 Dec 1;2.