What stops us from eating: A qualitative investigation of dietary barriers during pregnancy in Punjab, Pakistan.

Abstract

OBJECTIVE\nAdequate dietary intake during pregnancy is vital for the health and nutritional status of both mother and fetus. The nutritional status of reproductive age women in Pakistan is poor, with 14% being underweight (BMI<18.5) and 42% experiencing iron deficiency anemia. This may stem from beliefs, practices and other barriers influencing dietary intake. This qualitative study seeks to determine which factors impact dietary intake during pregnancy in rural Punjab.\n\n\nDESIGN\nIn-depth interviews and focus group discussions were conducted, and then analyzed using thematic analysis.\n\n\nSETTING\nThree purposively selected rural districts (Sahiwal, Okara, and Pakpatan) with the highest prevalence of maternal and child malnutrition in the province of Punjab, Pakistan.\n\n\nPARTICIPANTS\nMothers with children under age two (n=29), and healthcare providers with at least five years of experience working in the district (n=12).\n\n\nRESULTS\nWe identified a combination of physiological, socio-cultural, and structural barriers that inhibited healthful dietary intake during pregnancy. The primary physiological barriers to optimal dietary intake and dietary practices included food aversions and food cravings. Food classification, fear of a difficult childbirth, fear of high blood pressure, and household food politics were the principal socio-cultural barriers. Additionally, two structural barriers, inadequate antenatal counseling and a lack of affordable food options, were identified.\n\n\nCONCLUSIONS\nOur study demonstrates that complex barriers prevent pregnant women in the Punjab area from consuming adequate dietary intake, and that antenatal health education programs and structural interventions are needed to support healthful dietary practices during this critical period.