Maternal Dietary Diversity in Pakistan: Influences of Education, Poverty, and Food Insecurity from a Cross-Sectional Survey

Maternal Dietary Diversity: Influences of Education, Poverty, and Food Insecurity

Abstract

Maternal nutrition strongly influences pregnancy outcomes. In Pakistan, poor dietary diversity and food insecurity remain key drivers of malnutrition, particularly in disadvantaged areas. Objectives: To assess dietary diversity, household food insecurity, and nutritional status among pregnant women in Kurram District, Pakistan, and examine their associations with maternal education and poverty. Methods: A community-based cross-sectional baseline survey, nested within a non-randomized, cluster-controlled trial (ISRCTN94319790), was conducted in Upper Kurram from January to April 2018, using multi-stage cluster sampling (80 clusters from 12 health facilities) and consecutive home-based enrolment of 1,209 pregnant women (15–49 years). Data were collected via structured questionnaires (HFIAS, MDD-W), standardized anthropometry, and analyzed in Stata 14. Results: Mean age was 27.9 ± 5.8 years; 68.9% of women and 24% of husbands were uneducated. Most households were non-poor (87.6%), and 77.4% were food secure (mean HFIAS 4.2 ± 5.2). Dietary diversity was low, with only 13.2% achieving MDD-W ≥5; diets were dominated by cereals (98.4%), low in fruits, vegetables, and animal-source foods. Mean BMI was 24.9 ± 4.5; 4.5% were underweight, 29.8% overweight, and 11.0% obese. In bivariate analyses, food insecurity was more common among women with no formal education, the poorest households, and those consuming <5 food groups (all p<0.001). Conclusions: Findings reveal a double burden of malnutrition, with overweight and obesity coexisting with poor dietary diversity. Food insecurity was strongly linked to poverty, low education, and limited dietary diversity. Interventions addressing education, poverty, and dietary diversity are critical to improve maternal nutrition in similar low-resource settings.