Household food insecurity is associated with low dietary diversity among pregnant and lactating women in rural Malawi

Objective To examine the association between household food insecurity and dietary diversity in the past 24h (dietary diversity score (DDS, range: 0-9); minimum dietary diversity (MDD, consumption of three or more food groups); consumption of nine separate food groups) among pregnant and lactating women in rural Malawi.Design Cross-sectional study.Setting Two rural districts in Central Malawi.Subjects Pregnant (n 589) and lactating (n 641) women.Results Of surveyed pregnant and lactating women, 66.7 and 68.6 %, respectively, experienced moderate or severe food insecurity and only 32.4 and 28.1 %, respectively, met MDD. Compared with food-secure pregnant women, those who reported severe food insecurity had a 0.36 lower DDS (P<0.05) and more than threefold higher risk (OR; 95 % CI) of not consuming meat/fish (3.19; CI 1.68, 6.03). The risk of not consuming eggs (3.77; 1.04, 13.7) was higher among moderately food-insecure pregnant women. Compared with food-secure lactating women, those who reported mild, moderate and severe food insecurity showed a 0.36, 0.44 and 0.62 lower DDS, respectively (all P<0.05). The risk of not achieving MDD was higher among moderately (1.95; 1.06, 3.59) and severely (2.82; 1.53, 5.22) food-insecure lactating women. The risk of not consuming meat/fish and eggs increased in a dose-response manner among lactating women experiencing mild (1.75; 1.01, 3.03 and 2.81; 1.09, 7.25), moderate (2.66; 1.47, 4.82 and 3.75; 1.40, 10.0) and severe (5.33; 2.63, 10.8 and 3.47; 1.19, 10.1) food insecurity.Conclusions Addressing food insecurity during and after pregnancy needs to be considered when designing nutrition programmes aiming to increase dietary diversity in rural Malawi.