Determinants of intra-household food allocation between adults in South Asia – a systematic review

Abstract

BackgroundNutrition interventions, often delivered at the household level, could increase their efficiency by channelling resources towards pregnant or lactating women, instead of leaving resources to be disproportionately allocated to traditionally favoured men. However, understanding of how to design targeted nutrition programs is limited by a lack of understanding of the factors affecting the intra-household allocation of food.MethodsWe systematically reviewed literature on the factors affecting the allocation of food to adults in South Asian households (in Afghanistan, Bangladesh, Bhutan, India, Islamic Republic of Iran, Maldives, Nepal, Pakistan, Sri Lanka) and developed a framework of food allocation determinants. Two reviewers independently searched and filtered results from PubMed, Web of Knowledge and Scopus databases by using pre-defined search terms and hand-searching the references from selected papers. Determinants were extracted, categorised into a framework, and narratively described. We used adapted Downs and Black and Critical Appraisal Skills Programme checklists to assess the quality of evidence.ResultsOut of 6928 retrieved studies we found 60 relevant results. Recent, high quality evidence was limited and mainly from Bangladesh, India and Nepal. There were no results from Iran, Afghanistan, Maldives, or Bhutan. At the intra-household level, food allocation was determined by relative differences in household members’ income, bargaining power, food behaviours, social status, tastes and preferences, and interpersonal relationships. Household-level determinants included wealth, food security, occupation, land ownership, household size, religion / ethnicity / caste, education, and nutrition knowledge. In general, the highest inequity occurred in households experiencing severe or unexpected food insecurity, and also in better-off, high caste households, whereas poorer, low caste but not severely food insecure households were more equitable. Food allocation also varied regionally and seasonally.ConclusionProgram benefits may be differentially distributed within households of different socioeconomic status, and targeting of nutrition programs might be improved by influencing determinants that are amenable to change, such as food security, women’s employment, or nutrition knowledge. Longitudinal studies in different settings could unravel causal effects. Conclusions are not generalizable to the whole South Asian region, and research is needed in many countries.

Socio‐cultural and economic determinants and consequences of adolescent undernutrition and micronutrient deficiencies in LLMICs: a systematic narrative review

“…141 This is supported by a review of intrahousehold food allocation that shows that inequities are more likely in food insecure or poor households, although this also depends on other factors such as religion, household size, social status, and women's bargaining power. 142 For instance, a study in the far west corner of Nepal showed that adolescent girls ended up second last, or last in case of daughters-in-law, in the household serving order, which could have influenced their nutritional status, especially in food insecure households. 143 Unequal treatment may thus result when households face extreme circumstances, leading to discrimination against vulnerable women.…”

Maternal Mortality in India: An Overview of social causes

“…The intra-household food allocation is determined by social, cultural and environmental factors, especially in the south Asian country like India (Gittelsohn, 2003;Harris-Fry, 2017). Women are often considered of low social status in comparison to men and therefore, they are usually allocated less food and/or less preferred foods (Harris-Fry, 2017).…”

Energy intake from unhealthy snack food/beverage among 12‐23‐month‐old children in urban Nepal

“…The greater odds of high USFB consumption among female children and lower odds among children from upper caste households has not been reported elsewhere; these results indicate that sociocultural beliefs may be influencing diets of young children in Nepal. Although inequitable intra‐household food allocation by sex has been noted in South Asian contexts including Nepal, (Harris‐Fry, Shrestha, Costello, & Saville, ), literature on the influence of child sex and feeding of USFB is extremely limited. Fledderjohann et al () found greater consumption of fresh milk by sons as compared with daughters among Indian children below 5 years of age; further exploration of our data showed that male children consumed a higher %TEI‐NBF from healthy snacks than female children, particularly dairy‐based snacks.…”

“…Ordinal logistic regression model for high consumption a of unhealthy snack foods and beverages (comparison with low/moderate consumption b ) CI: confidence interval.The greater odds of high USFB consumption among female children and lower odds among children from upper caste households has not been reported elsewhere; these results indicate that sociocultural beliefs may be influencing diets of young children in Nepal.Although inequitable intra-household food allocation by sex has been noted in South Asian contexts including Nepal,(Harris-Fry, Shrestha, Costello, & Saville, 2017), literature on the influence of child sex and feeding of USFB is extremely limited Fledderjohann et al (2014). …”