Community perspectives on maternal dietary diversity in rural Kenya, Mozambique and The Gambia: A PRECISE Network qualitative study

Pregnant and lactating women in sub-Saharan Africa are vulnerable to micronutrient inadequacies, with risk of adverse pregnancy outcomes. Adequate intakes of diverse foods are associated with better micronutrient status and recommended by the World Health Organization as part of healthy eating counselling during antenatal care. However, our understanding of community knowledge of dietary diversity within the context of maternal diets is limited. We used a descriptive qualitative approach to explore community perceptions of dietary diversity during pregnancy and lactation, as well as influencing factors in sub-Saharan Africa. A total of 47 in-depth interviews were conducted between May and October 2022 in Kenya, Mozambique and The Gambia with a purposively drawn sample of pregnant women and mothers who had delivered within two years preceding the data collection, their male and female relatives, and community opinion leaders. Other methods included participant observation and photovoice. Data were analyzed using a thematic approach on NVivo software. Dietary diversity was found to be well aligned with local perceptions of healthy meals. All participants were able to differentiate between starchy staple grains and additional foods to provide nutrients. While diverse meals were valued for pregnant and lactating mothers, participants across the three countries shared that maternal diets were not more diverse compared to typical household meals. Furthermore, diverse diets were inaccessible for many in their communities, due to challenges in affordability, seasonality, gender norms, knowledge and preferences. Adequate nutrition knowledge, accessibility of foods, and support of household decision-makers, particularly husbands and partners, were all identified as critical to ensure women have adequate diverse maternal diets.