Socioeconomic, demographic, and obstetric inequalities in food insecurity in pregnant women

Fernandes, Renata Cordeiro; Manera, Fernanda; Boing, Larissa; Höfelmann, Doroteia Aparecida

doi:10.1590/1806-93042018000400008

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Revista Brasileira de Saúde Materno Infantil

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ORIGINAL ARTICLES • Rev. Bras. Saude Mater. Infant. 18 (4) • Oct-Dec 2018 • https://doi.org/10.1590/1806-93042018000400008 copy

Socioeconomic, demographic, and obstetric inequalities in food insecurity in pregnant women

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Objectives:

to estimate the prevalence of Food Insecurity (FI) in pregnant women and to identify its association with demographic, socioeconomic, obstetric, and anthropometric variables in female users of Family Health Units (FHUs) in the city of Colombo, state of Paraná, South Region of Brazil.

Methods:

a cross-sectional study of a representative sample of pregnant women from 17 FHUs in Colombo. We used the short version of the Brazilian Household Food Insecurity Measurement Scale (EBIA). In addition, we used Poisson Regression Models with robust, crude, and adjusted variance to investigate the association between FI and exposure variables.

Results:

316 pregnant women participated in the study. The prevalence of FI was 45.1% (CI95% = 39.6-50.6). Adjusted analysis showed higher prevalence of FI in pregnant women with 30 years of age or older (PR = 1.66; IC95% = 1.02-2.69), with black skin or indigenous background (PR= 1.39; CI95%= 1.08-1.79), with 7 years of education or less (PR = 1.58; CI95% = 1.14-2.19), and with lower income (PR = 2.07; CI95% = 1.36-3.14).

Conclusions:

There was a high prevalence of FI among pregnant women, particularly among those of older age and with worse socioeconomic conditions, a group that should be considered a priority for actions aimed at promoting food security.

Key words:
Food security; Pregnancy; Social inequality; Cross-sectional studies

Variables	N	%
Demographic
Age range (in years)
0-19	45	14.2
20-29	189	59.8
30 or more	82	26.0
Marital status
With partner	264	83.5
Without a partner	52	16.5
Color/race
White and Asian	156	49.5
Black and indigenous	159	50.5
Socioeconomic
Paid Work
Yes	138	43.7
No	178	56.3
Bolsa Família Program
No	272	86.1
Yes	44	13.9
Schooling (in years)
0-7	74	23.4
8-10	123	38.9
11 or more	119	37.7
Household income per capita (in reais)
18.70 -399	94	33.3
400 - 749	96	34.0
750 - 5000	92	32.7
Obstetric
No. of pregnancies
One	96	30.4
Two	113	35.7
Three or more	107	33.9
Nutritional status during pregnancy
Low weight	37	12.2
Eutrophy	126	41.6
Overweight	93	30.7
Obesity	47	15.5
Food Insecurity
Yes	142	45.1
No	173	54.9

Item	Question	With FI
Item	Question	n	%
1	In the last three months, did you have the preoccupation that the food in your house would end before you were able to purchase, receive or produce more food?	104	73.2
2	In the last three months, did the food end before you had money to buy more?	45	31.7
3	In the last three months, did you run out of money in order to have healthy and varied meals?	92	64.8
4	In the last three months, did you or any adult in your home decrease, from time to time, the amount of food at meals or did you skip meals because there was not enough money to buy food?	29	20.4
5	In the last three months, did you eat less than necessary because there was not enough money to buy food?	25	17.6

Variables	FI^* * Prevalence of FI in the categories of the variables - percentage in line.		PR gross (CI95%)	p ^ Wald test by means of Robust Poisson Regression.	Adjusted PR (CI95%)	p ^ Wald test by means of Robust Poisson Regression.
Demographic	n	%
Age range (in years)				0.015		0.023^a a adjusted for demographic variables (age group and race/color);
0-19	14	31.1	1.00		1.00
20-29	84	44.7	1.43 (0.90 -2.28)		1.41(0.88 -2.23)
30 or more	44	53.7	1.72 (1.06 -2.78)		1.66 (1.02 -2.69)
Marital status				0.255		-
With partner	115	43.7	1.00		-
Without a partner	27	57.9	1.18 (0.88 -1.59)		-
Color/race				0.007		0.009^a a adjusted for demographic variables (age group and race/color);
White and Asian	62	36.7	1.00		1.00
Black and indigenous	77	54.2	1.41 (1.09 -1.81)		1.39 (1.08 -1.79)
Socioeconomic				0.004		-
Paid Work
Yes	49	35.5	1.00		-
No	93	52.5	1.47 (1.13-1.92)		-
Bolsa Família Program				<0.001		0.121^b b adjusted for demographic variables (age and color/race) and socioeconomic (paid work, Bolsa Família, schooling, and income). PR altered to p<0.25 in the adjusted analysis. The p-values in bold were statistically significant (p<0.05).
Yes	113	41.7	1.00		1.00
No	29	65.9	1.58 (1.22 -2.04)		1.20 (0.95 -1.53)
Schooling (in years)				<0.001		0.003^b b adjusted for demographic variables (age and color/race) and socioeconomic (paid work, Bolsa Família, schooling, and income). PR altered to p<0.25 in the adjusted analysis. The p-values in bold were statistically significant (p<0.05).
0-7	44	59.5	1.84 (1.33 -2.55)		1.58 (1.14 -2.19)
8-10	60	48.8	1.51 (1.10 -2.08)		1.25 (0.88 -1.77)
11 or more	38	32.2	1.00		1.00
Household income per capita (in reais)^* ***** Based on the minimum wage of 2016 = R$ 880.00.				<0.001		<0.001^b b adjusted for demographic variables (age and color/race) and socioeconomic (paid work, Bolsa Família, schooling, and income). PR altered to p<0.25 in the adjusted analysis. The p-values in bold were statistically significant (p<0.05).
1^st tercile (18.70 - 399)	23	64.9	2.59 (1.76-3.81)		2.07 (1.36 -3.14)
2^nd tercile (400-749)	43	44.8	1.79 (1.17 -2.72)		1.59 (1.03 -2.46)
3^rd tercile (750-5000)	61	25.0	1.00		1.00
Obstetric
No. of pregnancies				<0.001		-
One	30	29.2	1.00	-	-
Two	90	45.1	1.54 (1.06 -2.24)	-	-
Three or more	22	59.4	2.03 (1.43-2.89)		-
Anthropometric
Nutritional status during pregnancy				0.828		-
Low weight	13	35.1	1.00	-	-
Eutrophy	66	52.4	1.49 (0.93-2.38)	-	-
Overweight	35	37.6	1.07 (0.64-1.78)	-	-
Obesity	24	51.1	1.45 (0.86-2.44)	-	-

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[TFN1] Quantity of information ignored by the variable: age n= 1; color/race, n= 4; paid work n= 1; Bolsa Família Program n=1; schooling n=1, household income per capita n= 34; number of pregnancies n= 1; nutritional status n=13; food insecurity, n=1. Household income per capita in US Dollars: 1^st tercile $ 5.74 -122.44; 2^nd tercile $ 122.4 - 229.84; 3^rd tercile $ 230.15 - 1534.30 (quote held on 12/31/2016 by the Central Bank of Brazil R$ 3.2588)