Project – Household Food Insecurity and the Dietary Diversity of Pregnant Women in Low-Income Urban Communities in Lagos

CHAPTER ONE

INTRODUCTION

1.1 Background to the Study

Pregnancy is a critical period of the life course during which adequate nutrition is essential for the health and well-being of both the mother and the developing fetus. The physiological demands of pregnancy increase the need for energy, protein, vitamins, minerals and other essential nutrients required for maternal tissue development, placental growth, fetal development and preparation for childbirth and breastfeeding. Consequently, the quality and quantity of food consumed by a pregnant woman can have important implications for maternal health, fetal growth and subsequent child health. The World Health Organization (WHO) emphasizes that healthy nutrition during pregnancy is fundamental to maternal and fetal health and recommends appropriate dietary counselling as part of quality antenatal care (WHO, 2016, 2023).

Pregnancy places additional nutritional demands on women because the developing fetus depends substantially on the mother for nutrients required for growth and development. Inadequate dietary intake during pregnancy can contribute to maternal undernutrition, anaemia, inadequate gestational weight gain and other adverse outcomes. At the same time, excessive consumption of energy-dense but nutrient-poor foods can contribute to overweight and other nutrition-related problems. This makes the issue of maternal nutrition more complex than simply ensuring that pregnant women eat enough food. The diet must also provide adequate variety and nutrient density.

Dietary diversity is an important component of diet quality. It refers to the consumption of foods from a variety of food groups over a specified period. A diverse diet increases the likelihood that an individual will obtain a wider range of essential nutrients. For women of reproductive age, the Food and Agriculture Organization (FAO) and related methodological work have developed the Minimum Dietary Diversity for Women (MDD-W) indicator, which assesses consumption across ten food groups. The indicator is based on whether a woman consumed foods from at least five of ten specified food groups during the previous 24 hours. These groups include grains, white roots and tubers, plantains, pulses, nuts and seeds, dairy, meat/poultry/fish, eggs, dark green leafy vegetables, and other fruits and vegetables.

Dietary diversity is particularly important during pregnancy because micronutrient requirements increase while the nutritional consequences of inadequate dietary intake may affect both the woman and her fetus. Nutrients such as iron, folate, calcium, iodine, vitamin A and other micronutrients play important roles in blood formation, neurological development, skeletal development, immune function and healthy pregnancy outcomes. WHO therefore recommends appropriate nutrition counselling during antenatal care and recommends iron and folic acid supplementation during pregnancy to reduce the risks associated with maternal anaemia and related adverse outcomes (WHO, 2016).

The importance of maternal dietary quality becomes even more pronounced in low- and middle-income countries where poverty, food price increases, limited access to diverse foods and household resource constraints may restrict dietary choices. In such settings, households may have sufficient access to inexpensive staple foods but limited ability to regularly purchase animal-source foods, fruits, vegetables, dairy products and other nutrient-rich foods. As a result, a pregnant woman may consume sufficient quantities of calories while still having an inadequate intake of essential micronutrients.

One of the major social and economic conditions that can undermine access to adequate and nutritious food is household food insecurity. The Food and Agriculture Organization (FAO) conceptualizes food insecurity in terms of inadequate or uncertain access to sufficient, safe and nutritious food necessary for normal growth and an active and healthy life. Food insecurity may occur when households lack sufficient economic resources, when food prices are too high, when income is unstable or when physical and social barriers prevent access to appropriate foods. Importantly, food insecurity is not limited to complete absence of food. It can also involve uncertainty about food access, compromises in food quality, reductions in dietary variety, reductions in food quantity and skipping meals.

Global evidence shows that food insecurity remains a major public health concern. The FAO’s State of Food Security and Nutrition in the World 2024 reported that approximately 2.33 billion people experienced moderate or severe food insecurity globally in 2023, including about 864 million people who experienced severe food insecurity. The report further emphasizes that food insecurity is experienced differently across rural, peri-urban and urban populations and has important gender dimensions.

Urbanization does not automatically eliminate food insecurity. Although cities may provide greater access to markets and employment opportunities, low-income urban households often depend heavily on purchased food. This can make them particularly vulnerable to inflation, unemployment, unstable income and sudden increases in food prices. Unlike some rural households that may produce portions of their own food, poor urban households frequently have little capacity to grow food for household consumption. Consequently, changes in food prices can directly affect what households can afford and the quality of foods they purchase.

This issue is highly relevant in Nigeria, where food insecurity continues to affect vulnerable populations. Nigeria has experienced substantial economic and social pressures that influence household food access, including poverty, unemployment, inflation, fluctuations in household purchasing power and increasing costs of food. These conditions can affect household decisions about what foods are purchased and consumed. When household resources become inadequate, families may prioritize cheaper staple foods over relatively expensive nutrient-dense foods such as meat, fish, eggs, dairy products, fruits and vegetables.

The relationship between food insecurity and maternal nutrition is particularly concerning because pregnant women have increased nutritional requirements. A household experiencing food insecurity may respond to limited resources by reducing meal frequency, reducing portion sizes, substituting expensive foods with cheaper alternatives, purchasing less diverse foods or prioritizing food for other household members. Such coping mechanisms can expose pregnant women to inadequate dietary diversity.

Evidence from Nigeria provides strong support for concern about food insecurity among pregnant women. Ujah et al. (2023), using data from the 2021 Nigeria Multiple Indicator Cluster Survey/Nationally representative data and multilevel analysis, found a high prevalence of food insecurity among pregnant women in Nigeria. Nearly three-quarters of the pregnant women studied experienced moderate or severe food insecurity. The study further reported that approximately 76% consumed only a limited variety of foods, 67% reported skipping meals because of lack of resources, and about 71% reported eating less than they thought they should because of financial constraints. Overall, 43.7% of the pregnant women were classified as living in households experiencing severe food insecurity, while 29.9% experienced moderate food insecurity.

These findings are particularly important because they demonstrate that food insecurity among pregnant women is not simply a question of whether food is physically available. Rather, food insecurity can directly influence the quality and variety of food consumed. A woman may have access to food every day but still experience inadequate dietary diversity because household resources restrict her ability to consume foods from multiple food groups.

The socioeconomic circumstances of households are therefore important in understanding dietary diversity. Household income, educational attainment, occupation, household size, wealth and food expenditure can influence the ability of pregnant women to obtain diverse foods. Where income is limited, households may purchase foods that provide the greatest quantity of energy for the available money. Staple foods such as rice, yam, cassava, bread and other carbohydrate-rich foods may consequently constitute a large proportion of household diets, while foods such as fruits, vegetables, eggs, fish, meat and dairy products may be consumed less frequently.

Pregnancy itself can further complicate dietary practices. Pregnant women may experience nausea, vomiting, food aversions, cravings and other physiological changes that influence their food choices. Cultural beliefs and food taboos may also lead some women to avoid certain foods during pregnancy. These practices can interact with household food insecurity. A woman who is already unable to afford a diverse diet may become even more vulnerable if cultural or personal food restrictions further reduce the range of foods she consumes.

Research conducted specifically among pregnant women attending primary healthcare centres in Lagos provides important evidence concerning dietary diversity. Akinyemi et al. (2021) examined dietary habits and dietary diversity among 350 pregnant women attending primary healthcare centres in Lagos State. The researchers found that only 30.8% of respondents had a high dietary diversity score. The mean dietary diversity score was 5.0 ± 1.7. Although starchy staples were widely consumed, consumption of several nutrient-rich food groups was considerably lower. For example, only 46.0% consumed eggs, 49.1% consumed legumes, nuts and seeds, 54.3% consumed milk and milk products, and 48.0% consumed dark green leafy vegetables during the 24-hour recall period.

The same Lagos study identified important socioeconomic differences in dietary diversity. Higher dietary diversity was associated with factors such as higher educational attainment, professional occupation and better housing conditions. This suggests that the capacity to consume a diverse diet is partly influenced by the socioeconomic resources available to pregnant women. The researchers concluded that healthy dietary habits and high dietary diversity were relatively low among the pregnant women studied and recommended nutrition interventions, particularly for women from lower socioeconomic backgrounds.

The Lagos evidence is especially relevant to the present study because the earlier study was conducted among pregnant women attending primary healthcare centres and included a pre-test in Mushin Local Government Area. However, its principal sampling area was Surulere LGA, and its primary objective was to assess dietary habits, diversity and predictors rather than specifically investigate the relationship between household food insecurity and dietary diversity among pregnant women in Mushin.

This distinction creates an important research opportunity. Food insecurity is potentially one of the pathways through which socioeconomic conditions influence dietary diversity. While socioeconomic status may predict dietary diversity, food insecurity provides a more direct measure of whether household resources are sufficient to secure adequate food. Examining food insecurity alongside dietary diversity may therefore provide a clearer understanding of the nutritional challenges experienced by pregnant women in low-income urban communities.

Mushin Local Government Area presents a relevant context for such an investigation. Mushin is an established urban area within Lagos State and is characterized by substantial population density and active commercial and residential activities. Like many low-income urban environments, households may depend heavily on purchased food and may face financial pressures associated with housing, transportation, healthcare, education and food expenditure. For pregnant women living in economically constrained households, these competing financial demands may influence the amount and variety of food that can be purchased.

The urban food environment can also influence dietary choices. Markets, food vendors, restaurants and informal food outlets are often readily available in densely populated urban communities. However, physical availability does not necessarily mean economic accessibility. A wide range of foods may be present in local markets while low-income households remain unable to purchase the more expensive and nutrient-dense options regularly. Consequently, food insecurity in urban areas may manifest through constrained purchasing power rather than absolute physical absence of food.

Primary healthcare centres are important points of contact for pregnant women in such communities. Antenatal care provides an opportunity for healthcare workers to identify nutritional risks, provide dietary counselling, encourage appropriate supplementation and refer women who require additional support. WHO recommends nutrition counselling during pregnancy as part of antenatal care and emphasizes the importance of promoting healthy eating, adequate energy and protein intake and appropriate use of micronutrient supplements.

Nevertheless, nutrition education alone may not be sufficient when the principal barrier to dietary diversity is household poverty or food insecurity. A pregnant woman may understand the importance of consuming fruits, vegetables, eggs, fish, legumes and dairy products but may not be able to afford them. WHO recognizes this distinction by noting that nutrition education and counselling may be more effective in undernourished populations when combined with appropriate nutrition support where needed.

The Nigerian primary healthcare system therefore has an important role in identifying pregnant women who may be nutritionally vulnerable. The National Nutrition and Health Survey conducted by the National Bureau of Statistics, in collaboration with the Federal Ministry of Health, National Population Commission and UNICEF, has emphasized the importance of assessing nutrition among women of reproductive age and monitoring nutrition-related conditions through health systems.

Household food insecurity can affect pregnant women through several pathways. First, it can reduce the quantity of food available. Second, it can reduce food quality because households substitute expensive foods with cheaper alternatives. Third, it can reduce dietary diversity because households repeatedly consume a limited number of affordable staple foods. Fourth, it can increase meal skipping and irregular eating. Fifth, it may increase dependence on inexpensive processed or energy-dense foods that may provide calories without sufficient micronutrients.

The potential consequences extend beyond the mother. Maternal nutritional status influences fetal growth and development, birth outcomes and, potentially, the child’s long-term health trajectory. WHO notes that appropriate nutrition during pregnancy is important for maternal and fetal outcomes and recommends dietary counselling and nutritional interventions according to the nutritional context of the population.

Dietary diversity therefore provides a useful lens through which maternal food access can be examined. A woman may not report hunger or complete absence of food but may still consume a monotonous diet dominated by staple carbohydrates. Such a dietary pattern may not provide adequate quantities of iron, folate, calcium, vitamin A, zinc, protein and other nutrients. Consequently, measuring dietary diversity alongside household food insecurity may reveal nutritional vulnerabilities that might not be identified by asking only whether women have enough food to eat.

The issue is also relevant to the Sustainable Development Goals, particularly SDG 2 (Zero Hunger), which seeks to end hunger, achieve food security and improved nutrition, and promote sustainable agriculture. Maternal nutrition is closely connected with these goals because ensuring adequate nutrition during pregnancy contributes to healthier mothers and children and helps reduce intergenerational cycles of malnutrition and poverty.

The urban setting further makes this investigation important. Rapid urbanization changes food systems, household livelihoods and patterns of food consumption. Poor urban households may experience unstable income while simultaneously facing high costs for food, transportation, housing and healthcare. Women in such households may be particularly vulnerable during pregnancy because nutritional requirements increase at a time when household resources may already be limited.

Against this background, the present study focuses on household food insecurity and dietary diversity among pregnant women attending selected primary healthcare centres in Mushin Local Government Area of Lagos State. The study seeks to determine the extent of household food insecurity among the pregnant women, assess their dietary diversity, identify the food groups most commonly and least commonly consumed, and determine whether household food insecurity is significantly associated with dietary diversity.

The study is particularly important because available evidence from Lagos has established that inadequate dietary diversity exists among pregnant women, while national evidence has demonstrated a high burden of food insecurity among pregnant women in Nigeria. However, there remains a need for localized evidence specifically examining how household food insecurity relates to dietary diversity among pregnant women receiving antenatal care in Mushin LGA. Such evidence can help primary healthcare providers, public health practitioners, policymakers and community nutrition programmes design interventions that address not only nutrition knowledge but also the economic and household-level barriers to healthy dietary practices.

1.2 Statement of the Problem

Adequate nutrition during pregnancy is essential for maternal health, fetal growth and healthy pregnancy outcomes. Nevertheless, many pregnant women in low- and middle-income settings continue to experience difficulties in accessing adequate and diverse diets. The problem is particularly concerning where household economic resources are insufficient to meet food needs. Household food insecurity may force families to reduce food quantities, compromise food quality, skip meals or rely heavily on inexpensive staple foods. For pregnant women, these coping strategies may result in diets that are monotonous and insufficiently diverse.

The problem is not simply the absence of food. A household may have food available but still be unable to provide a nutritionally adequate diet. When financial resources are limited, households often prioritize foods that are relatively cheap, filling and readily available. In many Nigerian settings, this can result in heavy reliance on staples such as rice, cassava, yam and other carbohydrate-rich foods while the consumption of animal-source foods, eggs, dairy products, fruits and vegetables is reduced. Such dietary patterns may provide energy but fail to adequately meet the increased micronutrient requirements of pregnancy.

Evidence from Nigeria demonstrates that food insecurity among pregnant women is substantial. Ujah et al. (2023) found that nearly three-quarters of pregnant women in Nigeria experienced moderate or severe food insecurity. The study reported that 76% consumed a limited variety of foods, 67% skipped meals because of lack of resources and approximately 71% ate less than they thought they should because of financial constraints. The study further found that 43.7% of pregnant women lived in households classified as severely food insecure.

These findings are alarming because food insecurity may directly undermine dietary diversity. When households cannot afford a broad range of foods, pregnant women may consume fewer food groups and rely on repetitive meals. This may increase the risk of inadequate intake of essential micronutrients and high-quality protein. Therefore, food insecurity should be considered not only as a social welfare problem but also as a maternal and public health concern.

Evidence from Lagos further demonstrates that dietary diversity among pregnant women is not optimal. A study of 350 pregnant women attending primary healthcare centres in Lagos found that only 30.8% had a high dietary diversity score. The study also found relatively low consumption of several nutrient-rich food groups, including eggs, legumes, nuts and seeds, milk and milk products, and dark green leafy vegetables.

The Lagos study also found that higher dietary diversity was associated with socioeconomic characteristics such as education, professional occupation and better housing conditions. These findings suggest that socioeconomic circumstances may influence pregnant women’s ability to consume diverse diets. However, socioeconomic status alone does not fully explain the immediate experience of food access within households. A household may have a particular income level but face different food demands depending on household size, income stability, debts, healthcare expenditure and other competing needs.

Household food insecurity therefore provides an important additional dimension. It captures the experience of uncertainty or inadequacy in food access and the strategies households use when resources are insufficient. A pregnant woman living in a household that frequently runs out of food, reduces meal portions or cannot afford nutritious foods may experience dietary limitations even if she attends antenatal care and has adequate knowledge of healthy eating.

This creates a major public health challenge. Healthcare workers may advise pregnant women to consume diverse diets containing fruits, vegetables, legumes, eggs, fish, meat and dairy products. However, such recommendations may be difficult to implement when household economic resources are insufficient. WHO’s antenatal care guidance recognizes the importance of nutrition counselling during pregnancy but also acknowledges that nutrition education may need to be complemented by nutritional support in undernourished populations.

Another dimension of the problem is that the nutritional consequences of food insecurity may remain hidden during routine antenatal care. A pregnant woman may attend clinic regularly, receive routine antenatal supplements and report no severe hunger while still consuming a diet with inadequate diversity. Dietary monotony may not be immediately visible unless healthcare providers specifically assess food consumption patterns and household food access.

The situation is particularly relevant in low-income urban communities such as those found within Mushin LGA. Urban households frequently depend on purchased food and may have limited opportunities for household food production. Consequently, household income and food prices have a direct influence on food choices. When household income is inadequate, pregnant women may have little control over the types of food purchased or may have to share limited household food resources with other family members.

Furthermore, pregnancy may increase household expenditure. Costs associated with antenatal care, transportation, medications, laboratory tests, preparation for delivery and other household needs may compete with available resources for food. In households with limited income, these competing demands may increase vulnerability to food insecurity.

There is also a potential interaction between household food insecurity and women’s individual food choices. Food insecurity may constrain what foods are available, while pregnancy-related nausea, vomiting, food aversion, cravings and cultural food restrictions may further reduce dietary variety. Consequently, a pregnant woman may experience inadequate dietary diversity through multiple interacting pathways.

The problem is particularly significant because dietary diversity is associated with the probability of obtaining a broader range of essential nutrients. The MDD-W framework provides a practical means of assessing whether women consume foods from a minimum number of food groups. FAO guidance identifies five or more of ten food groups as the threshold for achieving minimum dietary diversity among women of reproductive age.

Despite the relevance of this indicator, relatively limited localized evidence exists on the relationship between household food insecurity and dietary diversity among pregnant women specifically in Mushin LGA. Existing Lagos research has documented dietary diversity among pregnant women attending primary healthcare centres, but its main sampling area was Surulere LGA and it focused primarily on dietary habits, diversity and predictors rather than household food insecurity as the central explanatory variable.

Similarly, the national study by Ujah et al. (2023) established a high burden of food insecurity among pregnant women in Nigeria but was not designed specifically to explain the relationship between household food insecurity and dietary diversity among pregnant women attending selected PHCs in Mushin LGA.

This creates a contextual and empirical gap. National evidence may conceal important differences between urban communities, while findings from other parts of Lagos may not adequately represent the socioeconomic and food-access experiences of pregnant women in Mushin. Localized research is therefore required to establish whether household food insecurity is associated with lower dietary diversity among pregnant women receiving antenatal care in the area.

Failure to address this problem may have implications for maternal and child health interventions. If inadequate dietary diversity is primarily associated with lack of knowledge, nutrition education may be sufficient to some extent. However, if household food insecurity is a major determinant, education alone may have limited impact. Interventions may need to include targeted food support, social protection, economic empowerment, nutrition-sensitive programmes, appropriate referral systems and strengthened nutrition counselling within primary healthcare.

There is consequently a need for empirical evidence that moves beyond general discussions of maternal nutrition to examine the relationship between household food insecurity and the actual diversity of foods consumed by pregnant women. Understanding this relationship can help healthcare providers and policymakers identify women at greater nutritional risk and design interventions that address both immediate food access and longer-term dietary quality.

It is against this background that this study investigates Household Food Insecurity and the Dietary Diversity of Pregnant Women in Low-Income Urban Communities in Lagos, with specific focus on pregnant women attending selected primary healthcare centres in Mushin Local Government Area, Lagos State.

1.3 Aim of the Study

The main aim of this study is to examine the relationship between household food insecurity and dietary diversity among pregnant women attending selected primary healthcare centres in Mushin Local Government Area, Lagos State.

1.3.1 Specific Objectives

The specific objectives are to:

1. determine the level of household food insecurity among pregnant women attending selected primary healthcare centres in Mushin LGA;
2. assess the dietary diversity of pregnant women attending selected primary healthcare centres in Mushin LGA;
3. identify the major food groups consumed by pregnant women attending selected primary healthcare centres in Mushin LGA;
4. identify the major socioeconomic and household factors associated with household food insecurity among the pregnant women.

1.4 Research Questions

The following research questions will guide the study:

1. What is the level of household food insecurity among pregnant women attending selected primary healthcare centres in Mushin LGA?
2. What is the level of dietary diversity among pregnant women attending selected primary healthcare centres in Mushin LGA?
3. What major food groups are consumed by pregnant women attending selected primary healthcare centres in Mushin LGA?
4. What socioeconomic and household factors are associated with household food insecurity among the pregnant women?

1.5 Research Hypothesis

The following null hypothesis will be tested at the 0.05 level of significance:

H₀: There is no significant relationship between household food insecurity and dietary diversity among pregnant women attending selected primary healthcare centres in Mushin Local Government Area, Lagos State.

1.6 Significance of the Study

This study will be significant to pregnant women, healthcare workers, primary healthcare centres, Lagos State health authorities, public health practitioners, nutritionists, policymakers, community development organizations, researchers and other stakeholders concerned with maternal and child health.

Pregnant Women

The study may increase awareness among pregnant women about the importance of dietary diversity during pregnancy. It may also encourage women to discuss food-related challenges with healthcare providers during antenatal visits rather than assuming that nutritional difficulties are simply personal or household matters.

Healthcare Workers

The findings may assist nurses, midwives, community health officers, doctors and nutrition professionals working in primary healthcare centres to recognize food insecurity as a potential barrier to healthy dietary practices. The findings may encourage more individualized nutrition counselling during antenatal care.

Primary Healthcare Centres

The study may provide evidence that can be used to strengthen nutritional screening and counselling services within selected PHCs. Healthcare providers may be encouraged to identify women experiencing household food insecurity and provide appropriate counselling, referrals and support.

Lagos State Ministry of Health

The findings may provide useful local evidence for planning maternal nutrition interventions within primary healthcare services. If a significant association is identified between food insecurity and low dietary diversity, the evidence may support integration of food-security screening and nutrition-sensitive interventions into maternal health programmes.

Public Health Practitioners

Public health professionals may use the findings to design interventions that address both nutritional knowledge and socioeconomic barriers to healthy diets. This is important because nutrition education alone may be inadequate where women cannot afford diverse foods.

Nutritionists and Dietitians

The findings may assist nutrition professionals in developing culturally appropriate and economically realistic dietary recommendations for pregnant women in low-income urban households.

Policymakers

The study may contribute to evidence-based policy discussions concerning maternal nutrition, household food security, poverty reduction, social protection and primary healthcare. It may demonstrate the need for interventions that recognize the relationship between household economic conditions and maternal dietary quality.

Researchers

The study will contribute to the literature on food insecurity and maternal nutrition in Nigeria. It may also provide a basis for future research involving other LGAs in Lagos State and other urban communities in Nigeria.

1.7 Scope of the Study

The study focuses on household food insecurity and dietary diversity among pregnant women attending selected primary healthcare centres in Mushin Local Government Area, Lagos State.

Content Scope

The study will focus on household food insecurity, including inadequate access to food, uncertainty about food availability, inability to afford nutritious foods, meal reduction and other food-related coping experiences.

Dietary diversity will be examined in relation to the variety of food groups consumed by pregnant women. The study may employ the Minimum Dietary Diversity for Women framework, which assesses consumption across ten food groups and identifies whether a woman consumed food from at least five groups during the previous 24 hours.

The study will also examine selected sociodemographic and socioeconomic characteristics, including age, marital status, educational level, occupation, household size, income and other factors relevant to household food security and dietary practices.

Geographical Scope

The study will be conducted among pregnant women attending selected primary healthcare centres in Mushin Local Government Area of Lagos State, Nigeria.

Population Scope

The population will consist of pregnant women who attend the selected primary healthcare centres for antenatal care during the period of the study.

1.8 Delimitation of the Study

The study is delimited to pregnant women attending selected primary healthcare centres in Mushin LGA. It does not cover pregnant women receiving antenatal services exclusively from tertiary hospitals, private hospitals or facilities outside the selected PHCs.

The study is also specifically concerned with household food insecurity and dietary diversity. Other dimensions of maternal nutrition, such as biochemical micronutrient assessment, anthropometric measurements, anaemia diagnosis, gestational weight gain and pregnancy outcomes, may be considered only where relevant to the discussion but are not the principal variables of the study.

The study will assess dietary diversity based primarily on reported food consumption rather than laboratory analysis of nutrient intake.

1.9 Operational Definition of Terms

Household Food Insecurity

Household food insecurity refers to a household’s inadequate or uncertain access to sufficient, safe and nutritious food because of limited financial or other resources. In this study, it includes experiences such as inability to afford healthy foods, reducing food variety, reducing meal quantity, skipping meals and worrying about having enough food.

Dietary Diversity

Dietary diversity refers to the number and variety of different food groups consumed by a pregnant woman within a specified reference period, particularly the previous 24 hours.

Minimum Dietary Diversity for Women (MDD-W)

MDD-W is an indicator used to assess whether women of reproductive age have consumed foods from at least five of ten defined food groups during the previous 24 hours. It is used as a population-level indicator of dietary diversity.

Pregnant Women

Pregnant women refer to women who have a confirmed pregnancy and are attending antenatal care at the selected primary healthcare centres in Mushin LGA during the study period.

Low-Income Urban Community

A low-income urban community refers to a densely populated urban environment in which a substantial proportion of households experience economic constraints that may affect access to adequate housing, healthcare, food and other basic necessities.

Maternal Nutrition

Maternal nutrition refers to the nutritional status and dietary intake of a woman before and during pregnancy and its implications for her health and the health and development of her fetus.

Food Group

A food group refers to a category of foods with broadly similar nutritional characteristics. For dietary diversity assessment, the study will use the recognized food-group classification underlying the MDD-W framework.

Primary Healthcare Centre

A primary healthcare centre refers to a frontline health facility that provides basic preventive, promotive and curative health services, including antenatal care for pregnant women.

Antenatal Care

Antenatal care refers to healthcare services provided to pregnant women during pregnancy to promote maternal and fetal health, identify and manage risks and prepare women for childbirth and the postnatal period.

Household

A household refers to persons who normally live together and share arrangements for food and other basic household resources, as defined for the purpose of the study.

Food Insecurity Experience

Food insecurity experience refers to a woman’s or household’s reported experience of inadequate access to food due to insufficient money or other resources, including worry about food, reduced food quality or variety, reduced food quantity and meal skipping.

1.10 Organization of the Study

The study will be organized into five chapters.

Chapter One presents the introduction, background to the study, statement of the problem, aim and objectives, research questions, research hypothesis, significance of the study, scope, delimitation, operational definitions and organization of the study.

Chapter Two will review relevant literature on household food insecurity, maternal nutrition, dietary diversity, food access, socioeconomic determinants of maternal dietary practices and related empirical studies. Relevant theoretical perspectives will also be examined.

Chapter Three will present the research methodology, including the research design, study area, population of the study, sample size, sampling procedure, research instrument, validity and reliability, ethical considerations, method of data collection and methods of data analysis.

Chapter Four will present the results and analysis of data obtained from the respondents. The research questions will be answered and the research hypothesis will be tested using an appropriate statistical technique.

Chapter Five will present the summary of findings, conclusion and recommendations based on the results of the study. Suggestions for further research will also be provided.

Project – Household Food Insecurity and the Dietary Diversity of Pregnant Women in Low-Income Urban Communities in Lagos