Intra-Household Food Allocation In Rural Nepal

Background: It is often assumed that pregnant women are discriminated against in the allocation of food in South Asian households. Better understanding of food allocation trends and determinants could inform how nutrition programs can reduce intrahousehold inequity and improve maternal and child nutritional outcomes. Objectives: Measure and explain inequity in intra-household food allocation in rural Nepal by (1) testing for differences in calorie adequacy ratios between household members, (2) identifying determinants of Relative Dietary Energy Adequacy Ratios (RDEARs) – a measure of intra-household food allocation, and (3) testing the effects of ‘Participatory Learning and Action’ (PLA) women’s groups, PLA with food transfers, and PLA with cash transfers, on RDEARs and other dietary outcomes. Methods: Interventions were tested in a four-arm cluster-randomised controlled trial in 80 clusters in Dhanusha and Mahottari districts, Nepal. In 805 rural households across the trial arms, pregnant women, mothers-in-law, and male household heads responded to between one and three 24-hour dietary recalls each. Effects were analysed by fitting multivariable linear and logit regressions. Results: Pregnant women had lower calorie adequacy ratios (median=0.84) than their mothers-in-law (0.97; z=3.80, p<0.001) and male household heads (1.07; z=5.39, p