Abstract:
Background
Inequitable intrahousehold food allocation social norms are practices that can contribute to
unhealthy eating patterns in adolescent girls, such as restrictive diets or less quality and quantity
meals which can contribute to adolescent girls' thinness. This problem is particularly prevalent in
low- and middle- income countries where women are often the primary caregivers in households.
Caregivers' food distribution practices are shaped by community social norms and traditions that
can reinforce inequitable food distribution.
Objective
This dissertation has three main objectives. The first objective is to explore how food allocation
norms contribute to the perpetuation of inequality. The second objective is to examine the
association between these norms and thinness among adolescent girls. The third objective is to
assess the effect of an intervention involving influential community members on improving
household eating practices.
Method
A mix of methods, including qualitative study, cross-sectional study, and quasi-experimental
study, were implemented to address the study objectives. For the qualitative study, thematic
analysis was performed using Open Code software. In total, 192 individuals were involved in the
focus group discussion and in-depth interview. For the quantitative studies, mixed-effect logistic
regression model was applied to determine the association between adolescent girls’ thinness and
unequal intrahousehold food allocation norms using STATA 14.0 statisticalsoftware. A Difference in-difference analyses was performed to see the effect of community-engaging intervention on
family eating practice. A total of 1083 and 1849 of female caregivers and adolescent girls were
considered as a sample for the second and third objective, respectively. The result was described
in proportion and AOR with a 95% confidence interval (CI).
Results
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This dissertation found inequitable intrahousehold food allocation norms and food restrictions that
could negatively affect adolescent girls’ health and nutritional status. Overall, adolescent girls’
thinness was found to be 15.60% (95% CI 13.44–17.77%). The prevailing food allocation norms
were associated with adolescent thinness; Adjusted odds ratio (AOR): 1.43, 95% CI: 1.14–1.80)
in food-secure households. Female caregivers in the communities who participated in the
intervention were more likely to adopt eating together than those who did not participate in the
intervention, AOR 2.08 (95% CI: 1.06,4.09), p-value of 0.033.
Conclusion
The prevailing food allocation social norms in the study showed discriminatory practices that did
not favor adolescent girls. Harmful food allocation social norms exacerbate adolescent thinness in
food-secure households compared to food-insecure households, implying greater inequality when
food is available to allow discriminatory allocations. Paying attention to inequality in relatively
food-secure households is critical to improving the nutritional status of adolescents in low-income
countries. On the other hand, involving influential adult community members in interventions
significantly improves the family practice of eating together in households, favoring adolescent
girls. The intervention has great potential to minimize household food allocation inequalities and
thus improve the nutritional status of young adolescents. Additional studies are necessary for
different social norm contexts for the scale-up of the invention.