INTRA-HOUSEHOLD FOOD ALLOCATION NORMS AND ADOLESCENT GIRLS' NUTRITION IN WESTERN HARARGHE, OROMIA, ETHIOPIA

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 xv 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.