A formative study of the sociocultural influences on dietary behaviours during pregnancy in rural Bangladesh

Balanced energy protein supplementation (BEP) is recommended for contexts of high maternal undernutrition by the World Health Organization. Despite recent improvements in undernutrition, Bangladesh remains a context where BEP could help accelerate progress towards nutrition goals. In preparation for an effective trial testing a fortified BEP, a qualitative study was undertaken to better understand sociocultural factors influencing dietary behaviours in pregnancy. Married women of reproductive age (n = 23), their husbands (n = 6) and mothers-in-law (n = 6) were interviewed, and focus group discussions were conducted with women (n = 4). Women had a clear understanding of which nutritious foods are important to consume during pregnancy, including green leafy vegetables, dairy and other animal-source foods. Many explained affordability as a barrier to consuming those foods with the desired frequency. Women acquired information about diet and nutrition in pregnancy from community health workers as well as other women in the community. Most preferred to seek information from their own networks before formal health care providers. Women and husbands generally had positive views about micronutrient supplements, although some mothers-in-law were more hesitant. Some food taboos relating to the consumption of certain foods like duck and pigeon meat persist, mainly stemming from concerns for the unborn child. Opportunities exist to build on existing perceptions of healthy diets, potentially framing food or nutrient supplements as a beneficial 'add-on' to promote a healthy pregnancy. There is a scope to strengthen nutrition counselling, especially for the family members, to dispel myths and misconceptions and promote dietary and other support for pregnant women. This formative research study from rural Bangladesh explored factors influencing dietary behaviours during pregnancy. Women generally understood the importance of consuming nutritious foods during pregnancy, although many felt they were too expensive to regularly afford. Micronutrient supplements were viewed positively. Findings will inform a trial of balanced protein energy supplementation. image Women in this part of rural Bangladesh understood which foods were beneficial for health and nutrition during pregnancy and the importance of increasing food intake during pregnancy. Women and husbands were more likely to view nutrition supplements as beneficial during pregnancy; some mothers-in-law expressed reservations about supplements. In the context of a planned effectiveness trial of balanced-energy and protein supplementation, nutrition education should reinforce existing concepts of the importance of healthy diets during pregnancy and build on them to promote the use of nutritious supplements to meet nutrient needs in pregnancy. Financial constraints limit access to nutritious food and micronutrient supplements in pregnancy despite widespread beliefs about their value.