CHAPTER TWO
LITERATURE REVIEW
2.1 Introduction
This chapter presents a review of existing literature related to factors contributing to malnutrition among pregnant women. The review is structured according to the study objectives, which include: personal factors, socio-economic factors, and cultural factors influencing malnutrition among pregnant women.
2.2 Personal Factors Contributing to Malnutrition Among Pregnant Women
Numerous studies indicate that educational interventions not only improve knowledge about appropriate nutrition during pregnancy (Rao et al., 2008), but are also positively associated with healthier eating behaviors (Kim et al., 2009). Furthermore, Liu et al. (2009) observed that such interventions enable pregnant women to abandon unhealthy practices, thereby reducing postpartum complications. This highlights the importance of incorporating nutrition education into antenatal care (ANC) services.
A cross-sectional study by Mbule et al. (2013) in Ethiopia assessed maternal nutrition knowledge among 422 pregnant women. The findings revealed that nutritional knowledge significantly influences dietary behavior, with health education encouraging improved food intake. However, more than half (57.8%) of respondents lacked basic understanding of food concepts.
In terms of attitudes, some pregnant women perceive no benefit in attending ANC during the first trimester, as services are often viewed as curative rather than preventive (Mbule et al., 2013). Schaefer et al. (2014) further noted that lack of confidence in health systems—due to inadequate services and medicine shortages—has led to increased reliance on traditional medicine in Uganda. These misconceptions contribute to higher rates of malnutrition, emphasizing the need for strengthened community-based health education.
Child spacing is another critical factor. It refers to the interval between consecutive pregnancies and affects maternal nutritional recovery. Short inter-pregnancy intervals increase the risk of maternal anemia due to insufficient recovery time (Dewey et al., 2007).
Additionally, minor health conditions can impact nutrition. A study in the UK involving over 81,000 pregnant women found that severe nausea and vomiting increased the likelihood of preterm birth by 23% (National Institutes of Health, 2011). Poor nutrition and inadequate weight gain were identified as contributing factors.
Research by Singh et al. (2011) showed inadequate nutrient intake among pregnant women. Energy, protein, and vitamin A intake were below recommended levels, with many women skipping meals or failing to increase food intake during pregnancy. As a result, 9.2% were undernourished. The study concluded that addressing knowledge gaps is essential for improving maternal nutrition.
2.3 Socio-Economic Factors Contributing to Malnutrition Among Pregnant Women
Employment can improve a woman’s economic status, thereby enhancing her nutritional well-being and that of her household. However, if women lack control over income or decision-making, the benefits of employment may be limited.
Education plays a vital role in empowering women. Educated women are more likely to make informed decisions regarding nutrition and healthcare access (Emina et al., 2009). Even minimal education improves the ability to utilize available resources effectively.
Household economic status is a key determinant of nutrition. Higher income allows access to diverse and nutrient-rich foods, while low-income households often rely on cheaper, energy-dense foods with low nutritional value (Population Reference Bureau, 2012). Although economic growth can improve access to food and healthcare, poverty remains associated with malnutrition. Interestingly, in developed countries like the USA, low-income populations are more prone to obesity due to the affordability of unhealthy foods (Drewnowski, 2010).
Food insecurity leads households to prioritize calorie-dense foods to reduce hunger, often at the expense of nutritional quality (DiSantis et al., 2013). This can contribute to both undernutrition and obesity.
A demographic survey in Ethiopia (2010) found that never-married pregnant women were more likely to be undernourished compared to married women. This is attributed to limited decision-making power and restricted access to food resources. Adolescents are particularly vulnerable due to their increased nutritional needs.
Kirunda et al. (2015) found that rural women and those who were divorced, widowed, or separated had higher risks of undernutrition. Surprisingly, working women were also more likely to be undernourished, possibly due to engagement in low-paying, labor-intensive jobs with limited autonomy (Islam, 2010). These findings align with studies from other developing countries.
2.4 Cultural Factors Contributing to Malnutrition Among Pregnant Women
Cultural beliefs significantly influence dietary practices during pregnancy. A study in Nigeria involving 294 pregnant women found that 40% avoided nutritious foods due to cultural beliefs (Kever, 2015).
Similarly, Jacinta et al. (2011) reported that cultural norms and taboos contribute to malnutrition, as some communities restrict consumption of nutrient-rich foods based on religious or traditional beliefs. These socio-cultural factors directly affect food choices and intake.
Food taboos are particularly prevalent in rural settings, where pregnant women may be discouraged from consuming beneficial foods (Merchant, 2014). Such practices can negatively affect maternal and fetal health.
According to Paupério et al. (2014), food taboos involve deliberate avoidance of certain foods beyond personal preference. While some taboos may have protective origins, they can limit access to essential nutrients. Meyer-Rochow (2009) adds that food taboos help maintain cultural identity and social cohesion. However, when based on misinformation, they can deprive pregnant women of adequate nutrition during critical periods.
Overall, cultural beliefs and practices play a significant role in shaping dietary behaviors, often contributing to malnutrition among pregnant women.
