Conceptual framework of women’s food environments and determinants of food acquisition and dietary intakes in low- and middle-income countries: a systematic scoping review
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Background
Progress on maternal health in low- and middle-income countries (LMICs) has stagnated, underscoring calls for holistic approaches to improve women’s nutrition. Diets link human health and environmental sustainability, necessitating equitable food system transformations to address climate change and malnutrition in all its forms. Food environments are a key entry point within food systems for improving nutrition; however, existing frameworks are not gender-sensitive and few consider vulnerable groups in low-resource settings.
Methods
We conducted a systematic scoping review of peer-reviewed literature published in English, Spanish, Portuguese, and French from Web of Science, EBSCO, and PubMed to identify determinants of food acquisition practices and dietary intakes of women of reproductive age in LMICs. We synthesised 518 studies from 125 countries. By systematically identifying 143 eco-social, structural and individual-level determinants, we identified key determinants to develop an empirically grounded food environment conceptual framework for women.
Findings
We identified women’s agency, characterised by decision-making and financial autonomy, bargaining power, control over time, and freedom of movement, as a prominent mediator of women’s food acquisition and dietary intakes, including across regions and the rural-urban continuum. Findings indicate that women’s agency, alongside supportive legislative, structural, and social enabling environments will be critical leverage points for improving women’s access to and consumption of nutritious foods, especially where resources are constrained.
Conclusion
For countries to sustainably address malnutrition, this empirically grounded framework identifies pathways for addressing the macro, social and individual determinants of food acquisition and dietary intakes that are often overlooked yet critical for resilient food environments and sustainable development.
Key messages
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This is the first study to provide an empirically grounded food environment conceptual framework specific to women in LMICs.
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By systematically mapping key determinants of women’s food acquisition and dietary intakes, we identified novel food environment dimensions to develop an empirically grounded framework for women with applicability across regions and the rural-urban continuum in low- and middle-income countries.
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This novel conceptual framework, emphasising the importance of women’s agency in relation to external and personal food environments, may be used to guide research needs, analyses, and entry points for interventions to sustainably improve women’s nutrition in LMICs, especially in resource-constrained settings.
Research in context
Evidence before this study
Women in low- and middle-income countries (LMICs) are disproportionally affected by malnutrition in all its forms. Food environments are a key food system entry point to improve nutrition. However, current food environment frameworks are not gender-sensitive, limiting the effectiveness of nutrition interventions. We systematically searched Web of Science Core Collection, EBSCO, and PubMed for peer-reviewed studies published between 1 st January 2010 and 30 th April 2023 in English, Spanish, Portuguese, and French reporting on determinants of women’s food acquisition practices and dietary intakes in LMICs. We used a broad search criterion based on emerging food environment concepts and the expanded food security definition. Data were extracted for women aged 15-49 years and by physiological status (pregnant, lactating, and non-pregnant/non-lactating).
Added value of this study
This is the first study to provide an empirically grounded food environment conceptual framework specific to women in LMICs. By mapping patterns of 143 determinants inductively derived from the literature against existing conceptual frameworks, we identified novel determinants of women’s food acquisition and dietary intakes. Our results are representative across multiple geographical regions and the rural-urban continuum in LMICs. We add a novel socio-ecological layer: women’s agency as a key mediator for the ability of an individual to exert control over resources contributing to one’s own dietary outcomes.
Implications of all the available evidence
Women’s food environments are complex, necessitating holistic systems approaches to sustainably improve women’s nutrition in LMICs. It is critical that policies and programmes address underlying legislative, structural and socio-cultural determinants mediating women’s agency, alongside other key external and personal food environment determinants influencing procurement and consumption of nutritious diets. This novel empirically grounded conceptual framework can guide future research priorities, analytical approaches, and key intervention points to optimise women’s nutrition.
