Adequate dietary diversity among lactating women in conflict-affected and severely food-insecure rural settings in the western part of the Democratic Republic of the Congo

Background Lactating women have heightened nutritional needs to sustain optimal maternal health and adequate breast milk production. Little is known about their diet in low-income and conflict-affected settings and the role of household income sources on maternal diet quality. This study investigated the determinants of dietary diversity and role-playing by household income and nutritional status among lactating women in a food-insecure and conflict-affected area. Methods Between July and September 2024, a community-based cross-sectional study was conducted among 662 lactating women (15–49 years) in Popokabaka Health Zone, Kwango Province, DRC. Dietary diversity was assessed using the Minimum Dietary Diversity for Women (MDD-W). BMI and MUAC were used to measure maternal nutritional status, while household food insecurity was assessed using the Household Food Insecurity Access Scale (HFIAS). Household income sources were categorized as agriculture-only or mixed/non-agricultural. Multivariable logistic regression models coupled to propensity score matching (PSM) and mediation analysis were applied to examine determinants of adequate dietary diversity (MDD-W ≥ 5). Results A total of 662 lactating women were surveyed, with a mean age of 32.8 years. Only 34.8% achieved MDD-W ≥ 5. Multivariable analysis showed that income diversification increased the odds of adequate dietary diversity (AOR: 1.65; 95% CI: 1.09–2.48), while maternal BMI was strongly associated: women with normal BMI (AOR: 1.87; 95% CI: 1.19–2.94) and overweight/obese women (AOR: 6.44; 95% CI: 2.36–17.52) were more likely to meet MDD-W compared to underweight women. After applying PSM, women relying on mixed income sources had significantly higher dietary diversity compared to those relying solely on agriculture (ATET = 0.19, p = 0.001). In addition, mediation analysis suggested that maternal underweight modestly mediated the relationship between income diversification and dietary diversity. Conclusions and recommendations Dietary diversity can be reached by lactating women in conflict-affected rural areas. Household income diversification and maternal nutritional status were the strongest predictors of MDD-W. Understanding adaptive behaviors applied by the lactating to achieve MDD-W should provide an opportunity for improving maternal diets and prioritizing livelihood diversification and targeted nutrition support for undernourished women, alongside broader strategies addressing food insecurity in fragile rural settings.