Magnitude and determinants of food insecurity among pregnant women in Nigeria: evidence from a nationwide cross-sectional survey

Background: Food security is crucial to improve maternal nutrition during pregnancy. However, evidence of the magnitude and social determinants of food insecurity among pregnant women is scarce in Nigeria. Therefore, this study used nationally representative data to assess the prevalence and determinants of food insecurity among pregnant women in Nigeria. Methods: The study setting was Nigeria. The study is a secondary analysis of data from the Nigeria Demographic and Health Survey 2018 using a cross-sectional household survey design. We adjusted the data for sampling weight, stratification, and cluster sampling design. The dependent variable was food security status: food security (dietary diversity) and food insecurity (no dietary diversity). The independent variables included women's socio-demographic and household characteristics. We cross-tabulated food security status and pregnant women's characteristics to measure the association using the Chi-square statistics. We included all significant variables from the bivariate analysis in a complex sample logistic regression model to determine the adjusted effect of each independent variable on food insecurity. We set the statistical significance for all inferential analyses at p <0.05. Results: The prevalence of food insecurity among pregnant women in Nigeria is 45%. Residing in the North-East (AOR:1.70, 95%CI:1.26-2.29, p<0.001), Southeast (AOR: 1.47, 95%CI:1.04-2.07, p=0.028) regions, having no education (AOR:1.86, 95%CI:1.28-2.70, p=0.001), primary education (AOR:1.86, 95%CI:1.28-2.69, p=0.001), married/living with a partner (AOR:3.33, 95%CI:1.28-8.67, p=0.014), widowed/divorced/separated (AOR:3.83,95%CI:1.68-8.73, p=0.001), non-exposure to television (AOR:1.55, 95%CI:1.26-1.92, p<0.001), healthcare access barrier (AOR:1.69, 95%CI:1.43-1.99, p<0.001) increased pregnant women's likelihood of being food-insecure. Conclusions: The proportion of food-insecure pregnant women needs to improve in Nigeria. The government and its partners must address the cost of healthy diets, abate conflicts, and strengthen the implementation of food and nutrition policies. It is imperative to incorporate the social determinants of food insecurity identified in this study into policies and plans to improve food security among pregnant women in Nigeria.