Addressing embodied inequities in health: how do we enable improvement in women's diet in pregnancy?

L McKerracher; S Oresnik; T Moffat; B Murray-Davis; J Vickers-Manzin; L Zalot; D Williams; D M Sloboda; M E Barker

doi:10.1017/S1368980020001093

Addressing embodied inequities in health: how do we enable improvement in women's diet in pregnancy?

Public Health Nutr. 2020 Nov;23(16):2994-3004. doi: 10.1017/S1368980020001093. Epub 2020 Jul 6.

Authors

L McKerracher^{1

2}, S Oresnik², T Moffat², B Murray-Davis³, J Vickers-Manzin⁴, L Zalot⁴, D Williams², D M Sloboda^#^{1

5

6

7}, M E Barker^#⁸

Affiliations

¹ Department of Biochemistry and Biomedical Sciences, McMaster University, Hamilton, ON, Canada.
² Department of Anthropology, McMaster University, Hamilton, ON, Canada.
³ Department of Midwifery, McMaster University, Hamilton, ON, Canada.
⁴ Public Health Services, Healthy Families Division, Hamilton, ON, Canada.
⁵ Department of Obstetrics and Gynecology, McMaster University, Hamilton, ON, Canada.
⁶ Department of Pediatrics, McMaster University, Hamilton, ON, Canada.
⁷ Farncombe Institute of Digestive Health, McMaster University, Hamilton, ON, Canada.
⁸ Medical Research Council Lifecourse Epidemiology Unit, Southampton University, Southampton, United Kingdom of Great Britain and Northern Ireland.

^# Contributed equally.

Abstract

Objective: To disrupt cycles of health inequity, traceable to dietary inequities in the earliest stages of life, public health interventions should target improving nutritional wellbeing in preconception/pregnancy environments. This requires a deep engagement with pregnant/postpartum people (PPP) and their communities (including their health and social care providers, HSCP). We sought to understand the factors that influence diet during pregnancy from the perspectives of PPP and HSCP, and to outline intervention priorities.

Design: We carried out thematic network analyses of transcripts from ten focus group discussions (FGD) and one stakeholder engagement meeting with PPP and HSCP in a Canadian city. Identified themes were developed into conceptual maps, highlighting local priorities for pregnancy nutrition and intervention development.

Setting: FGD and the stakeholder meeting were run in predominantly lower socioeconomic position (SEP) neighbourhoods in the sociodemographically diverse city of Hamilton, Canada.

Participants: All local, comprising twenty-two lower SEP PPP and forty-three HSCP.

Results: Salient themes were resilience, resources, relationships and the embodied experience of pregnancy. Both PPP and HSCP underscored that socioeconomic-political forces operating at multiple levels largely determined the availability of individual and relational resources constraining diet during pregnancy. Intervention proposals focused on cultivating individual and community resilience to improve early-life nutritional environments. Participants called for better-integrated services, greater income supports and strengthened support programmes.

Conclusions: Hamilton stakeholders foregrounded social determinants of inequity as main factors influencing pregnancy diet. They further indicated a need to develop interventions that build resilience and redistribute resources at multiple levels, from the household to the state.

Keywords: Community engagement; Developmental origins; Dietary inequities; Health inequities; Pregnancy.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Canada
Diet*
Female
Focus Groups
Humans
Postpartum Period
Preconception Care
Pregnancy
Pregnancy Outcome
Prenatal Care
Social Support
Socioeconomic Factors

Abstract

Publication types

MeSH terms

Grants and funding