Background
Materials and methods
Search method
(((((family OR household*)) AND (food OR energy intake OR food habits OR diet OR nutrition*)) AND (allocat* OR distribut* OR decision* OR shared OR sharing OR share))) AND (age factors OR "age" OR sex OR "gender")
Inclusion and exclusion criteria
Study quality assessment
Data extraction strategy
Results
Author | Year | Study method | Sample size | Sample characteristics | Analysis method | Determinant | IHFA outcome |
---|---|---|---|---|---|---|---|
Bangladesh (n = 5) | |||||||
Abdullah and Wheeler [65] | 1985 | Longitudinal 4x 3 day WFR | 53 HH | Rural Muslim households with at least one child under 5 years, from one village. Men and non-pregnant, non-lactating women (age not specified) | Analysis of variance | Season (March to July vs September to December) | RDEAR = Relative Dietary Energy Adequacy Ratio (individual calorie intake as a proportion of body weight / adult male calorie intake as a proportion of body weight) |
Bouis and Novenario-Reese [69] | 1997 | Longitudinal 2x 1 day WFR | 590 HH | Households from 8 rural thanas. Men and women aged >18 years (average age 39 and 35 years respectively) | Regression (coefficients not reported) | • Occupation (farmer or agricultural labourer) • Age and education of head of household • Land ownership | FS/ES = Ratio between ‘food share’ (FS), proportion of total household food that a person consumed, and ‘energy share’ (ES), proportion of household calories that an individual consumed. |
Kumar and Bhattarai [61] | 1993 | Longitudinal 3x 1 day WFR | 300 HH | Households from 8 villages in 4 districts. Men and women aged >18 years | Multivariate analysis (more detail not given; results described but effect size not reported) | Household caloric adequacy | Calorie ‘adequacy’ (Intakes / Requirements) |
Pitt, Rosenzweig and Hassan [32] | 1990 | Longitudinal 1x 1 day WFR in 335 HH; 4x 1 day WFR in 50 HH | 385 HH | Bengali households from 15 villages (excludes hill tribes). Men and women aged ≥12 years. | Linear regression coefficient | Health endowments | Calorie intake |
Tetens et al. [72] | 2003 | Longitudinal 2x 1 day WFR | 304 HH | Two rural villages in lean and peak seasons. Men and women aged 18 to <30, 30 to <60, and ≥60. | Analysis of variance | • Season (lean vs peak season) • Village • Socio-economic status | Calorie intake |
India (n = 8) | |||||||
Aurino [37] | 2016 | Longitudinal 2x 1 day survey (older cohort only) | 976 HH | 20 clusters, with over-sampling in disadvantaged areas. >90% Hindu, and 8% female headed households. Older cohort of boys and girls includes adolescents aged 15 years. | Linear regression coefficient | • Puberty (growth) • School enrolment • Time use • Number of meals • Physical activity | Dietary Diversity Score by gender |
Babu, Thirumaran and Mohanam [62] | 1993 | Longitudinal 6x 3 day WFR | 120 HH | 1 rural village in peak and lean seasons. Sample includes non-agricultural workers (mainly silk weavers), agricultural labourers, and land owning subsistence or ‘market-oriented’ cultivators. Men and women (age not specified) | Descriptive comparisons | • Season • Occupation (subsistence, market-oriented, non-agricultural, and agricultural labourer households) | RDEAR = Relative Dietary Energy Adequacy Ratio (Individual calorie intake as a proportion of individual requirements / Adult male intake as a proportion of his requirements); RDPAR = Relative Dietary Protein Adequacy Ratio (Individual protein intake as a proportion of requirements / Adult male intake as a proportion of his requirements) |
Barker et al. [45] | 2006 | Cross-sectional 1x 1 day survey | 101 HH | 1 rural village, mostly cash crop farmers. Selected households containing a minimum of: husband and wife (age not specified), plus son and daughter both aged 3 to 8 years. | Principal component analysis | • Farm work, household chores | Oil intake (g), and frequency of snacking, fasting, and missing meals |
Basu et al. [67] | 1986 | Cross-sectional 1x 1 day 24h | 219 HH | Households from West Bengal, with men and women aged > 18 years. | Analysis of variance | • Rural vs urban • Occupation (agriculturalist vs plantation worker) • Religion • Ethnicity • Microeconomic subgroups | EI-ER (Energy intake - Energy requirements), and age-sex groups ranked in order of EI-ER |
Behrman and Deolalikar [63] | 1990 | Longitudinal 4x 1 day 24h | 2 rounds of 120 HH | Three rural villages. Sampling stratified to include landless agricultural labourers and landowning cultivators. Men and women (age group not specified) | Linear regression coefficient | Food price elasticities | NAR = Nutrient adequacy ratio (Nutrient intakes / Requirements) |
Brahmam, Sastry and Rao [66] | 1988 | Cross-sectional 1x 1 day 24h | 1878 HH | 10 Indian states, selected households with at least one member of preschool age. | Descriptive comparison for adults | Household calorie adequacy (based on intakes of all respondents within the household) | Calorie adequacy (‘adequate’ = Calorie intake ≥ 70% Recommended Daily Intakes) |
Chakrabarty [73] | 1996 | Longitudinal 2x 2 day 24h | 221 HH | Three groups (high caste, Scheduled Tribe, Scheduled Caste) in West Bengal. Sampled nuclear families with both parents alive, non-working women (for high caste) and working women (for Scheduled Tribe). |
t-test | Availability of food (lean vs peak season) | Cereal intake – Recommended cereal intakes for a balanced diet |
Harriss-White [27] | 1991 | Longitudinal 4x 1 day 24h | 176 HH | Six villages in central and southern India. Men and women (age not specified) |
t-test | • Season • Region • Land holding vs landless | RI = Relative calorie intakes (Individual intakes / Adult male intakes) |
Nepal (n = 1) | |||||||
Gittelsohn [9] | 1991 | Cross-sectional 1x 1 day 24h & observation | 115 HH | Six villages in Western hills. Men and women aged 18-24, 25-49, and ≥50 | Correlation | Food serving habits, including serving order, asking for food, having second helpings, substituting foods, and channelling foods. | FQS = Food quantity score (individual consumption as a proportion of total household consumption / Individual body weight as a proportion of total household body weight) |
Pakistan (n = 1) | |||||||
Government of Pakistan [38] | 1979 | Cross-sectional 1x 24h | 975 HH | Male head of household, plus woman of childbearing age (preferably pregnant or lactating) and all children aged under 3 years. | Linear regression (coefficients not reported) | • Education • Region • Household size • Income | Individual intake / Household intake (calories, protein, iron and vitamin A) |
Sri Lanka (n = 1) | |||||||
Rathnayake and Weerahewa [30] | 2002 | Cross-sectional 1x 24h | 60 HH | Households from lower income group in urban Kandy. Fathers and mothers (age not specified) | Linear regression coefficient and t-test | • Mother’s income • Mother’s education • Ethnicity • Family size | RCA = Relative calorie allocation (calorie intake as a proportion of recommended allowance / Household intake as a proportion of household allowance) |
Qualitative studies (n = 15) | |||||||
---|---|---|---|---|---|---|---|
Author | Year | Study method | Sample size | Sample characteristics | Analysis method | Determinant / theme | IHFA outcome |
Bangladesh (n = 4) | |||||||
Abdullah [36] | 1983 | Unstructured interviews | 40 HH | One rural Muslim village in central-west Bangladesh. Mostly male respondents. Particularly in poor households, women also participated. | Notes recorded on paper, and results analysed by wealth group. | • Economic contributions • Norms relating to receiving a ‘fair share • Food security and scarcity • Household structure (allocation to women in parental vs marital homes) | Food allocation |
Mukherjee [75] | 2002 | Seasonal calendar | 1 group | Not reported | Method of quantifying discrimination not specified | • Season | Discrimination in consumption of food items and types |
Naved [35] | 2000 | Focus group discussions, case studies, and other methods. | Case studies of 22 women; 19 men | Three villages participating in an agricultural program. Male and female beneficiaries of the program. | Triangulation of multiple qualitative techniques | • Physically strenuous labour contributions • Bargaining power • Individuals tastes and preferences (women eating more less-preferred foods than men) • Food availability (Seemingly contradictory anecdotes that increased food availability did not change food allocation patterns much, but food scarcity led to men being less likely to have sufficient food than women.) | Allocation of specific food items |
Rohner and Chaki-Sircar [71] | 1988 | Observation? (limited detail) | 1 village | Not reported | Not reported | • Caste - High caste men and boys had the best quality food, especially eggs, milk and fish. Implied that this is less the case with lower caste households.
| Food quality |
India (n = 7) | |||||||
Caldwell, Reddy and Caldwell [51] | 1983 | In-depth questions and case studies | 50% of 4773 population (n = 2387) | One large village and eight smaller villages in rural area of southern Karnataka. Individual respondent characteristics not reported. | Daily scrutiny of findings and on-going modification of questions to identify behavioural patterns | • Beliefs about equity - Respondents were reluctant to talk about food allocation. This “demonstrates the existence of some belief in equitable distribution”. Inequity was “as much a matter of poor communication as of deliberate intent”. • Interpersonal relationships – Differential food allocation was in decline due to the strengthening bond between husband and wife. | Food allocation |
Daivadanam et al. [59] | 2014 | Interviews and focus group discussions | 17 individuals; 3 groups | Rural areas (one coastal and one non-coastal) Men and women aged between 23 and 75 years, of different religions and socio-economic status. Mostly female heads of household and others involved in dietary decision-making. One group mostly comprised of men. | Modified framework analysis using inductive and deductive reasoning – did not try to fit the data into pre-identified themes. | • Tastes and preferences - women prioritised their own food preferences the least | Allocation of preferred foods |
Katona-Apte [39] | 1977 | In-depth interviews | 62 pregnant women or mothers | Two districts from Tamil Nadu. All households had a total income of <200 Indian Rupees per month. All female respondents, and most were pregnant, lactating, or a mother of child under two years. | Analysis method not reported. | • Cultural beliefs about foods – pregnant and lactating women avoided certain foods, and this caused them to have less adequate diets, particularly if there was lack of variety or budget to replace avoided foods with nutritious alternatives | Allocation of specific food types that have different properties |
Khan et al. [33] | 1987 | In-depth interviews and participant observations | 20 individuals | One study village from western Uttar Pradesh 20 main female informants (age not reported) from different caste and class groups, and extensive discussions with other villagers, including men. | Analysis method not reported. | • Economic contributions - Respondents said that men should eat more because they earn and provide for the family. The belief that men should be given more food was rarer (3 / 6 respondents) when women earned an income. Some women ate less because they did not have time to eat. Women had less appetite due to fatigue after cooking and serving her family members. • Religious and cultural beliefs - Women “enjoy this spirit of sacrifice for the family”. There was also a belief that pregnant women should eat ghee (clarified butter) to give lubrication during birth. The cultural norm of the female cook eating last meant that women eat less. • Status - Women had a religious obligation to fast for the family and for men to have superior status and allocation of food. • Household income - In poor households, the eating order negatively affected women; in wealthy landowning families it did not. | Allocation of food generally, and also of specific food items |
Miller [58] | 1981 | Review of ethnographies | 58 studies | Review of many studies from across India. | Meta-analysis | • Interpersonal relationships - Serving food was a way that women show love and affection to their men. Similarly, refusing to eat food was a common method for a man to punish his wife or mother. | Food allocation |
Nichols [74] | 2016 | Semi-structured interviews, and informal conversations and participant observation | 81 individuals | Four villages in sub-Himalayan district. Respondents: Government workers, NGO employees, village men, women, and couples. Convenience sampling to include respondents from different class, caste, age, gender and household composition. Plus, national-level NGO representatives from Delhi. | Thematic analysis, by coding themes and intersections between themes | • Labour / physically strenuous economic contributions - women ate the least during planting and harvest seasons when they were working the hardest (and working harder than men) due to a lack of appetite from the exhaustion of the labour | Food allocation |
Palriwala [34] | 1993 | Participant observation | 1 village | Sikar district, rural agricultural village with Hindu (85%) and Muslim (15%) castes. Individual participant characteristics not reported. | Not reported | • Cultural beliefs / eating order - youngest daughter in law usually cooks and eats last, leading to less diverse diet as there may be no lentils or vegetables left. • Food scarcity – eating order particularly affected the daughters-in-law during food scarcity. • Economic contributions affect food allocation – income earners are given priority of delicacies and nutrient-rich items like ghee, • Interpersonal relationships – food allocation affected by kinship status, particularly agnation. | Allocation of specific food items |
Nepal (n = 4) | |||||||
Gittelsohn, Thapa and Landman [41] | 1997 | Key informant interviews, participant observation, unstructured pilot observations, focus group discussions, and structured pile sorts | 105 HH | Six rural villages, with a mixture of agricultural and non-agricultural occupations. Men aged 18 to 50 years, and women aged 18 to 50 years, including menstruating, pregnant, lactating, and postpartum women. | Analysis method of qualitative results not reported | • Cultural beliefs - Men were considered the least vulnerable and therefore had the fewest dietary restrictions, unless they were ill. Older people considered vulnerable and believed to require strengthening foods. Some pregnant women mentioned preferentially eating animal products due to ‘craving’. Post-partum women avoided ‘cold’ foods and ‘indigestible’ foods like wheat bread, peanuts, soybeans and corn porridge. They preferentially ate certain ‘hot’ foods like fish and millet roti. Lactating women avoided fresh green leafy vegetables that were perceived as ‘cold’ and believed to cause arthritis, swelling and other illnesses. • Status - Women’s status increased by having children. Before childbearing, young married women had low status and were subtly discouraged from eating special foods like animal products and certain fried foods. Men’s higher status was “recognised in many ways, including household food behaviour” | Allocation of ‘special’ foods |
Madjdian and Bras [40] | 2016 | In-depth interviews | 30 individuals | Two Himalayan communities from Humla district. Female respondents (15 Buddhist; 15 Hindu Dalit or Chhetri) of reproductive age (aged 15 to 49 years). Selected respondents who were pregnant or had been pregnant at least once before. | Inductive coding based on a conceptual framework, using bottom-up and top-down coding to allow new themes to emerge. | • Beliefs about ‘fair share’ / Religion - Buddhist households allocated food according to appetite; this was not reported in Hindu households. • Cultural beliefs and food habits - Certain foods believed to cause skin allergies. Eating order was associated with eating less. • Food security - Food insecure households did not adhere to food proscriptions due to a lack of food | Food allocation |
Morrison, J. et al. Formative research to inform the development of interventions to tackle low birth weight in the rural plans of Nepal. In preparation. | Unpublished observations | Interviews and focus group discussions | 25 women, 2 groups. | One district in Terai. 25 young daughters-in-law from marginalised groups living in extended families, one focus group discussion with men, and one with Female Community Health Volunteers who were mothers-in-law. Most (90%) respondents were Hindu. Respondent age not reported | Descriptive content analysis. Data were copied from transcripts into columns of 15 descriptive emergent categories. | • Status - Respondents reported that men ate more because they had higher status and so deserved to. • Interpersonal relationships - Husbands may hide food for their pregnant wives, disrespecting the mother-in-law. • Household structure - Married women who visited or lived at their maternal homes had fewer food restrictions. • Economic contributions – Manual labourers were perceived to deserve more • Cultural food beliefs – pregnant women ate less (fear of full stomach harming the baby) • Household income – no effect of food being bought vs grown on food decisions. | Allocation of food generally, and also of ‘special’ foods |
Panter-Brick and Eggerman [64] | 1997 | Semi-structured interviews | 120 heads of household | Population of high and low caste Indo-Nepalese and Tibeto-Burmese ethnic groups from four Panchayats in two districts. Sampled households to ensure proportional representation of large and small land-holding farmers Age of respondents not reported. | Analysis method of qualitative results not reported. | • Food shortages / Ethnicity - Indo-Nepalese household used discrimination against women as a coping mechanism during food shortages whereas Tibeto-Burmese households did not. | Food allocation |
Author | Year | Determinant | IHFA outcome |
---|---|---|---|
Bangladesh (n = 5) | |||
Chaudry [70] | 1983 | Household size | Relative calorie adequacy |
Chen, Huq and d’Souza [4] | 1981 | Relative economic contributions | Allocation of food quantity and quality |
Kabeer [44] | 1988 | Cultural beliefs / serving order | Food allocation |
Rizvi [50] | 1981 | Relative social status | Food allocation |
Rizvi [68] | 1983 | Household wealth (poverty) Household size | Food allocation |
India (n = 3) | |||
Cantor and Associates [31] | 1973 | Relative economic contributions (proxied by body size) Household wealth | Food allocation |
Coffey, Khera and Spears [47] | 2015 | Relative social status | Food allocation |
Das Gupta [49] | 1996 | Relative social status (having sons) Nutrition knowledge | Relative calorie adequacy |
Nepal (n = 1) | |||
Gittelsohn, Mookherji and Pelto [42] | 1998 | Cultural food beliefs Household food insecurity | Food allocation |
South Asia (n = 2) | |||
Agarwal [56] | 1997 | Bargaining power | Food allocation |
Appadurai [8] | 1981 | Relative cultural status / life cycle in the household Bargaining power Interpersonal relationships | Food allocation |
International (n = 16) | |||
DeRose, Das and Millman [14] | 2000 | Relative social status Decision-making Nutrition knowledge | Calorie and food allocation |
Haddad and Kanbur [25] | 1990 | Control over income Food insecurity | Calorie and food allocation |
Haddad et al. [11] | 1996 | Decision-making (identify of decision-maker) Food insecurity | Food allocation |
Haddad [54] | 1999 | Control over income Food insecurity | Food allocation |
Kumar [26] | 1983 | Decision-making | Food allocation |
Messer [48] | 1997 | Relative social status (the traditional role and perceptions of women) Beliefs about fairness | Food allocation |
Pinstrup-Andersen [15] | 1983 | Nutritional need Preferences Decision-making Household income | Food allocation |
Wheeler [12] | 1991 | Relative economic contributions Beliefs about fairness Bargaining power | Allocation of nutrient-rich foods |
Carloni [53] | 1981 | Decision-making Social mobility / participation in shopping | Food allocation |
Hartog [28] | 1972 | Economic contributions Cultural beliefs Social status Interpersonal relationships | Food allocation |
De Schutter [52] | 2013 | Beliefs about fairness Control over food production or purchasing Food insecurity | Food allocation |
Den Hartog [43] | 2006 | Religious beliefs Beliefs about fairness | Food allocation |
Gunewardena [60] | 2014 | Food insecurity | Food allocation |
Pelto [46] | 1984 | Social status (in relation to modernisation and urbanisation) | Food allocation |
Ramachandran [55] | 2007 | Decision-making / control over income Bargaining power Food insecurity Household composition (nuclear vs joint households) | Food allocation |
Van Esterik [29] | 1985 | Economic contributions Overlap between cultural beliefs during pregnancy, social status, and poverty Social mobility Interpersonal relationships Household size (number of senior women) Religion Food availability | Food allocation |
No countries mentioned (n = 2) | |||
Doss [24] | 1996 | Relative economic contributions Bargaining power | Food allocation |
Hamburg et al. [57] | 2014 | Interpersonal relationships | Food sharing |
Quality assessment of selected papers
Study quality | No | Unable to determine | Yes | |
---|---|---|---|---|
n
|
n
|
n
| (%) | |
Is the hypothesis or aim of the study clearly described? | 0 | NA | 16 | (100) |
Are the outcomes described in the Introduction or Methods? | 1 | NA | 15 | (94) |
Are the characteristics of the respondents described? | 6 | NA | 10 | (63) |
Are the determinants of interest described? | 2 | NA | 14 | (88) |
Are the distributions of principal confounders described? | 6 | NA | 10 | (63) |
Are the main findings of the study clearly described? | 1 | NA | 15 | (94) |
Does the study provide estimates of random variability? | 9 | NA | 7 | (44) |
Have probability values (not cutoffs) been reported? | 14 | NA | 2 | (13) |
Validity, bias and confounding | ||||
Was the sample representative of the population? | 1 | 7 | 8 | (50) |
Were the respondents representative of the population? | 0 | 14 | 2 | (13) |
Were the statistical tests appropriate? | 4 | 0 | 12 | (75) |
Were the main outcome measures used valid and reliable? | 0 | 3 | 13 | (81) |
Was there adequate adjustment for confounding? | 8 | 2 | 6 | (38) |
Were losses of respondents taken into account? | 3 | 11 | 2 | (13) |
Critical Appraisal Skills Programme (CASP) quality indicator | No | Unable to determine | Yes | |
---|---|---|---|---|
n
|
n
|
n
| (%) | |
Was there a clear statement of the aims of the research (the goal, importance, and aims)? | 0 | 0 | 15 | (100) |
Is a qualitative methodology appropriate? | 0 | 0 | 15 | (100) |
Was the research design justified as appropriate to address the aims of the research? | 0 | 7 | 8 | (53) |
Was the recruitment strategy justified as being appropriate to the aims of the research (how and why respondents were sampled, or discussions of non-response)? | 0 | 7 | 8 | (53) |
Were the data collected in a way that addressed the research issue (detail and justification of methods, issues of data saturation)? | 0 | 9 | 6 | (40) |
Has the relationship between researcher and participants been adequately considered? | 0 | 9 | 6 | (40) |
Have ethical issues been considered (informed consent and ethical approval)? | 0 | 13 | 2 | (13) |
Was the data analysis sufficiently rigorous? | 0 | 10 | 5 | (33) |
Is there a clear statement of findings? | 1 | 0 | 14 | (93) |