Understanding the Multi-Level Factors Influencing Maternal Diets in Sri Lanka

OBJECTIVES: To understand the multi-level factors influencing maternal diet in Sri Lanka. METHODS: Study design . This ethnographic sub-study was conducted using an iterative four-phase, mixed methods formative research design. Data collection methods and sampling. To understand the multi-level factors influencing maternal diets across the rural, urban and estate sectors of Sri Lanka, community members from each sector were purposefully sampled. Pregnant women (n = 21), community leaders (n = 10) and influencers (n = 37) were interviewed using a semi-structured interview guide. Data analysis. Data were analyzed using Dedoose software and the socio-ecological model to conceptualize influencing factors of maternal diets across sectors. RESULTS: In Sri Lanka, a variety of multi-level factors reportedly influence maternal diets. At the community level, high food availability and inter-household food sharing facilitate diverse maternal diets while traditional food rules (e.g., 20 prescriptions and 21 proscriptions) may negatively influence them. Strong social protection and antenatal care programs provided by the Sri Lankan government promote improved nutrition, but food baskets provided as part of social assistance are not always utilized by beneficiaries as intended. At the interpersonal level, pregnant women receive health and nutrition information from many social influencers such as Public Health Midwives, female elders, and husbands, among others. At the individual level, differential nutrition knowledge, food preferences, risk perception, competing demands, and food access influence maternal diet synergistically. CONCLUSIONS: Upstream factors (e.g., culturally bound food taboos) seem to be more important drivers of maternal diets than individual-level knowledge and personal food preferences addressing multi-level determinants of maternal diets in concert may positively impact population-level maternal nutrition in Sri Lanka. FUNDING SOURCES: UNICEF Sri Lanka.