Abstract
Background
Food insecurity (FI), defined as the lack of consistent access to sufficient and nutritious food, remains a critical public health issue in low- and middle-income countries. In Pakistan, approximately 37% of the population experiences FI. Pregnant women are particularly vulnerable, as nutritional challenges during pregnancy may affect their health-seeking behaviors. This study aimed to describe the prevalence of household food insecurity and patterns of antenatal care (ANC) utilization among pregnant women in Karachi, Pakistan.
Methods
This descriptive cross-sectional study was conducted at the Department of Gynecology and Obstetrics, Jinnah Postgraduate Medical Center, Karachi, from June to August 2024. Through convenience sampling, 358 pregnant women in their third month of gestation or later were enrolled in the study. Data were collected using a structured questionnaire that included the validated household food security access scale (HFIAS). Data were analyzed using SPSS version 25. Frequencies, percentages, and cross-tabulations were used for description.
Results
The mean age of the 358 participants was 26.45 ± 4.9 years. A total of 60.3% of the respondents were from food-insecure households. ANC utilization was reported by 89.3% of the participants. The highest ANC attendance was observed among women aged 21–26 years, women with primary or secondary education, and housewives. Most ANC users have household incomes ranging between PKR 30,000 and 60,000. ANC use was common among multigravida women and among those without any prior stillbirths or abortions. Most women who underwent ANC were informed or guided about their importance.
Conclusion
A considerable proportion of pregnant women in Karachi reported utilizing ANC services, including those from food-insecure households. Various demographic, educational, and reproductive characteristics of ANC attendance have been described. These findings provide an overview of ANC utilization patterns in an urban tertiary care setting and highlight the coexistence of food insecurity among ANC users.
Supplementary Information
The online version contains supplementary material available at 10.1186/s12884-025-07795-7.
Keywords: Food insecurity, Antenatal care, Maternal health, Cross-sectional study, Pakistan
Introduction
Food insecurity (FI) is a significant public health concern and an underappreciated socioeconomic predictor of health. FI is a condition in which people lack the physical, social, and financial means to consistently obtain sufficient nutritious foods to meet their dietary requirements for a productive, effective, and healthy life [1, 2]. FI occurs when food availability, quality, and quantity are limited or inaccessible in a socially acceptable manner to improve individual health and well-being [3]. Globally, approximately two billion individuals, or 26.4% of the world population, live in moderate to severe food-insecure circumstances, with around 1.04 billion in Asia [4]. Pakistan has also been one of the world’s worst-impacted nations in terms of a massive increase in the number of chronically food-insecure populations. Approximately 37% of the population is facing the problem of FI, and 13% of households in Pakistan are food insecure [5, 6].
FI is associated with detrimental physical and mental health outcomes. FI during pregnancy is associated with poor maternal health and may be a risk factor for adverse antenatal outcomes and postpartum practices [7]. Moreover, FI, often rooted in socioeconomic deprivation, has been identified as a potential barrier to accessing adequate antenatal care (ANC), particularly in low-income countries such as Pakistan [8, 9]. Inadequate nutrition caused by FI has frequently been linked to poor pregnancy outcomes such as low birth weight and premature birth.
Furthermore, financial constraints caused by FI and associated factors can limit access to antenatal care services, as women may prioritize basic needs over health care costs. FI causes additional psychosocial stress, which may lead to decreased health-seeking behavior. Moreover, FI frequently coexists with other socioeconomic stressors, such as poverty and lack of education, which can hinder ANC utilization among those with limited resources [10–12].
ANC is a critical component of maternal and child health services and provides the necessary assistance and monitoring during pregnancy. ANC allows healthcare providers to recognize and handle complications early, lowering the chances of adverse effects for both the mother and infant [10, 12].
In low-income countries such as Pakistan, it is essential to understand the prevalence of FI among ANC users to reduce disparities in maternal and child health outcomes. While much is known about how food insecurity and socioeconomic stress affect pregnancy outcomes [13], limited research has examined how food insecurity and ANC attendance appear together in maternal health settings. This study provides a descriptive account of the socioeconomic and healthcare-related characteristics of participants using ANC. Describing these features helps portray the settings in which ANC services are utilized by pregnant women. This information may help policymakers and healthcare providers to understand the broader conditions faced by pregnant women, ultimately contributing to more informed and equitable maternal health strategies.
Materials and methods
Study design and setting
This was an observational descriptive study with a cross-sectional approach conducted at the Department of Gynecology and Obstetrics, Jinnah Postgraduate Medical Center (JPMC), Karachi, Sindh, Pakistan, from June 2024 to August 2024. The JPMC was selected as the setting because it is one of the largest tertiary care hospitals in Karachi, with a high patient outflow and a significant number of pregnant women referred for antenatal care, emergency labor, and cesarean sections.
Participants
Pregnant women at or above 13 weeks of gestation, irrespective of religion, class, color, ethnicity, and age of 18 years or above, who presented to the Department of Gynecology and Obstetrics throughout the study period, were included. The women reported their pregnancy status and gestational weeks. Women who were pregnant before 13 weeks of pregnancy were excluded from the study.
Sample size
The sample size of 358 was determined based on the prevalence of food insecurity in Pakistan, which is reported to be 36.9% by the World Food Programme [14]. Sample size (n) was calculated using the following formula:
 |
Where z = 1.96, confidence level (α) = 95%, p = proportion (expressed as a decimal), and e is the margin of error.
 |
 |
Data collection and variables
After obtaining approval from the hospital ethical review board (No F.2–81/2024-GENL/73/JPMC) to conduct the research and obtain informed written consent (Supplementary material 1) from the participants or their attendants if the participant was unable to provide consent, data were recorded from all included cases. In cases where language barriers existed, trained translators were available to ensure that the participants fully understood the consent process. Data were collected by medical students and doctors using a structured and standardized questionnaire (Supplementary material 2), which was partially self-developed and partially adapted from the validated Household Food Insecurity Access Scale (HFIAS) to assess food insecurity [15].
Data were collected based on participants’ previous ANC visits during their current pregnancy. The questionnaire included variables such as patient demographics, including age, media exposure, residence, and total monthly income (household income was classified as low if it was less than PKR 30,000 per month, middle if it was between PKR 30,000 and 60,000 per month, and high if it exceeds PKR 60,000 per month); maternal education (participants were classified as having passed primary and secondary, graduates, and postgraduates if they attended any educational institute, and as having no formal education if they never did); maternal occupation (employed refers to a woman who is currently working for pay or profit, either as an employee or self-employed, unemployed refers to a woman who is willing and able to work but is currently without a job or employment, and housewife refers to those females who are not the breadwinner of the family and look after household chores); number of family members (classified as < 4, 4–6, and ≥ 7); health care-related information such as gravida (both in numbers and ranges, i.e., 1, ≥ 2); parity (both in numbers and ranges, i.e., ≤ 1, 2–4, and ≥ 5); termination of pregnancy (abortion, miscarriage, and stillbirth); birthplace (classified as at home and hospital); gestation (classified as months and weeks); antenatal care-related questions such as the frequency of antenatal care appointments and reasons for using ANC services.
To measure the level of food insecurity, a standardized questionnaire called the Household Food Insecurity Access Scale (HFIAS), developed by the United States Agency for International Development (USAID), was adapted and applied. The HFIAS is a nine-item scale comprising occurrence questions, followed by frequency of occurrence questions (Supplementary material 2). Households were categorized into four levels of food security based on their total scores (out of 27): food secure (0), mildly food insecure (1–8), moderate food insecure (9–18), and severely food insecure (19–27). These categories were based on the response scores of household participants during a recall period of four weeks. A standardized protocol prescribed by the USAID was used to operationalize HFIAS in the Urdu language.
Statistical analysis
The data were cleaned, organized, and entered into IBM SPSS Statistics for Windows, Version 25 (IBM Corp., Armonk, NY, USA). Frequencies and percentages were generated for all variables to provide an overview of the response distribution. Descriptive statistics, including mean and standard deviation (SD), were used to summarize continuous variables, such as age. To explore patterns in antenatal care (ANC) utilization, comparisons were made across different levels of household food insecurity (secure, mild, moderate, and severe). Similar comparisons were carried out for household income groups, as well as for various sociodemographic and health care-related factors. Confidence intervals and p-values were calculated to supplement the descriptive findings, offering insights into the observed differences between the groups. Statistical significance threshold of < 0.05.
Results
Sociodemographic characteristics of study participants
All 358 participants consented to participate, resulting in a 100% response rate. The mean age was 26.45 years (SD ± 4.9), with an age range of 18–43 years (Fig. 1). A total of 239 participants (66.8%, 95% CI: 61.8–71.5%) had a formal education, while 119 (33.2%) did not. Most participants were housewives (309 women, 86.3%, 95% CI: 82.3–89.6%), while 49 (13.7%) were either employed or currently unemployed. Regarding income, 170 participants (47.5%, 95% CI: 42.5–52.6%) reported monthly household income between PKR 30,000 and 60,000. A large family size (≥ 7 members) was reported by 161 women (45.0%, 95% CI: 40.0–50.1%). Media exposure was present in 235 participants (65.6%, 95% CI: 60.6–70.3%) and 345 women (96.4%, 95% CI: 93.7–98.1%) residing in urban areas (Table 1).
Fig. 1.
Pie chart of the age groups
Table 1.
Sociodemographic characteristics
| Variables | Categories | Frequencies (n = 358) |
Percentage (%) | 95% Confidence Interval (CI) (%) |
|---|---|---|---|---|
| Age groups | 15–20 | 36 | 10.1 | 1.4–1.6 |
| 21–26 | 163 | 45.5 | ||
| 27–32 | 107 | 29.9 | ||
| > 32 | 52 | 14.5 | ||
| Maternal Education | No Formal Education | 119 | 33.2 | 0.8-1.0 |
| Primary or Secondary | 171 | 47.8 | ||
| Higher Secondary (Grades 11–12) | 50 | 14 | ||
| Bachelor’s degree or equivalent | 17 | 4.7 | ||
| Master’s degree or equivalent | 5 | 0.3 | ||
| Occupation | Employed | 34 | 9.5 | 1.7–1.8 |
| Currently Unemployed | 15 | 4.2 | ||
| Housewife | 309 | 86.3 | ||
| Media Exposure | No | 123 | 34.4 | 0.6–0.7 |
| Yes | 235 | 65.6 | ||
| Family members | < 4 | 71 | 19.8 | 1.2–1.3 |
| 4–6 | 126 | 35.2 | ||
| ≥ 7 | 161 | 45 | ||
| Income | Low income:< PKR 30,000/month | 130 | 36.3 | 1.7–1.9 |
| Middle income: PKR 30,000–60,000/month | 170 | 47.5 | ||
| High income:> PKR 60,000/month | 58 | 16.2 | ||
| Residence | Rural | 13 | 3.6 | 0.9-1.0 |
| Urban | 345 | 96.4 |
Healthcare-related characteristics
Most participants (320 women, 89.3%, 95% CI: 85.6–92.2%) attended ANC appointments more than once. Multigravida status was reported by 253 women (71.1%, 95% CI: 66.2–75.6%), and 206 participants (57.5%, 95% CI: 52.4–62.4%) had a parity of ≤ 1. Hospital delivery was reported by 348 participants (98.0%, 95% CI: 96.0–99.2%). A history of stillbirth was documented by 45 women (12.6%, 95% CI: 9.3–16.4%), and prior abortion was reported by 102 (28.5%, 95% CI: 24.0–33.3%). Awareness of ANC services was noted among 330 participants (87.4%, 95% CI: 83.6–90.5%), and 342 (95.5%, 95% CI: 92.9–97.5%) received advice during prenatal visits. The majority (348 women, 97.2%, 95% CI: 91.5–99.4%) were in their third trimester, with 29.1% being in their 36th week of gestation (Table 2).
Table 2.
Descriptive statistics of healthcare-related factors
| Variables | Category | Frequency (n) (n = 358) |
Percentage (%) | 95% Confidence Interval CI (%) |
|---|---|---|---|---|
| Gravida in groups | 1 | 105 | 29.3 | 0.66–0.75 |
| ≥ 2 | 253 | 70.7 | ||
| Parity in groups | ≤ 1 | 206 | 57.5 | 0.39-0.051 |
| 2–4 | 143 | 39.9 | ||
| ≥ 5 | 9 | 2.5 | ||
| Stillbirth | No | 313 | 87.4 | 0.09–0.16 |
| Yes | 45 | 12.6 | ||
| Abortion | No | 256 | 71.5 | 0.24–0.33 |
| Yes | 102 | 28.5 | ||
| Place of Birth | At home | 7 | 2.0 | 0.97–0.99 |
| At hospital | 351 | 98.0 | ||
| Heard about ANC? | No | 45 | 12.6 | 0.84–0.91 |
| Yes | 313 | 87.4 | ||
| How many times attended ANC? | Once | 36 | 10.1 | 1.47–1.62 |
| 2–3 times | 93 | 26.0 | ||
| 4 or more times | 227 | 63.4 | ||
| Didn’t attend ANC appointments | 2 | 0.6 | ||
| Did you receive advice? | No | 16 | 4.5 | 0.93–0.98 |
| Yes | 342 | 95.5 |
Household food insecurity status
Among the participants, 216 (60.3%, 95% CI: 55.3–65.1%) were from food-insecure households, while 142 (39.7%, 95% CI: 34.9–44.7%) were from food-secure households. Of the ANC users, 133 (38.1%) were from mildly food insecure, 60 (17.2%) from moderately food insecure, and 18 (5.2%) from severely food insecure households (Fig. 2). Overall, 111 ANC users (60.5%) resided in food-insecure households. No statistically significant difference in ANC utilization was observed across food insecurity groups (p = 0.850) (Table 3).
Fig. 2.
Pie chart of the household food insecurity status
Table 3.
Effect of household food insecurity on antenatal care
| Household food insecurity status | Antenatal care during the current pregnancy (n = 358) |
p-value | |
|---|---|---|---|
| Yes | No | ||
| Mild | 133 (38.1%) | 4(44.4%) | 0.850 |
| Moderate | 60 (17.2%) | 1 (11.1%) | |
| Severe | 18 (5.2%) | 0 (0.0%) | |
| Insecure | 211 (60.5%) | 5 (55.5%) | |
| Food Secure | 138 (39.5%) | 4 (44.5%) | |
Antenatal care utilization and background characteristics
The highest utilization of ANC services was observed among women aged 21–26 years, with 159 (44.6%, 95% CI: 42.4–60.4%, p = 0.434). Attendance was lower in the 27–32 years age group (29.8%) and lowest among women aged 15–20 years (9.7%). Women with primary or secondary education had the highest ANC attendance, at 169 (48.4%, 95% CI: -0.149 to 0.021, p = 0.074). Attendance declined among those with higher education levels: bachelor’s degree holders (4.9%) and those with a master’s degree or higher (0.3%). Among ANC users, 101 were housewives (86.2%, 95% CI: 72.8–85.9%, p = 0.811), while fewer employed or currently unemployed women used ANC services. ANC utilization was most frequently reported among women in the PKR 30,000–60,000 income bracket, totaling 166 women (47.6%, 95% CI: 75.1–89.7%, p = 0.293). Among women from households with seven or more members, 158 (45.3%, 95% CI: 19.6–35.7%, p = 0.768) reported using ANC services (Table 4).
Table 4.
Association of sociodemographics with antenatal care
| Variable | Category | Antenatal care during the current pregnancy (n = 358) | p-value | 95% Confidence Interval (CI) (%) | |
|---|---|---|---|---|---|
| No | Yes | ||||
| Age group | 15–20 | 2 (22.2%) | 34 (9.7%) | 0.434 | 0.424–0.604 |
| 21–26 | 4 (44.4%) | 159 (44.6%) | |||
| 27–32 | 3 (33.4%) | 104 (29.8%) | |||
| > 32 | 0 (0.0%) | 52 (14.9%) | |||
| Maternal Education | No formal education | 7 (77.8%) | 112 (32.1%) | 0.074 | -0.149-0.021 |
| Primary or secondary | 2 (22.2%) | 169 (48.4%) | |||
| Higher secondary (grades 111 − 12) | 0 (0.0%) | 50 (14.3%) | |||
| Bachelor’s degree or equivalent | 0 (0.0%) | 17 (4.9%) | |||
| Masters or above | 0 (0.0%) | 1 (0.3%) | |||
| Occupation | Employed | 1 (11.1%) | 33 (9.5%) | 0.811 | 0.728–0.859 |
| Currently Unemployed | 0 (0.0%) | 15 (4.3%) | |||
| Housewife | 8 (88.9%) | 301 (86.2%) | |||
| Income | Low income:< PKR 30,000/month | 5 (55.6%) | 125 (35.8%) | 0.293 | 0.751–0.897 |
| Middle income: PKR 30,000–60,000/month | 4 (44.4%) | 166 (47.6%) | |||
| High income:> PKR 60,000/month | 0 (0.0%) | 58 (16.6%) | |||
| Media Exposure | No | 3 (33.3%) | 120 (34.4%) | 0.948 | -0.371-0.266 |
| Yes | 6 (66.7%) | 229 (65.6%) | |||
| Family members | < 4 | 2 (22.2%) | 69 (19.8%) | 0.768 | 0.196–0.357 |
| 4–6 | 4 (44.4%) | 122 (34.9%) | |||
| ≥ 7 | 3 (33.4%) | 158 (45.3%) | |||
| Residence | Rural | 0 (0.0%) | 13 (3.7%) | 0.555 | -0.037-0.015 |
| Urban | 9(100.0%) | 336 (96.3%) | |||
Among multigravida women (≥ 2 pregnancies), 248 (71.1%, 95% CI: -31.7% to -21.9%, p = 0.313) reported ANC attendance. Women with parity ≤ 1 represented the largest group of ANC users, totaling 200 (57.3%, 95% CI: -58.4% to -46.7%, p = 0.790). Attendance was higher among women without a history of stillbirth (105, 87.4%, 95% CI: -88.7%–-81.1%, p = 0.894) and among those with no history of abortion (251, 71.9%, 95% CI: -74.1% to -63.9%, p = 0.283). Almost all ANC users had previously delivered to hospitals (343, 98.3%; 95% CI: -0.015 to 0.026; p = 0.045). ANC awareness and prenatal guidance are frequently reported in patients with ANC. A total of 111 women who had heard about ANC services (89.1%, 95% CI: -13.4% to -6.7%, p < 0.001) and 338 who had received advice during visits (96.8%, 95% CI: -4.1–0.2%, p < 0.001) reported utilizing ANC services (Table 5).
Table 5.
Effect of health-related factors on antenatal care
| Variables | Category | Antenatal care during the current pregnancy (n = 358) | p-value | 95% Confidence Interval (CI) (%) | |
|---|---|---|---|---|---|
| No | Yes | ||||
| Gravida in groups | ≥ 2 | 5 (55.6%) | 248 (71.1%) | 0.313 | -0.317 - -0.219 |
| 1 | 4 (44.4%) | 101 (28.9%) | |||
| Parity in Groups | ≤ 1 | 6 (66.7%) | 200 (57.3%) | 0.79 | -0.584 - -0.467 |
| 2–4 | 3 (33.3%) | 140 (40.1%) | |||
| ≥ 5 | 0 (0.0%) | 9 (2.6%) | |||
| Stillbirth | No | 8 (88.9%) | 305 (87.4%) | 0.894 | -0.887 - -0.811 |
| Yes | 1 (11.1%) | 44 (12.6%) | |||
| Abortion | No | 5 (55.6%) | 251 (71.9%) | 0.283 | -0.741 - -0.639 |
| Yes | 4 (44.4%) | 98 (28.1%) | |||
| Place of Birth | At home | 1 (11.1%) | 6 (1.7%) | 0.045 | -0.015–0.026 |
| At hospital | 8 (88.9%) | 343 (98.3%) | |||
| How many times attended ANC? | Once | 4 (44.4%) | 32 (9.2%) | < 0.001 | 0.499–0.641 |
| 2–3 times | 1 (11.1%) | 92 (26.4%) | |||
| 4 or more times | 2 (22.2%) | 225 (64.5%) | |||
| Did not attend ANC appointments | 2 (22.2%) | 0 (0%) | |||
| Heard about ANC? | No | 7 (77.8%) | 38 (10.9%) | < 0.001 | -0.134 --0.067 |
| Yes | 2 (22.2%) | 311 (89.1%) | |||
| Did you receive advice? | No | 5 (55.6%) | 11 (3.2%) | < 0.001 | -0.041 -0.002 |
| Yes | 4 (44.4%) | 338 (96.8%) | |||
Discussion
Household food insecurity, commonly driven by economic and resource constraints, refers to inadequate or unstable access to nutritious food [16]. Regular ANC visits are important for improving outcomes for both mothers and babies, as they allow early detection and management of pregnancy-related problems [17]. This study describes the patterns of ANC utilization that vary among pregnant women in Karachi based on their food security status, sociodemographic characteristics, and previous pregnancy history.
In this study, the highest ANC attendance was observed among women aged 21–26 years, which is consistent with the findings of Sarah et al. [18]. Younger women may be more exposed to educational and health information [19]. Previous studies from Nepal, Nigeria, and South Asian countries have documented that media exposure is commonly reported among younger women who use ANC, skilled birth attendance, and postnatal care [20–22]. Women with a primary or secondary education constituted the largest proportion of ANC attendees. A smaller proportion of ANC users was observed among women with higher educational levels. This pattern contrasts with earlier reports that suggest higher service use among more educated women. Women with more education may prefer alternative facilities or schedules that were not included in this study. In this sample, housewives comprised the majority of antenatal care users. Housewives with more flexible daily routines may find it easier to attend health care visits. Conversely, employed women frequently face competing demands on their time, balancing their professional and domestic responsibilities. Providing flexible work schedules, remote work opportunities, or dedicated maternity leave could be useful in facilitating ANC attendance among working women.
ANC use in this sample was most frequently reported among women from households with a monthly income of between PKR 30,000 and 60,000. Women from both lower- and higher-income groups were represented to a lesser extent. Camara et al. [23] observed a similar pattern in Guinea. This distribution may reflect the availability of public healthcare services, which reduces financial obstacles. Continued investment in subsidized maternal care may support access to ANC across all income brackets. There were no significant differences in ANC utilization based on the number of children, suggesting that family size may not have a major influence in this setting. However, women from larger families were slightly more represented by ANC users. Support from extended family networks has been commonly noted in other studies as contributing to healthcare utilization [24]. Many participants in this study lived in urban areas, where attending antenatal care (ANC) seemed to be more common. This may be because cities usually offer easier access to hospitals and clinics, along with more health information. In contrast, women in rural areas often face more difficulties, such as long travel distances to health centers, fewer facilities, and limited exposure to health education [25–28]. These challenges can make it more difficult for pregnant women in rural areas to seek timely care. Fortunately, targeted programs that focus on improving health awareness and education in rural communities have shown promising results in closing this gap in various regions [29]. When families, local leaders, and health workers work together to spread knowledge, it can truly make a difference in helping expectant mothers access the care they require.
The food insecurity status did not show a statistically significant difference in ANC attendance (p = 0.850). A notable proportion of ANC users came from food-insecure households. This suggests that women in such households still accessed ANC, possibly because of cultural norms, family encouragement, or the availability of subsidized care. This reflects what Zaidi et al. described in their work, that supportive programs can help overcome financial barriers in cities [30]. In Karachi, for instance, many women turn to antenatal care not just because of the services offered, but also because families and communities often expect and encourage them. Even in food-insecure households, women may prioritize ANC because of cultural norms or advice from the elderly and community health workers. Similar results were found in other studies conducted in Malawi and South Ethiopia [31, 32].
The study found a higher rate of ANC attendance among women who had been pregnant more than once, possibly because having been pregnant before made them more comfortable with the process and more aware of the importance of regular check-ups. Women who were early in their motherhood journey and those with fewer children also showed strong participation. This suggests that their first experiences with pregnancy may have positively shaped how they approach healthcare in the future [33]. Conversely, the data showed that women who had experienced stillbirths or abortions were less likely to attend ANC. Understandably, these painful experiences can make the idea of pregnancy more frightening, and some may feel unsure or afraid of seeking help. Prior research suggests that such painful experiences can make it harder to seek care, even when needed [34]. Offering mental health support and counseling can make a real difference for women who have experienced difficult pregnancy experiences, such as stillbirth or miscarriage. These emotional wounds often linger and can affect how confidently a woman approaches the next pregnancy. In addition, we found that women who knew about ANC services and received helpful advice during their visits were more likely to return. This suggests that, to promote continued involvement in maternal healthcare, meaningful health education and guidance should be provided during ANC visits.
These findings suggest several possible steps. Tailored health education campaigns may be useful, especially for older women, those with lower education, and those with prior negative pregnancy experiences. One-on-one counseling by healthcare staff during ANC could encourage steady attendance. Flexible workplace policies and maternity leave options may assist employed women in accessing care. Additionally, leveraging local community leaders and organizations for outreach may help promote ANC participation across diverse socioeconomic groups.
Limitations
This study has several limitations that should be considered when interpreting the results. First, it relies on self-reported data, which may be influenced by memory inaccuracies and lack confirmation through ultrasound or laboratory testing, potentially affecting the gestational age. To minimize this bias, we carefully designed the questionnaire with clear, concise, and time-bound questions to aid accurate recall. Furthermore, trained data collectors provided clarification as needed to reduce misunderstandings and improve the reliability of the responses. Moreover, the data collection was limited to one healthcare organization, limiting the scope of the findings. The study included participants aged 18 years and above, with age groups labeled “15–20 years” for consistency and equal age intervals for data presentation and analysis. In addition, the small sample size may have limited the ability to draw definitive conclusions about the relationship between household food insecurity, its associated factors, and ANC utilization. Finally, we were unable to perform logistic regression owing to dataset limitations, such as variable distribution and sample constraints. Therefore, the findings were limited to descriptive reporting without adjustment for confounding factors.
Conclusion
This study highlights the widespread issue of household food insecurity among pregnant women attending ANC in Karachi. Despite these difficulties, many women continue to use vital health services. By looking at their backgrounds and health habits, we obtain a clearer picture of the challenges they face and how they manage to seek care. These insights remind us of the importance of designing support systems that understand and address the unique needs of women living in food-insecure households.
Electronic supplementary material
Below is the link to the electronic supplementary material.
Acknowledgements
Not Applicable.
Author contributions
M.S.K.: Supervision, Conceptualization, Methodology, Writing–reviewing and editing, validation, and formal analysis. M.F.: writing, reviewing, and editing; formal analysis. M.T.A.: Project admin-istration, visualization, writing, reviewing, and editing. M.K.: Investigation, Methodology, data cu-ration. N.F.: Resources, Writing, reviewing, and editing. I.S.: writing, reviewing, editing, Investiga-tion, Methodology, Data Curation, and Correspondence. All authors have contributed to the manuscript and approved the submitted version.
Funding
The authors received no extramural funding.
Data availability
All data generated or analyzed during this study are included in this published article.
Declarations
Ethical approval and consent to participate
This study was approved by the Research Ethics Committee of the JPMC Hospital’s Ethics Review Board (No F.2–81/2024-GENL/73/JPMC) and conducted by the Declaration of Helsinki, local regulations, and institutional guidelines. Written informed consent was obtained from all participants before their inclusion in the study.
Informed consent
Written informed consent was taken from the participants.
Consent for publication
Not Applicable.
Competing interests
The authors declare no competing interests.
Footnotes
Publisher’s note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
References
- 1.Siegel FR, Siegel FR. Food security/insecurity, food systems. The Earth’s Human Carrying Capacity: Limitations Assessed, Solutions Proposed. 2021:21–37.
- 2.Kifle Y, Kabeta A, Tamiru D. Household food insecurity and nutritional status of under-five children and women of reproductive age from pond fish farming households in Sidama zone, Southern Ethiopia: community-based cross-sectional study. J Hum Nutr. 2020;4(1):106–11. [Google Scholar]
- 3.Getacher L, Egata G, Aynalem YA, Molla A, Tesfaye A, Abebe H, Bayih WA, Habtegiorgis SD. Food insecurity and its predictors among lactating mothers in North Shoa zone, central Ethiopia: a community-based cross-sectional study. BMJ Open. 2020;10(11):e040627. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 4.Dinagde DD, Wada HW, Chewaka MT. Household food insecurity and associated factors among postpartum women in Southern Ethiopia: a community-based cross-sectional study. Sci Rep. 2024;14(1):4003. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 5.Pakistan Bureau of Statistics (PBS). Key findings of the household integrated economic survey 2018. https://www.pbs.gov.pk/pslm-publications (Accessed on August 30, 2024).
- 6.National Nutrition Survey. (2018). Ministry of National Health Services Regulation and Coordination. Government of Pakistan. https://www.unicef.org/pakistan/national-nutrition-survey-2018 (Accessed on August 1, 2024).
- 7.Mildon A, Francis J, Stewart S, Underhill B, Ng YM, Rousseau C, Tarasuk V, Di Ruggiero E, Dennis CL, O’Connor DL, Sellen DW. Household food insecurity is prevalent in a cohort of postpartum women who registered in the Canada prenatal nutrition program in Toronto. Public Health Nutr. 2023;26(7):1468–77. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 8.Adamu YM, Salihu HM. Barriers to the use of antenatal and obstetric care services in rural Kano. Nigeria J Obstet Gynecol. 2002;22(6):600–3. [DOI] [PubMed] [Google Scholar]
- 9.Downe S, Finlayson K, Walsh D, Lavender T. Weighing up and balancing out’: a meta-synthesis of barriers to antenatal care for marginalized women in high‐income countries. BJOG: Int J Obstet Gynecol. 2009;116(4):518–29. [DOI] [PubMed] [Google Scholar]
- 10.Testa A, Jackson DB. Barriers to prenatal care among food-insufficient women: findings from the pregnancy risk assessment monitoring system. J Women’s Health. 2021;30(9):1268–77. [DOI] [PubMed] [Google Scholar]
- 11.Nnakwe NE. The prevalence of food insecurity among pregnant women in a community-based intervention program. FASEB J. 2017;31:791–11. [Google Scholar]
- 12.Abubakar M, Bibi A, Hussain R, Bibi Z, Gul A, Bashir Z, Arshad SN, Uppal MA, Chaudhary SU. Towards providing full-spectrum antenatal health care in low and middle-income countries. InHEALTHINF. 2016;21:478–83.
- 13.Iqbal S, Ali I. Maternal food insecurity in low-income countries: revisiting its causes and consequences for maternal and neonatal health. J Agric Food Res. 2021;3:100091. [Google Scholar]
- 14.World Food Programme. Pakistan| World Food Programme. www.wfp.org.2024. Available from: https://www.wfp.org/countries/pakistan
- 15.Coates J, Swindale A, Bilinsky P. Household Food Insecurity Access Scale (HFIAS) for Measurement of Food Access: Indicator Guide VERSION 3. 2007. Available from: https://www.fantaproject.org/sites/default/files/resources/HFIAS_ENG_v3_Aug07.pdf
- 16.Edward A. Frongillo. Europe PMC. Europepmc.org. Published 2016. Accessed October 1, 2024. https://europepmc.org/article/med/31561810
- 17.Duru CB, Eke NO, Ifeadike CO, et al. Antenatal care services utilization among women of reproductive age in urban and rural communities of South East Nigeria: a comparative study. Afrimedic J. 2014;5(1):50–8. https://www.ajol.info/index.php/afrij/article/view/109314 [Google Scholar]
- 18.Wablembo SM, Doctor HV. The influence of age cohort differentials on antenatal care attendance and supervised deliveries in Uganda. J Nurs Educ Pract. 2013;3(11). 10.5430/jnep.v3n11p101
- 19.GIBSON D. Getting better will take some time. The effects of social policy on four generations of older women**. Australian Feminist Stud. 2003;18(41):173–86. 10.1080/08164640301731 [Google Scholar]
- 20.Acharya D, Khanal V, Singh JK, Adhikari M, Gautam S. Impact of mass media on the utilization of antenatal care services among women of rural community in Nepal. BMC Res Notes. 2015;8. 10.1186/s13104-015-1312-8 [DOI] [PMC free article] [PubMed]
- 21.Acharya D, Adhikari R, Kreps GL. Does exposure to mass media associate with utilisation of ANC services? A trend analysis from Nepal demographic and health surveys. Int J Health Plann Manage Published Online July. 2021;12. 10.1002/hpm.3285 [DOI] [PubMed]
- 22.Fatema K, Lariscy JT. Mass media exposure and maternal healthcare utilization in South Asia. SSM - Popul Health. 2020;11:100614. 10.1016/j.ssmph.2020.100614 [DOI] [PMC free article] [PubMed] [Google Scholar]
- 23.Woldegiorgis MA, Hiller J, Mekonnen W, Meyer D, Bhowmik J. Determinants of antenatal care and skilled birth attendance in sub-Saharan Africa: a multilevel analysis. Health Serv Res. 2019;54(5):1110–8. 10.1111/1475-6773.13163 [DOI] [PMC free article] [PubMed] [Google Scholar]
- 24.Ohashi A, Higuchi M, Shokria AL, Asmaa GM, Chiang C, Aoyama A. Family support for women’s health-seeking behavior: a qualitative study in rural southern Egypt (Upper Egypt). Nagoya Journal of Medical Science. 2014;76(1–2):17–25. Accessed October 1, 2024. https://nagoya.repo.nii.ac.jp/records/17397 [PMC free article] [PubMed]
- 25.Gamage S, Biswas RK, Bhowmik J. Health awareness and skilled birth attendance: an assessment of sustainable development goal 3.1 in South and South-East Asia. Midwifery. 2022;115:103480. 10.1016/j.midw.2022.103480 [DOI] [PubMed] [Google Scholar]
- 26.Imo Chukwuechefulam Kingsley. Household poverty-wealth and decision-making autonomy as predictors of reproductive and maternal health services utilization among rural women in Nigeria: evidence from a national survey. PubMed. 2023;33(1):163–72. 10.4314/ejhs.v33i1.20 [DOI] [PMC free article] [PubMed] [Google Scholar]
- 27.Dairo MD, Owoyokun K. Factors affecting the utilization of antenatal care services in ibadan, Nigeria. Benin J Postgrad Med. 2011;12(1). 10.4314/bjpm.v12i1.63387
- 28.Haruna-Ogun OA. Geographical differentials in uptake of antenatal care services in Nigeria. Health Care Women Int. 2017;39(1):34–49. 10.1080/07399332.2017.1388804 [DOI] [PubMed] [Google Scholar]
- 29.Obaremi OD, Olatokun WM. A survey of health information source use in rural communities identifies complex health literacy barriers. Health Inform Libr J Published Online Febr. 2021;22. 10.1111/hir.12364 [DOI] [PubMed]
- 30.Zaidi S, Bigdeli M, Aleem N, Rashidian A. Access to essential medicines in Pakistan: policy and health systems research concerns. Meara JG, ed. PLoS ONE. 2013;8(5):e63515. 10.1371/journal.pone.0063515 [DOI] [PMC free article] [PubMed]
- 31.Roberts J, Hopp Marshak H, Sealy DA, Manda-Taylor L, Mataya R, Gleason P. The role of cultural beliefs in accessing antenatal care in malawi: a qualitative study. Public Health Nurs. 2016;34(1):42–9. 10.1111/phn.12242 [DOI] [PubMed] [Google Scholar]
- 32.Kotiso GB, Abame DE, Belachew T, Tamrat M, Mekango DE. Disparities in antenatal care service utilization among food-secure and food-insecure women in Gombora district, Hadiya zone, South Ethiopia. Pan Afr Med J. 2020;37. 10.11604/pamj.2020.37.377.19862 [DOI] [PMC free article] [PubMed]
- 33.Asweto CO, Aluoch JR, Obonyo CO, Ouma JO. Maternal autonomy, distance to health care facility and ANC attendance: findings from Madiany division of Siaya county, Kenya. Am J Public Health Res. 2014;2(4):153–8. 10.12691/ajphr-2-4-5 [Google Scholar]
- 34.Nilsson C, Bondas T, Lundgren I. Previous birth experience in women with intense fear of childbirth. J Obstetric Gynecologic Neonatal Nurs. 2010;39(3):298–309. 10.1111/j.1552-6909.2010.01139.x [DOI] [PubMed] [Google Scholar]
Associated Data
This section collects any data citations, data availability statements, or supplementary materials included in this article.
Supplementary Materials
Data Availability Statement
All data generated or analyzed during this study are included in this published article.