Prevalence and determinants of food insecurity among pregnant women in Nigeria: A multilevel mixed effects analysis.

Food insecurity (FI) remains a key priority for sustainable development. Despite the well-known consequences of food insecurity on health and well-being, evidence regarding the burden and determinants of FI among pregnant women in Nigeria is limited. Framed by the social-ecological model, this study aimed to determine the prevalence of FI, and its associations with individual-/household-level and contextual-level factors among pregnant women in Nigeria. A cross-sectional study based on the Nigerian Multiple Indicator Cluster Survey (2021 Nigerian MICS6) was conducted among a sample of 3519 pregnant women aged 15-49 years. Several weighted multilevel multinomial logistic regression models were fitted to assess the association between individual-/household-s level and community-level characteristics with FI. We estimated and reported both fixed effects and random effects to measure the associations and variations, respectively. Results: The prevalence of FI among pregnant women in Nigeria was high, with nearly 75% of the participants reporting moderate to severe FI in the past 12 months (95% CI = 71.3%-75.8%) in 2021. There were also significant differences in all the experiences of food insecurity due to lack of money or resources, as measured by the Food Insecurity Experience Scale (FIES), except for feeling hungry but not eating because of lack of money or resources (p < 0.0001). Multivariate analysis revealed that higher parity, households with 5 or more members, household wealth index, urban residence, and community-level poverty were significantly associated with FI. Our study demonstrates a significantly high prevalence of FI among pregnant women in Nigeria in 2021. Given the negative consequences of FI on maternal and child health, implementing interventions to address FI during pregnancy remains critical to improving pregnancy outcomes.