A qualitative exploration of women's experiences of food insecurity around pregnancy aligned with the socio-ecological model

Pregnancy, postpartum, and infancy are pivotal periods when food insecurity (FI), defined as inconsistent access to sufficient, safe, and nutritious food, can adversely impact maternal and child health. Despite high FI rates in the UK, little is known about women's experiences during this time. This study explores FI during pregnancy and postpartum amongst a multi-ethnic group of women. Between October 2023 and February 2024 semi-structured interviews were conducted with purposively sampled food-insecure individuals (>18 years, pregnant or postpartum <12 months, residing in South London with recourse to public funds). Demographics were analysed with SPSS, and interviews using Reflexive Thematic Analysis in NVivo. Findings were discussed in alignment with the socio-ecological model. Three key themes were generated from eleven interviews. 1) Societal systems failure and its nutritional impact, 2) System 'soothers' mitigating FI, and 3) Creating Coordinated Care. Theme one describes the structural drivers' influencing maternal food strategies, eating and feeding behaviours. Theme two explores factors protecting or inhibiting women access to support. Theme three discusses the benefits and opportunities for improved health and social care coordination to address FI during pregnancy. This study emphasizes how structural determinants exacerbate FI during pregnancy and postpartum, with unique structural drivers to this life course period worsening its impact. FI influences health eating despite resourceful cooking and food management strategies. Greater coordinated care is urgently needed to address FI, promote healthy diets, and improve access.