Researchers studied 681 pregnant women in South Africa to understand what they eat during pregnancy. They found that most women eat starchy foods like bread and rice, but very few eat beans, nuts, seeds, or leafy greens—foods that provide important nutrients for both mom and baby. The study discovered that women who are unemployed, have less education, earn very little money, or struggle to afford food are even less likely to eat a variety of healthy foods. These findings suggest that poverty and food insecurity are major barriers preventing pregnant women from eating the diverse, nutritious diets they need.

The Quick Take

  • What they studied: Whether pregnant women in South Africa eat a variety of different foods and what factors prevent them from doing so
  • Who participated: 681 pregnant women receiving care at a large hospital in central South Africa. The study included women from different income levels and educational backgrounds
  • Key finding: Only about 1 in 3 pregnant women (32.9%) ate enough variety of foods. Nearly all women ate starchy foods, but fewer than 1 in 10 ate beans, nuts, seeds, or dark leafy greens. Women facing unemployment, poverty, and food insecurity were much less likely to eat diverse foods
  • What it means for you: If you’re pregnant or planning pregnancy in similar situations, eating variety matters for your baby’s development. While this study shows the challenge is real, it also highlights that improving access to affordable, diverse foods could make a big difference. Talk to your healthcare provider about affordable nutrition options in your area

The Research Details

Researchers conducted a cross-sectional study, which is like taking a snapshot at one moment in time. They asked 681 pregnant women at a South African hospital about what foods they ate, whether they had enough money for food, their jobs, education level, and monthly income. They used a specific tool called the MDD-W (Minimum Dietary Diversity for Women) to measure whether women were eating enough different types of foods. This tool checks if women eat foods from at least 5 different food groups, which is considered adequate dietary diversity.

The researchers also measured household food insecurity—meaning whether families had enough money to buy food—using a standard questionnaire. They collected all this information at one point in time rather than following women over months or years. This approach is useful for understanding what’s happening right now in a population, though it can’t prove that one thing causes another.

This research approach is important because it shows the real-world situation for pregnant women in South Africa right now. By collecting information about diet, money, jobs, and education all at the same time, researchers can see patterns—like whether poorer women tend to eat less variety. Understanding these patterns helps identify where help is needed most. The study uses a recognized international tool (MDD-W) that scientists use worldwide, making the results comparable to other countries

The study’s strengths include a reasonably large sample size (681 women) and use of validated measurement tools that are recognized internationally. However, because this is a snapshot study rather than following women over time, we can’t be completely certain about cause-and-effect relationships. The study was conducted at one hospital, so results may not represent all pregnant women in South Africa. The researchers relied on women’s memories of what they ate, which can sometimes be inaccurate. Despite these limitations, the findings provide valuable insight into a real problem affecting pregnant women’s nutrition

What the Results Show

The study revealed a striking pattern: nearly all pregnant women (99.4%) ate starchy staple foods like bread, rice, and maize. However, very few ate protein-rich foods or vegetables. Only 7.9% ate beans and pulses, 10.6% ate nuts and seeds, and 13.5% ate dark green leafy vegetables. When researchers checked if women were eating enough variety from different food groups, they found that only about one-third (32.9%) met the minimum dietary diversity standard.

The researchers then looked at which women were most likely to have inadequate diets. They found four major factors associated with poor dietary diversity: unemployment, having only primary school education, severe food insecurity (struggling to afford food), and very low monthly income. Women who were unemployed had 69% lower odds of eating diverse foods. Those with only primary education had 43% lower odds. Women experiencing severe food insecurity had 82% lower odds, and those earning between 100-1000 South African Rand monthly had 69% lower odds.

These findings paint a clear picture: poverty and lack of access to money are the main barriers preventing pregnant women from eating the variety of foods they need. When women can’t afford food or don’t have jobs, they tend to buy only the cheapest, most filling foods—usually starches—rather than more expensive proteins, nuts, and vegetables.

The study also showed that education level matters significantly. Women with more education were more likely to eat diverse foods, possibly because they understand nutrition better or have access to better-paying jobs. The combination of multiple challenges—being unemployed AND having low income AND experiencing food insecurity—likely makes the situation even worse for some women. The research suggests that these factors work together rather than independently to limit dietary diversity

Similar studies in other African countries have found comparable patterns of low dietary diversity in pregnancy, particularly among low-income populations. This study confirms that the problem isn’t unique to South Africa but reflects broader challenges in the region. However, the specific percentages of women eating certain foods may vary by country and community. The finding that poverty and food insecurity are the main barriers aligns with previous research showing that economic factors are the strongest predictors of diet quality

Several important limitations should be considered. First, this study only included women at one hospital, so results may not represent all pregnant women in South Africa or other regions. Second, women were asked to remember what they ate, which can be inaccurate. Third, the study took a snapshot at one moment rather than following women over time, so we can’t be completely sure that poverty causes poor diet—only that they’re connected. Fourth, the study didn’t measure actual nutrient levels in women’s bodies, only what they reported eating. Finally, the research doesn’t explain exactly how unemployment or low education lead to poor diets, only that they’re associated

The Bottom Line

If you’re pregnant or planning pregnancy: (1) Try to eat foods from as many different groups as possible, even if they’re affordable options—beans, eggs, and leafy greens are often cheaper than meat. (2) Talk to your healthcare provider or a nutritionist about affordable ways to improve your diet. (3) Look into local food assistance programs if you qualify. Healthcare providers should: (1) Screen pregnant women for food insecurity and poverty. (2) Provide practical nutrition advice based on what women can actually afford. (3) Connect women with social services and food assistance programs. Policymakers should address the root causes by improving job opportunities, education access, and food security programs. These recommendations have moderate to strong evidence support based on this and similar studies

This research is most relevant to pregnant women in low-income settings, particularly in South Africa and similar regions. Healthcare providers caring for pregnant women should pay attention to these findings. Policymakers and public health officials should use this information to design better food assistance and economic support programs. Women with limited income, education, or job security should be especially aware that dietary diversity during pregnancy is important and seek help if they’re struggling to afford varied foods. This research is less directly applicable to women with adequate income and food security, though the general principle of eating diverse foods during pregnancy applies to everyone

Improving dietary diversity during pregnancy can happen relatively quickly—even small changes in food choices can make a difference within weeks. However, the bigger changes needed—like reducing poverty and food insecurity—require longer-term policy and economic changes that may take months or years. If a pregnant woman improves her diet today, her baby can benefit from better nutrition for the remainder of the pregnancy. The most critical times are the second and third trimesters when the baby’s growth accelerates

Want to Apply This Research?

  • Track the number of different food groups eaten each day using a simple checklist: (1) Grains/starches, (2) Beans/legumes, (3) Nuts/seeds, (4) Dairy/eggs, (5) Meat/fish, (6) Dark leafy greens, (7) Other vegetables, (8) Fruits. Aim to check off at least 5 different groups daily. Record weekly totals to see patterns
  • Set a specific, achievable goal like ‘add one new food group to my diet this week’ or ’eat beans or lentils 3 times this week instead of only starches.’ Use the app to plan affordable meals that include variety. If food insecurity is an issue, use the app to find and track local food assistance resources and programs
  • Weekly check-ins on dietary diversity scores. Monthly review of which food groups are being eaten most and least. Track any changes in energy levels, cravings, or how you’re feeling as diet improves. If using a wearable device, monitor weight gain patterns to ensure healthy pregnancy progression. Share weekly summaries with your healthcare provider to get feedback and support

This research describes patterns in one population and should not be used for self-diagnosis or treatment decisions. Pregnant women should always consult with their healthcare provider or a registered dietitian about their individual nutritional needs, as requirements vary based on personal health conditions, pregnancy complications, and other factors. If you’re experiencing food insecurity or struggling to afford nutritious foods during pregnancy, please speak with your healthcare provider about available resources and assistance programs in your area. This article is for educational purposes and does not replace professional medical advice