Impact of household food insecurity on the use of maternal health services in the Savanes region, Togo: a qualitative study.

Publisher: BioMed Central Country of Publication: England NLM ID: 100968562 Publication Model: Electronic Cited Medium: Internet ISSN: 1471-2458 (Electronic) Linking ISSN: 14712458 NLM ISO Abbreviation: BMC Public Health Subsets: MEDLINE

Original Publication: London : BioMed Central, [2001-

Maternal Health Services*/statistics & numerical data ; Patient Acceptance of Health Care*/statistics & numerical data ; Food Insecurity*; Rural Population/statistics & numerical data ; Humans ; Female ; Adult ; Qualitative Research ; Togo ; Middle Aged ; Young Adult ; Adolescent ; Focus Groups ; Family Characteristics ; Pregnancy ; Health Services Accessibility ; Interviews as Topic

Background: Food insecurity is a major public health challenge in many parts of the world, especially in sub-Saharan Africa. It affects the health and well-being of vulnerable populations, particularly women of reproductive age in their use of maternal health services. This study explores the impact of food insecurity on the use of maternal health services among Togolese women in the Savanes region, aged between 18 and 49 years.
Methods: This qualitative study was carried out using both focus group discussions (FGD) and in-depth interviews (IDI), which were conducted from March 14th to May 20th, 2022 in three different rural areas of the Savanes region in Togo. Firstly, we conducted twelve in-depth interviews with health professionals in three community health centers. In addition, we conducted three FGDs with 8 participants each in three different rural areas. For analysis, all the data collected were transcribed verbatim, and themes were coded using Nvivo14.
Results: Household food insecurity is perceived as a significant threat and barrier to maternal healthcare utilization. Women experiencing food insecurity are less likely to seek maternal health services, as their limited financial resources are prioritized for food rather than healthcare. In contexts of poverty where finances are already precarious, food insecurity further diverts funds that could otherwise be used for medical care. As a result food and financial insecurity intersect influencing women's decisions on whether to access maternal health services. Additionally, the majority of participants identified the COVID-19 pandemic as a factor that seriously exacerbated household food insecurity and consequently further reduced access to maternal healthcare in the region. Enhancing women's socio-economic empowerment and promoting food self-sufficiency were highlighted as potential solutions to improve access to maternal healthcare services while ensuring food security.
Conclusions: Findings from this study highlight the link between food insecurity and maternal healthcare utilization, emphasizing the need to address food insecurity at its root in programs aiming to improve maternal health. Prioritizing poverty reduction through education, income, women's socioeconomic empowerment and food self-sufficiency is crucial. Hence, intersectorial interventions including prenatal nutrition programs are essential to improving access to maternal healthcare.
(© 2025. The Author(s).)

Declarations. Ethics approval and consent to participate: The protocol received ethical approval from both the National Health Research Bioethics Committee of Togo, Ref No. 022-2021-CBRS and the University of Ottawa Research Ethics Board, Canada, Ref No.H-07-21-6967, which conforms to the Tri-Council Policy Statement: Ethical Conduct for Research Involving Humans-TCPS2 (2022) https://ethics.gc.ca/eng/policy-politique_tcps2-eptc2_2022.html - based on the Declaration of Helsinki. We also received written permission from the Scientific and Technical Research Department of Togo, Ref. No 086/MESR/SG/DRST/21. Before data collection, all participants gave consent to take part in the interviews. Informed consent was obtained in writing from healthcare professionals, and verbally from rural women, in line with the ethics committee’s guidelines and regulations, due to barriers related to language or literacy. All research activities were carried out in full compliance with the ethical principles outlined in the Declaration of Helsinki and complied with the national regulations governing research involving human participants. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests.

BMC Health Serv Res. 2023 Feb 2;23(1):109. (PMID: 36732806)
BMC Pregnancy Childbirth. 2022 Feb 19;22(1):138. (PMID: 35183141)
J Appl Gerontol. 2017 Dec;36(12):1415-1432. (PMID: 26912734)
PLoS One. 2013 May 27;8(5):e61277. (PMID: 23723968)
BMJ Sex Reprod Health. 2021 Oct;47(4):252-260. (PMID: 33579717)
Health Serv Res. 2018 Jun;53(3):1600-1620. (PMID: 28608473)
J Multidiscip Healthc. 2020 Nov 02;13:1415-1426. (PMID: 33173303)
BMJ Open. 2023 Mar 13;13(3):e061693. (PMID: 36914184)
Health Equity. 2024 Mar 21;8(1):206-225. (PMID: 38559844)
Am J Manag Care. 2018 Sep;24(9):399-404. (PMID: 30222918)
BMC Pregnancy Childbirth. 2023 Jun 13;23(1):436. (PMID: 37312017)
BMC Public Health. 2023 Nov 20;23(1):2298. (PMID: 37986174)
Epidemiol Rev. 2025 Jan 10;47(1):. (PMID: 39968733)
BMC Pregnancy Childbirth. 2022 Nov 17;22(1):849. (PMID: 36397014)
Matern Child Nutr. 2025 Jan;21(1):e13714. (PMID: 39263941)
Sci Rep. 2023 Jan 19;13(1):1071. (PMID: 36658260)
Nutrition. 2023 Dec;116:112165. (PMID: 37573618)
PLoS One. 2020 Dec 9;15(12):e0243553. (PMID: 33296428)
Matern Child Health J. 2024 Apr;28(4):679-690. (PMID: 37934327)
Int J Health Plann Manage. 2021 Mar;36(2):288-301. (PMID: 33000498)
Curr Nutr Rep. 2022 Sep;11(3):486-499. (PMID: 35501553)
Health Policy. 2019 Jan;123(1):87-95. (PMID: 30391120)
Public Health Nutr. 2024 Apr 12;27(1):e120. (PMID: 38605538)
Arch Public Health. 2022 Sep 16;80(1):208. (PMID: 36114556)
J Glob Health. 2021 Oct 09;11:04048. (PMID: 34737857)
Front Nutr. 2022 Jan 03;8:794607. (PMID: 35047547)
Public Health Action. 2022 Mar 21;12(1):34-39. (PMID: 35317534)
Int Labour Rev. 2022 Jun;161(2):171-194. (PMID: 34898713)
BMC Pregnancy Childbirth. 2022 Jan 21;22(1):56. (PMID: 35062893)
Int J Womens Health. 2021 Jul 16;13:711-716. (PMID: 34295193)
BMJ Glob Health. 2022 Jan;7(1):. (PMID: 35012970)
J Nutr. 2020 Nov 19;150(11):3033-3040. (PMID: 32856046)
Health Serv Res. 2021 Oct;56(5):864-873. (PMID: 33598952)
J Patient Exp. 2021 Mar 2;8:2374373521998820. (PMID: 34179402)
Am J Clin Nutr. 2011 Dec;94(6):1729S-1739S. (PMID: 22089434)
Health Econ Rev. 2021 Sep 18;11(1):36. (PMID: 34536153)
BMC Health Serv Res. 2023 Aug 1;23(1):822. (PMID: 37528374)
Arch Womens Ment Health. 2025 Apr 12;:. (PMID: 40220206)
Depress Anxiety. 2024 Sep 20;2024:1882604. (PMID: 40226692)
Heliyon. 2024 Mar 30;10(7):e28946. (PMID: 38596121)
J Venom Anim Toxins Incl Trop Dis. 2023 Jul 03;29:e20230002. (PMID: 37405230)
PLOS Glob Public Health. 2022 Jul 20;2(7):e0000385. (PMID: 36962364)
Popul Health Metr. 2021 Jan 11;19(1):2. (PMID: 33430907)
BMC Health Serv Res. 2016 Jul 22;16:295. (PMID: 27443346)
Pan Afr Med J. 2020 Dec 24;37:377. (PMID: 33796190)
Lancet Glob Health. 2020 Jul;8(7):e901-e908. (PMID: 32405459)
CMAJ. 2015 Oct 6;187(14):E429-E436. (PMID: 26261199)
Qual Quant. 2018;52(4):1893-1907. (PMID: 29937585)
Lancet Glob Health. 2023 Aug;11(8):e1165-e1167. (PMID: 37474218)
PLoS One. 2021 Sep 28;16(9):e0257782. (PMID: 34582490)
Front Public Health. 2023 Jan 24;11:1087955. (PMID: 36761119)
Health Serv Res. 2020 Oct;55 Suppl 2:883-893. (PMID: 32187388)
Prev Med Rep. 2023 Jul 01;35:102293. (PMID: 37593356)
Lancet Reg Health West Pac. 2023 Sep 21;41:100904. (PMID: 37780633)
BMC Pregnancy Childbirth. 2023 Jan 4;23(1):6. (PMID: 36600225)
Obesity (Silver Spring). 2015 Jun;23(6):1303-11. (PMID: 25959858)
Agric Food Secur. 2022;11(1):56. (PMID: 36532512)
PLoS One. 2021 Sep 10;16(9):e0257032. (PMID: 34506525)
Am J Trop Med Hyg. 2021 Mar 08;104(5):1613-1615. (PMID: 33684060)
Adv Med. 2022 Aug 30;2022:8180387. (PMID: 36082202)
Am J Obstet Gynecol MFM. 2023 May;5(5):100884. (PMID: 36739912)
BMJ Open. 2021 Mar 16;11(3):e045343. (PMID: 33727273)
BMC Glob Public Health. 2024 Aug 7;2(1):51. (PMID: 39681911)
PLoS One. 2021 Mar 25;16(3):e0249195. (PMID: 33765080)
PLoS One. 2023 Feb 7;18(2):e0281260. (PMID: 36749776)
Reprod Health. 2023 Jul 25;20(1):109. (PMID: 37488593)
World Dev. 2021 Apr;140:105296. (PMID: 34548740)

Keywords: Food insecurity; Maternal health services utilization; Qualitative study; Rural areas; Togo

Date Created: 20250602 Date Completed: 20250603 Latest Revision: 20250606

20260130

PMC12128485

10.1186/s12889-025-23220-2

40457279