Understanding undernutrition among pregnant women in rural Ethiopia: Double diamond model of human-centered approach

Abstract Background Undernutrition among pregnant women is a huge global public health problem affecting the health of the mothers and their (unborn) children. In Ethiopia, the problem persists at an excessively high level despite conventional interventions. This study employed a qualitative human-centered design for a better understanding of undernutrition among pregnant women in rural Ethiopia. Methods We conducted a phenomenological study in three districts of rural Ethiopia in 2022. Eighteen in-depth interviews and eight focus group discussions involving mothers and healthcare workers were conducted in two phases. Data were audio recorded, transcribed, translated, and thematic code analysis was supported by qualitative data analysis software, ATLAS.ti, version 7.0.92. Result Gender inequality, a decline in nutritional education at maternal health services and initiatives, and a resulting lack of nutritional knowledge, were identified as main causes of undernutrition among pregnant women in rural Ethiopia. The stakeholders engaged in the discussion emphasized that the most effective approach to address undernutrition among pregnant women involves closing the current gap in nutritional knowledge and practices among pregnant women, husbands, and mothers-in-law. They also proposed enhancing nutritional education provided during maternal healthcare services and initiatives like the couples forum. Moreover, they highlighted the importance of reducing gender inequalities to make a significant impact on this issue. Conclusion Mothers and healthcare workers identified key factors contributing to the persistently high prevalence of undernutrition among pregnant women. To address this issue, interventions should prioritize improving knowledge and addressing inequalities. Achieving this will require collaboration across multiple sectors and new initiatives like couples’ forums.