Researchers in rural India discovered a big gap between what doctors recommend pregnant women eat and what they actually eat. The study found that 85% of pregnant mothers didn’t increase their food intake during pregnancy, even though doctors say they should. Education made the biggest difference—women who went to school longer were three times more likely to eat better during pregnancy. The study also found that cultural beliefs about food, family advice, and local health workers all influence what pregnant women choose to eat. Understanding these cultural factors is important for helping pregnant women get the nutrition they need for healthy babies.

The Quick Take

  • What they studied: Why pregnant and postpartum women in rural India don’t follow doctor’s advice about eating more nutritious food, and what influences their food choices
  • Who participated: 1,200 mothers and 400 health workers (called ASHAs) across multiple districts in Bihar, India, plus 78 additional mothers and mothers-in-law in focus groups and interviews
  • Key finding: Most pregnant women (85%) didn’t eat more food during pregnancy as recommended, but women with more education were three times more likely to improve their diets. Cultural beliefs about which foods are safe or appropriate during pregnancy had a major impact on eating habits.
  • What it means for you: If you’re pregnant or know pregnant women in similar communities, education about nutrition and respecting cultural food beliefs are both important. Simply telling women to eat more isn’t enough—understanding why they avoid certain foods and building on foods their culture already values works better.

The Research Details

Researchers used a combination of two different research methods to understand the problem. First, they talked to groups of mothers, interviewed health workers, and observed families in their homes to understand cultural beliefs and real-life eating patterns. Second, they surveyed 1,600 people (mothers and health workers) using questionnaires to count how many followed nutrition guidelines. This mixed approach helped them see both the numbers and the reasons behind the numbers.

The study focused on three main areas: whether women ate enough calories, whether they consumed foods with important vitamins and minerals, and which foods they avoided. They compared what pregnant mothers actually did with what health workers (ASHAs) recommended, since these workers are trained to teach nutrition but also live in the same communities.

The researchers analyzed their data in two ways: they counted patterns in the survey responses and looked for common themes in what people said during interviews and group discussions. This helped them understand both how widespread the problem was and why it happened.

This research approach is important because nutrition advice doesn’t work the same way everywhere. In rural India, cultural beliefs, family traditions, and local practices are just as important as medical guidelines. By combining numbers with personal stories, researchers could see that the problem isn’t simply that women don’t know what to eat—it’s more complicated. Understanding these cultural factors helps create better solutions that actually work in real communities.

The study is reliable because it included a large number of people (1,600 surveyed) across multiple areas, not just one village. The researchers used multiple methods to check their findings—they didn’t just ask questions, they also observed real families and talked to different types of people (mothers, mothers-in-law, health workers). The study was published in a respected nutrition journal. However, the research was done only in one region of India, so results may not apply everywhere. Also, people sometimes answer survey questions differently than they actually behave, so some reported eating habits may not be completely accurate.

What the Results Show

The biggest finding was that most pregnant women weren’t eating more food during pregnancy, even though doctors recommend it. Specifically, 85% of mothers and 75% of health workers didn’t increase their food intake during pregnancy. This shows that the advice isn’t being followed, even by the health workers who are supposed to teach it.

Education was the strongest factor that changed eating habits. Women who had completed 14-17 years of school (roughly high school level) were three times more likely to eat better during pregnancy compared to women with less education. This suggests that helping women stay in school or learn about nutrition could make a real difference.

Cultural food preferences played a major role. Certain foods like rice mixed with ghee (clarified butter) and milk were widely accepted and eaten. However, foods rich in important vitamins and minerals (like leafy greens, eggs, and legumes) were eaten less often because of cultural beliefs about which foods are appropriate during pregnancy. Interestingly, more educated women didn’t just eat less of restricted foods—they made more thoughtful choices about what to eat and what to avoid, showing they understood the reasons behind dietary changes.

The study found that mothers-in-law and family members had significant influence on what pregnant women ate. Health workers (ASHAs) wanted to promote better nutrition but faced challenges in their communities because of strong cultural beliefs. The research showed that ASHAs themselves often didn’t follow the nutrition guidelines they were supposed to teach, suggesting they also struggle with the gap between recommendations and real life. This indicates that training health workers alone isn’t enough—they need support to overcome community barriers and cultural beliefs.

Previous research has shown that malnutrition during pregnancy is a problem in many developing countries, but this study adds important details about why it happens. Earlier studies focused mainly on poverty and lack of food availability, but this research shows that cultural beliefs and education are equally important factors. The finding that education is so powerful aligns with other research showing that educated women make more informed health choices. However, this study goes further by showing that cultural respect and education together work better than either one alone.

The study was conducted only in Bihar, a specific region of India, so the results may not apply to other parts of India or other countries with different cultures. The research relied on people’s memories of what they ate, which isn’t always accurate. The study didn’t measure actual nutrition levels in mothers’ blood or babies’ health outcomes, so we can’t say for certain that the eating patterns directly affected health. Additionally, the study captured a moment in time and didn’t follow women over many months to see if behaviors changed. Finally, the researchers couldn’t prove that education directly causes better eating—it’s possible that more educated women have other advantages (like more money or access to better food) that also help them eat better.

The Bottom Line

If you’re working with pregnant women in rural communities: (1) Provide education about nutrition, as this showed the strongest effect on dietary choices—High confidence. (2) Build nutrition programs around culturally accepted foods like milk and rice rather than trying to replace them—High confidence. (3) Train and support health workers with resources to help them overcome community barriers—Moderate confidence, as the study showed ASHAs want to help but need support. (4) Involve mothers-in-law and family members in nutrition education, since they influence food choices—Moderate confidence based on observations in the study.

Pregnant women and new mothers in rural areas should care about this research, especially if they have limited education or live in communities with strong food traditions. Healthcare workers, public health officials, and organizations working to improve maternal health in developing countries should use these findings to design better programs. Families and mothers-in-law should understand that good nutrition during pregnancy helps both the mother and baby. However, these findings are most relevant to rural communities in South Asia with similar cultural practices; urban areas or different countries may have different barriers.

Changes in eating habits during pregnancy would need to happen relatively quickly—ideally before or early in pregnancy—to benefit the developing baby. Educational interventions might take several months to show results, as women need time to learn, change habits, and access different foods. Health improvements in babies might not be visible until after birth, when birth weight and early development can be measured. Long-term benefits for child health could take years to fully appear.

Want to Apply This Research?

  • Track daily food intake by logging meals and snacks, with specific focus on: (1) total calories consumed, (2) servings of micronutrient-rich foods (leafy greens, eggs, legumes, fortified foods), and (3) culturally important foods eaten (rice, ghee, milk). Use a simple photo log or checklist rather than complex calorie counting.
  • Start with one small change: add one additional serving of a culturally accepted food (like milk or eggs) to your daily diet during pregnancy. Once this becomes a habit, gradually add other nutritious foods. Use the app to celebrate small wins and track progress over weeks, not days.
  • Weekly check-ins to review food logs and identify patterns. Monthly summaries comparing intake to recommendations. Connect with health workers through the app to get personalized feedback. Track not just what you eat, but also how you feel and any barriers you face, so solutions can be tailored to your situation.

This research describes eating patterns in rural India and should not be used as personal medical advice. Pregnant women should follow guidance from their own healthcare providers, who know their individual health situation. If you’re pregnant or planning to become pregnant, talk to your doctor or midwife about how much and what types of food are right for you. This study shows what happened in one region of India and may not apply to your specific situation. Always consult with qualified healthcare professionals before making changes to your diet during pregnancy or while breastfeeding.