A Mixed Methods Study on How Urban Slum Food Environments Influence Caregivers' Feeding Practices for Children Under Five Years in Pune, India (FEFC)

Hirabai Cowasji Jehangir Medical Research Institute

Status: Not yet enrolling

Conditions: Feeding Practices; Maternal and Child Health; Food Choices

Study type: Observational

Funder types: Other

Identifiers

NCT07146477

MCH-FEFC-2025-07

Details and patient eligibility

About

The goal of this observational study is to examine how urban slum food environments influence caregivers' feeding practices for children under five years of age in Pune. The main questions it aims to answer are:

• What are the characteristics of the food environment in selected slums of Pune using the 5 A's framework: availability, accessibility, affordability, acceptability, and accommodation?
• What are caregivers' perceptions of food safety, food prestige, and convenience as additional drivers of food choice within the slum context?
• Are caregivers' aware, and have understanding about the use of packaged food labels, especially in relation to identifying foods for young children?
• How do the local food environment and food choice (FEFC) drivers interact to influence caregivers' feeding practices, with a particular focus on the consumption of unhealthy foods and sugar-sweetened beverages among children under five years of age? Participants will be interviewed using digital forms to assess their food environment and food choice drivers. Anthropometric measurements of all children under five years of age in the household will be taken.

Full description

In India there is a high prevalence of poor complementary feeding practices. Around 1 in 2 caregivers introduced complementary foods to infants at 6-8 months, while 1 in 4 infants had the minimum dietary diversity, and 1 in 10 consumed the minimum acceptable diet. A worrisome trend being observed is the widespread consumption of ultra-processed foods (UPFs) among children across all socioeconomic groups in India. In informal settlements in Mumbai, nearly 60% children under 6 years were found to be consuming UPFs daily. Increased UPF consumption contributes significantly to the prevalence of double burden of malnutrition in India.

Pune is a rapidly growing mega-city in Maharashtra with a population of 9.4 million, which includes over 1.2 million slum-dwellers, including around 300,000 children under-five years of age. In 2020, only 6% infants had adequate diets and 12% achieved dietary diversity. Specific data is lacking on time of introduction of complementary foods and no data are available on slum-dwelling populations. The United Nations Human Settlements Program defines a slum as "a group of individuals who live under the same roof, and that lack one or more of the following conditions: access to improved water, access to improved sanitation, sufficient living space, the durability of housing, and secure tenure". Slums are a unique and complex ecosystem where caregivers face multiple, intersecting challenges when making food choices for their children. These settings are often marked by limited infrastructure, economic constraints, and a high density of informal food vendors-conditions that may promote the availability and consumption of unhealthy foods.

The food environment defined as "consumer interface within the food system that encompasses the availability, affordability, convenience, quality and promotion, and sustainability of foods and beverages in wild, cultivated, and built spaces" is increasingly recognized as a key determinant of dietary behavior. Yet there is limited evidence from Indian slum settings on how food environments influence infant and young child feeding (IYCF) practices. Most existing research focuses on maternal knowledge or household-level factors, with minimal attention to the broader environmental and structural influences.

This study responds to this gap by assessing the 5 A's of the food environment (availability, accessibility, affordability, acceptability, and accommodation), and by exploring how these dimensions interact with caregivers' perceptions of convenience, food safety, and prestige, as well as their ability to understand and use food labels. These factors are particularly relevant in urban slums, where informal food systems dominate, and where unhealthy foods may be more readily available and aspirationally consumed. Therefore, the objectives of this study are:

1. To characterize the food environment in selected slums of Pune using the 5 A's framework: availability, accessibility, affordability, acceptability, and accommodation.
2. To explore caregivers' perceptions of food safety, food prestige, and convenience as additional drivers of food choice within the slum context.
3. To assess caregivers' awareness, understanding, and use of packaged food labels, especially in relation to identifying foods for young children.
4. To examine how the local food environment and food choice drivers interact to influence caregivers' feeding practices, with a particular focus on the consumption of unhealthy foods and sugar-sweetened beverages among children under five.
5. To disseminate findings through awareness sessions and cooking competitions.

Enrollment: 370 estimated patients

Sex: All

Ages: 18+ years old

Volunteers: Accepts Healthy Volunteers

Inclusion criteria

• For Family Units:

  1. Families who had participated in the previous house-to-house survey to determine maternal healthcare utilization and infant and young child feeding practices.
  2. Families where all the female caregivers are willing to participate.

• For Food Vendors:

  1. Food vendors who regularly carry out business in the 500 m radius of the household.
  2. Willingness to participate in the study.

Exclusion criteria

• 1. Families who were a part of the earlier project but have moved out of the survey area.

Trial design

370 participants in 2 patient groups

Family or Household

Description:

Family or Households (n = 250) include all the members residing in one house sharing food and other amenities and who have children under 5 years of age.

Food Vendors

Description:

Food Vendors (n = 120) who operate in the 500 m radius of the household cluster will be interviewed in depth to characterize the type of foods sold so that the food environment of the family can be characterized.