The Double Burden of Food Insecurity and Poor Oral Health Among Pregnant Women in eThekwini, KwaZulu-Natal.

Objectives: To estimate the prevalence of household food insecurity and of poor oral health, and to identify factors associated with each outcome among pregnant women attending public-sector antenatal care (ANC) at two community health centres (CHCs) in eThekwini, KwaZulu-Natal (KZN), South Africa. Methods: An analytic cross-sectional study was conducted among 420 pregnant women attending ANC at Cato Manor and KwaMashu CHC. Data were collected from February to March 2026, using interviewer-administered structured questionnaires. Food insecurity was measured using the eight-item Food Insecurity Experience Scale (FIES), while oral health was assessed using adapted WHO Oral Health Survey items. Logistic regression was used for statistical analysis. Results: Reported food insecurity prevalence was 44.4% (95% CI: 39.7-49.2), with 20.0% (95% CI: 16.5-24.2) reporting moderate or severe food insecurity. Poor oral health affected 12.6% (95% CI: 9.8-16.2) and 57.0% (95% CI: 52.2-61.7) reported at least one pregnancy-onset symptom. In bivariate analysis, moderate or severe food insecurity was more common among younger women ( Conclusions: Household food insecurity was significantly and independently associated with poor oral health among pregnant women attending ANC. As a cross-sectional study, this study demonstrates association rather than causation and supports the need for longitudinal or prospective research to establish causal pathways. They also support integrating food insecurity screening into ANC and inform maternal health, nutrition, and oral health policies to strengthen comprehensive maternal healthcare services in South Africa.