In the Golestan Province, northwest of Iran, this is the first study to investigate household food insecurity. Out of 5129 households surveyed in the present study, 2913 (56.8%) households experienced some food insecurity. Severe food insecurity was observed in 8.4% of the households, particularly in Azadshahr, Ramyan, and Kalaleh. These three regions are similar to other regions in terms of age and proportion of heads of households, but in terms of literacy level, they were lower than other regions. Regarding the male head of the household, the percentage of labor jobs was higher, and the rate of (governmental) employees was lower than in other regions. In the three regions, the ratio of Sistani was two times, and the ratio of Baloch was four times more than in other regions. Additionally, 29.75, 18.64, and 8.4% of the population reported mild, moderate, or severe food insecurity, respectively. Factors such as the father’s or mother’s low literacy, the father’s or mother’s occupation, ethnicity, and the number of family members were related to food insecurity in Golestan province. As we mentioned earlier, the Sistani and Baluchi were mainly a migrant population who migrated from Sistan and Baluchistan province to Golestan many years ago due to famine. They often settled in certain geographical areas of the province and often had low-income labor jobs. We think that in addition to policymaking at the national and provincial levels, to reduce the factors related to household food insecurity, delegation more authority to local managers to implement local interventions based on local facilities, capabilities and conditions, including specific interventions to empower and employment of more vulnerable groups such as Sistani and Baluchi can help reduce food insecurity.
Researchers reported 28.6% mild, 14.9% moderate, and 6.0% severe food insecurity in Iran in a meta-analysis of experiences/perceptions . Also, Payab et al. reported that 50.2% of mothers with primary school children in Ray (a County of Tehran) suffer from food insecurity . In other studies, different prevalences of food insecurity have been reported in different parts of Iran. For example, the majority of food insecurity in different parts of Iran was as 37.8% in Tehran, 34.3% in Kerman, 58.8% in Zahedan, and 50.7% in rural areas of Gilan [19,20,21,22]. According to the FAO, about two billion people around the world are dealing with moderate or severe food insecurity . Food insecurity affects developing and developed countries and could be as low as about 10% in the USA to as high as 100% in Sudan [23, 24]. The prevalence of moderate or severe food insecurity worldwide has increased slightly from 22.6 to 26.6% from 2014 to 2019. This prevalence in Golestan province is almost in the same range as in other parts of Iran, but by comparing food insecurity in the urban and even rural areas (Fig. 1), the areas with more severe food insecurity are identified. It seems that in addition to determining policies to reduce food insecurity at the provincial level, local interventions based on the potential local capabilities of each region should be designed and implemented in cities or villages . These statements demonstrate the importance of more accurate local assessments to understand the factors influencing food insecurity and designing local interventions.
In our study, food insecurity was significantly associated with gender, literacy, household size, and the head of household employment status. The relationship between food insecurity with being female as head of the household in the studies of Gilan and Kerman, with the education level of the head of the household in the studies of Tabriz and Kerman, with the number of household members in the studies of Kerman, Tehran, and Tabriz and with the employment status of the head of the household in the studies of Kerman and Tehran were confirmed [19, 20, 22, 26, 27]. A cross-sectional study of food insecurity and predictors in the elderly of the United States found depression severity, financial instability, and a nutritional support package to be significantly associated with food insecurity . Consistent with other studies, with the increase in the number of household members, especially those without income, i.e., children and the elderly, the need for adequate food increases, which in case of insufficient supply, increases the risk of malnutrition and food insecurity [28,29,30]. Our study showed the importance of parental employment in reducing food insecurity. This relationship has been emphasized in other studies in Iran (Tabriz, Kerman, Qazvin). Having a job increases the household’s economic access to food resources [20, 27, 29]. In our research, there is an inverse relationship between the mother or father’s education level and the state of food insecurity. Other studies have also shown this inverse relationship [31, 32]. Literate and educated parents are more likely to have better nutritional knowledge, which affects the household’s food intake.
Since parents, especially mothers, are the main decision-makers of household food consumption, promoting maternal health literacy and nutritional literacy is essential for proper family nutrition . When access to food is restricted, household members inevitably eat less or do not receive some of their meals. In the study of Kohhande et al., the results of dietary diversity showed little variation in the dietary status of households. Due to the reduction of access to diverse food sources and the subsequent development of malnutrition, especially in micronutrients, this situation may indicate an increased likelihood of food insecurity in households. Families with more educated parents, especially more educated women, benefit from better nutrition and are less prone to malnutrition . Policymakers need to increase the literacy of household members, especially mothers, to reduce food insecurity in the long term. In addition, training the household head, especially the mother, on choosing suitable foods according to the household’s income level can help reduce food insecurity in the short term. The country’s Supreme Health Council has compiled and approved the national document on nutrition and food security in Iran, in which programs such as education, women’s empowerment, nutritional support, and cash subsidies are provided to support food-insecure households .
In the present study, we used the SAMAT system for GIS-mapping and identification of major food-insecure areas in the Golestan Province . Moore et al. used GIS to study the relationships between grocery store access and diet quality across states in the US. In participants who lived without supermarkets nearby, the likelihood of eating healthy was 25 to 46% lower than in participants who lived near supermarkets . Kim et al. used GIS to reveal a strong relationship between the accessibility of green space and obesity predictors . In another study, GIS-assisted and multivariate logistic regression analyses demonstrated that increasing obesity rates were associated with geographic proximity to fast-food restaurants (OR ≥ 1.2), and a decrease in obesity rates was related to living in neighborhoods with green spaces . Indeed, GIS can be employed to better manage potential food resources, thereby reducing food insecurity . Previous research in Nevada, USA, used GIS to investigate relations between social determinants of health and food insecurity. The study demonstrated that students living in catchment areas with higher food insecurity rates were more likely to be absent from schools. Although free meals have been provided for poor students in certain schools, the high absenteeism rates further hinder the food intake of poor students . Climate-related conditions such as drought, flood, land degradation, and vegetation that influence food production and accessibility can also be investigated using GIS . Household location and geographic inequalities can influence the relationship between socio-economic factors and food security. These results indicate that the prevalence and severity of food insecurity in the Golestan Province are higher than the national average. The existence of food insecurity in more than half of the households in the province requires the attention of the local government and support for interventions to reduce the food insecurity of households. Since food insecurity points are marked on the GIS map of the province, it is possible to conduct more detailed local surveys in known food insecurity areas. In all regions of the province, there were food-insecure colonies in both villages and urban areas. Identifying these hot points can help local authorities take appropriate and accurate measures to address food insecurity in the province. The location of households is a crucial factor determining the socio-economic factors and food security relations in urban areas of Iran . Government and food insecurity-related institutions can promote and support community-based interventions in these areas.
Although this study was conducted with a large sample size and a large provincial scale, which can provide appropriate estimates of food insecurity at the urban and even rural levels, in expressing the limitations of this research, it should be noted that access to some of the families located in remote geographical areas and locating the GPS of those families during the implementation caused problems that we tried to solve with the help of the technical team. Some families were not present during the interviews, which were undertaken according to the neighboring neighbors’ executive protocol. This means that if it was impossible to reach the household after three visits, the first neighboring household was questioned. Also, due to the limitations of cross-sectional studies, we may not be able to show the lead-lag relationship between variables and food insecurity.