Challenges faced by migrant seasonal agricultural farmworkers for food accessibility in Spain: A qualitative study

ABSTRACT

Migrants who work seasonally in agriculture face living and working conditions that significantly impact their health. Some of these conditions are related to inadequate food access or food preservation and preparation hygiene. This study aimed to explore how migrant and seasonal agricultural farmworkers access food in Spain from the perspective of professionals supporting this population. We conducted a qualitative study in 2021 based on semistructured interviews with 92 social and health service professionals involved in the care of seasonal migrant workers in 4 Spanish provinces. We identified three themes through reflective thematic analysis: (1) Access to food depends on NGOs and institutions, especially after the COVID-19 pandemic; (2) Relevant cultural differences in diet depending on North African or sub-Saharan origin; (3) Seasonal migrant workers frequently suffer from nutritional and other health problems related to food security. The professionals interviewed described the diet of seasonal migrant workers as based on food with little variety, insufficient protein content, and obesogenic products. They also reported a generalized lack of hygiene in food storage and preparation. This study calls for encouraging dietary support strategies to reduce challenges in food accessibility, which would prevent health problems in this population and bring them social justice.

KEYWORDS:

• Migrants
• agricultural workers
• food access
• COVID-19
• qualitative research

Introduction

European countries’ agricultural sectors depend on migrant workers, especially during specific periods such as harvest season (Molinero-Gerbeau, 2021). Likewise, Spain has historically been a country destination for agricultural workers from abroad (Martin, 2016). These workers are mainly recruited during specific periods of a few months, which vary from region to region and involve different work activities such as harvesting and processing agricultural production (Zimmerer et al., 2020). Migrant and seasonal agricultural farmworkers (MSAFW’s) in Spain are mainly people from the Maghreb, sub-Saharan Africa, Eastern Europe, and, to a lesser extent, Latin America (González, 2018; Martin, 2016). In 2018, around 150,000 and 276,000 temporary workers were hired in Spain for agricultural work (Augère-Granier, 2021).

Often, MSAFW’s face precarious living and working conditions caused by instability in employment, in some cases irregular, which implies geographic mobility and less guarantee of their rights (Fries-Tersch et al., 2021; Triandafyllidou & Bartolini, 2020). These poorer conditions entail a higher risk of poorer health and less access to the health and social protection system (Urrego-Parra et al., 2022). This situation also entails a high risk of suffering challenges to access nutritionally adequate food due to poorer access to food and more significant difficulties in food preparation and preservation (Kiehne & Mendoza, 2015).

Food security depends fundamentally on four aspects: availability, access, utilization, and stability (FAO, 2009). In this study, we will focus on access to food, understood as the household's or individual's ability to obtain available food (Briones et al., 2018). While malnutrition is not solely determined by this aspect, it can lead to an increased risk of food-related problems (Pinstrup-Andersen, 2009). In this sense, food access problems are also included when this access leads to vulnerability or marginalization, such as through donations, charities, food banks, or theft (Anderson, 1990; Radimer et al., 1992).

Among MSAFW’s, the prevalence of food insecurity is estimated at 87% (Al-Bazz et al., 2022; Kiehne & Mendoza, 2015). There are barriers to accessing food, such as remoteness from supermarkets and grocery shops, a lack of means and time to do the shopping, and a lack of access to affordable, sufficient, varied, and healthy food (Meierotto & Som Castellano, 2020; Summers et al., 2015). As a result, they could have poor dietary behaviours, including irregular intake patterns, low consumption of nutritious foods, and a lack of time for meal preparation (Benazizi et al., 2018; Rodríguez, 2019; Sliwa et al., 2015).

Because of the difficulty of accessing this population, to the best of our knowledge, few studies have described access to food and its implications for the health of MSAFW’s in Spain. One way of approaching the reality of MSAFW’s is through the professionals who work in the protection and support system for migrants in public institutions or NGOs (Cánovas et al., 2022; Mozo et al., 2022). The lack of knowledge related to food accessibility that is experienced among the migrant population, in general, and among MSAFW’s, increases the invisibility of the vulnerability of these groups and hinders the effective guarantee of the rights to health and an adequate standard of living (Corrado & Palumbo, 2022). Therefore, this study aimed to explore how MSAFW’s access food in Spain from the perspective of professionals supporting this population.

Material & Methods

Study design and setting

This qualitative, exploratory and descriptive study is part of the first phase of a broader project (ANONIMIZED), focused on assessing the influence of job insecurity and social exclusion on the health of migrant women and men working in the agricultural sector in Spain. During 2021, semistructured interviews were carried out in four provinces of Spain with different types of agricultural production (seasonal campaigns: Catalonia and La Rioja/intensive agriculture: Andalusia and Murcia). Agricultural seasons in the north (Lleida and La Rioja) last a few months and are open-air, extensive, and focused on exploiting a reduced range of products. In contrast, the campaigns in the south (Murcia and Almeria) tend to last several months, be intensive, under plastic or orchards, and produce a wide range of products (Martínez Fernández, 2020; Molinero-Gerbeau & Muñoz-Rico, 2022; Soruco-Parada, 2021). In all of them, there are many agricultural work activities: harvesting, pruning, picking, processing, and packaging (González et al., 2021). Seasonal work is mainly carried out in the field for harvesting, processing, and topping fruit and vegetables, in agricultural stations for harvesting, on farms or vineyards, or in nurseries. There is also a significant group dedicated to working in sheds or warehouses for the packaging and storage of produce and storage of produce (Gadea et al., 2016).

Participants

Participants were health and social care professionals working in public institutions and NGOs involved in the support of MSAFW’s. Participating NGOs were national and local organizations created to improve living conditions in areas such as health, education, housing, public services, transport, and employment, among other aspects (Delgado, 2010). Recruitment was carried out by purposive sampling by identifying key informants in the four selected regions and then by using the snowballing technique. A total of 92 participants (55 women, 37 men) involved in the care and support offered to MSAFW’s were recruited, including professionals from Health care: physicians, nurses, psychologists (n = 23), social services (n = 3), NGOs and cultural mediators (n = 43), worker unions (n = 17) and Governmental institutions (n = 6) in four Spanish regions: Andalusia (n = 31), Catalonia (n = 24), La Rioja (n = 20) and Murcia (n = 17)[ Table 1]. We chose semistructured interviews as the data collection technique to obtain deep information from each informant regarding several topics included in the interview guide. We conducted 86 interviews (individual n = 80 or in pairs n = 6) in person or by Zoom until the information saturation. This resulted in no new information being obtained.

Table 1. Study participants according to the sector and region (N = 92).

Region	Sex		Sector
	Female	Male	Health care	Social services	NGOs	Mediation	Worker unions	Governmental institutions
Andalusia	25	6	9	1	17	4	0	0
Catalonia	10	14	9	0	7	4	2	3
La Rioja	13	7	3	2	5	0	6	2
Murcia	7	10	2	0	6	0	9	1
Total participants N = 92	55	37	23	3	35	8	17	6

A single interview script with open-ended questions was designed by the project's research team in accordance with the project's objectives and previous literature. It contained five sections: care and support for MSAFW’s provided by the service, migratory trajectory, MSAFW’s living conditions, MSAFW’s health and impact of the COVID-19 pandemic. The interviews were conducted from January to October 2021. The duration of the interviews lasted on average 60 minutes (between 30 and 90 minutes). The team of interviewers were members of the mentioned research project. The interviews were conducted both online and in-person in the aforementioned regions. They were audio-recorded electronically and then transcribed verbatim.

Analysis

The transcripts were imported into the ATLAS.ti web software (online version 9) (ATLAS.ti Scientific Software Development GmbH, 2022), which was used to organize and code the information during the analysis. We conducted a reflective thematic analysis (Braun & Clarke, 2022). In the first step, the researchers elaborated a code tree based on the interview script to identify the key concepts in the transcripts, assigning a code with a similar meaning to each sentence or paragraph. In the second step, they labelled the paragraphs related to the study's objectives with open codes summarising the meaning of each sentence. Finally, following a constant comparison process, the resulting list of open codes was grouped under groups of codes according to their similarity, resulting in the subthemes and themes shown in the results section. The authors met several times to discuss the final themes and the structure of the results.

The rigour of the analysis was ensured through a combination of strategies, including heterogeneity of participant profiles, regions of origin and researcher perspectives, as well as by accompanying the results with meaningful excerpts (verbatim quotations) from the interviews.

Ethical considerations

The study was conducted taking into account all ethical considerations of the Declaration of Helsinki. Prior to data collection, approval was obtained from the Healthcare Ethics Committee of the Arnau of Vilanova Hospital in Lleida in 2021 [CEIC– 2459].. Respondents agreed to participate voluntarily and signed an informed consent document guaranteeing confidentiality of the data. During data collection and transcription, an identification number was assigned to each participant in order to preserve their anonymity. Consolidated Criteria for Reporting Qualitative Research (COREQ) criteria were followed (Tong et al., 2007).

Results

The results have been structured into three emerging themes (1) Support and food distribution by institutions and NGOs; (2) Nutrition characteristics of MSAFW’s; and (3) Nutrition-related health problems of MSAFW’s, with their corresponding subthemes.

Support and food distribution by institutions and NGOs

Seeking support and accessing food-related resources

The participating professionals described that MSAFW’s face situations of economic precariousness. Although, in some cases, MSAFW’s resort to collaboration or begging strategies, donations from institutions and NGOs are their primary source of accessing food. Professionals highlighted that MSAFW's main demands for support at the institutions are food and housing costs. Participants identified barriers to accessing food resources, such as knowing where food resources are provided, time constraints, and the size of the city to go to such places.

For example, if they come outside of regular hours, I won’t feed them, and sometimes someone will come one and a half hours late. There’s a schedule here and you have to stick to it. (E50, Social worker, NGO, La Rioja)

The participating professionals indicated that they also assisted homeless MSAFW’s by supporting them in obtaining food, housing, and economic resources. Some NGOs have specific programs to help people experiencing homelessness, not specific to MSAFW’s, and professionals reported that they serve many of them. In other cases, professionals directly gave food to homeless MSAFW’s when they assisted them with other administrative or health-related issues.

Sometimes you’ll bump into a guy and he’ll ask if you can please lend him 50 cents. If he hasn’t eaten for two days or one day, well, you really feel like you have to buy him a sandwich. (E32, Mediator, Mediation, Catalonia)

To distribute food and essential products, local councils and public institutions diagnose basic needs, refer to the corresponding circuits, promote proper contracts, and distribute food and hygiene products with NGOs. It can be done regularly in facilities or by transporting the food to the MSAFW's locations. Usually, the food packs include three meals daily (breakfast, lunch, and dinner), for example, including a lunch box with a sandwich they bring to work, depending on the available budget.

There’s a municipal meal service. They have two versions. One does hot meals, where they serve lunch and dinner, and this operates every day of the year, and we can refer them there from the technical department. And then the other one is a lower-demand service, where they give out sandwiches for people who don’t sign up for the lunch service or aren’t signed up to a jobseekers plan, but that sandwich service somehow guarantees that they get at least one meal a day even if it’s something temporary. (E52, Social worker, City Hall, Catalonia)

The interviewed professionals explained that food distribution can also be offered through vouchers or financial allocation.

We need to move towards having them buy their own [food], we need to help with direct transfers, and one very interesting measure that is working in Barcelona, but hasn’t been brought in here yet, is cards. (E14, Social worker, Union, Catalonia)

And the other aid that’s increased the most is the money we give out. It’s a direct cash transfer for them to buy food. This is what’s increased the most as a result of the pandemic. What they call ‘financial donations' it’s just they bring you their vouchers and you give them the money … (E15, NGO, Catalonia)

In addition, the interviewees explained that to distribute food, the NGOs consider their specific needs, such as their age, the location of the MSAFW’s homes and household appliances, and their employment situation.

For instance, if they don’t have work, we give them food and a bit … They’ll have to manage their shopping a bit, but also considering whether they have a fridge or not. (E64, Nurse, Healthcare, Andalusia)

Collaborative work of different NGOs and an extensive volunteer network available are in charge of food distribution. Other actions carried out by NGOs were referrals to other support devices.

I mean, here at [NGO] we have no resources, I can’t feed them, I have to send them to [NGO], you know what it’s like. I’m in charge of vulnerability programs. So about aid, if we get one of them here, then we have to send them over there, whether it’s the shelter if they need a place to sleep, or to [NGO] if they need somewhere to eat. (E27, Social worker, NGO, La Rioja)

Another intervention highlighted was health education related to food processing and hygiene to prevent illnesses from food contamination. At the same time, the professionals themselves recognized that living conditions often do not allow MSAFW’s to guarantee these measures.

One of the things NGOs do is all the environmental stuff, like helping them clean up the camp and explaining some basic simple stuff like if they used a battery, then don’t leave it near the food storage or water supply, to avoid contamination. (E2, Nurse, Healthcare, Andalusia)

Food distribution during the COVID-19 pandemic

During the first wave of the COVID-19 pandemic in 2020 and 2021, city halls and NGOs have provided different types of humanitarian aid to cover the basic needs of MSAFW’s, such as hygiene (laundry, showers) and food. The interviewees indicated that the municipalities were responsible for coordinating the distribution of food and hygiene kits following COVID-19 prevention regulations. NGOs also worked collaboratively to distribute food and referrals to other support mechanisms.

[Other NGO] they’d provide a special van for distributing meals. We were making the food, we moved to a kitchen that was set up there, from a tent in the street so there would be ventilation. On each trip we’d feed some 25 people, so we had to set up four, four food stations. (E50, Social worker, NGO, La Rioja)

Nutrition characteristics of MSAFW’s

Diet characteristics of MSAFW’s

The interviewees explained that the diet of the MSAFW’s was based on essential products and, with little variability, cheap food delivered by associations and NGOs based on rice, flour, and pulses. While consuming fruit and protein was limited, foods high in sugar were high.

Some of them work every other day, getting their wages one day at a time, don’t they? Well, those resources are what they buy their food with, but the food they can buy is very basic food, like maybe some flour, or some beans, but their access to a balanced diet is limited, they don’t … So they do have access to the best vegetables they can get in the greenhouses where they’re hired, or where one of their nationals is hired, but no access to a balanced diet where they get their meat and their fish, well, none of that. (E87, Coordinator, NGO, Andalusia)

As a result, professionals described MSAFW's diets as based on essential products, unbalanced and incomplete. They explained it because of their precarious working conditions, which prevent them from buying enough food. In this regard, participants identified the diet of MSAFW’s living in shanty settlements and without a family as worse than those living with their families. Participants also suggested that occasionally, for survival reasons, MSAFW’s resorted to socially unacceptable food-hoarding strategies, such as stealing food or eating dog meat in the settlements.

We get newcomer immigrants, but they have family here already … Their diet is usually a bit better, but the ones living in the camps don’t usually get any family support, they don’t have the support from a friend. So then their diet is very limited. (E4, Primary Care Physician, Healthcare, Andalusia)

Cultural differences among MSAFW’s

The interviewees noted that food consumption varied according to the origin of the MSAFW’s. They explained that MSAFW’s working in the Spanish camps were mainly from the Maghreb provinces, especially Morocco, and sub-Saharan Africa; while the former ate meals with a variety of foods (meat, vegetables, and their traditional food) and individual eating practices; the latter ate low-cost, inexpensive food (such as rice for breakfast, lunch, and dinner) as they cannot afford to buy meat due to its high price, and tend to resort to community organizational strategies to reduce food costs, such as making everyday purchases of sacks of rice that they cook together.

North Africans have a different attitude, they respect privacy more … Making a communal latrine, sharing the cooking spaces and all that is much more common among Sub-Saharans than among North Africans. North Africans look for more privacy. If they get a room, then they’ll have a cooker, their kettle, they have everything in their own room … (E12, Project coordinator, NGO, Murcia)

In this sense, the interviewees explained that sometimes the food distributed by NGOs is not the most appropriate and could be rejected by MSAFW’s if it is not considered culturally acceptable or if they need to learn how to cook it. Then, the importance of considering preferences when distributing food was highlighted.

It’s a bit of a problem for us sometimes, when we go around giving out food. Because, for example, we’ll give them beans and people don’t know how to cook them. So there’s no point in giving them that. Then we have to consider things like that when we give out food. (E6, Nurse, Healthcare, Andalusia)

They won’t eat this type of food and then this food gets thrown away. Apparently, a lot of it goes to waste. (E54, Mediator, Cityhall, Catalonia)

Nutrition-related health problems of MSAFW’s

Risky dietary practices-related risky problems of MSAFW’s

The interviews revealed several ailments and health problems arising from scarcity of food and poor hygienic practices. The participants identified digestive problems, such as stomach ache or gastroenteritis, and oral problems among the MSAFW’s. This situation was especially acute in irregular settlements where many MSAFW’s live in unsanitary conditions. They related it to an unhealthy diet, little variety in their food, and a lack of hygiene. For instance, interviewees inferred that vomiting, itching, headaches, and stomach pain could be due to eating unwashed fruit exposed to pesticides, contaminated water, and sanitary products.

And then stomach aches or stomach discomfort, vomiting … […] They say itchy, itchiness, a lot of it, headaches, and especially itching, and stomach aches, stomach … Because they eat fruit, sometimes they won’t wash it. (E9, Nurse, Healthcare, Catalonia)

On the one hand, other health problems described among MSAFW’s were skin and eye problems related to vitamin deficits. Even some interviews identified that MSAFW’s unhealthy diet could act as a precursor to problems such as hypercholesterolemia, kidney disease, and diabetes – which in turn could be under-diagnosed;

In women, we did see some significant nutritional deficits, some of them, for instance, have developed skin or ocular conditions … (E4, Primary Care Physician, Healthcare, Andalusia)

Their diets are terrible. So they get cholesterol problems very early on, at a very young age, and kidney issues. Right? And so I think we’re still at the beginning, so we’ll see a wave of chronic conditions that are typical of marginalized populations … (E24, Activist, Andalucía)

On the other hand, other interviewed professionals indicated that nutritional disorders in MSAFW’s were scare.

We thought that maybe the disease, diabetes, could be more prevalent in these people, where we think it could be linked to their diets; they drink lots of sugary beverages, they have lots of carbohydrates. (E6, Nurse, NGO, Andalusia)

Discussion

Professionals supporting MSAFW’s identified them as at risk of experiencing challenges in the food supply in Spain. According to the results, the pandemic positively impacted, creating a greater synergy between NGOs and public institutions. Moreover, the deployment of food aid and referral to specific food aid mechanisms during the pandemic was a beneficial strategy to reduce food scarcity and tackle structural barriers like material poverty, accessing resources, and cultural characteristics of MSAFW’s. The results could be explained through the lens of the conceptual framework of Weiser et al. (2015). According to this model, challenges in food supply contribute to food insecurity by acting at three levels: a community-structural level, a household-behavioral level, and an individual level. There is an interrelation between these levels, where challenges to food supply trigger food insecurity, shape nutritional behavior, influence physical health, and have repercussions on morbidity and mortality (Weiser et al., 2015).

At the community-structural level, the constant demand for food aid by MSAFW’s seems to be a consequence of the pattern of agricultural seasons in Spain that encourages movement between regions (Martin, 2016). Therefore, food subsidies are a necessary sustenance, not a temporary relief measure. Although food distribution systems are a support network, they are unable to respond to all the dietary demands and needs of MSAFW’s on their own (Bazerghi et al., 2016).

Although mainly NGOs are responsible for providing direct food support through solidarity and donations, this study has identified collaborative work with public institutions, such as local governments. That was the case, for example, in responding to the needs of MSAFW’s during the first waves of the COVID-19 pandemic. The measures taken to contain the COVID-19 outbreaks led to an improvement in baseline levels of hygiene in some settlements that lacked basic services (Cockburn, 2020). However, this joint response has functioned as a coping strategy in response to the high demand for support that collapsed aid systems (Güell & Garcés-Mascareñas, 2020). Evidence from the USA, where similar strategies have been adopted, indicates that some of the changes introduced have not necessarily been sustained over time (Accorsi et al., 2020).

At the household-behavioural level, the MSAFW’s economic project focuses on saving as much as possible at the expense of their food and material needs. Economic marginalisation, resulting from working conditions, results in requiring support to meet their food needs (Rodríguez et al., 2021). Also, the reported food wastage by some MSAFW’s may be a consequence of cultural differences, such as unfamiliarity with local food and a lack of means or knowledge of food preparation, as has been reported in a study in Canada with a North African population (Hassan & Hekmat, 2012). In this regard, the strategies used to cope with hunger, like food sharing and receiving donations described in sub-Saharan Africans, were previously reported in other contexts of extreme poverty to face challenges related to food scarcity (Mbhenyane et al., 2020).

Moreover, food acceptance might depend on cultural factors such as married status, which has been identified as a regulator of adherence to a more traditional diet in North Africa (El Rhazi et al., 2015). In sub-Saharan Africans, factors such as inaccessibility to traditional ingredients result in acculturation to a more high-calorie Western diet (Renzaho & Burns, 2006) that might not be obtained in the food aid services reported, as our data point out. These factors must be considered to provide successful food aid services that reduce food scarcity. At the individual level, health problems such as oral health have been previously linked to MSAFW’s poor diet in the USA (Kiehne & Mendoza, 2015). As identified in the results, constipation and digestive problems related to an astringent diet have been related to conditions of poverty, with lower expenditure on high-fibre foods, such as fruit and vegetables (Drewnowski & Specter, 2004).

Nonetheless, a lack of access to the health system translates into a higher incidence of health problems, such as diabetes (Quandt et al., 2018). In contrast, in Spain, access to the national health system is universal, although there may be other barriers (Bernal-Delgado et al., 2018). The absence or delay in the diagnosis of metabolic problems such as dyslipidaemias, diabetes, or nephropathies could be due to the lack of diagnostic services in primary health care (Bawadi et al., 2012; Gil-González et al., 2015; Sarría-Santamera et al., 2016). This could be explained because an absence of preventive health education, which leads to ignoring the signs of the onset of metabolic diseases, has been documented (Sarría-Santamera et al., 2016; Urrego-Parra et al., 2022). In turn, evidence indicates that the greater the number of farms where MSAFW’s work, the higher the incidence of diseases related to pesticide and chemical contamination (Edelson et al., 2018). Health promotion actions are required to reduce the impact of pesticides in the food MSAFW’s consume.

Moreover, at the community level, MSAFW’s might have met their dietary needs by accessing emergency food resources, such as food banks (Bazerghi et al., 2016). Evidence from the USA suggests that when MSAFW’s are beneficiaries of programs aimed at reducing food scarcity, there is an increase in dietary knowledge and an improvement in their eating habits (Lee & Won, 2015).

However, metabolic health problems underreported by professionals in our data could be related to the age of debut of metabolic diseases (Olson et al., 2023) or to experiencing barriers in accessing healthcare due to incompatibility of working hours with health care services schedules (Caxaj et al., 2023). For example, in Mexican MSFW, only 3% reported metabolic health problems, possibly due to a lack of primary healthcare access and low-quality and unhygienic nutritional services (Ortega et al., 2016). In addition, in the U.S., MSAFW’s without recent healthcare access had 83% lower odds of reporting known diabetes in comparison to nonmigrant farmworkers (Olson et al., 2023). Guarantee access to primary care health is essential to correctly diagnose health problems in MSAFW’s.

Limitations and strengths

The limitations of this study include that, firstly, the information reported within is not exempt from a possible memory bias or pass over specific information from professionals involved in treating MSAFW’s. Since specific information related to the age of the MSFWs was not discussed among the participants, the young age of most of the MSFWs workers might lead to an under-diagnosis of the expected rates of chronic disease and health problems. The next step would require performing a detailed diet assessment of Spanish MSAFW’s to measure the consequences of the challenges related to food access and its impact on health. Secondly, the results are limited to the four aforementioned Spanish regions, although they can be considered the most representative regions in terms of the presence of MSAFW’s. Even though no gender differences have emerged, evidence indicates that female MSAFW’s face more challenges related to food accessibility and have a more significant unpaid workload associated with care tasks related to food acquisition and preparing food for their family compared to men (Kiehne & Mendoza, 2015).

Our study has some unique contribution. Firstly, our study explores the challenges in the food supply from the experience of professional involved in treating MSAFW’s in Spain. In addition, the number of interviews conducted has allowed us to explore aspects related to food supply challenges in MSAFW’s both at community-structural level and at household-behavioral contributing to the existing literature.

Conclusions

This study highlighted the protagonism of public institutions and NGOs in food distribution among the MSAFW’s. According to the perception of health and social care professionals working in these institutions, MSAFW’s base their diet on food with little variety, insufficient protein content, and obesogenic products, which they relate to pathologies in the digestive-metabolic system, together with health problems related to a lack of hygiene and food contamination. The study suggests the need to strengthen and maintain this collaboration over time, to focus on proposing culturally appropriate food support strategies, and to promote decent living conditions to reduce the detected health problems associated with the MSAFW’s diet.

Future studies should delve deeper into the meaning that MSAFW’s give to the food they receive in canteens, donations from institutions and NGOs, and their perceptions and acculturation of the food available in Spain and culinary techniques. Additional studies researching living conditions will complement how these factors combine with challenges to food accessibility condition decision-making and impact the health of MSAFW’s in Spain.

In order to design future interventions in those locations where women MSAFW’s predominate, such as southern Spain (the provinces of Huelva and Almeria in Andalusia), future studies from the perspectives of the MSAFW’s could delve into the division and distribution of tasks associated with purchasing, preparing and distributing food, which is generally associated with feminized care work.

Acknowledgements

The authors want to thank to all participants and their institutions.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Additional information

Funding

This study has been funded by Instituto de Salud Carlos III (ISCIII) through the project PI20/01310 (Co-funded by European Regional Development Fund/European Social Fund “A way to make Europe”/“Investing in your future”).