This study has improved our knowledge of food security among asylum seekers in Norway. It is the first study on this subject in Norway and one of the first in Europe. We found that 93% of the participants reported having experienced food insecurity within the last 12 months: among adults, 11% reported food insecurity without hunger and 78% reported food insecurity with hunger. Among families with children, 20% reported child hunger.
A high proportion of the world’s refugees are resettled in high-income countries with abundant food supplies. However, several studies within the last decade have documented a high prevalence of food insecurity among refugees in high-income countries. In the United States, Hadley et al. found that 85% of Liberian refugee households were food insecure [4]; among Somali immigrants, 72% of households were food insecure [16]; for Sudanese immigrants, 37% had experienced household food insecurity and hunger [17]; and among West African refugees, 53% had experienced food insecurity [2]. Studies from Australia and the United Kingdom have also shown that food insecurity among refugees is widespread. In the United Kingdom, 100% of refugee families with children under 5 years indicated food insecurity [18], and in a sample of newly arrived refugees in Australia, 71% reported having previously run out of food [19]. Even though the prevalence of food insecurity in these other studies varies, it is comparable to our findings and shows that food insecurity is widespread among refugees in affluent countries. The comparatively low prevalence of food insecurity in the Norwegian population (3%) [20] indicates that asylum seekers are a particularly vulnerable group even in a country such as Norway with a generous welfare state system [21]. Other studies conducted in Norway have also reported poor living conditions and poverty among asylum seekers [8, 13, 22].
In the present study, monthly budget was a strong predictor of adult food insecurity. In 2017, asylum seekers in Norway received 250 euros per person per month to cover all their expenses (food, medicine, clothing, and transport). Asylum seekers whose applications were rejected had their monthly allowance reduced to 190 euros [23]. To give an indication of the purchasing power of this allowance, one adult living in Norway would need approximately 250 euros to cover their food costs only, and a Norwegian family is using 11% of their budget on food [24]. Asylum seekers are vulnerable to food insecurity in part because of their low income. Income and specific knowledge about shopping for food in a new environment are needed to access the abundant food supplies in high-income countries [3, 5, 25]. Studies of refugees resettled in the United States, the United Kingdom, and Australia suggest that limited income is an important correlate and a plausible underlying causal determinant for high levels of food insecurity among this population [17, 18, 26, 27]. These studies have also generated qualitative data suggesting that along with income and difficulty with budgeting in a new economy, limited information about shopping and cooking options may contribute to an individual’s ability to achieve and/or maintain food security [19, 25, 28]. The fact that few asylum reception centers are located in Oslo, the Norwegian capital, where most immigrants live, could also reduce the opportunities for asylum seekers to benefit from support from relatives and acquaintances.
We found that men had almost four times higher odds of experiencing adult food insecurity with hunger than women. This could be explained in part by the differences in cooking skills among men and women. Around 40% of the men reported that they were able to cook compared to 90% of the women. Differences in being able to prepare a simple meal between men and women have also been reported in other studies [29]. This can reflect cultural differences in gender roles in the country of origin where women traditionally have the responsibility of preparing meals for the family, and male relatives and men in general might not consider it appropriate to engage in food preparation-related activities [30,31,32,33]. As a result, women are likely to be better trained to economize food purchases, which might make the monthly allowance last longer and limit their vulnerability to food insecurity compared to men. In addition, a higher percentage of the men lived alone, without family or children. Previous studies have indicated that the waiting time at the reception centers, leads to deterioration of daily rhythms, with people tending to sleep or stay in their rooms until late in the day [12, 34, 35]. To be part of a family and having children—some of them attending school or kindergarten—might contribute to a more stable organization of life and family meals at asylum reception centers. Asylum seekers receive an allowance per person in the household and more women lived with children than men. Living with more children therefore results in a higher total monthly budget, which could be the explanation why those with more children had lower odds of experiencing adult food insecurity.
In our study, length of stay in Norway was not associated with adult food insecurity among asylum seekers, meaning that the risk of food insecurity did not diminish with duration of residence in Norway. Hadley, Anderson, et al. reported the same finding among Sudanese immigrants in the US, and suggested that the underlying reason for this persistent vulnerability was continued low employment and income due to language barriers, as well as low education and limited access to employment opportunities among this group of refugees [17, 27]. In Norway, only asylum seekers with an approved application have permission to work. Surprisingly we found no difference in monthly budget among asylum seekers with approved or rejected applications. This could be due to the difficulties of finding a job while still residing in asylum centers, often located in areas with limited work opportunities, or by the fact that the asylum seekers also have some form of additional economic support from relatives and friends. However this was not a topic specifically investigated in our study.
The energy and nutrient requirements of children (especially young children and adolescents) to maintain good health and secure optimal development are high [36]. In order to cover their micronutrient needs, children (to a larger extent than adults) must rely on foods with high nutrient density, which are generally more costly. Household food insecurity has been associated with insufficient energy intake and child hunger [37], as well as a reduced quality of diet in different settings [38, 39]. Since their requirements are higher [36], the negative health effects of insufficient food and poor quality diets will be noticeable earlier in children than in adults. Thus, within the food insecurity scale, child hunger is the most serious category, wherein caregivers report that they know the child is sometimes hungry but cannot afford to buy more food. The present study found that 20% of the families had experienced child hunger. In a study of recently resettled Sudanese refugees in the US [17], 14% reported child hunger, and among Liberian refugees in the US [4], 42% experienced severe levels of food insecurity or child hunger. Additionally, a UK study reported that 60% of the children in refugee households were experiencing hunger [18], and recent arrival, being a younger mother, and lack of access to benefits are risk factors for child hunger. Maternal education was not a risk factor for child hunger. Conversely, length of stay in the US, maternal education, income, and being employed were negatively associated with child hunger among Liberian refugees in the US [4].
The primary strength of this study is the relatively high number of participants, including men and women of different nationalities, which provides novel and broad knowledge on the extent of food insecurity and some of its determinants in a European country. It is an especially important study as there has been little research investigating food security in Europe. Sellen assessed food security among refugees in London with the Radimer/Cornell Scale in 2002 [18]. Different ways of measuring self-reported food security can be found in the literature [40,41,42]. According to a systematic review of methods to measure food security [40], the instruments most frequently found in the scientific literature were the Household Food Security Survey Module Six-Item Short Form, the Self-Perceived Household Food Security Scale and the Radimer/Cornell Scale. Key strengths of the Radimer/Cornell scale is that it is well-grounded conceptually, being based on an in-depth understanding of the experience of food insecurity in the households. Each set of the food insecurity and hunger questions (Table 2) captures a different degree of severity, and the full range of severity and distinguishes among its different levels. This feature is critical for accurately gauging the prevalence of each level of severity. In addition, the Radimer/Cornell scale is quick and simple to administer. The limitations of the scale include the determination of cutoff points for defining food insecurity, mitigating potential response bias from experience-based measures and actual measurement of dietary adequacy [41, 43]. Other methods for assessing food security can be used, such as the 24-h dietary recall or food frequency recall data. While these methods might have the advantage of providing more reliable assessment, they still present measurement challenges. For example, how many and which food groups to include in the measure, how to account for the quantity of each food group consumed, what recall period to use, and how to assign cutoff values for defining levels of dietary diversity [43]. Therefore, the use of complementary approaches could contribute to ameliorating the assessment of food security.
There are also some limitations to the study. First, the convenience sampling strategy used to identify the participants precludes generalization of the findings to all asylum seekers in Norway. The findings remain valid for the participants involved and may well be indicative of conditions experienced by other asylum seekers. Second, the sample size was relatively small in terms of the group of families who experienced child hunger (8 out of 41 families). Consequently we did associational analyses only evaluating adult food insecurity with hunger and no other food insecure categories. Third, the study was cross-sectional and only assessed bivariate associations. Consequently, we are limited in our ability to determine the direction of associations with food insecurity and cannot fully disentangle relationships between the socioeconomic variables themselves. Food insecurity is a complex phenomenon, with a number of factors at play [40, 41]. Food security measures based on an individual’s self-reported experiences need to take into consideration contextual factors that might influence data collection. In our study, some of the reception centers received news that they were going to close down while we were collecting data. This caused uncertainty and frustration among the residents, as they were going to be relocated to other centers, which could have influenced their responses to the questionnaire.
