Rural food markets and their implications for the availability and affordability of nutrient-dense foods in Bihar, India

The adequate consumption of nutrient-dense foods such as fruits, vegetables, and animal-source foods is crucial for achieving good health. However, in many low- and middle-income countries (LMICs), consumption of nutrient-dense foods is extremely low. Food markets are a critical node in the rural food environments of LMICs. Yet, they remain understudied and there is little granular information available on how well-equipped they are to supply affordable nutrient-dense foods. We address this gap in knowledge by contributing information on rural food markets from Bihar, India. We use a primary market survey conducted in two districts of Bihar, and examine how market infrastructure, governance, and spatial organisation shape the availability and prices of nutrient-dense foods. By applying agglomerative hierarchical clustering, we identify three market types and link the market typology with information from a separate primary survey of food prices to ask whether prices of nutrient-dense foods differ by market type. There are three main findings of our study: (i) There is a near universal and extreme lack of market infrastructure relevant to making safe and affordable nutrient-dense foods available. (ii) Market types differ largely by size and proximity to the nearest urban centre but display remarkably little difference in infrastructure and governance. (iii) Availability of nutrient-dense foods is lower in remote rural markets, but prices in these markets are not consistently higher than in larger, more urban markets. Our findings highlight that modest infrastructure investments, standardised management practices, and promotion of a diverse mix of long and short supply chains could enhance access to nutrient-dense foods to address nutrition challenges in similar contexts of rural LMICs.