Food environment, Food access, Diet quality, Household, Women of reproductive age, Food systems, Nutrition. Foods and food supply, TX341-641, Food processing and manufacture, TP368-456, Medicine (General), R5-920

Abstract Background Undernutrition is a significant challenge in Ethiopia, where limited dietary diversity and widespread micronutrient deficiencies affect millions, especially women of reproductive age. Although much research has explored dietary gaps and practices, the impact of the food environment (FE) on diet quality remains understudied. This study examines how FE factors influence dietary quality, using a food systems approach to inform sustainable nutrition policies. Methods A cross-sectional survey of 1,828 households was utilized to assess women’s dietary quality using Poisson regression, with food environment (FE) components and socioeconomic variables predicting four indicators: women’s diet diversity score (WDDS), fruit and vegetable score (FVS), global dietary quality score (GDQS), and household diet diversity score (HDDS). Results Dietary diversity was low, with fewer than 20% of women meeting the minimum recommendation; however, improvement was observed with higher quality food environments (FE). Starchy staples dominated consumption across all FE, while pulses and dark green leafy vegetables increased in households with medium and high FE. Low household dietary diversity (average 6.23) and a GDQS of 20.7 (far below the maximum of 49) indicate widespread deficiency. Poisson regression (adjusted for socioeconomic covariates) showed that a high FE score significantly predicted better diet quality compared to a low FE score: 27% higher WDDS (exp(β) = 1.27, 95% CI: 1.22–1.32, p