In the Journals

Maternal food insecurity creates barrier for exclusive breast-feeding

Valerie Tarasuk

Despite confirmed attempts to exclusively breast-feed their children, mothers who experience food insecurity are less likely to sustain this practice by 4 months.

“Breast-feeding for the recommended 6 months is proving to be difficult for all women, irrespective of their food security status,” Valerie Tarasuk, PhD, from the department of nutritional sciences at the University of Toronto, told Infectious Diseases in Children. “It takes a supportive environment to achieve this endpoint, and that is not something women struggling with food insecurity have. The stress and social isolation that characterize food insecurity may make it difficult for women to manage continued breast-feeding.”

“It is also very likely that some of the women who were food insecure had to return to work because they could not afford to take extended maternity leave,” she continued. “I suspect that women in these circumstances did not have the resources to maintain exclusive breast-feeding once they returned to work.”

To examine the relationship between food household food insecurity in Canada, breast-feeding initiation, length of time spent exclusively breast-feeding and the use of vitamin D supplements, Tarasuk and colleagues conducted an analysis of data collected from the Maternal Experiences — Breastfeeding Module and the Household Food Security Survey Module of the Canadian Community Health Survey. All data were gathered between 2005 and 2014, and mothers who participated gave birth no more than 1 year before their interview.

Food insecurity was defined as “inadequate or insecure access to food because of financial constraints.”

The researchers then assessed the connection between food insecurity and feeding practices of infants using multivariable Cox proportional hazards models and logistic regression. Adjustments were made to account for sociodemographic characteristics, maternal mood disorders and diabetes mellitus.

Of the 10,450 women who completed the survey, 17% reported food insecurity. Moderate insecurity was experienced by 8.6% of women, and 2.9% reported severe food insecurity (weighted percentages). Tarasuk and colleagues observed that mothers who experienced food insecurity were as likely to begin breast-feeding and vitamin D supplementation for their children as those who did not experience food insecurity.

By 2 months, half of the women who reported food insecurity did not continue exclusive breast-feeding, whereas most women who did not experience food insecurity breast-fed for 4 months or more. Additionally, exclusive breast-feeding was less likely to be completed for 4 months by women with marginal, moderate and severe food insecurity when compared with women who had food security.

Furthermore, women who experienced moderate food insecurity were less likely to exclusively breast-feed by 6 months regardless of sociodemographic characteristics (OR =  0.60; 95% CI, 0.39-0.92). When the researchers accounted for maternal mood disorder or diabetes, these relationships were slightly reduced.

“I think it is important for clinicians to recognize the particular vulnerability of patients who are struggling to make ends meet,” Tarasuk said. “While the nature of services and supports for very low-income households in the United States is somewhat different than in Canada, I think it is important for clinicians to help vulnerable patients access the programs available.”

“This is not to suggest that programs [available in the U.S.] will eliminate the probability of food insecurity, but there is certainly research indicating that these programs have some positive effects on household food insecurity,” she added.– by Katherine Bortz

Disclosures: The authors report no relevant financial disclosures.

Valerie Tarasuk

Despite confirmed attempts to exclusively breast-feed their children, mothers who experience food insecurity are less likely to sustain this practice by 4 months.

“Breast-feeding for the recommended 6 months is proving to be difficult for all women, irrespective of their food security status,” Valerie Tarasuk, PhD, from the department of nutritional sciences at the University of Toronto, told Infectious Diseases in Children. “It takes a supportive environment to achieve this endpoint, and that is not something women struggling with food insecurity have. The stress and social isolation that characterize food insecurity may make it difficult for women to manage continued breast-feeding.”

“It is also very likely that some of the women who were food insecure had to return to work because they could not afford to take extended maternity leave,” she continued. “I suspect that women in these circumstances did not have the resources to maintain exclusive breast-feeding once they returned to work.”

To examine the relationship between food household food insecurity in Canada, breast-feeding initiation, length of time spent exclusively breast-feeding and the use of vitamin D supplements, Tarasuk and colleagues conducted an analysis of data collected from the Maternal Experiences — Breastfeeding Module and the Household Food Security Survey Module of the Canadian Community Health Survey. All data were gathered between 2005 and 2014, and mothers who participated gave birth no more than 1 year before their interview.

Food insecurity was defined as “inadequate or insecure access to food because of financial constraints.”

The researchers then assessed the connection between food insecurity and feeding practices of infants using multivariable Cox proportional hazards models and logistic regression. Adjustments were made to account for sociodemographic characteristics, maternal mood disorders and diabetes mellitus.

Of the 10,450 women who completed the survey, 17% reported food insecurity. Moderate insecurity was experienced by 8.6% of women, and 2.9% reported severe food insecurity (weighted percentages). Tarasuk and colleagues observed that mothers who experienced food insecurity were as likely to begin breast-feeding and vitamin D supplementation for their children as those who did not experience food insecurity.

By 2 months, half of the women who reported food insecurity did not continue exclusive breast-feeding, whereas most women who did not experience food insecurity breast-fed for 4 months or more. Additionally, exclusive breast-feeding was less likely to be completed for 4 months by women with marginal, moderate and severe food insecurity when compared with women who had food security.

Furthermore, women who experienced moderate food insecurity were less likely to exclusively breast-feed by 6 months regardless of sociodemographic characteristics (OR =  0.60; 95% CI, 0.39-0.92). When the researchers accounted for maternal mood disorder or diabetes, these relationships were slightly reduced.

“I think it is important for clinicians to recognize the particular vulnerability of patients who are struggling to make ends meet,” Tarasuk said. “While the nature of services and supports for very low-income households in the United States is somewhat different than in Canada, I think it is important for clinicians to help vulnerable patients access the programs available.”

“This is not to suggest that programs [available in the U.S.] will eliminate the probability of food insecurity, but there is certainly research indicating that these programs have some positive effects on household food insecurity,” she added.– by Katherine Bortz

Disclosures: The authors report no relevant financial disclosures.