1
|
Francis J, Mildon A, Tarasuk V, Frank L. Household food insecurity is negatively associated with achievement of prenatal intentions to feed only breast milk in the first six months postpartum. Front Nutr 2024; 11:1287347. [PMID: 38356859 PMCID: PMC10865492 DOI: 10.3389/fnut.2024.1287347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Accepted: 01/09/2024] [Indexed: 02/16/2024] Open
Abstract
Background Household food insecurity (HFI) has been associated with suboptimal breastfeeding practices. Postpartum factors reported by caregivers include stressful life circumstances and maternal diet quality concerns. It is unknown whether prenatal breast milk feeding intentions, a well-established predictor of breastfeeding outcomes, differ by HFI status. We explored associations between HFI and prenatal intentions to feed any and only breast milk in the first 6 months postpartum, and achievement of these intentions. Methods We utilized data from self-identified biological mothers with children 6-12 months of age who responded to a retrospective, cross-sectional online infant feeding survey conducted in Nova Scotia, Canada. HFI (yes/no) was assessed using the Household Food Security Survey Module. Prenatal intentions to feed any and only breast milk were assessed based on responses to five options for infant milk feeding plans. Achievement of intentions was assessed by breast milk and formula feeding practices in the first 6 months. Multivariable logistic regressions were conducted, adjusting for maternal socio-demographics. Results Among 459 respondents, 28% reported HFI; 88% intended to feed any breast milk and 77% intended to feed only breast milk, with no difference by HFI status. Of those intending to feed any breast milk, 99% succeeded, precluding further analysis. Among mothers who intended to provide only breast milk, only 51% achieved their intention, with lower odds among those with HFI (aOR 0.54, 95% CI 0.29-0.98). Conclusion HFI was not associated with intentions for feeding breast milk in the first 6 months postpartum, but mothers with HFI were less likely to achieve their intention to provide only breast milk. Further research is needed to understand the underlying reasons for this and to guide intervention designs to address HFI and help mothers reach their breastfeeding goals.
Collapse
Affiliation(s)
- Jane Francis
- Department of Sociology, Acadia University, Wolfville, NS, Canada
| | - Alison Mildon
- Department of Nutritional Sciences, University of Toronto, Toronto, ON, Canada
| | - Valerie Tarasuk
- Department of Nutritional Sciences, University of Toronto, Toronto, ON, Canada
| | - Lesley Frank
- Department of Sociology, Acadia University, Wolfville, NS, Canada
| |
Collapse
|
2
|
Chan K, Labonté JM, Francis J, Zora H, Sawchuk S, Whitfield KC. Breastfeeding in Canada: predictors of initiation, exclusivity, and continuation from the 2017-2018 Canadian Community Health Survey. Appl Physiol Nutr Metab 2023; 48:256-269. [PMID: 36596236 DOI: 10.1139/apnm-2022-0333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Human milk is the ideal source of nutrition for infants; however, adherence to breastfeeding recommendations is suboptimal and availability of Canadian breastfeeding data are limited. Using the 2017-2018 Canadian Community Health Survey Public Use Microdata File (Maternal Experiences Module, n = 5558, weighted n = 1 669 462) we computed breastfeeding indicators and explored sociodemographic, health, and geographical predictors of breastfeeding with univariate logistic regression models. Nationally, of all participants who gave birth in the preceding 5 years, 91% initiated breastfeeding, 43% exclusively breastfed to ≥5 months and 35% to ≥6 months, 56% reported any breastfeeding at ≥6 months, and 31% reported breastfeeding at ≥12 months. Breastfeeding cessation was most commonly attributed to insufficient milk supply (25%), but reasons differed significantly by breastfeeding duration. Breastfeeding initiation, exclusivity for ≥5 months, and extended breastfeeding ≥12 months all differed by geographic region, and by most sociodemographic and health characteristics. Positive breastfeeding outcomes were highest in British Columbia, and lowest in Quebec and the Atlantic region, and generally higher if caregivers had recently immigrated to Canada, were married, were >30 years of age, were not White, were nonsmoking, had completed postsecondary education, and had an annual household income >$40 000. These disparities indicate the need for tailored, equitable approaches to breastfeeding support, and continued regional monitoring of breastfeeding outcomes.
Collapse
Affiliation(s)
- Kathleen Chan
- Department of Applied Human Nutrition, Mount Saint Vincent University, Halifax, NS, Canada
| | - Jocelyne M Labonté
- Department of Applied Human Nutrition, Mount Saint Vincent University, Halifax, NS, Canada
| | - Jane Francis
- Department of Sociology, Acadia University, Wolfville, NS, Canada
| | - Haley Zora
- Department of Applied Human Nutrition, Mount Saint Vincent University, Halifax, NS, Canada
| | - Sandra Sawchuk
- Library, Mount Saint Vincent University, Halifax, NS, Canada
| | - Kyly C Whitfield
- Department of Applied Human Nutrition, Mount Saint Vincent University, Halifax, NS, Canada
| |
Collapse
|
3
|
Dharod JM, Hernandez M, Labban JD, Black MM, Ammerman A, Frazier C, Raynor N, Ramos-Castillo I. Associations between early introduction to complementary foods, subsequent cereal-added bottle feeding and daily macronutrient intake among infants. Appetite 2023; 182:106453. [PMID: 36621723 PMCID: PMC9907061 DOI: 10.1016/j.appet.2023.106453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Revised: 12/19/2022] [Accepted: 01/04/2023] [Indexed: 01/07/2023]
Abstract
Introducing complementary foods early during infancy has been associated with an increased risk of overweight later in life, but the pathway is an understudied topic. Hence the study was conducted with low-income and primarily minority mother-infant dyads to: 1) understand how the introduction of complementary foods prior to 4 months was associated with socio-demographic characteristics and food security status; 2) determine the association between early introduction to complementary foods and breastfeeding and adding cereal into the bottle in later infancy (i.e., at 6 and 9 months), and; 3) examine how adding infant cereal into the bottle was related to daily calorie and macronutrient intake in infancy. We conducted interviews with mothers (n = 201) at 4 months of age and 24-h feeding recalls at age 6 and 9 months. Results indicated that 29% of the infants were fed complementary foods before 4 months of age. Introducing complementary foods early was negatively associated with breastfeeding and positively associated with adding cereal into the bottle at 6-months. This practice was more common among those who experienced marginal to very low levels of food security. Comparing by race/ethnicity, Latinx mothers were significantly less likely to introduce solids early. After controlling for sex, infants fed cereal in the bottle were consuming significantly more calories compared to their counterparts. Specifically, adding cereal into the bottle resulted in approximately 10% additional daily calorie intake among infants. Understanding how these feeding practices affect appetite development and weight status during infancy is warranted.
Collapse
Affiliation(s)
- Jigna M Dharod
- Department of Nutrition, School of Health and Human Sciences, University of North Carolina at Greensboro, USA.
| | - Marlen Hernandez
- Department of Nutrition, School of Health and Human Sciences, University of North Carolina at Greensboro, USA
| | - Jeffrey D Labban
- Office of Research, School of Health and Human Sciences, University of North Carolina at Greensboro, USA
| | - Maureen M Black
- RTI International, Research Triangle Park, NC, USA; Department of Pediatrics, University of Maryland School of Medicine, USA
| | - Alice Ammerman
- Department of Nutrition, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, USA; Center for Health, Promotion and Disease Prevention, University of North Carolina at Chapel Hill, USA
| | - Christina Frazier
- Department of Nutrition, School of Health and Human Sciences, University of North Carolina at Greensboro, USA
| | - Nichole Raynor
- Department of Nutrition, School of Health and Human Sciences, University of North Carolina at Greensboro, USA
| | - Isa Ramos-Castillo
- Department of Nutrition, School of Health and Human Sciences, University of North Carolina at Greensboro, USA
| |
Collapse
|
4
|
Sim SM, Rothfus M, Aston M, Kirk SFL, Frank L, Jefferies K, Macdonald M. Breastfeeding experiences among mothers living with food insecurity in high resource, Western countries: a qualitative systematic review protocol. JBI Evid Synth 2021; 19:675-681. [PMID: 33074987 DOI: 10.11124/jbies-20-00052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
OBJECTIVE The objectives of this review are to identify, appraise, and synthesize the qualitative evidence on the breastfeeding experiences of mothers living with food insecurity in high-resource, Western countries. INTRODUCTION Breastfeeding and food insecurity are inter-related health issues. Globally, breastfeeding augments food security at individual, household, and community levels, but a growing body of evidence from high-resourced countries also suggests that a mother's breastfeeding practice may be negatively impacted by the additional experience of food insecurity. This protocol outlines a systematic approach to understanding the experiences of breastfeeding from the perspective of mothers living with food insecurity. Findings will provide much-needed evidence toward guiding policies and practices that support mothers to breastfeed. INCLUSION CRITERIA The review will consider studies that explore the breastfeeding experiences of mothers aged 18 years and older who self-identify, or are classified using a screening tool, as food insecure. Papers that will be included in this review will consider all qualitative methodologies and will be limited to studies from countries identified as being within the United Nations classification of Western European and Other States Group (WEOG). METHODS The authors will conduct a three-step search process across both published and gray literature to identify relevant studies for inclusion. A preliminary search using the PubMed database was undertaken in January 2020. Studies published in English from 1981 to 2020 will be included. The recommended JBI methodology for qualitative systematic review for study selection, critical appraisal, data extraction, and data synthesis will be followed. SYSTEMATIC REVIEW REGISTRATION NUMBER PROSPERO CRD42020183652.
Collapse
Affiliation(s)
- Sarah Meaghan Sim
- Healthy Populations Institute, Faculty of Health, Dalhousie University, Halifax, NS, Canada.,Nova Scotia Health Authority Research, Innovation and Discovery, Halifax, NS, Canada.,Aligning Health Needs and Evidence for Transformative Change (AHNET-C): A JBI Centre of Excellence, Halifax, NS, Canada
| | - Melissa Rothfus
- WK Kellogg Health Sciences Library, Dalhousie Libraries, Dalhousie University, Halifax, NS, Canada.,Aligning Health Needs and Evidence for Transformative Change (AHNET-C): A JBI Centre of Excellence, Halifax, NS, Canada
| | - Megan Aston
- Aligning Health Needs and Evidence for Transformative Change (AHNET-C): A JBI Centre of Excellence, Halifax, NS, Canada.,School of Nursing, Faculty of Health, Dalhousie University, Halifax, NS, Canada
| | - Sara F L Kirk
- Healthy Populations Institute, Faculty of Health, Dalhousie University, Halifax, NS, Canada
| | - Lesley Frank
- Department of Sociology, Faculty of Arts, Acadia University, Wolfville, NS, Canada
| | - Keisha Jefferies
- Aligning Health Needs and Evidence for Transformative Change (AHNET-C): A JBI Centre of Excellence, Halifax, NS, Canada.,School of Nursing, Faculty of Health, Dalhousie University, Halifax, NS, Canada
| | - Marilyn Macdonald
- Aligning Health Needs and Evidence for Transformative Change (AHNET-C): A JBI Centre of Excellence, Halifax, NS, Canada.,School of Nursing, Faculty of Health, Dalhousie University, Halifax, NS, Canada
| |
Collapse
|
5
|
Tarasuk V, Gundersen C, Wang X, Roth DE, Urquia ML. Maternal Food Insecurity is Positively Associated with Postpartum Mental Disorders in Ontario, Canada. J Nutr 2020; 150:3033-3040. [PMID: 32856046 PMCID: PMC7675029 DOI: 10.1093/jn/nxaa240] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Revised: 05/28/2020] [Accepted: 07/17/2020] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Household food insecurity has been associated with pregnancy complications and poorer birth outcomes in the United States and with maternal mental disorders in the United Kingdom, but there has been little investigation of the effects of food insecurity during this life stage in Canada. OBJECTIVES Our objective was to examine the relationship between the food insecurity status of women during pregnancy and maternal and birth outcomes and health in infancy in Canada. METHODS We drew on data from 1998 women in Ontario, Canada, whose food insecurity was assessed using the Household Food Security Survey Module on the Canadian Community Health Survey, cycles 2005 to 2011-2012. These records were linked to multiple health administrative databases to identify indications of adverse health outcomes during pregnancy, at birth, and during children's first year of life. We included women who gave birth between 9 months prior and 6 months after their interview date, and for whom infant outcome data were available. Multivariable Poisson regression models were used to compare outcomes by maternal food security status, expressed as adjusted relative risks (aRR) with 95% CIs. RESULTS While pregnant, 5.6% of women were marginally food insecure and 10.0% were moderately or severely food insecure. Food insecurity was unrelated to pregnancy complications and adverse birth outcomes, but 26.8% of women with moderate or severe food insecurity had treatment for postpartum mental disorders in the 6-month postpartum period, compared to 13.9% of food-secure women (aRR, 1.86; 95% CI, 1.40-2.46). Children born to food-insecure mothers were at elevated risk of being treated in an emergency department in the first year of life (aRR, 1.18; 95% CI, 1.01-1.38). CONCLUSIONS Maternal food insecurity during pregnancy in Ontario, Canada, is associated with postpartum mental disorders and a greater likelihood of infants being treated in an emergency department.
Collapse
Affiliation(s)
- Valerie Tarasuk
- Department of Nutritional Sciences, University of Toronto, Toronto, Canada
| | - Craig Gundersen
- Department of Agricultural and Consumer Economics, University of Illinois, Urbana, IL, USA
| | - Xuesong Wang
- Institute for Clinical and Evaluative Sciences Central, Toronto, Canada
| | - Daniel E Roth
- Department of Nutritional Sciences, University of Toronto, Toronto, Canada
- The Hospital for Sick Children, Toronto, Canada
| | - Marcelo L Urquia
- Institute for Clinical and Evaluative Sciences Central, Toronto, Canada
- Manitoba Centre for Health Policy, University of Manitoba, Manitoba, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| |
Collapse
|
6
|
Orozco J, Echeverria SE, Armah SM, Dharod JM. Household Food Insecurity, Breastfeeding, and Related Feeding Practices in US Infants and Toddlers: Results From NHANES 2009-2014. JOURNAL OF NUTRITION EDUCATION AND BEHAVIOR 2020; 52:588-594. [PMID: 32276879 DOI: 10.1016/j.jneb.2020.02.011] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Revised: 02/17/2020] [Accepted: 02/17/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVE To examine the relationships among food insecurity, breastfeeding, and other related feeding practices by race/ethnicity among US infants and toddlers. DESIGN National Health and Nutrition Examination Surveys 2009-2014, a nationally representative cross-sectional survey. PARTICIPANTS Infants and toddlers aged 0-24 months with complete data on household food security status (n = 2,069). MAIN OUTCOME MEASURES Initiation of breastfeeding (yes or no), duration of breastfeeding, and age of introduction to foods/drinks. ANALYSIS Differences in feeding practices by food security status were tested in survey-weighted, stratified multiple regression models. RESULTS Breastfeeding initiation rates among non-Hispanic whites, Hispanics, and non-Hispanic blacks were estimated at 80.0%, 77.5%, and 57.4%, respectively (P < .001). A total of 43% of infants and toddlers were introduced to foods/drinks before 4 months. After adjusting for household income, education, and other covariates, food insecurity was not a significant predictor of poor feeding behaviors. CONCLUSIONS AND IMPLICATIONS Racial/ethnic disparities existed, with non-Hispanic black infants at the highest risk for never being breastfed, nor to continue through the recommended period of breastfeeding. Food insecurity was not shown to affect breastfeeding and other infant feeding practices directly. Further investigation is needed to understand whether food insecurity, through stress and other sociostructural pathways, mediates poor infant feeding practices.
Collapse
Affiliation(s)
- Jovanna Orozco
- Department of Nutrition, University of North Carolina at Greensboro, Greensboro, NC
| | - Sandra E Echeverria
- Department of Public Health Education, University of North Carolina at Greensboro, Greensboro, NC
| | - Seth M Armah
- Department of Nutrition, University of North Carolina at Greensboro, Greensboro, NC
| | - Jigna M Dharod
- Department of Nutrition, University of North Carolina at Greensboro, Greensboro, NC.
| |
Collapse
|
7
|
Francis J, Mildon A, Stewart S, Underhill B, Tarasuk V, Di Ruggiero E, Sellen D, O'Connor DL. Vulnerable mothers' experiences breastfeeding with an enhanced community lactation support program. MATERNAL AND CHILD NUTRITION 2020; 16:e12957. [PMID: 31984642 PMCID: PMC7296823 DOI: 10.1111/mcn.12957] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Revised: 11/12/2019] [Accepted: 01/06/2020] [Indexed: 01/24/2023]
Abstract
The Canada Prenatal Nutrition Program (CPNP) provides a variety of health and nutrition supports to vulnerable mothers and strongly promotes breastfeeding but does not have a formal framework for postnatal lactation support. Breastfeeding duration and exclusivity rates in Canada fall well below global recommendations, particularly among socially and economically vulnerable women. We aimed to explore CPNP participant experiences with breastfeeding and with a novel community lactation support program in Toronto, Canada that included access to certified lactation consultants and an electric breast pump, if needed. Four semistructured focus groups and 21 individual interviews (n = 46 women) were conducted between September and December 2017. Data were analysed using inductive thematic analysis. Study participants reported a strong desire to breastfeed but a lack of preparation for breastfeeding‐associated challenges. Three main challenges were identified by study participants: physical (e.g., pain and low milk supply), practical (e.g., cost of breastfeeding support and maternal time pressures), and breastfeeding self‐efficacy (e.g., concern about milk supply and conflicting information). Mothers reported that the free lactation support helped to address breastfeeding challenges. In their view, the key element of success with the new program was the in‐home visit by the lactation consultant, who was highly skilled and provided care in a non‐judgmental manner. They reported this support would have been otherwise unavailable due to cost or travel logistics. This study suggests value in exploring the addition of postnatal lactation support to the well‐established national CPNP as a means to improve breastfeeding duration and exclusivity among vulnerable women.
Collapse
Affiliation(s)
- Jane Francis
- Department of Nutritional Sciences, University of Toronto, Toronto, Ontario, Canada.,Translational Medicine Program, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Alison Mildon
- Department of Nutritional Sciences, University of Toronto, Toronto, Ontario, Canada
| | - Stacia Stewart
- Health Promotion & Community Engagement, Parkdale Queen West Community Health Centre, Toronto, Ontario, Canada
| | - Bronwyn Underhill
- Health Promotion & Community Engagement, Parkdale Queen West Community Health Centre, Toronto, Ontario, Canada
| | - Valerie Tarasuk
- Department of Nutritional Sciences, University of Toronto, Toronto, Ontario, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Erica Di Ruggiero
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Daniel Sellen
- Department of Nutritional Sciences, University of Toronto, Toronto, Ontario, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.,Joannah and Brian Lawson Centre for Child Nutrition, University of Toronto, Toronto, Ontario, Canada
| | - Deborah L O'Connor
- Department of Nutritional Sciences, University of Toronto, Toronto, Ontario, Canada.,Translational Medicine Program, The Hospital for Sick Children, Toronto, Ontario, Canada
| |
Collapse
|
8
|
Wong PD, Parkin PC, Moodie RG, Dai DWH, Maguire JL, Birken CS, Borkhoff CM. Total Breastfeeding Duration and Household Food Insecurity in Healthy Urban Children. Acad Pediatr 2019; 19:884-890. [PMID: 30831248 DOI: 10.1016/j.acap.2019.02.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2018] [Revised: 01/24/2019] [Accepted: 02/10/2019] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Health care policy positions breastfeeding as an important part of the solution to household food insecurity; however, there are critical gaps in our knowledge of the relationship between breastfeeding duration (exposure variable) and household food insecurity (outcome variable). Our objective was to examine this relationship. METHODS A cross-sectional study was conducted from 2008 to 2016 of healthy urban children (N = 3838) who were 0 to 3 years old and recruited from The Applied Research Group for Kids (TARGet Kids!), a practice-based research network in Toronto, Canada. Total breastfeeding duration was collected from parent-reported questionnaires. Household food insecurity was measured using 1-item and 2-item food insecurity screens. Multivariable regression analysis was performed adjusting for prespecified covariates. RESULTS The median total breastfeeding duration was 10.5 months (interquartile range, 6.0-14.0), and 14.7% of households were food insecure. After adjusting for child characteristics (age, sex), maternal characteristics (age, ethnicity, education, employment), and family characteristics (number of children, single parent family, neighborhood equity score), there was no significant association between total breastfeeding duration and household food insecurity (odds ratio, 0.99; 95% confidence interval, 0.98-1.01). Although low-income families had an increased odds of being household food insecure (P ≤ .001), we found no significant association between total breastfeeding duration and household food insecurity at varying income levels. CONCLUSIONS We found no association between breastfeeding duration and household food insecurity, regardless of family income. Although breastfeeding is associated with improved child health outcomes and considered to be part of the solution to household food insecurity, interventions focused on social determinants may provide more promising targets for the prevention of household food insecurity.
Collapse
Affiliation(s)
- Peter D Wong
- Department of Paediatrics, Faculty of Medicine (PD Wong, PC Parkin, RG Moodie, JL Maguire, and CS Birken); Division of Paediatric Medicine and the Paediatric Outcomes Research Team (PD Wong, PC Parkin, JL Maguire, CS Birken, and CM Borkhoff); Sick Kids Research Institute (PD Wong, PC Parkin, CS Birken, and CM Borkhoff), Hospital for Sick Children.
| | - Patricia C Parkin
- Department of Paediatrics, Faculty of Medicine (PD Wong, PC Parkin, RG Moodie, JL Maguire, and CS Birken); Joannah & Brian Lawson Centre for Child Nutrition (PC Parkin, JL Maguire, and CS Birken); Institute of Health Policy, Management and Evaluation (PC Parkin, JL Maguire, CS Birken, and CM Borkhoff), University of Toronto; Division of Paediatric Medicine and the Paediatric Outcomes Research Team (PD Wong, PC Parkin, JL Maguire, CS Birken, and CM Borkhoff); Sick Kids Research Institute (PD Wong, PC Parkin, CS Birken, and CM Borkhoff), Hospital for Sick Children
| | - Rosemary G Moodie
- Department of Paediatrics, Faculty of Medicine (PD Wong, PC Parkin, RG Moodie, JL Maguire, and CS Birken); Division of Neonatology (RG Moodie)
| | - David W H Dai
- Li Ka Shing Knowledge Institute (DWH Dai and JL Maguire), St. Michael's Hospital, Toronto, Ontario, Canada
| | - Jonathon L Maguire
- Department of Paediatrics, Faculty of Medicine (PD Wong, PC Parkin, RG Moodie, JL Maguire, and CS Birken); Joannah & Brian Lawson Centre for Child Nutrition (PC Parkin, JL Maguire, and CS Birken); Institute of Health Policy, Management and Evaluation (PC Parkin, JL Maguire, CS Birken, and CM Borkhoff), University of Toronto; Division of Paediatric Medicine and the Paediatric Outcomes Research Team (PD Wong, PC Parkin, JL Maguire, CS Birken, and CM Borkhoff); Department of Paediatrics (JL Maguire); Li Ka Shing Knowledge Institute (DWH Dai and JL Maguire), St. Michael's Hospital, Toronto, Ontario, Canada
| | - Catherine S Birken
- Department of Paediatrics, Faculty of Medicine (PD Wong, PC Parkin, RG Moodie, JL Maguire, and CS Birken); Joannah & Brian Lawson Centre for Child Nutrition (PC Parkin, JL Maguire, and CS Birken); Institute of Health Policy, Management and Evaluation (PC Parkin, JL Maguire, CS Birken, and CM Borkhoff), University of Toronto; Division of Paediatric Medicine and the Paediatric Outcomes Research Team (PD Wong, PC Parkin, JL Maguire, CS Birken, and CM Borkhoff); Sick Kids Research Institute (PD Wong, PC Parkin, CS Birken, and CM Borkhoff), Hospital for Sick Children
| | - Cornelia M Borkhoff
- Institute of Health Policy, Management and Evaluation (PC Parkin, JL Maguire, CS Birken, and CM Borkhoff), University of Toronto; Division of Paediatric Medicine and the Paediatric Outcomes Research Team (PD Wong, PC Parkin, JL Maguire, CS Birken, and CM Borkhoff); Sick Kids Research Institute (PD Wong, PC Parkin, CS Birken, and CM Borkhoff), Hospital for Sick Children
| | | |
Collapse
|
9
|
Orr SK, Dachner N, Frank L, Tarasuk V. Relation between household food insecurity and breastfeeding in Canada. CMAJ 2018; 190:E312-E319. [PMID: 29555861 PMCID: PMC5860892 DOI: 10.1503/cmaj.170880] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/20/2017] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND Qualitative studies have suggested that food insecurity adversely affects infant feeding practices. We aimed to determine how household food insecurity relates to breastfeeding initiation, duration of exclusive breastfeeding and vitamin D supplementation of breastfed infants in Canada. METHODS We studied 10 450 women who had completed the Maternal Experiences - Breastfeeding Module and the Household Food Security Survey Module of the Canadian Community Health Survey (2005-2014) and who had given birth in the year of or year before their interview. We used multivariable Cox proportional hazards models and logistic regression to examine the relation between food insecurity and infant feeding practices, adjusting for sociodemographic characteristics, maternal mood disorders and diabetes mellitus. RESULTS Overall, 17% of the women reported household food insecurity, of whom 8.6% had moderate food insecurity and 2.9% had severe food insecurity (weighted percentages). After adjustment for sociodemographic factors, women with food insecurity were no less likely than others to initiate breastfeeding or provide vitamin D supplementation to their infants. Half of the women with food insecurity ceased exclusive breastfeeding by 2 months, whereas most of those with food security persisted with breastfeeding for 4 months or more. Relative to women with food security, those with marginal, moderate and severe food insecurity had significantly lower odds of exclusive breastfeeding to 4 months, but only women with moderate food insecurity had lower odds of exclusive breastfeeding to 6 months, independent of sociodemographic characteristics (odds ratio 0.60, 95% confidence interval 0.39-0.92). Adjustment for maternal mood disorder or diabetes slightly attenuated these relationships. INTERPRETATION Mothers caring for infants in food-insecure households attempted to follow infant feeding recommendations, but were less able than women with food security to sustain exclusive breastfeeding. Our findings highlight the need for more effective interventions to support food-insecure families with newborns.
Collapse
Affiliation(s)
- Sarah K Orr
- Public Health Ontario (Orr); Department of Nutritional Sciences (Dachner, Tarasuk), University of Toronto, Toronto, Ont.; Department of Sociology (Frank), Acadia University, Wolfville, NS
| | - Naomi Dachner
- Public Health Ontario (Orr); Department of Nutritional Sciences (Dachner, Tarasuk), University of Toronto, Toronto, Ont.; Department of Sociology (Frank), Acadia University, Wolfville, NS
| | - Lesley Frank
- Public Health Ontario (Orr); Department of Nutritional Sciences (Dachner, Tarasuk), University of Toronto, Toronto, Ont.; Department of Sociology (Frank), Acadia University, Wolfville, NS
| | - Valerie Tarasuk
- Public Health Ontario (Orr); Department of Nutritional Sciences (Dachner, Tarasuk), University of Toronto, Toronto, Ont.; Department of Sociology (Frank), Acadia University, Wolfville, NS
| |
Collapse
|
10
|
Abstract
AbstractObjectiveThere have been few studies investigating the association between food security and breast-feeding duration and none have been conducted among Canadian Inuit, a population disproportionately burdened with food insecurity. We evaluated the association between household food security and breast-feeding duration in Canadian Inuit children.DesignData were obtained from the Nunavut Inuit Child Health Survey, a population-based cross-sectional survey.SettingThe Canadian Territory of Nunavut in 2007 and 2008.SubjectsCaregivers of Inuit children aged 3–5 years. Participating children were randomly sampled from community medical centre lists.ResultsOut of 215 children, 147 lived in food-insecure households (68·4 %). Using restricted mean survival time models, we estimated that children in food-secure households were breast-fed for 16·8 (95 % CI 12·5, 21·2) months and children in food-insecure households were breast-fed for 21·4 (95 % CI 17·9, 24·8) months. In models adjusting for social class, traditional knowledge and child health, household food security was not associated with breast-feeding duration (hazard ratio=0·82, 95 % CI 0·58, 1·14).ConclusionsOur research does not support the hypothesis that children living in food-insecure households were breast-fed for a longer duration than children living in food-secure households. However, we found that more than 50 % of mothers in food-insecure households continued breast-feeding well beyond 1 year. Many mothers in food-secure households also continued to breast-feed beyond 1 year. Given the high prevalence of food insecurity in Inuit communities, we need to ensure infants and their caregivers are being adequately nourished to support growth and breast-feeding, respectively.
Collapse
|
11
|
Salmon L. Food security for infants and young children: an opportunity for breastfeeding policy? Int Breastfeed J 2015; 10:7. [PMID: 25750657 PMCID: PMC4352266 DOI: 10.1186/s13006-015-0029-6] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2014] [Accepted: 01/05/2015] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Increased global demand for imported breast milk substitutes (infant formula, follow-on formula and toddler milks) in Asia, particularly China, and food safety recalls have led to shortages of these products in high income countries. At the same time, commodification and trade of expressed breast milk have fuelled debate about its regulation, cost and distribution. In many economies suboptimal rates of breastfeeding continue to be perpetuated, at least partially, because of a failure to recognise the time, labour and opportunity costs of breast milk production. To date, these issues have not figured prominently in discussions of food security. Policy responses have been piecemeal and reveal conflicts between promotion and protection of breastfeeding and a deregulated trade environment that facilitates the marketing and consumption of breast milk substitutes. DISCUSSION The elements of food security are the availability, accessibility, utilization and stability of supply of nutritionally appropriate and acceptable quantities of food. These concepts have been applied to food sources for infants and young children: breastfeeding, shared breast milk and breast milk substitutes, in accordance with World Health Organization (WHO)/United Nations Children's Fund (UNICEF) guidelines on infant feeding. A preliminary analysis indicates that a food security framework may be used to respond appropriately to the human rights, ethical, economic and environmental sustainability issues that affect the supply and affordability of different infant foods. SUMMARY Food security for infants and young children is not possible without high rates of breastfeeding. Existing international and national instruments to protect, promote and support breastfeeding have not been implemented on a wide scale globally. These instruments need review to take into account the emerging trade environment that includes use of the internet, breast milk markets and globalised supply chains for breast milk substitutes. New approaches are required to handle the long-standing policy conflicts that surround infant and young child feeding. Placing breastfeeding in a food security framework may achieve the political attention and policy co-ordination required to accelerate breastfeeding rates in a range of economies.
Collapse
Affiliation(s)
- Libby Salmon
- Australian Centre for Economic Research on Health, Research School of Population Health, The Australian National University, Building #62, Corner of Mills & Eggleston Roads, Canberra, ACT 0200 Australia
| |
Collapse
|