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Public policy positions breastfeeding as a key strategy to protect vulnerable children from household food insecurity (1, 2). Using data from a Canadian population-representative survey, Orr and colleagues (3) report that household food insecurity negatively impacts the duration of exclusive breastfeeding. They demonstrate that mothers with severe household food insecurity breastfeed for a significantly shorter time, compared to mothers who are food secure or are marginally and moderately food insecure. However, among Canadian Inuit mothers with high prevalence of household food insecurity, this difference does not seem to be apparent (4).
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In emerging nations, widespread poverty often results in extreme household food insecurity which, in contrast to mothers in developed nations, may lead to exclusive breastfeeding by way of “last resort exclusive breastfeeding.” Mothers practice exclusive breastfeeding because they have no alternative food source for their infant (5). Nevertheless, they may have perceptions of breast milk insufficiency and feelings of weakness (6). These polar differences may reflect the spectrum for household food insecurity, from marginal to severe and extreme, that may not be captured in categorical data collection.
Findings of Orr and colleagues reinforce prior impressions that a breastfeeding paradox exists, whereby, “women who can least afford to buy infant formula and whose infants can benefit most from the health-promoting qualities of...Competing Interests: None declared.