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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).
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 breast milk are the least likely to breastfeed” (1, 2). Recognition of the full spectrum of household food insecurity needs incorporation into policies and programs that may strengthen food security and support mother and child nutrition.
References
1. Venu I, van den Heuvel M, Wong JP, Borkhoff CM, Moodie RG, Ford-Jones EL, et al. The breastfeeding paradox: Relevance for household food insecurity. Paediatrics & child health. 2017;22(4):180-3.
2. Frank L. The Breastfeeding Paradox: A Critique of Policy Related to Infant Food Insecurity in Canada. Food, Culture & Society. 2015;18(1):107-29.
3. Orr SK, Dachner N, Frank L, Tarasuk V. Relation between household food insecurity and breastfeeding in Canada. Canadian Medical Association journal. 2018;190(11):E312-E9.
4. McIsaac KE, Stock DC, Lou W. Household food security and breast-feeding duration among Canadian Inuit. Public health nutrition. 2017;20(1):64-71.
5. Lesorogol C, Bond C, Dulience SJL, Iannotti L. Economic determinants of breastfeeding in Haiti: The effects of poverty, food insecurity, and employment on exclusive breastfeeding in an urban population. Matern Child Nutr. 2018;14(2):e12524.
6. Webb‐Girard A, Cherobon A, Mbugua S, Kamau‐Mbuthia E, Amin A, Sellen DW. Food insecurity is associated with attitudes towards exclusive breastfeeding among women in urban Kenya. Maternal & child nutrition. 2012;8(2):199-214.