Skip to main content

Main menu

  • Home
  • Content
    • Current issue
    • Past issues
    • Early releases
    • Collections
    • Sections
    • Blog
    • Infographics & illustrations
    • Podcasts
    • COVID-19 Articles
  • Authors
    • Overview for authors
    • Submission guidelines
    • Submit a manuscript
    • Forms
    • Editorial process
    • Editorial policies
    • Peer review process
    • Publication fees
    • Reprint requests
    • Open access
  • CMA Members
    • Overview for members
    • Earn CPD Credits
    • Print copies of CMAJ
  • Subscribers
    • General information
    • View prices
  • Alerts
    • Email alerts
    • RSS
  • JAMC
    • À propos
    • Numéro en cours
    • Archives
    • Sections
    • Abonnement
    • Alertes
    • Trousse média 2022
  • CMAJ JOURNALS
    • CMAJ Open
    • CJS
    • JAMC
    • JPN

User menu

Search

  • Advanced search
CMAJ
  • CMAJ JOURNALS
    • CMAJ Open
    • CJS
    • JAMC
    • JPN
CMAJ

Advanced Search

  • Home
  • Content
    • Current issue
    • Past issues
    • Early releases
    • Collections
    • Sections
    • Blog
    • Infographics & illustrations
    • Podcasts
    • COVID-19 Articles
  • Authors
    • Overview for authors
    • Submission guidelines
    • Submit a manuscript
    • Forms
    • Editorial process
    • Editorial policies
    • Peer review process
    • Publication fees
    • Reprint requests
    • Open access
  • CMA Members
    • Overview for members
    • Earn CPD Credits
    • Print copies of CMAJ
  • Subscribers
    • General information
    • View prices
  • Alerts
    • Email alerts
    • RSS
  • JAMC
    • À propos
    • Numéro en cours
    • Archives
    • Sections
    • Abonnement
    • Alertes
    • Trousse média 2022
  • Visit CMAJ on Facebook
  • Follow CMAJ on Twitter
  • Follow CMAJ on Pinterest
  • Follow CMAJ on Youtube
  • Follow CMAJ on Instagram
Commentary

Food insecurity and breastfeeding

Meta van den Heuvel and Catherine Birken
CMAJ March 19, 2018 190 (11) E310-E311; DOI: https://doi.org/10.1503/cmaj.180167
Meta van den Heuvel
Division of Paediatric Medicine, Department of Paediatrics, The Hospital for Sick Children; Department of Paediatrics, Faculty of Medicine, University of Toronto, Toronto, Ont.
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Catherine Birken
Division of Paediatric Medicine, Department of Paediatrics, The Hospital for Sick Children; Department of Paediatrics, Faculty of Medicine, University of Toronto, Toronto, Ont.
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
  • Article
  • Responses
  • Metrics
  • PDF
Loading

See related article at www.cmaj.ca/lookup/doi/10.1503/cmaj.170880

KEY POINTS
  • A better understanding about the biopsychosocial determinants of breastfeeding women who face food insecurity is necessary to develop effective interventions.

  • Public policy should be extended to ensure that children receive optimal nutrition during sensitive periods of their early development.

  • The government should plan a rigorous evaluation of the Canada Child Benefit program, with specific focus on maternal and child health outcomes among vulnerable recipients.

Food insecurity — the unreliable access to sufficient quantities of affordable, nutritious food — is a serious public health concern in Canada.1 PROOF (Food Insecurity Policy Research) reported that 12% of Canadian households faced some level of food insecurity in 2014.2 In adults, food insecurity has been associated with poor physical and mental health, including chronic health conditions like diabetes and depression, and an increased rate of hospital admissions.3,4 Households with children have a greater risk for food insecurity; one in six Canadian children faced household food insecurity in 2014.2 Inadequate quality and quantity of food is associated with adverse outcomes in children. Children living in families that report food insecurity have reduced healthy food intake and lower academic outcomes, as well as higher rates of asthma, obesity, depression and anxiety.2,5,6

In a linked study, Orr and colleagues7 report on the association of household food insecurity and breastfeeding initiation, the duration of exclusive breastfeeding and vitamin D supplementation of women who participated in the Canadian Community Health Survey (2005–2014).

Interestingly, the authors did not identify an association between food insecurity and the initiation of breastfeeding and the supplementation of vitamin D. A strength of the study is that the authors adjusted their analysis for important sociodemographic factors associated with breastfeeding, including education, partnership status, immigrant status, household income, Aboriginal identity and maternal health factors related to breastfeeding (mood disorders and diabetes). However, they did not include general ethnocultural identity in their analysis. Rates of breastfeeding initiation are strongly influenced by social and ethnocultural factors.8 In Canada, according to the 2009–2010 Community Health Survey, significantly more mothers who were of self-identified Asian (93.5%) or black (93.9%) background began breastfeeding than mothers who self-identified as white (86.7%).9 To explore the association between breastfeeding initiation and food insecurity in more detail, future studies should explore ethnocultural factors.

The linked study did show an association between food insecurity and the duration of exclusive breastfeeding. Almost half of women in food-insecure households had ceased exclusive breastfeeding after two months, whereas half of the women in food-secure households breastfed exclusively for at least four months. Exclusive breastfeeding rates are low in Canada. In 2009–2010, only 25.9% of mothers breastfed exclusively for the recommended six months.9 This rate was even lower in women in food-insecure households (20.7% in the marginally food-insecure group, 16.7% in the moderately insecure group and 15.7% in the severely food-insecure group). Surprisingly, only the women in the moderately food-insecure group had a significant risk of early cessation of exclusive breastfeeding (before six months) compared with mothers in food-secure households in the adjusted analysis. This may be explained by the relatively small number of women in the severely food-insecure group in the study, as acknowledged by the authors.

Another important confounder for both food insecurity and duration of breastfeeding is maternal employment. In the United States, early cessation of breastfeeding is associated with non-managerial employment and a lack of job flexibility.10 In the 2009–2010 Canadian Health Survey, 9% of women identified the need to return to employment as a reason to stop breastfeeding. Therefore, an alternative explanation for the nonsignificant association between women in the marginally and severely food-insecure groups and the duration of breastfeeding could also be explained by a difference in employment status. Other unmeasured sociobiological factors — such as comorbid medical or mental health problems, use of medications or maternal weight status — could also explain the association.

Despite these limitations, and those raised by the authors, the current study provides an important contribution to the literature on food insecurity and key maternal and child health outcomes. It is alarming that “women who can least afford to buy infant formula and whose babies can benefit most from the health-promoting qualities of breast milk are the least likely to breastfeed.”11,12 Many social, emotional and cultural barriers undermine breastfeeding, and for many women, exclusive breastfeeding is not feasible.11 However, the literature does not provide us with an answer about why women in food-insecure households in Canada stop exclusive breastfeeding early. A better understanding about the biopsychosocial determinants of breastfeeding in this vulnerable population is necessary to develop effective interventions.

Canada’s policy relating to infant food security focuses mainly on promoting breastfeeding as the pathway to infant food security. Relying on promoting breastfeeding alone to address nutrition in vulnerable children is inadequate.11 In contrast to the US, where the Women, Infants and Children program provides food supplementation to infants and children, there is no national feeding program for infants and children in Canada. When Canadian mothers who report food insecurity require nutritional supplementation for their infants, they are left to rely on local food banks to obtain formula. The local policies of these food banks vary with respect to formula provisioning, likely resulting in differing access to appropriate nutrition for infants.11 Other options for nutritional supplementation to breastfeeding may include access to donor breast milk; however, this is limited in Canada. Intensifying public policy to ensure optimal nutrition during sensitive periods of early child development is essential to improve child health outcomes.12

Measures to increase household income comprise a promising strategy to promote food security. A recent randomized clinical trial showed that in the United Kingdom, financial incentives improved breastfeeding rates in areas with low breastfeeding prevalence.13 In Canada, the recent introduction of the nationwide Canada Child Benefit might have an important impact on household food insecurity. However, a rigorous evaluation of this income support program is needed, with specific focus on maternal and child health outcomes, to answer key questions; for example, “Will mothers who report food insecurity have equitable access to these benefits?” To improve outcomes for food-insecure families, policy-makers must evaluate the Canada Child Benefit program by examining child and family health outcomes, and providers of child health, researchers and tax-payers must ensure that policy-makers do so.

Footnotes

  • Competing interests: None declared.

  • This article was solicited and has not been peer reviewed.

  • Contributors: Both authors contributed to the conception and design of the work, drafted the manuscript, revised it critically for important intellectual content, gave final approval of the version to be published and agreed to be accountable for all aspects of the work.

References

  1. ↵
    Food insecurity. Vancouver: Dietitians of Canada; [updated 2016]. Available: www.dietitians.ca/dietitians-views/food-security/overview.aspx (accessed 2018 Jan. 5).
  2. ↵
    1. Tarasuk V,
    2. Mithcell A,
    3. Dachner N
    . Household food insecurity in Canada, 2014. Toronto: PROOF Food Insecurity Policy Research; 2016.
  3. ↵
    1. Vozoris NT,
    2. Tarasuk VS
    . Household food insufficiency is associated with poorer health. J Nutr 2003;133:120–6.
    OpenUrlAbstract/FREE Full Text
  4. ↵
    1. Jessiman-Perreault G,
    2. McIntyre L
    . The household food insecurity gradient and potential reductions in adverse population mental health outcomes in Canadian adults. SSM — Pop Health 2017(3):464–72. Available: www.dx.doi.org/10.1016/j.ssmph.2017.05.013 (accessed 2018 Jan. 5).
  5. ↵
    1. Kirkpatrick SI,
    2. McIntyre LPM
    . Child hunger and long-term adverse consequences for health. Arch Pediatr Adolesc Med 2010;164:754–62.
    OpenUrlCrossRefPubMed
  6. ↵
    1. Fuller A,
    2. Maguire JL,
    3. Carsley S,
    4. et al
    . Difficulty buying food, BMI, and eating habits in young children. Can J Public Health 2018;108:e497–e502.
    OpenUrl
  7. ↵
    1. Orr SK,
    2. Dachner N,
    3. Frank L,
    4. et al
    . Relation between household food insecurity and breastfeeding in Canada. CMAJ 2018;190:E312–9.
    OpenUrlAbstract/FREE Full Text
  8. ↵
    1. Balogun OO,
    2. O’Sullivian EJ,
    3. McFadden A,
    4. et al
    . Interventions for promoting the initiation of breastfeeding. Cochrane Database Syst Rev 2016;(11):CD001688.
  9. ↵
    Breastfeeding initiation in Canada: key statistics and graphics (2009–2010). Ottawa: Statistics Canada; [modified 2012]. Available: www.canada.ca/en/health-canada/services/food-nutrition/food-nutrition-surveillance/health-nutrition-surveys/canadian-community-health-survey-cchs/breastfeeding-initiation-canada-key-statistics-graphics-2009-2010-food-nutrition-surveillance-health-canada.html (accessed 2018 Jan. 5)
  10. ↵
    1. Guendelman S,
    2. Kosa JL,
    3. Pearl M,
    4. et al
    . Juggling work and breastfeeding: effects of maternity leave and occupational characteristics. Pediatrics 2009;123:e38–46.
    OpenUrlAbstract/FREE Full Text
  11. ↵
    1. Frank L
    . The breastfeeding paradox: a critique of policy related to infant food insecurity in Canada. Food Cult Soc 2015;18:107–29.
    OpenUrl
  12. ↵
    1. Venu I,
    2. Van Den Heuvel M,
    3. Wong JP,
    4. et al
    . The breastfeeding paradox: relevance for household food insecurity. Paediatr Child Health 2017;22:180–3.
    OpenUrl
  13. ↵
    1. Relton C,
    2. Strong M,
    3. Thomas KJ,
    4. et al
    . Effect of financial incentives on breastfeeding. JAMA Pediatr 2018;172:e174523.
    OpenUrl
PreviousNext
Back to top

In this issue

Canadian Medical Association Journal: 190 (11)
CMAJ
Vol. 190, Issue 11
19 Mar 2018
  • Table of Contents
  • Index by author

Article tools

Respond to this article
Print
Download PDF
Article Alerts
To sign up for email alerts or to access your current email alerts, enter your email address below:
Email Article

Thank you for your interest in spreading the word on CMAJ.

NOTE: We only request your email address so that the person you are recommending the page to knows that you wanted them to see it, and that it is not junk mail. We do not capture any email address.

Enter multiple addresses on separate lines or separate them with commas.
Food insecurity and breastfeeding
(Your Name) has sent you a message from CMAJ
(Your Name) thought you would like to see the CMAJ web site.
CAPTCHA
This question is for testing whether or not you are a human visitor and to prevent automated spam submissions.
Citation Tools
Food insecurity and breastfeeding
Meta van den Heuvel, Catherine Birken
CMAJ Mar 2018, 190 (11) E310-E311; DOI: 10.1503/cmaj.180167

Citation Manager Formats

  • BibTeX
  • Bookends
  • EasyBib
  • EndNote (tagged)
  • EndNote 8 (xml)
  • Medlars
  • Mendeley
  • Papers
  • RefWorks Tagged
  • Ref Manager
  • RIS
  • Zotero
‍ Request Permissions
Share
Food insecurity and breastfeeding
Meta van den Heuvel, Catherine Birken
CMAJ Mar 2018, 190 (11) E310-E311; DOI: 10.1503/cmaj.180167
Digg logo Reddit logo Twitter logo Facebook logo Google logo Mendeley logo
  • Tweet Widget
  • Facebook Like

Jump to section

  • Article
    • Footnotes
    • References
  • Responses
  • Metrics
  • PDF

Related Articles

  • Relation between household food insecurity and breastfeeding in Canada
  • PubMed
  • Google Scholar

Cited By...

  • Food insecurity and the nutritional health and well-being of women and children in high-income countries: protocol for a qualitative systematic review
  • Google Scholar

More in this TOC Section

  • Revisiting the concept of urgency in surgical prioritization and addressing backlogs in elective surgery provision
  • Antiviral treatment for COVID-19: ensuring evidence is applicable to current circumstances
  • Who is Black? The urgency of accurately defining the Black population when conducting health research in Canada
Show more Commentary

Similar Articles

 

View Latest Classified Ads

Content

  • Current issue
  • Past issues
  • Collections
  • Sections
  • Blog
  • Podcasts
  • Alerts
  • RSS
  • Early releases

Information for

  • Advertisers
  • Authors
  • Reviewers
  • CMA Members
  • Media
  • Reprint requests
  • Subscribers

About

  • General Information
  • Journal staff
  • Editorial Board
  • Advisory Panels
  • Governance Council
  • Journal Oversight
  • Careers
  • Contact
  • Copyright and Permissions
  • Accessibiity
  • CMA Civility Standards
CMAJ Group

Copyright 2022, CMA Impact Inc. or its licensors. All rights reserved. ISSN 1488-2329 (e) 0820-3946 (p)

All editorial matter in CMAJ represents the opinions of the authors and not necessarily those of the Canadian Medical Association or its subsidiaries.

To receive any of these resources in an accessible format, please contact us at CMAJ Group, 500-1410 Blair Towers Place, Ottawa ON, K1J 9B9; p: 1-888-855-2555; e: cmajgroup@cmaj.ca

Powered by HighWire