Greater household food insecurity is associated with lower breast milk intake among infants in western Kenya

Abstract

Household food insecurity has been hypothesized to negatively impact breastfeeding practices and breast milk intake, but this relationship has not been rigorously assessed. To generate an evidence base for breastfeeding recommendations among food‐insecure mothers in settings where HIV is highly prevalent, we explored infant feeding practices among 119 mother–infant dyads in western Kenya at 6 and 24 weeks postpartum. We used the deuterium oxide dose‐to‐the‐mother technique to determine if breastfeeding was exclusive in the prior 2 weeks, and to quantify breast milk intake. Sociodemographic data were collected at baseline and household food insecurity was measured at each time point using the Household Food Insecurity Access Scale. Average breast milk intake significantly increased from 721.3 g/day at 6 weeks postpartum to 961.1 g/day at 24 weeks postpartum. Household food insecurity at 6 or 24 weeks postpartum was not associated with maternal recall of exclusive breastfeeding (EBF) in the prior 24 hr or deuterium oxide‐measured EBF in the prior 2 weeks at a significance level of 0.2 in bivariate models. In a fixed‐effects model of quantity of breast milk intake across time, deuterium oxide‐measured EBF in the prior 2 weeks was associated with greater breast milk intake (126.1 ± 40.5 g/day) and every one‐point increase in food insecurity score was associated with a 5.6 (±2.2)‐g/day decrease in breast milk intake. Given the nutritional and physical health risks of suboptimal feeding, public health practitioners should screen for and integrate programs that reduce food insecurity in order to increase breast milk intake.

“If there is no water, we cannot feed our children”: The far‐reaching consequences of water insecurity on infant feeding practices and infant health across 16 low‐ and middle‐income countries

“…Insufficient breastmilk, whether perceived or occurring, can lead to early introduction of non‐breastmilk foods, which in turn decreases breastmilk production (Tully & Dewey, ). Breastmilk production is a common concern for lactating women globally (Gatti, ) and specifically in the context of food insecurity (Miller et al, ; Webb‐Girard et al, ; Young et al, ). Quantifying whether water insecurity impacts breastfeeding behaviors or breastmilk production will be important in creating responsive programming and policy.…”

“…Numerous determinants of infant and young child feeding have been explored, including but not limited to maternal empowerment (Santoso et al, ), maternal HIV status (Tuthill, McGrath, & Young, ), household food security (Miller, Young, Boateng, Oiye, & Owino, ; Webb‐Girard et al, ), household agricultural production (Kumar, Harris, & Rawat, ), and household market integration (Hirvonen & Hoddinott, ). The role of water in optimal feeding of breastmilk and non‐breastmilk foods, however, has received minimal attention.…”

The role of prenatal food insecurity on breastfeeding behaviors: findings from the United States pregnancy risk assessment monitoring system

“…However, our findings differ from the qualitative results from Haiti [21] and Nova Scotia [24], which suggest that food insecurity leads to breastfeeding cessation due to maternal weakness, perceived or actual breast milk insufficiency, and/or concern that breastmilk is not nutritionally adequate because of poor maternal diet. Other studies that have measured exclusive breastfeeding show either no relationship with hunger [18,19,26,27], or an association between food insecurity and increased likelihood of earlier exclusive breastfeeding cessation [19,23].…”

“…The relationship between food insecurity and breastfeeding behaviors has been assessed in several different geo-cultural contexts and appears complex. Among some less developed countries, such as Kenya [18] and Uganda [19], where HIV rates are relatively high, household food insecurity is not associated with maternal recall of exclusive breastfeeding or any breastfeeding at several time points after birth. Yet, greater household food insecurity is associated with a reduced volume of breast milk intake among infants [18], and mothers reporting moderate to severe household hunger are more likely than mothers experiencing little to no household hunger to cease exclusive breastfeeding between 4 and 6 months [19].…”

“…Among some less developed countries, such as Kenya [18] and Uganda [19], where HIV rates are relatively high, household food insecurity is not associated with maternal recall of exclusive breastfeeding or any breastfeeding at several time points after birth. Yet, greater household food insecurity is associated with a reduced volume of breast milk intake among infants [18], and mothers reporting moderate to severe household hunger are more likely than mothers experiencing little to no household hunger to cease exclusive breastfeeding between 4 and 6 months [19]. Additionally, food insecure mothers are significantly more likely than food secure mothers to believe exclusive breastfeeding for 6 months would be an insufficient mode of infant feeding, and that they would be unable to exclusively breastfeed for 6 months if recommended to do so by a healthcare worker [20].…”