Food insecurity is associated with attitudes towards exclusive breastfeeding among women in urban Kenya

Abstract

This study aimed to document whether food insecurity was associated with beliefs and attitudes towards exclusive breastfeeding (EBF) among urban Kenyan women. We conducted structured interviews with 75 human immunodeficiency virus (HIV)-affected and 75 HIV-status unknown, low-income women who were either pregnant or with a child ≤24 months and residing in Nakuru, Kenya to generate categorical and open-ended responses on knowledge, attitudes and beliefs towards EBF and food insecurity. We facilitated six focus group discussions (FGD) with HIV-affected and HIV-status unknown mothers (n = 50 women) to assess barriers and facilitators to EBF. Of 148 women with complete interview data, 77% were moderately or severely food insecure (FIS). Women in FIS households had significantly greater odds of believing that breast milk would be insufficient for 6 months [odds ratio (OR), 2.6; 95% confidence interval (95% CI), 1.0, 6.8], that women who EBF for 6 months would experience health or social problems (OR, 2.7; 95% CI, 1.0, 7.3), that women need adequate food to support EBF for 6 months (OR, 2.6; 95% CI, 1.0, 6.7) and that they themselves would be unable to follow a counsellor's advice to EBF for 6 months (OR, 3.2; 95% CI, 1.3, 8.3). Qualitative analysis of interview and FGD transcripts indicated that the maternal experience of hunger contributes to perceived milk insufficiency, anxiety about infant hunger and a perception that access to adequate food is necessary for successful breastfeeding. The lived experience of food insecurity among a sample of low-income, commonly FIS, urban Kenyan women reduces their capacity to implement at least one key recommended infant feeding practices, that of EBF for 6 months.

The acceptability of dietary tools to improve maternal and child nutrition in Western Kenya

“…Several authors have written about maternal perceptions of food consumption and its association with milk production (27)(28)(29)(30) . In a mixed-methods study in Nakuru, Kenya, Webb-Girard et al observed a strong positive conceptual link between maternal hunger and food insecurity and the perceived ability to produce sufficient breast milk (31) . An increased perceived ability to produce sufficient milk may increase breast-feeding selfefficacy, a critical behavioural component for successful breast-feeding (32) .…”

Food Insecurity and Obesogenic Maternal Infant Feeding Styles and Practices in Low-Income Families

“…Some evidence suggests that food-insecure families encounter greater barriers to exclusive breastfeeding. 49 Other studies suggest that mothers participating in WIC may not exclusively breastfeed as a result of financial incentives to formula feed. 50 We found no relationship between food insecurity and exclusive breastfeeding.…”

Levels and Predictors of Food Insecurity among HIV Positive Adult Patients Taking Highly Active Anti-Retroviral Therapy at Arba Minch General Hospital, Southern Ethiopia, 2016

“…Millions of HIV infected people live in countries with high levels of poverty and food insecurity. Food insecurity and HIV/AIDS are interlinked and causing significant morbidity and mortality in sub-Saharan Africa [15][16][17].…”