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

Abstract

Background: In addition to its health and nutritional benefits, breastfeeding can save low-income, food insecure mothers the cost of infant formula so that money can be spent on food and other necessities. Yet breastfeeding may exacerbate food insecurity by negatively affecting maternal employment. The relationship between food insecurity and breastfeeding has been explored previously, with varying results. The purpose of this study was to determine the relationship between prenatal food insecurity and breastfeeding initiation and early cessation (< 10 weeks) among U.S. mothers. Methods: Data were pooled from 2012 to 2013 (Phase 7) of the Pregnancy Risk Assessment Monitoring System, a population-based cross-sectional survey of postpartum women administered 2-4 months after delivery. The analytic sample was drawn from Colorado, Maine, New Mexico, Oregon, Pennsylvania, and Vermont, and limited to mothers aged 20 years and older whose infants were alive and living with them at the time of the survey (n = 10,159). We used binomial and multinomial logistic models to assess the predictive association between food insecurity and breastfeeding initiation and early cessation, respectively, while controlling for confounders. Results: Most women reported prenatal food security (90.5%) and breastfeeding initiation (91.0%). Of those who initiated breastfeeding, 72.7% breastfed for > 10 weeks. A larger proportion of food secure women compared to food insecure women, initiated breastfeeding (91.4% vs. 87.6%, P < 0.01), and patterns of early breastfeeding cessation differed significantly between the two groups (P < 0.01). In the final models, prenatal food insecurity was not associated with breastfeeding initiation or early cessation, with one exception. Compared to food secure mothers, mothers reporting food insecurity had a lower risk of breastfeeding for 4-6 weeks than for > 10 weeks, independent of covariates (relative risk ratio 0.65; 95% CI 0.50, 0.85; P < 0.01). Women who were married, had a college degree, and did not smoke were more likely to initiate breastfeeding and breastfeed for a longer time, regardless of food security status (P < 0.01).

Breastfeeding Practices Before and During the COVID-19 Pandemic in Fortaleza, Northeastern Brazil

“…In Brazil, a higher prevalence of BF has been found among food-insecure families of children aged 12-24 months (Gomes & Goubert, 2012). However, this result has not been observed in developed countries where inverse or no associations between food insecurity and breastfeeding initiation and duration were reported (Dinour et al, 2020;Orr et al, 2018). Similar to previous findings (Pacheco et al, 2021), no association of BF patterns with COVID-19 related exposure was found.…”

Lockdown-Associated Hunger May Be Affecting Breastfeeding: Findings from a Large SMS Survey in South Africa

“…In response to the COVID-19 pandemic, South Africa imposed a strict national lockdown on 27 March 2020, which resulted in severe job and income losses, as well as food insecurity and mental health concerns [ 5 ]. This study was inspired by this context and the literature on lower breastfeeding rates and earlier cessation of exclusive breastfeeding seen with increased severity of food insecurity experienced by the mother and the household [ 6 , 7 , 8 , 9 ].…”

Meal patterning and the onset of spontaneous labor

“…In the broader population, skipping meals may not always be a choice as approximately 10% of pregnant people experience prenatal food insecurity, 30 whereas, in this sample the majority of participants reported regularly eating all three meals during the control period. The prevalence of skipping a meal during the week and the 24 hours before labor onset was greater among non‐Hispanic Black participants.…”