ISSUE
The impact of household food insecurity on infant health is becoming increasingly apparent. Over the past few years, the Healthy Families department has observed several families struggle to afford adequate infant formula while experiencing breastfeeding challenges. The department’s multidisciplinary team works diligently to help clients optimize breastfeeding and improve access to infant formula, however, a collaborative strategy is urgently needed to address this public health issue at the population level.
BACKGROUND
Local Prevalence: Food Insecurity, defined as inadequate or insecure access to food due to financial constraints (Li et al., 2023), remains a significant public health issue in Windsor-Essex County (WEC). Household food insecurity in WEC rose from 16.0% in 2019 to 19.8% in 2022 (Public Health Ontario, 2023). While the local prevalence of infant-specific food insecurity has not been formally investigated, it is likely significant considering that 1 in 7 children in Windsor-Essex County is living in poverty (Canada Census, 2021). Declining breastfeeding rates in WEC have created additional vulnerability, as infant formula prices rise and the formula supply chain remains unstable. Rates of exclusive breastfeeding at hospital discharge have steadily declined since 2015 and remain significantly below the Ontario average (45.7% vs 52.8%) (Public Health Ontario, 2023).
Women in lower income households are also less likely to sustain breastfeeding for the recommended duration. Local infant feeding surveillance revealed that WEC mothers whose annual household income was less than $60,000 were 1.71 times less likely to continue breastfeeding until two months postpartum compared to mothers with higher household income (WECHU, 2019). This paradox was also observed in a larger Canadian study which reported that mothers experiencing food insecurity were significantly less likely to sustain exclusive breastfeeding past four months compared to their food secure peers (Orr et al., 2018).
Potential Impact on Infant Health: When household food insecurity results in unreliable access to breast milk or formula, both infant health and parental mental health are threatened. Undernutrition during infancy can lead to cognitive impairments, growth faltering, and health complications, which may have lifelong repercussions. In a meta-analysis, Corbett and Drewitt (2004) concluded that significant undernutrition during infancy (i.e., failure-to-thrive) is associated with adverse intellectual outcomes significant enough to be of importance at a population-level. Shankar et al. (2017) confirmed the positive correlation between household food insecurity and behavioral, academic, and emotional problems starting in early childhood. Undernutrition during critical periods of development impairs physical maturation and increases risk of acute and chronic morbidity (Martins et al, 2011), causing unnecessary personal suffering and strain on the healthcare system.
In addition to increased risk for malnutrition and its manifestations, infants in food insecure households are more likely to have a parent experiencing mental health concerns. Food insecurity has been consistently associated with parental depression, anxiety, and stress (Cain et al, 2022). In Ontario, maternal food insecurity was correlated with postpartum mood disorders and a greater likelihood of infants being treated in an emergency department (Tarasuk et al, 2020). Further, preliminary evidence suggests that maternal mental health issues negatively impact attachment with infant children (Barnes & Theule, 2019). These associations imply that there may be secondary impacts of food insecurity on infant development related to parental mental health.
Existing Infant Food Security Initiatives: The Healthy Families department has implemented several initiatives to help low-income clients secure reliable sources of nutrition for their infants. These initiatives include reinstating the in-home lactation consultation program to reduce financial barriers to accessing breastfeeding services. The Healthy Babies, Healthy Children program also provides infant feeding education and helps clients access necessary feeding essentials. Unfortunately, no local organization consistently supplies infant formula or other infant feeding supplies to low-income families. In response, the department will pilot a breast pump loan program and has collaborated with the local social services agency to identify efficiencies in the Special Diet Allowance application process for clients who require formula due to inadequate breastmilk supply. While these initiatives help Health Unit clients access the products they need, an upstream strategy is required to adequately address this public health issue at the population level.
The Healthy Families Department is well-positioned to lead this strategy and monitor the efficacy of the associated work. The department already collaborates with many of the key stakeholders and will be relaunching the Windsor-Essex Infant Feeding Surveillance survey this year, which will include measures of infant food security. Initial work should include the formation of a Windsor-Essex Infant Food Security Working Group, including representation from each birthing centre and midwifery clinic, in addition to related community agencies and primary care providers. Key deliverables should include the implementation of community-wide strategies to screen for infant food insecurity and improve breastfeeding rates and infant formula access. The working group could also facilitate coordinated advocacy efforts to support equitable access to infant feeding products and services, such as the most recent Call to Action from Ontario Dietitians in Public Health and Food Allergy Canada (2023). This Call to Action would ensure equitable access to specialized formulas for children with a medical diagnosis requiring strict avoidance of standard soy and milk proteins.
PROPOSED MOTION
WHEREAS improving household food security among families with infants is essential to protecting the health and cognitive potential of future generations.
WHEREAS immediate action is required to improve access to proactive breastfeeding education and timely, coordinated lactation support.
WHEREAS immediate action is required to improve access to infant formula and associated education for low-income families when exclusive breastfeeding is not possible.
WHEREAS effective solutions to infant food insecurity require coordinated, community-wide policies and programs.
NOW THEREFORE BE IT RESOLVED that the Board of Health at the Windsor-Essex County Health Unit will continue to advocate for more sustainable solutions to household food insecurity and will advocate for equitable access to infant formula and in-person breastfeeding support.
AND FURTHER that the Board of the Windsor-Essex County Health Unit endorses the Call to Action: ODB Program amendments to support infants and children with a medical diagnosis requiring strict avoidance of standard soy and milk proteins (Ontario Dietitians in Public Health & Food Security Canada, 2023).
AND FURTHER that the Board of the Windsor-Essex County Health Unit supports infant food security by prioritizing the following initiatives:
- The creation of a comprehensive strategic plan to improve infant food security in Windsor-Essex County, including targeted food insecurity screening initiatives and the creation of an associated referral pathway.
- Community mobilization to improve equitable access to infant feeding products, education, and consultation. Work will include the formation and leadership of an Infant Food Security Working Group, which will have representation from birthing centres, midwifery clinics, dietitians, primary healthcare providers, and related community agencies.
- Surveillance of infant food security in WEC and the coordination of related advocacy efforts. The cost of formula feeding will also be monitored as part of the Health Unit’s annual Cost of Healthy Eating initiative.
- The development or enhancement of internal policies and procedures to support equitable access to early nutrition. These initiatives will include screening for food insecurity during feeding and growth assessments and prioritizing associated internal and external referrals.
References:
Barnes J, Theule J. (2019). Maternal depression and infant attachment security: A meta-analysis. Infant Ment Health J. 2019 Nov;40(6):817-834. doi: 10.1002/imhj.21812. Retrieved from: https://pubmed.ncbi.nlm.nih.gov/31415711/
Cain KS, Meyer SC, Cummer E, Patel KK, Casacchia NJ, Montez K, Palakshappa D, Brown CL. Association of Food Insecurity with Mental Health Outcomes in Parents and Children. Acad Pediatr. 2022 Sep-Oct;22(7):1105-1114. Retrieved from:
https://pubmed.ncbi.nlm.nih.gov/35577282/
Corbett and Drewitt (2004). To what extent is failure to thrive in infancy associated with poorer cognitive development? A review and meta-analysis. J Child Psychol Psychiatry, 45 (3): 641-54. Retrieved from: https://pubmed.ncbi.nlm.nih.gov/15055382/
Li T, Fafard St-Germain AA, Tarasuk V. (2023). Household food insecurity in Canada, 2022. Toronto: Research to identify policy options to reduce food insecurity (PROOF). Retrieved from https://proof.utoronto.ca/
Martins VJ, Toledo Florêncio TM, Grillo LP, do Carmo P Franco M, Martins PA, Clemente AP, Santos CD, de Fatima A Vieira M, Sawaya AL. (2011). Long-lasting effects of undernutrition. Int J Environ Res Public Health. 2011 Jun;8(6):1817-46. Retrieved from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3137999/
Ontario Dietitians in Public Health and Food Allergy Canada (2023). Call to Action: ODB Program amendments to support infants and children with a medical diagnosis requiring strict avoidance of standard soy and milk proteins. Retrieved from: www.odph.ca/advocacy
Orr S, Dachner N, Frank L, Tarasuk V. (2018). Relation between household food insecurity and breastfeeding in Canada. CMAJ, 190:E312-9. Retrieved from: https://www.cmaj.ca/content/190/11/E312
Public Health Ontario (2023). Household Food Insecurity Snapshot. Retrieved from: https://www.publichealthontario.ca/en/Data-and-Analysis/Health-Equity/Household-Food-Insecurity
Risi A, Pickard JA, Bird AL (2021). The implications of parent mental health and wellbeing for parent-child attachment: A systematic review. PLoS One. 16(12):e0260891. Retrieved from: https://pubmed.ncbi.nlm.nih.gov/34914730/
Shanker P, Chung R, Frank D (2017). Association of Food Insecurity with Children’s Behavioral, Emotional, and Academic Outcomes: A Systematic Review. J Dev Behav Pediatr. 38(2):135-150. Retrieved from: https://pubmed.ncbi.nlm.nih.gov/28134627/
Tarasuk V, Gundersen C, Wang X, Roth D, Urquia M (2020). Maternal Food Insecurity is Positively Associated with Postpartum Mental Disorders in Ontario, Canada. The Journal of Nutrition, 150 (11), 3033-3040. Retrieved from: https://doi.org/10.1093/jn/nxaa240