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Objective: To assess the prevalence, severity and socio-demographic predictors of household food insecurity among vulnerable women accessing the Canada Prenatal Nutrition Program (CPNP) and to examine associations between household food insecurity and breastfeeding practices to 6 months. Design: Cohort investigation pooling data from two studies which administered the 18-item Household Food Security Survey Module at 6 months postpartum and collected prospective infant feeding data at 2 weeks and 2, 4 and 6 months. Household food insecurity was classified as none, marginal, moderate or severe. Logistic regression analyses were performed to assess predictors of household food insecurity and associations between household food security (any and severity) and continued and exclusive breastfeeding. Setting: Three Toronto sites of the CPNP, a federal initiative targeting socially and/or economically vulnerable women. Participants: 316 birth mothers registered prenatally in the CPNP from 2017 to 2020. Results: Household food insecurity at 6 months postpartum was highly prevalent (44 %), including 11 % in the severe category. Risk of household food insecurity varied by CPNP site (P < 0·001) and was higher among multiparous participants (OR 2·08; 95 % CI 1·28, 3·39). There was no association between the prevalence or severity of food insecurity and continued or exclusive breastfeeding to 6 months postpartum in the adjusted analyses. Conclusions: Household food insecurity affected nearly half of this cohort of women accessing the CPNP. Further research is needed on household food insecurity across the national CPNP and other similar programmes, with consideration of the implications for programme design, service delivery and policy responses. [ABSTRACT FROM AUTHOR]

Background: In Canada, 91% of all mothers initiate breastfeeding, but 40–50% stop by 6 months and only 34% breastfeed exclusively for 6 months, with lower rates among socially and/or economically vulnerable women. The Canada Prenatal Nutrition Program (CPNP) aims to support breastfeeding among vulnerable women, but there is no formal framework or funding for sites to integrate proactive postnatal breastfeeding support. This research aimed to i) describe infant feeding practices among clients of one Toronto CPNP site using charitable funds to offer a lactation support program (in-home lactation consultant visits, breast pumps); ii) determine whether breastfeeding outcomes at 6 months differ based on maternal sociodemographics and food insecurity; and iii) assess utilization of the lactation support program. Methods: Infant feeding practices were collected prospectively at 2 weeks, 2, 4 and 6 months postpartum via telephone questionnaires (n = 199). Maternal sociodemographics were collected at 2 weeks and food insecurity data at 6 months postpartum. Program monitoring records were used to determine utilization of the lactation support program. Results: Ninety-one percent of participants were born outside of Canada; 55% had incomes below the Low-Income Cut-Off; and 55% reported food insecurity. All participants initiated breastfeeding, 84% continued for 6 months and 16% exclusively breastfed for 6 months. Among breastfed infants, ≥76% received vitamin D supplementation. Approximately 50% of infants were introduced to solids before 6 months. Only high school education or less and food insecurity were associated with lower breastfeeding rates. Overall, 75% of participants received at least one visit with a lactation consultant and 95% of these received a breast pump. Conclusions: This study provides initial evidence that postnatal lactation support can be delivered within a CPNP site, with high uptake by clients. While all participants initiated breastfeeding and 84% continued for 6 months, adherence to the recommended 6 months of exclusive breastfeeding was low. Further research is needed to better understand the barriers to exclusive breastfeeding and how to support this practice among vulnerable women. Study registered at clinicaltrials.gov as NCT03400605. [ABSTRACT FROM AUTHOR]

The Canada Prenatal Nutrition Program (CPNP) provides a variety of health and nutrition supports to vulnerable mothers and strongly promotes breastfeeding but does not have a formal framework for postnatal lactation support. Breastfeeding duration and exclusivity rates in Canada fall well below global recommendations, particularly among socially and economically vulnerable women. We aimed to explore CPNP participant experiences with breastfeeding and with a novel community lactation support program in Toronto, Canada that included access to certified lactation consultants and an electric breast pump, if needed. Four semistructured focus groups and 21 individual interviews (n = 46 women) were conducted between September and December 2017. Data were analysed using inductive thematic analysis. Study participants reported a strong desire to breastfeed but a lack of preparation for breastfeeding‐associated challenges. Three main challenges were identified by study participants: physical (e.g., pain and low milk supply), practical (e.g., cost of breastfeeding support and maternal time pressures), and breastfeeding self‐efficacy (e.g., concern about milk supply and conflicting information). Mothers reported that the free lactation support helped to address breastfeeding challenges. In their view, the key element of success with the new program was the in‐home visit by the lactation consultant, who was highly skilled and provided care in a non‐judgmental manner. They reported this support would have been otherwise unavailable due to cost or travel logistics. This study suggests value in exploring the addition of postnatal lactation support to the well‐established national CPNP as a means to improve breastfeeding duration and exclusivity among vulnerable women. [ABSTRACT FROM AUTHOR]

We aimed to determine the prevalence of, and factors associated with, breastfeeding initiation in Canadian Inuit. We used data from the Nunavut Inuit Child Health Survey, a population-based, cross-sectional survey conducted in the Canadian territory of Nunavut. Inuit children aged 3-5 years in 2007 or 2008 were randomly selected for the survey. Select household, maternal, infant and community characteristics were collected from the child's primary caregiver and entered into logistic regression models as potential predictors of breastfeeding initiation. Analyses were repeated in a subgroup of caregiver reports from biological mothers. The reported prevalence of breastfeeding initiation was 67.6 % (95 % CI 62.4-72.8) overall and 85.1 % (95 % CI 80.2-90.1) in a subgroup of caregiver reports from biological mothers. Adjusted prevalence odds ratios (pOR) indicate the primary caregiver was an important determinant of breastfeeding (adopted parent vs. biological mother: pOR = 0.03, 95 % CI 0.01-0.07; other vs. biological mother: pOR = 0.33, 95 % CI 0.14-0.74). Maternal smoking during pregnancy and having access to a community birthing facility were also potentially important, but not statistically significant ( p > 0.05). In conclusion, data from the Nunavut Inuit Child Health Survey indicate breastfeeding is initiated for more than two-thirds of children, but rates are below the national average and this may be one of several pathways to poor health outcomes documented in many Inuit communities. Considered in the particular context of birthing facilities utilization and postnatal care arrangements in Inuit communities, these results suggest that increasing breastfeeding initiation will require health interventions that effectively engage all types of primary caregivers. [ABSTRACT FROM AUTHOR]

Forced migration puts families at risk of household food insecurity and economic hardship. We administered a questionnaire to examine household food insecurity in a sample of 49 recently legally resettled Sudanese refugees with at least one child under age 3 years. Of households polled, 37% had experienced household food insecurity and 12% reported child hunger within the previous month. Increasing severity of household food insecurity was associated with decreased consumption of high-cost, high-nutrient-density food items and increased consumption of some low-cost traditional Sudanese foods by adult caregivers of young children. Furthermore, household food insecurity was associated with decreased household and per capita food expenditure, indicators of more limited dietary change with migration, and indicators of increased social support. [ABSTRACT FROM PUBLISHER]

Background: The mental health of caregivers has been shown to be important for improving HIV prevention and treatment. Household food insecurity affects hundreds of millions of individuals in Sub-Saharan Africa, a region that experiences a disproportionate burden of the HIV pandemic. Both maternal HIV diagnosis and household food insecurity may be linked with maternal stress. This in turn may lead to unhealthy coping behaviors. We examined the independent associations of HIV, persistent household food insecurity and the synergistic effect of both on maternal stress. Methods: Ghanaian women recruited prenatally from hospitals offering voluntary counseling and testing (VCT) were followed for 12 months after childbirth (N = 232). A locally adapted 7-item version of the US Household Food Security Survey Module was applied at four time points postpartum. We dichotomized participant households as being persistently food insecure (i.e., food insecure at each time point) or not (i.e., food secure at any time point). We dichotomized participant women as not perceiving vs. perceiving stress at 12 months postpartum in reference to the median sample score on the 4-item Cohen's stress scale. Binary multivariate logistic regression models were used to assess the independent and interactive effects of maternal HIV and persistent household food insecurity on maternal stress. Results: The proportion of HIV-positive women that lived in severe food insecure households increased over time. By contrast, the HIV-negative group living in severely food insecure households experienced a steady decline across time. HIV-infection (AOR = 2.31, 95% CI 1.29-4.12) and persistent household food insecurity (AOR = 3.55, 95% CI 1.13- 11.13) were independently associated with maternal stress in a multivariate model. Being both HIV-positive and persistently food insecure strongly and synergistically increased the risk for maternal perceived stress (AOR = 15.35, 95% CI 1.90-124.14). Conclusion: In agreement with syndemic theory there is a powerful synergism between maternal HIV diagnosis and household food insecurity on maternal stress. Comprehensive multi-dimensional intervention studies are needed to better understand how to reduce stress among HIV-positive women living in persistently food insecure households and how to reduce the likelihood of food insecurity in HIV-affected households in Sub-Saharan Africa. [ABSTRACT FROM AUTHOR]

It is not known to what extent food insecurity may underlie the continued high rates of maternal to child transmission of HIV and AIDS (MTCT) in sub-Saharan Africa, where most cases of pediatric HIV and AIDS are reported to occur. However, a number of plausible conceptual models and a growing evidence base drawn from both qualitative and empirical studies suggest that food insecurity contributes significantly to the epidemic of pediatric HIV infection. Specifically, food insecurity puts women at risk of HIV infection and weakens the ability of infected women and the health systems to which they may have access to prevent secondary infection of their children. Applied anthropologists have played a role in understanding some of the pathways through which food insecurity mediates biological and social risks of maternal to child transmission of HIV and AIDS. Efforts to understand and address the biocultural pathways through which food insecurity increases transmission of HIV from mothers to children can raise awareness of the importance of food and nutrition security among policy makers and program planners. Applied research on food insecurity by anthropologists can inform communities and contribute to the design of improved programs to prevent of MTCT. [ABSTRACT FROM AUTHOR]

Recently a few vocal health experts have suggested that some of the billions of dollars currently used to prevent and treat HIV and AIDS be reallocated to address more basic problems such as malnutrition, tuberculosis, malaria, and enteric and diarrheal disease caused by lack of access to clean water. While not universally agreed upon, this reassessment of policy priorities acknowledges that there are multiple other health problems that deserve renewed attention from the international community. It also highlights the fact that the impacts of the HIV pandemic are exacerbated by widespread poverty, food insecurity and malnutrition, and gender inequality. Nowhere is this more evident than in sub-Saharan Africa, where multiple epidemics conflate and seriously compromise the survival of individuals and communities. Given the widespread occurrence of famine in sub-Saharan Africa, issues of food and economic security become of paramount importance in efforts to address the region's HIV epidemics. This paper examines the historical, political-economic, and cultural dimensions of the HIV epidemic in the context of the growing problem of food and economic insecurity. Furthermore, using theoretical frameworks that emphasize the dynamic interrelation between HIV/AIDS and food insecurity, we present suggestions for combining traditional HIV-prevention strategies with food production and nutrition-education programming. In light of the complex interactions between HIV/AIDS and food insecurity and the lack of accessible treatment modalities, such programming could potentially reduce the risk for transmission of HIV through behavioural changes and improved nutritional and immune status, and increase the life expectancy of people living with HIV or AIDS. [ABSTRACT FROM AUTHOR]