'We're failing some children:' Women struggling to put food on table may be less likely to keep breastfeeding

Canadian women who worry about making ends meet are less likely to continue to breastfeed their baby compared with other women, say researchers who are calling for more supports for vulnerable families.

Of more than 10,000 women who were surveyed over nine years, almost everyonestarted breastfeeding, the study's authors reported in the Canadian Medical Association Journal.

But by the two-month mark, more than half of those who said they had trouble affording enough nutritious foodstopped breastfeeding, whereas half of other women exclusively breastfed to at least four months.

Researchers say that's important because public health authorities such as the the World Health Organization recommendthat infants breastfeed exclusively for six months "to achieve optimal growth, development and health."

"This is a very stark piece of evidence that we're failing some children in this country at a very early age," said study author Valerie Tarasuk, a professor of nutritional sciences at the University of Toronto.

Researchers focused on food insecurity, or people having unreliable access to enough affordable, nutritious food. Their study was based on data from more than 10,000 women who responded to a Statistics Canada health survey up to a year after giving birth.

To be classified as food insecure, the level of deprivation in a household must be substantial, Tarasuk said.Overall, 17 per cent of the women reported food insecurity.

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Breastfeeding promotes health of babies and women, Tarasuksaid, and the high rates of starting breastfeeding suggest women have got the message.

Tarasuk said food insecurity compounds a stressful situation as a women struggles to afford to meet her basic needs and provide for a newborn.

The study itself doesn't explore why women stopped breastfeeding. Tarasuk said some possibilities may include:

• Worry about being undernourished themselves.
• Worry about going back to work.
• Lack of access to childcare or maternity benefits.

Across Canada, hungry children are more likely to face poorer health in general and to be diagnosed with conditions such as asthma and depression, the researchers said.

Disadvantaged lives

"I would suggest that the two-month mark, that's the beginning of a much longer trajectory whereby those children's lives will be different than the other children because of the disadvantages they're born into," said Tarasuk, who also works at the Dalla Lana School of Public Health at U of T.

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Tarasuk and her co-authors from Public Health Ontario and Acadia University in Wolfville, N.S., said it will be important to evaluate the effects of the Canada Child Benefit that was introduced in July 2016 on household food insecurity status and breastfeeding duration. The benefit effectively creates an income floor for households with children.

In a journal commentarypublished with the study, Dr. Meta van den Heuvel and Dr. Catherine Birken from the Hospital for Sick Children in Toronto call it alarming that women who can least afford infant formula were the least likely to breastfeed. What's more, babies who could benefit most from the health-promoting qualities of breast milk are the least likely to be breastfed.

They also say a rigorous evaluation of income support from the Canada Child Benefit is needed to answer key questions such as whether it truly helps mothers who struggle to feed themselves.

In outlining the limitations of the research, Birken and van den Heuvel called maternal employment an important factor contributing to both food insecurity and duration of breastfeeding. Unmeasured factors such as use of medications or maternal weight status could also play a role.

Nearly fourmillion Canadians have a hard time putting food on the table because of a lack of money, based on data from Statistics Canada.

The study was funded by the Canadian Institutes of Health Research.