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Infants Consume Less Breast Milk in Households with Insecure Food Access, IAEA Research Project Finds

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Scientists in Kenya studied the role of food security in breastfeeding practices and infant breast milk intake by analyzing deuterium enrichment in saliva samples. (Photo: S. Oiye/University of Nairobi)

Greater food insecurity is associated with lower intake of breast milk, a recent IAEA research project in western Kenya using isotopic techniques has found. The results of the study were published last month in the Maternal and Child Nutrition journal.

The study also found no correlation between household food security status and exclusive breastfeeding rates in the first six months of life. “This implies that food insecurity may undermine breast milk output, but not her choice to give her infant breast milk only, which could be the result of inadequate energy and nutrient intake by the mother,” said Victor Owino, nutrition specialist at the IAEA's Division of Human Health.

“Before this study, the role of food insecurity in breastfeeding hadn’t been evaluated using an objective measurement of exclusive breastfeeding or quantity of breast milk ingested,” said Sera Young, a food security expert leading the IAEA-supported study and Assistant Professor of Anthropology and Global Health at Northwestern University in the United States. “This is an important missing piece of information, because of the high prevalence of food insecurity worldwide and the many pathways by which food insecurity may negatively impact exclusive breastfeeding.”

Approximately 2 billion people are currently exposed to food insecurity, meaning they have no access to safe and affordable food for a day or more, according to a new United Nations system report on the state of food security and nutrition in the world.

According to the World Health Organization (WHO), breastfeeding plays an important role in providing infants with the essential nutrients they need for optimal growth, development and health. Breastfeeding also has numerous health benefits for mothers, such as protection against breast cancer and ovarian cancer.

The WHO recommends that infants are exclusively breastfed for the first six months of life, however recent data suggests that globally only about 40% of infants under six months are exclusively breastfed, against the global target of at least 50%.

“It’s crucial to understand barriers to optimal infant feeding practices during the first two years of life, because good nutrition during this period sets the trajectory for lifelong health and well-being, school performance, and eventual economic productivity,” said Young.

To generate a wider evidence base for breastfeeding recommendations, the study used isotopic techniques to explore breastfeeding practices and to quantify breast milk intake in an area with high prevalence of food insecurity in Kenya. Researchers recruited over 100 mother-infant pairs and measured reported household food insecurity and breast milk intake at two time points: six weeks and six months postpartum. To determine the amount of breast milk consumed by the infant, they used the deuterium oxide dose-to-mother technique (see Deuterium oxide dose-to-mother (DTM) technique), which entails giving lactating mothers small amounts of deuterium to drink and tracking its flow from the mother to the infant.

“Isotopic methods have been found to be more accurate than other methods for measuring breast milk intake, which involve weighing infants pre- and post-feeding,” said Joshua Miller, a research study coordinator at Northwestern University and lead author of the manuscript. “Interestingly, this method also allows us to determine if infants consumed water from non-breast milk sources, meaning we can objectively determine whether infants were exclusively breastfed or not. Most other studies rely upon self-reported behaviour, which can be biased.”

Addressing food insecurity to improve infant breast milk intake

The results of the most recent study have wide-reaching implications, explained Owino. “We can see that children are not well fed and are not getting enough nutrition, which affects them not only as children, but can also impair their productivity later in life. Breastfeeding can be an important component in reaching development goals, not just in Africa, but worldwide,” he said. “Policies that enable timely screening and detection of food insecurity should be enacted to allow for appropriate mitigating interventions that not only protect breastfeeding, but also ensure adequate maternal nutrient intake.”  

Addressing food insecurity through screening and implementing programmes, particularly targeting vulnerable populations such as women living with HIV for whom good nutrition is important to maintain their immune systems, may not only increase breast milk intake and benefit the child, but also address other health issues.

“This study justifies what nutrition practitioners in Kenya have been advocating for in what they call multi-sectoral programming,” said Shadrack Oiye, a Kenyan Nutrition Specialist at the Intergovernmental Authority on Development, who was responsible for the field implementation of the research project. “These findings confirm that the health sector, which is mandated to work on breastfeeding counselling, education and awareness, as well as regular follow-up, needs to work hand-in-hand with the agriculture sector, which is in charge of food security programmes.” 

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