Integrating Breastfeeding Into Early Childhood Nutrition Security Programs
March 23, 2023 | Deborah Backman
Childhood food insecurity is a major public health issue in the United States, with significant disparities by race/ethnicity and socioeconomic status. Nearly 20% of Black, non-Hispanic households, 16% of Hispanic households, and one in five Native American people are food-insecure; the national average is 10%. One in five families with incomes below 185% of the federal poverty threshold ($27,549 for four people) is food insecure. And families with children are more likely to be food insecure than those without children (12% vs. 9%).
Early childhood nutrition insecurity is especially detrimental because children experience more growth and development in the first 1,000 days (the period from pregnancy to age two) than at any other time. Thus, it is difficult for children to recover from negative impacts of early malnutrition on brain development and health. Childhood food insecurity can increase children’s risk for obesity and chronic disease, developmental and mental health issues, and decreased academic and cognitive performance.
The Role of Breastfeeding in Early Childhood Nutrition Security
Breastfeeding is a key protective factor against infant and toddler nutrition insecurity and is the ideal source of nutrition for most infants, since it adapts to each child’s unique nutritional needs. Research indicates that breastfeeding serves as a protective factor against obesity and related chronic diseases. Furthermore, some research indicates that families who follow optimal breastfeeding practices can save over $1,000 in an infant’s first year.
Improving breastfeeding support can also reduce disparities in food and nutrition security. Similarly to racial/ethnic inequities in food security, non-Hispanic Black families and Hispanic families are significantly less likely than white families to have breastfed their infants at six months due to systemic workplace, healthcare, and community barriers. Families with lower maternal education and household incomes also generally are less likely to have breastfed. Providing culturally congruent lactation support and transforming policies and systems to improve breastfeeding support could reduce early childhood food insecurity and improve lifelong health in these populations.
States Promoting Breastfeeding and Nutrition Security: Minnesota and Alaska
Through ASTHO’s State Innovations to Advance Breastfeeding and Health Equity grant, the Minnesota Department of Health (MDH) partnered with the Minnesota Breastfeeding Coalition (MBC) and other organizations to improve access to pasteurized human donor milk and lactation support for families facing food insecurity. MDH and MBC conducted environmental scans to understand how formula moved through three food pantry systems and worked with the food pantries to develop policy, systems, and environmental strategies for improving breastfeeding support.
The Minnesota team also trained food pantry and Hennepin County Supplemental Nutrition Program for Women, Infants, and Children (WIC) staff in donor human milk distribution and implemented a distribution program with a food pantry system that provides donor human milk for infants of food pantry clients in neonatal intensive care units whose parents’ milk is delayed or insufficient. By integrating breastfeeding and donor human milk resources with food pantry services, this initiative has the potential to improve breastfeeding rates and early childhood nutrition security.
With funding from CDC’s State Physical Activity and Nutrition (SPAN) program and support from the ASTHO Breastfeeding Learning Community, the Alaska Department of Health – Division of Public Health (DPH) is implementing a variety of evidence-based strategies to improve nutrition and physical activity in the state. Through the National Association of Chronic Disease Directors (NACDD) Building Resilient Inclusive Communities (BRIC) initiative, DPH is building on its SPAN work to promote breastfeeding and nutrition security.
Alaska’s BRIC program includes developing a messaging campaign and resources that will engage early care and education (ECE) centers across the state in connecting families with WIC, the Supplemental Nutrition Assistance Program (SNAP), and other resources that support breastfeeding and nutrition security. This campaign will focus on communities disproportionately impacted by food and nutrition insecurity.
DPH is also conducting an in-depth community assessment in the rural Northwest Arctic Borough to determine community-level barriers to breastfeeding and develop an action plan to guide future breastfeeding activities. DPH’s efforts to elevate breastfeeding as a key nutrition security strategy can serve as a model for state and territorial health agencies.
Recommendations for State and Territorial Agencies
- Partner with healthcare, businesses, and social services organizations to plan and implement evidence-informed and cross-sector programs and initiatives that improve breastfeeding support for families. Examples include:
- Working with birthing facilities to improve breastfeeding policies and practices.
- Providing technical assistance and grants to workplaces and ECE facilities to improve lactation accommodations.
- Training healthcare providers and other maternal and child health practitioners on breastfeeding.
- Engage and prioritize people who have low incomes and/or who are Black, Indigenous, People of Color (BIPOC)—and experience systemic barriers to both breastfeeding and nutrition security—when planning and implementing breastfeeding initiatives. This includes partnering with organizations serving and led by members of these populations, including religious institutions, BIPOC-run community-based organizations, and other entities. Engaging in collaborating and shared decision-making can ensure that agency staff are listening to the voices of community members and leaders, and that breastfeeding and nutrition security programs meet their needs.
- Collaborate with food and nutrition security organizations and programs (e.g., food pantries and federal nutrition programs) to provide a single location to share information about the benefits of breastfeeding and resources that address both breastfeeding and other aspects of early childhood nutrition security.
Conclusion
Given its importance in lifelong nutrition security and health, breastfeeding should be considered a key component of early childhood nutrition security. State and territorial health agencies should partner with diverse cross-sector organizations, including those led by people experiencing systemic barriers to both breastfeeding and nutrition security, to address inequities. ASTHO is poised to help state and territorial health agencies integrate breastfeeding into nutrition security programs to promote optimal health and nutrition for all young children.