Food insecurity is associated with attitudes towards exclusive breastfeeding among women in urban Kenya

• Type of Material: Article
• Authors: Amy Girard, Emory University; Anne Cherobon, Egerton University; Samwel Mbugua, Egerton University; Elizabeth Kamau-Mbuthia, Egerton University; Allison Amin, University of Toronto; Daniel W. Sellen, University of Toronto
• Language: English
• Date: 2012-04-01
• Publisher: Wiley
• Publication Version: Final Published Version
• Copyright Statement: © 2010 Blackwell Publishing Ltd.
• License: Creative Commons Attribution-NonCommercial 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1111/j.1740-8709.2010.00272.x
• Title of Journal or Parent Work: Maternal & Child Nutrition
• Volume: 8
• Issue: 2
• Start Page: 199
• End Page: 214
• Grant/Funding Information: Additional financial and logistical support was provided by a Canadian International Development Agency‐Consultative Group on International Agriculture Research‐Linkages grant through a project implemented by the International Potato Center entitled Sustainable Environments and Health through Urban Agriculture (SEHTUA) project.; Financial support was provided by a Canadian Institutes of Health Research Post‐Doctoral Fellowship (ALW and DWS) and by a Canada Research Chair program award, a Canadian Foundation for Infrastructure award and an Ontario Innovation Trust award (DWS).
• Keywords: Maternal depression; food security; HIV; Infant; Kenya; Pediatrics; Security; Growth; Nutrition & Dietetics; Transmission; exclusive breastfeeding; Life Sciences & Biomedicine; Children; AIDS; urban; Human milk; Science & Technology; Communities; Lactation
• Research Categories: Psychology, Behavioral; Health Sciences, Nutrition; Health Sciences, Public Health; Sociology, Public and Social Welfare

Abstract

This study aimed to document whether food insecurity was associated with beliefs and attitudes towards exclusive breastfeeding (EBF) among urban Kenyan women. We conducted structured interviews with 75 human immunodeficiency virus (HIV)-affected and 75 HIV-status unknown, low-income women who were either pregnant or with a child ≤24months and residing in Nakuru, Kenya to generate categorical and open-ended responses on knowledge, attitudes and beliefs towards EBF and food insecurity. We facilitated six focus group discussions (FGD) with HIV-affected and HIV-status unknown mothers (n=50 women) to assess barriers and facilitators to EBF. Of 148 women with complete interview data, 77% were moderately or severely food insecure (FIS). Women in FIS households had significantly greater odds of believing that breast milk would be insufficient for 6months [odds ratio (OR), 2.6; 95% confidence interval (95% CI), 1.0, 6.8], that women who EBF for 6months would experience health or social problems (OR, 2.7; 95% CI, 1.0, 7.3), that women need adequate food to support EBF for 6months (OR, 2.6; 95% CI, 1.0, 6.7) and that they themselves would be unable to follow a counsellor's advice to EBF for 6months (OR, 3.2; 95% CI, 1.3, 8.3). Qualitative analysis of interview and FGD transcripts indicated that the maternal experience of hunger contributes to perceived milk insufficiency, anxiety about infant hunger and a perception that access to adequate food is necessary for successful breastfeeding. The lived experience of food insecurity among a sample of low-income, commonly FIS, urban Kenyan women reduces their capacity to implement at least one key recommended infant feeding practices, that of EBF for 6months.