Prepared by Ontario Dietitians in Public Health
We acknowledge that this document refers to breastfeeding. Breastfeeding is traditionally understood to involve an individual of the female sex and gender identity who also identifies as a woman and mother. However, it is important to recognize that there are individuals in a parenting and human milk feeding relationship with a child who may not self-identify as such and who may prefer to use the term “chestfeeding” rather than breastfeeding.
Nutrition is fundamental for growth and development in the early years of life (1). Early childhood malnutrition presents a considerable burden to the health care system in Ontario. The long-term effects of malnutrition during early childhood include increased risk of hypertension, dyslipidemia, insulin resistance in adulthood, poor school achievement due to impaired cognitive development and increased risk of mental illness (2). These conditions cost millions of dollars in health care expenditures.
Food insecurity, inadequate or insecure access to food due to household financial constraints, continues to be a serious and pervasive public health problem. While the prevalence of infant-specific food insecurity has not been formally investigated, as no provincial surveillance system exists, it is likely significant considering that nearly 1 in 4 children under the age of six live in a household experiencing food insecurity (3).
In the last year, Statistics Canada data demonstrated that the price of food has increased by 10.6%, rising at a rate not seen since the early 1980s (4). During the same time, the price of infant formula increased 35.5% in Ontario (5). Exclusive breastfeeding is recommended for up to two years and beyond to support healthy growth and development (6), yet many families choose to offer infant formula instead of breastfeeding for a variety of reasons. Women who experience food insecurity tend to stop exclusive breastfeeding sooner than those who are food secure and they tend to struggle more often to maintain an adequate supply of breastmilk (7,8). Medical conditions such as food allergies are another reason one may choose to offer infant formula. For those with a medical diagnosis* requiring the strict avoidance of standard soy and milk proteins, there is no substitute for breastmilk other than specialized infant formula. It is estimated that 5,125 infants and children 0-24 months of age in Ontario have a medical diagnosis requiring strict avoidance of standard soy and milk proteins and must have specialized infant formula to meet their nutrient needs (9). When household food insecurity results in unreliable access to breast milk or formula, both infant health and parental mental health are threatened which can have significant implications for our healthcare system.
*Medical diagnosis can include an IgE mediated food allergy and/or a non-IgE mediated food allergy, such as food protein-induced enterocolitis syndrome (FPIES), food protein-induced enteropathy (FPE), allergic proctocolitis (AP), eosinophilic esophagitis (EoE) and several others. Due to the variability in clinical presentation and lack of validated diagnostic tests, a diagnosis relies on a detailed medical history, physical examination, and a trial elimination of the suspected food allergen.
Provincial interventions that reduce the prevalence of food insecurity, optimize breastfeeding, and improve access to infant formula, including expansion of the Ontario Drug and Benefit program, must be actioned.
References
- Britto, P. R., Lye, S. J., Proulx, K., Yousafzai, A. K., Matthews, S. G., Vaivada, T., Perez- Escamilla, R., Rao, N., Ip, P., Fernald, L. C. H., MacMillan, H., Hanson, M., Wachs, T. D., Yao, H., Yoshikawa, H., Cerezo, A., Leckman, J. F., & Bhutta, Z. A. (2017). Nurturing care: promoting early childhood development. The Lancet, 389(10064), 91–102. https://doi.org/10.1016/s0140-6736(16)31390-3
- Martins, V. J. B., Toledo Florêncio, T. M. M., Grillo, L. P., Do Carmo P. Franco, M., Martins, P. A., Clemente, A. P. G., Santos, C. D. L., Vieira, M. de F. A., & Sawaya, A. L. (2011). Long-Lasting Effects of Undernutrition. International Journal of Environmental Research and Public Health, 8(6), 1817–1846. https://doi.org/10.3390/ijerph8061817
- Li T, Fafard St-Germain AA, Tarasuk V. (2023). Household food insecurity in Canada, 2022. Toronto: Research to identify policy options to reduce food insecurity (PROOF). Retrieved from https://proof.utoronto.ca/
- Statistics Canada. Consumer Price Index, February 2023. Retrieved 13 April 2023 from https://www150.statcan.gc.ca/n1/daily-quotidien/230321/dq230321a-eng.pdf.
- Statistics Canada. Monthly Average Retail Prices for Selected Products. Retrieved March 19 2024 from Monthly average retail prices for selected products (statcan.gc.ca)
- Health Canada, Canadian Paediatric Society, Dietitians of Canada, & Breastfeeding Committee for Canada. (2014). Nutrition for healthy term infants: Recommendations from six to 24 months. Canadian Journal of Dietetic Practice and Research, 75(2), 107.
- Orr, S. K., Dachner, N., Frank, L., & Tarasuk, V. (2018). Relation between household food insecurity and breastfeeding in Canada. Canadian Medical Association Journal, 190(11), E312–E319. https://doi.org/10.1503/cmaj.170880
- Frank, L. (2018). Finding formula: Community-based organizational responses to infant formula needs due to household food insecurity. Canadian Food Studies / La Revue Canadienne Des Études Sur L’alimentation, 5(1), 90. https://doi.org/10.15353/cfs- rcea.v5i1.230
- Ontario Dietitians in Public Health and Food Allergy Canada. (2023). Call to Action: ODB Program Amendments to Support Infants and Children with a Medical Diagnosis* Requiring Strict Avoidance of Standard Soy and Milk Proteins. Retrieved from www.odph.ca
