Written by Dr. Lesley Frank
Associate Professor, Sociology
Acadia University, Wolfville, Nova Scotia, Canada

Infants experience income-related food insecurity most notably through its effect on infant feeding practices. Infancy, as opposed to other childhood stages, suffers from the highest rate of child poverty in Canada – also a time when poverty has its greatest health impact. We now know that the first 1,000 days from conception to two years is the most crucial time for opti­mizing growth and development.  The focus of my new book Out of Milk: Infant Food Insecurity in a Rich Nation exposes infant food insecurity as an urgent social justice, health equity and public policy issue that until now, has been largely ignored as a social problem.

The research for this book mostly took place in my home province of Nova Scotia where many years ago - as a young mother myself - I worked as a prenatal/early infancy outreach worker with families living in low income circumstance. I remember vividly my work to promote and support breastfeeding, advocate for breastfeeding in the community, find equipment for moms’ when needed (breast pumps, shields, pads, bras), and my detailed collection of breastfeeding data. I remember the pride mothers felt when breastfeeding was going well. I remember the disappointment and shame when it did not. But what was different was the fear – the fear of what was to come if breastfeeding failed or couldn’t or didn’t happen – the fear of not being able to afford to feed your baby. In contrast, though I breastfed for a decade straight during that time (4 babies, all born two years apart) my middle-class life protected me from that fear. Seeing that fear in my day to day working life at first made me work harder – thinking “if I could just help moms to breastfeed longer, if they could just be more like me, they…. ” Admittingly my sociological thinking back in the day was a little rusty. I’m not sure when, but I finally started to see things differently. I was reminded daily that infant feeding in food insecure families is far more complex than a casual onlooker might suppose. I came to understand that my effort to shape infant feeding practice had little power to address the poverty and the food insecurity that mothers faced when navigating the work of feeding their children.

Those long-ago lessons sparked the idea for this book. I went back some time later, not so rusty, and travelled from one end of the province to the other - welcomed into the homes of families to capture their stories of the work of feeding their babies in conditions of material deprivation. With their help I was able to narrate a picture of how household, maternal, and infant food insecurity is experienced, thought about, and addressed (or not) in public policy and in practice. I also collected stories from health and nutrition policy workers, community services workers, community food, and family resources worker in Nova Scotia and across the country.

Mothers like Lorraine told me that breastfeeding was a reliable and perfect food system. She said she doesn’t “have to worry about the milk. It’s free, there’s no risk of cross contamination, it’s there, it’s ready, it’s the right amount, it’s the perfect food, it adapts to your baby’s needs, it’s amazing. It’s a big comfort knowing that my son is going to have milk when he needs it any time of day or night.” Hannah, riddled with fear explained that she “knew that there was no money and wasn’t going to be able to afford formula” And then said, “ I need to produce enough milk. I have to.”

Mary and other mothers taught me that breastfeeding, as a food system, has unique sustainability issues due to maternal food insecurity. She shared:

“I don’t know if what I was producing was really enough nutrient-wise, if it was, how would you put it, healthy enough for him, giving him what he needed. Plus, in order to be able to produce milk the mother needs to be food secure and you don’t have that all the time. The situation could change for you on the drop of a dime.”

Contesting the idea that breastfeeding is free, Sally pointed out, “you do have to pay, because you have to eat in order to give your baby the nutrition that it need. Breastfeeding may be cheaper than formula feeding, but it still costs.”

And mothers like Heather left me broken, and later enraged, that I live in a country as wealthy as Canada while mothers blame themselves for having to beg, borrow, steal, and go without food to feed their babies. This blog “from the couch” disguises that I have never been able to read these words from Heather out loud without my voice trembling -

“There would be a week at time that me and my partner would eat nothing and just be going on coffee. We would feed the kids first and if they didn’t eat everything, we would take what was left on the plate. Even if it was a spoonful it was something…You can sometimes get formula at the food bank, and at [the church], and the [family resource centre]…You take what you can get. It is a matter of being able to feed the baby at all…If I am going to [steal] to feed [the baby], then I am going to do it. We might have only done it a handful of times, but we did it. I am not proud of it, but we did it. My kids are still alive…Sometimes honestly, I just wanted to jump off the bridge or have someone hopefully stab me because what kind of mom or dad can’t provide for their child?”

Out of Milk: Infant Food Insecurity in a Rich Nation is organized by three main themes portraying the complexity of infant food insecurity in a high resourced country. It moves from experiences of breastfeeding as a food security measure, to failed breastfeeding, and the shocking realities that occur when formula is unaffordable and non-accessible. The stories above hint at the question I ultimate am trying to answer in this book -the question I call “the breastfeeding paradox” - why women who can least afford to buy infant formula are less likely to breastfeed. Spoiler alert – it has less to do with individual choice over feeding methods than you might think. The problem is much more complex than arguing the benefits of breast feeding over bottle-feeding. Open the pages of Out of Milk to learn how the breastfeeding paradox is rooted in a succession of public policy failures that put babies at risk by limiting mothers’ ability to feed their babies - regardless of how they are fed.

In the wake of the COVID-19 pandemic lockdown, media reports in Canada and other high-income countries signal what food insecurity scholars and activists have long feared – food system disruption coupled with an economic downturn. Before this there are 1.2 million children living in families where access to food is compromised because of lack of money. With increased economic hardship now, and likely into the future, Canada can no longer ignore the serious public health threat of increasing and deepening income-related food insecurity. Now, more than ever, it is time to make visible the implications for Canada’s most vulnerable – Our Babies.