PREPARED BY: Comprehensive Health Promotion
DATE: 2026-03-12
SUBJECT: Food Insecurity Compromises Maternal and Infant Health
BACKGROUND/PURPOSE
Food insecurity is a pervasive issue in Windsor-Essex County (WEC) causing significant health disparities across the lifespan. The period from conception to 18 months shapes life-long physical health, cognitive potential, and emotional resilience. Exposure to food insecurity during this critical phase of development can increase the risk of adverse birth outcomes, hinder metabolic and immune health, contribute to cognitive delays, and disrupt parent-child bonding (Bell et al, 2024, Cain et al, 2022, Chehab et al, 2025, Shanker et al, 2017, Zaslow et al, 2009). Not only are the effects of food insecurity particularly devastating during pregnancy and infancy, the risk of experiencing food insecurity may be greatest during this period.
Families with infants often face unique financial pressures, caused by reduced household income and increased infant-related expenses, which can cause or worsen food insecurity. Infants are especially vulnerable to these changes due to their primary dependence on only two food sources (i.e., breast milk or infant formula). Declining breastfeeding rates in WEC, paired with barriers to accessing formula have increased vulnerability for local infants.
Breastfeeding initiation rates in WEC are at a 10-year low and remain less than the provincial average. The rate of exclusive breastfeeding prior to hospital discharge in WEC declined from 61.2% in 2012 to 35.7% in 2024, which is significantly below the Ontario average (46.8%) (WECHU, 2026). Further, internal analysis reveals that infants in lower income households are less likely to initiate exclusive breastfeeding and sustain breastfeeding until two months postpartum (WECHU,2024,2026). These disparities mean that infants born to low-income families are less likely to receive the benefits of breastfeeding and that families least able to afford infant formula are more likely to be dependent on it. To make matters worse, there is no reliable emergency access to infant formula in WEC and there are barriers to accessing associated subsidies (e.g., Special Diet Allowance).
The public health consequences of this situation are significant and require continued, coordinated action to protect the health and prosperity of future generations.
DISCUSSION
On March 21, 2024, the Board of Health (BOH) passed the resolution, Food Insecurity Compromises Infant Health. Through this resolution, the BOH acknowledged the devastating impacts of food insecurity on infant health and committed to advocating for income-based solutions. The BOH also committed to prioritizing local initiatives to lessen the impact of food insecurity among families with infants. Progress with associated advocacy and local initiatives are summarized below:
Collective Advocacy: The March 2024 resolution served as a foundational document for broader provincial advocacy, including the Ontario Dietitians in Public Health resolution, A24-04 Early Childhood Food Insecurity, which was passed by the Association of Local Public Health Agencies (alPHa) in June 2024. This resolution resulted in province-wide advocacy to improve social assistance nutrition and diet allowances to (1) reduce food insecurity during pregnancy and while breastfeeding and (2) to more adequately cover the cost of infant formula, when medically necessary. The resolution also advocated for the expansion of the Ontario Drug Benefit Program to help cover the significant cost of the speciality infant formulas needed to manage allergies to standard soy and milk proteins. To guide this work, ODPH partnered with Public Health Ontario to create a protocol to calculate the cost of infant feeding, by Health Unit district, to demonstrate the inadequacy of the existing subsidies for food and infant formula.
Enhanced Surveillance: In addition to incorporating the cost of infant feeding into annual food cost surveillance, the WECHU has re-launched the Infant Feeding Survey. Beginning in February, the survey will be sent to all consenting mothers seven months after birth and will provide valuable information about the rates of perinatal food insecurity and disparities in breastfeeding rates across several demographic variables. This information was not previously available and will be used to guide future advocacy and community programming.
Improved Food Insecurity Screening and Care: As discussed in the March 2025 information report, Food Insecurity Screener: A Brief Contact Intervention Pilot Information, the Comprehensive Health Promotion (CHP) department and Healthy Families department partnered to pilot a validated 2-item food insecurity screener for Healthy Babies, Healthy Children (HBHC) clients. During the 10-month pilot, 374 clients were screened, identifying 72 families as food insecure. This screener has been successfully incorporated into HBHC practice and food insecure clients now have access to an updated food insecurity care plan and priority access to internal referrals for income optimization and infant feeding support. With these enhanced supports in place, HBHC is well-positioned to accept referrals from community partners for food insecurity-related care.
Next Steps: In 2026, the WECHU will employ a four-year community mobilization strategy to facilitate the collaboration needed to effectively reduce the impact of food insecurity during the perinatal period. Through this mobilization initiative, key stakeholders will work together to:
- expand food insecurity screening among healthcare providers and create an associated referral pathway for prenatal patients and families with infants. The pathway will direct patients to local resources to improve access to food and nutrition supplements, prepare for and support infant feeding, and optimize household income.
- improve equitable access to breastfeeding education and timely breastfeeding support.
- continue to advocate for income-based strategies to improve food security.
- minimize barriers to accessing infant formula, when medically necessary.
This collaborative approach and focus on reducing health disparities closely aligns with the Health Unit’s strategic plan and the Ontario Public Health Standards.
References
Bell Z, Nguyen G, Andreae G, et al. Associations between food insecurity in high-income countries and pregnancy outcomes: A systematic review and meta-analysis. PLoS Med. 2024 Sep 10;21(9). Retrieved from: https://pubmed.ncbi.nlm.nih.gov/39255262/
Cain KS, Meyer SC, Cummer E, et al. Association of Food Insecurity with Mental Health Outcomes in Parents and Children. Acad Pediatr. 2022 Sep-Oct;22(7):1105-1114. Retrieved from: pubmed.ncbi.nlm.nih.gov/35577282/
Chehab RF, Croen LA, Laraia BA, et al. Food Insecurity in Pregnancy, Receipt of Food Assistance, and Perinatal Complications. JAMA Netw Open. 2025;8(1). Retrieved from: https://pubmed.ncbi.nlm.nih.gov/39847356/
Public Health Ontario (2025). Household Food Insecurity Snapshot. Retrieved from: https://www.publichealthontario.ca/en/Data-and-Analysis/Health-Equity/Household-Food-Insecurity
Shanker P, Chung R, Frank D (2017). Association of Food Insecurity with Children’s Behavioral, Emotional, and Academic Outcomes: A Systematic Review. J Dev Behav Pediatr. 38(2):135-150. Retrieved from: https://pubmed.ncbi.nlm.nih.gov/28134627/
Windsor-Essex County Health Unit (2026). Maternal and Reproductive Health Dashboard. Retrieved from: https://www.wechu.org/reports/maternal-reproductive-health
Zaslow M, Bronte-Tinkew J, Capps R, et al. Food security during infancy: implications for attachment and mental proficiency in toddlerhood. Matern Child Health J. 2009 Jan;13(1):66-80. Retrieved from: https://pubmed.ncbi.nlm.nih.gov/18317892/