The cost and affordability of growing and feeding a baby in Nova Scotia

Abstract

Objective

This paper examines the affordability of a basic nutritious diet for low-income families in Nova Scotia over three developmental periods (pregnancy, perinatal, early infancy) using economic simulations that include food costing and secondary data.

Methods

The cost of a nutritious food basket was determined from a random sample of grocery stores in Nova Scotia (n = 21), along with the cost of infant formula (n = 29) and prenatal vitamins and vitamin D drops (n = 15), from randomly selected pharmacies. The monthly funds remaining to purchase a basic nutritious diet were calculated for several household scenarios, after deducting essential living expenses from net incomes. Each scenario included either a pregnant woman or a breastfed or formula-fed infant at 3 months, and either Income Assistance, Federal Maternity Benefits based on minimum wage employment, or a $15/h wage.

Results

Income Assistance and Federal Maternity Benefits, based on minimum wage, were inadequate to purchase a basic nutritious diet during pregnancy or in early infancy whether breastfeeding or formula feeding. All household scenarios faced significant potential monthly deficits if they were to purchase a basic nutritious diet.

Conclusion

Minimum wage and income security programs are inadequate for the purchase of a basic nutritious diet throughout the prenatal, perinatal, and early infancy periods in Nova Scotia, emphasizing risk of food insecurity as a critical issue for young families facing income constraints. Adequate maternity protection is required to support access to food and nutrition essential for maternal and infant health.

Introduction

The first 1000 days of life are now considered the most critical time for optimizing growth and development (Martorell 2017). Adequate prenatal and infant nutrition is a modifiable factor crucial for healthy infant development (Meyers and Chawla 2000). Poor prenatal nutrition increases the odds of low birth weight infants (Grieger and Clifton 2015), who are at greater risk for chronic disease, morbidity, and premature mortality (Moore et al. 2004). Health Canada, in line with the World Health Organization, recommends exclusive breastfeeding from birth to 6 months of age, with continued breastfeeding up to 2 years of age and beyond, along with appropriate complementary food (Health Canada 2012). Increased maternal energy (e.g., extra snack or small meal) and nutrient needs (e.g., often achieved during pregnancy via daily multivitamin with 16 to 20 mg of iron and 0.04 mg of folic acid) during pregnancy and lactation (Government of Canada 2009) and the key role commercial formulas play in infants (not breastfed) are both widely recognized (Health Canada 2012). Also relevant, Health Canada currently recommends that all breastfed or partially breastfed healthy, full-term babies receive a daily supplement of 400 IU vitamin D, from birth until breastfeeding concludes (Health Canada 2012).

Household food insecurity (HFI) encompasses a range of experiences from psychological dimensions of worry about affordable food access to qualitative and quantitative food deprivation because of financial constraints (Anderson 1990). Women’s socio-economic disadvantage has been found to account for higher rates of food insecurity in non-married households in Canada. Moreover, in married households, women report higher levels of food insecurity compared with men (Matheson and McIntyre 2014). While the prenatal, perinatal, and early infancy periods require special nutritional needs, this is a time of diminished incomes and higher rates of poverty, as evidenced by children under one having the highest child poverty rate in Canada (Statistics Canada 2017).

HFI negatively impacts the nutritional status of women in childbearing years (Ivers and Cullen 2011), including contributing to increased risk for high pre-pregnancy body weight and gestational weight gain and associated complications in pregnancy or childbirth (Nunnery and Dharod 2015; Laraia et al. 2010). HFI is a modifiable risk factor that affects the health of infants and young children, whereby they are more likely to have poor health (Cook et al. 2004), compromised development (Rose-Jacobs et al. 2008), and in very low-food-secure conditions, iron deficiency anemia (Skalicky et al. 2006). Additionally, research shows relationships between HFI and maternal depression and parenting behaviours, negatively impacting attachment and cognitive development in the toddler years (Zaslow et al. 2009).

Mothers of infants in food-insecure households in Canada are no less likely to initiate breastfeeding compared with food-secure mothers but are less able to sustain exclusive breastfeeding (Orr et al. 2018). Food insecurity and resulting poor diets and insufficient milk supply are reasons mothers give for early cessation of breastfeeding (Frank 2015). Moreover, biophysiological conditions that are more likely in food-insecure mothers, such as maternal diabetes and obesity, which can delay lactogenesis II, have been shown to lead to earlier cessation of breastfeeding (Hartmann and Cregan 2001; Rasmussen et al. 2001).

Prior research has shown that a basic nutritious diet (Williams et al. 2006, 2012a) is unaffordable for low-income families with children in Nova Scotia (NS). This paper furthers such inquiry to assess the affordability of a basic nutritious diet during pregnancy and early infancy using several social welfare income security scenarios. This study attempts to assess whether maternity social benefit protections are adequate for the affordability of a basic nutritious diet in prenatal, perinatal, and early infancy periods.

Methods

The study derived necessary information from three surveys. The cost of a basic nutritious diet for household members aged 2 and up was determined using participatory food costing (PFC) methods (Williams et al. 2006, 2012a) with a standardized food basket tool, the PFC survey tool, adapted from the National Nutritious Food Basket (NNFB) (Health Canada 2009). As a proxy for a basic nutritious diet, the NNFB differs in cost based on nutritional needs by ages and genders, as well as for pregnancy and breastfeeding status (see Appendix A). Food cost data were derived from a sample of 21 randomly selected grocery stores across Nova Scotia representing rural, urban, small, and large stores (Table 1). A total of 29 people, who were participants from 11 community Family Resource Centres and Women’s Resource Centres, were trained to document the cost of the 67 items in the NNFB.

Appendix A.

Cost of the National Nutritious Food Basket (NNFB) for relevant age and sex groups in Nova Scotia in 2015

	Age (years)	Cost/Month
Boy	2–4	$134.58
	5–8	$170.34
	9–13	$213.18
	14–18	$332.46
Girl	2–4	$134.66
	5–8	$168.13
	9–13	$197.32
	14–18	$236.94
Man	19–30	$321.85
	31–50	$290.20
	51–70	$279.93
	71+	$277.29
Woman	19–30	$248.58
	31–50	$245.60
	51–70	$215.59
	71+	$211.61
Pregnancy	Under 19	$265.60
	19–30	$268.94
	31–50	$262.66
Lactation	Under 19	$275.78
	19–30	$287.30
	31–50	$281.03

Table 1.

Data sources for food costs

Data source	Variable derived	Sample size	Data collected
National Nutritious Food Basket (NNFB)	Monthly food cost for household members > 2	21 grocery stores	Spring 2015
Secondary participatory cost survey	Prenatal vitamins and vitamin D drops	15 pharmacies	Fall 2016
Nova Scotia Consumer Food Environment Study (NSCFES)	Powdered infant formula	29 grocery stores	November 2015–January 2016

The NNFB does not include baby foods, recommended doses of vitamin D for breastfed infants, or peri-conceptual vitamins. Therefore, costs of these necessary items were collected separately. The average cost of a prenatal vitamin ($3.65/month) and a daily dose of vitamin D for breastfed infants ($2.43/month) were determined from a sample of 15 randomly selected pharmacies in Fall 2016. Infant formula prices were collected between November 2015 and January 2016 as part of the Nova Scotia Consumer Food Environment Study (NSCFES) in which data were collected and analyzed on a variety of indicators of the Nova Scotia consumer food environment that may have impact on the health of Nova Scotians. Three types of infant formula needed for age-related energy requirements were costed: ready to feed (RTF), liquid concentrate, and powdered (see Appendix B). The median monthly cost of formula was determined based on typical consumption guidelines by age. The median cost of powdered formula needed for a 3-month-old ($73.67/month) was used in the affordability assessments; powdered formula is significantly less expensive than liquid concentrate ($153.00/month) or RTF ($960.40/month) and thus a more realistic option for low- and modest-income families. A 3-month-old, healthy infant was chosen for the household scenarios because at this age there is less risk of illness associated with powdered infant formula and inappropriate introduction of complementary foods. The NSCFES collected data from 47 randomly stratified selected grocery stores; only 29 sold powdered infant formula.

Appendix B.

Median cost of infant formula in Nova Scotia 2015 by age based on PEN infant formula amount to prepare calculations

Age1	Weight (kg)2	Estimated daily energy needs from formula (kcal)	Estimated complementary food energy (kcal)	Formula amount to prepare (ounces; calculation based on 20 kcal/ounce)	Median monthly cost ready to feed (based on midrange amount to prepare at $0.0339/mL)	Median monthly cost powdered (based on midrange amount to prepare at $0.0026/mL)	Median monthly cost liquid concentrate (based on midrange amount to prepare at $0.0054/mL)
Birth	2.3–4.2	280–449	n/a	14–22	$549.07	$42.11	$87.46
1 week	2.7–4.6	298–485	n/a	15–24	$594.96	$45.63	$94.77
2 weeks	2.7–5.0	315–520	n/a	16–26	$640.33	$49.11	$102.00
1 month	3.0–5.7	342–582	n/a	17–29	$701.68	$53.82	$111.77
2 months	4.0–7.0	431–698	n/a	22–35	$869.24	$66.67	$138.46
3 months	4.6–8.0	484–787	n/a	24–39	$960.49	$73.67	$153.00
4 months	5.0–8.8	401–739	n/a	20–37	$868.72	$66.63	$138.38
5 months	5.5–9.2	446–775	n/a	22–39	$930.07	$71.33	$148.15
6 months	5.8–9.9	342–707	130	17–35	$792.42	$60.78	$126.23
7 months	6.0–10.2	326–700	130	16–35	$777.47	$59.63	$123.84
8 months	6.2–10.7	344–744	130	17–37	$823.35	$63.15	$131.15
9 months	6.5–11.0	190–291	310	10–30	$609.91	$46.78	$97.15
10 months	6.7–11.3	208–618	310	10–31	$625.38	$47.96	$99.62
11 months	6.9–11.7	226–653	310	11–33	$670.75	$51.44	$106.84
12 months	7.0–12.0	0–410	580	0–21	$320.16	$24.56	$51.00

¹Practice-Based Evidence in Nutrition (PEN) Table estimates of amount of formula to prepare for an infant by age based on Food and Nutrition Board estimated energy requirements. http://www.pennutrition.com/KnowledgePathway.aspx?kpid=1874&pqcatid=146&pqid=1745&kppid=1746&book=Comments&num=1#Comments

²Range of daily cost to feed infant based on min and max formula consumption as estimated by PEN table multiplied by the median cost per mL

Estimating monthly household incomes

The affordability of a basic nutritious diet in pregnancy (second trimester), perinatal, and early infancy was determined for two household types: a lone-woman household and a two-parent (man and woman) household with two children. Four general income scenarios were assessed varying by prenatal/postnatal status of the woman and household type: Income Assistance (IA), minimum wage (MW) ($10.60/h) employment, employment based on $15/h, and federal Maternity Benefits (MB) (Table 2).

Table 2.

Household affordability scenarios

Prenatal scenarios
Pregnant lone woman	This household is made up of:
	A woman aged 19–30 in her second trimester
	It shows how affordable a basic nutritious diet is for a household with:
	1) Income Assistance
	2) A full-time minimum wage salary ($10.60/h)
	3) A full-time $15/h wage
Pregnant woman family of three	This household is made up of:
	A woman (in her second trimester) and man aged 19–30, a 4-year-old boy
	It shows how affordable a basic nutritious diet is for a household with:
	1) Income Assistance
	2) A full-time and part-time minimum wage salary ($10.60/h)
	3) A full-time and part-time $15/h wage
Postnatal scenarios
Lone woman one child	This household is made up of:
	A woman aged 19–30 and a 3-month-old infant (breastfed and formula-fed)
	It shows how affordable a basic nutritious diet is for a household with:
	1) Income Assistance
	2) Maternity Leave from a full-time minimum wage salary ($10.60/h)
	3) Maternity Leave from a full-time $15/h wage
Household of four	This household is made up of:
	A woman and man aged 19–30, a 4-year-old boy, and a 3-month-old infant (breastfed and formula-fed)
	It shows how affordable a basic nutritious diet is for a household with:
	1) Income Assistance
	2) A full-time minimum wage salary ($10.60), and Maternity Leave from a part-time minimum wage salary
	3) A full-time $15/h salary, and Maternity Leave from a part-time $15/h salary

Income from IA for each of the household scenarios was estimated using the Nova Scotia Income Assistance allowances reported as of June 2015 (Government of Nova Scotia 2015). Maximum transportation, special needs, and maternal nutritional allowances were assumed. These scenarios assume no childcare allowance for ineligible prenatal women in lone households, or family-of-four households with school-aged children, and mothers on maternity leave in the postnatal scenarios.

Minimum wage ($10.60/h) is that reported by Human Resources and Skills Development Canada for June 2015 (Government of Nova Scotia 2013). Increased minimum wage of $15/h was also used within the scenarios as a standard for fair wages in Canada in 2016 (Canadian Labour Congress 2016). Monthly incomes were calculated by multiplying the minimum wage and the $15 wage by the number of hours assumed to be worked per week, 20 for part-time (PT) and 40 for full-time (FT), which was then multiplied by 4.33, the average number of weeks per month. Federal MB were calculated using guidelines provided by the federal Employment Insurance (EI) program for the region based on insurable employment earning in the last 52 weeks (Government of Canada 2015). In the two-parent household, it was assumed the mother is receiving MB based on PT employment, in which case they are entitled to standard benefits at 55% of regular income. The lone women working for minimum wage and $15 wage were additionally eligible for the EI Maternity and Parental Leave Family Supplement because the annual family income was below $25,921, calculated with Employment Insurance Regulations tables to be $35.45 and $6.25/month, respectively (Ministry of Justice 2017). For wage employment and MB, applicable federal and provincial taxes were deducted from payments. In all scenarios, federal and provincial tax benefits were considered where applicable.

Estimating monthly household expenses

Monthly costs for essential items were estimated using reliable secondary data sources, such as Statistics Canada’s 2015 Survey of Household Spending (SHS) (Statistics Canada 2015a), Canada Mortgage and Housing Corporation (CMHC) (Canada Mortgage and Housing Corporation 2015), and the Consumer Price Index (CPI) (Statistics Canada 2015b). The SHS reports median spending in NS for various income brackets, allowing us to choose conservative and stable estimates. The second income quintile was used to estimate costs for mobile telephone, transportation, clothing and footwear, personal care items, and household cleaning supplies cost. For shelter, April 2015 CMHC NS data were used to estimate costs of monthly rented accommodation for the appropriate household size. The cost of power was estimated by apartment size using energy rates for 2015. To ensure a consistent time frame for the cost of all household expenses, all data, if not already reported for the year 2015, were adjusted to 2015 costs using published CPI data.

Results

The following describes scenario-based affordability of a basic nutritious diet in Nova Scotia in 2015 for a lone-woman household and a two-parent household with two children. The results demonstrate that both Income Assistance and Maternity Benefits based on minimum wage were inadequate to purchase a basic nutritious diet for both household types during pregnancy, perinatal, or early infancy, regardless of how the infant is fed.

Pregnant lone woman and pregnant woman in a family of three

Table 3 details affordability scenarios for two prenatal household types by three income scenarios—IA, minimum wage FT, and a $15/h FT wage—to assess the affordability of a basic nutritious diet. A pregnant woman in Nova Scotia on IA would face severe potential monthly deficits ($701.28 for a lone pregnant woman and $1004.53 for a pregnant woman in a two-parent household with a 4-year-old) if a basic nutritious diet was purchased for the household. A potential monthly deficit of $484.60 was also found for the pregnant woman in the two-parent family when the mother worked PT and father FT for minimum wage.

Table 3.

Prenatal food affordability scenarios for lone-woman (second trimester) and two-parent household with 4-year-old boy (mother in second trimester)

	Lone woman (19–30 years)			Man and woman (19–30 years)
	Income Assistance***	Minimum wage FT ($10.60/h)	FT ($15/h)	Income Assistance***	Minimum wage ($10.60/h, 1FT and 1 PT)	$15/h (1FT and 1 PT)
Monthly gross income
Wages	0	1835.92	2598.00	0	2753.88	3897.00
Deductions	N/A	303.29	532.37	N/A	365.87	379.98
Canada Child Tax Benefit	N/A	N/A	N/A	364.58	122.58	122.58
Universal Childcare Benefit	N/A	N/A	N/A	160.00	121.94	121.94
GST Benefit	23.33	35.08	35.08	58.08	58.08	46.94
Personal Allowance†	255.00	N/A	N/A	510.00	N/A	N/A
Shelter Allowance‡	300.00	N/A	N/A	620.00	N/A	N/A
Transportation Allowance§	150.00	N/A	N/A	150.00	N/A	N/A
NS Poverty Reduction Tax Credit	20.83	N/A	N/A	N/A	N/A	N/A
NS Affordable Living Tax Credit	N/A	21.25	21.25	26.25	26.25	0
Maternal Allowance	51.00	N/A	N/A	51.00	N/A	N/A
Total disposable income	800.16	1588.96	2121.96	1952.41	2472.34	3263.94
Basic monthly expenses
Shelter	794.00	794.00	794.00	1201.00	1201.00	1201.00
Power	158.56	158.56	158.56	201.53	201.53	201.53
Transportation||	159.50	159.50	159.50	415.02	415.02	415.02
Telephone	28.23	28.23	28.23	50.84	50.84	50.84
Clothing/footwear	74.46	74.46	74.46	193.74	193.74	193.74
Personal care expenses	26.57	26.57	26.57	69.13	69.13	69.13
Household cleaning supplies	8.78	8.78	8.78	22.84	22.84	22.84
Prenatal vitamins*	3.65	3.65	3.65	3.65	3.65	3.65
Total	1253.75	1253.75	1253.75	2157.75	2157.75	2157.75
Total remaining for food	− 432.34	335.21	868.21	− 205.34	314.59	1106.19
Cost of food basket**	268.94	268.94	268.94	799.19	799.19	799.19
Funds remaining	− 701.28	66.27	599.27	− 1004.53	− 484.60	307.00

^†Personal Allowance covers the cost of food, clothing and footwear, personal care expenses, and miscellaneous expenses for adults < 19

^‡Shelter Allowance covers the cost of rent, heat, and electricity

^§Transportation Allowance of up to $150 a month is available per adult if seeking employment or enrolled in an approved educational program

^||Transportation costs are based on the costs of owning and operating a private vehicle, from the Canadian Survey of Household Spending, second quintile

*The average monthly cost of a prenatal vitamin in 15 randomly selected Nova Scotian pharmacies in Fall 2016 ($0.12/day)

**NNFB cost for the household which includes a pregnant women in 2nd trimester

***Man attending an educational program

Postnatal scenarios

Table 4 details postnatal food affordability scenarios by IA, MB based on a FT minimum wage, and MB based on FT $15/h wage for a lone woman with a 3-month-old breastfed or formula-fed infant. Both IA and minimum wage-determined MB were insufficient, despite the additional income obtained postnatally from government tax transfers specific to children (Canada Child Tax Benefit and Universal Childcare Benefit). In both scenarios, the household would experience a potential monthly deficit if they were to purchase a basic nutritious diet for lactation ($371.97 and $166.01 respectively). If the infant was formula fed at a cost of $73.61/month, and the mother’s diet cost was reduced due to non-lactation nutritional needs, the potential monthly deficits for these households would increase by $26.65. Only MB based on a $15/h FT wage were sufficient for the purchase of a basic nutritious diet for the lone mother lactating or formula feeding her infant.

Table 4.

Food affordability scenarios for lone woman (aged 19–30) with a 3-month-old infant (breastfed and formula-fed)

	Breastfeeding			Formula feeding
	Income Assistance	Maternity leave from minimum wage ($10.60/h) FT	Maternity leave from $15/h FT	Income Assistance	Maternity leave from minimum wage ($10.60/h) FT	Maternity leave from $15/h FT
Monthly gross income
Wages	0.00	0.00	0.00	0.00	0.00	0.00
EI Maternity Benefits	N/A	1163.25	1455.96	N/A	1163.25	1455.96
Deductions	N/A	43.23	108.11	N/A	365.87	379.98
Canada Child Tax Benefit	364.58	364.58	364.58	364.58	122.58	122.58
Universal Childcare Benefit	160.00	121.94	121.94	160.00	121.94	121.94
GST Benefit	58.08	58.08	58.08	58.08	58.08	46.94
Personal Allowance†	255.00	N/A	N/A	510.00	N/A	N/A
Shelter Allowance‡	570.00	N/A	N/A	620.00	N/A	N/A
NS Affordable Living Tax Credit	26.25	26.25	26.25
Maternal Allowance	51.00	N/A	N/A	51.00	N/A	N/A
Total disposable income	1484.91	1588.96	1918.70	1952.41	2472.34	3263.94
Basic monthly expenses
Shelter	980.00	980.00	980.00	980.00	980.00	980.00
Power	158.56	158.56	158.56	158.56	158.56	158.56
Transportation||	159.50	159.50	159.50	159.50	159.50	159.50
Telephone	28.23	28.23	28.23	28.23	28.23	50.84
Clothing/footwear	134.10	134.10	134.10	134.10	134.10	193.74
Personal care expenses	47.85	47.85	47.85	47.85	47.85	69.13
Household cleaning supplies	15.81	15.81	15.81	15.81	15.81	22.84
Vitamin D drops*	2.43	2.43	2.43	N/A	N/A	N/A
Powdered infant formula	N/A	N/A	N/A	73.61	73.61	73.61
Total expenses	1526.48	1526.48	1526.48	1526.48	1526.48	1526.48
Total remaining for food	−41.57	164.39	392.22	− 122.75	93.21	321.04
Cost of food basket**	330.40	330.40	330.40	285.87	285.87	285.87
Funds remaining	− 371.97	− 166.01	61.82	− 390.62	− 192.66	35.17

^†Personal Allowance covers the cost of food, clothing and footwear, personal care expenses, and miscellaneous expenses for adults < 19

^‡Shelter Allowance covers the cost of rent, heat, and electricity

^§Transportation Allowance of up to $150 a month is available per adult if seeking employment or enrolled in an approved educational program

^||Transportation costs are based on the costs of owning and operating a private vehicle, from the Canadian Survey of Household Spending, second quintile

*The average monthly cost of vitamin D drops in 15 randomly selected Nova Scotian pharmacies in Fall 2016 ($0.08/day)

**NNFB cost for a lactating woman and the NNFB costs for a non-lactating woman

Table 5 presents postnatal affordability scenarios for a two-parent household with a 4-year-old and a 3-month-old breastfed or formula-fed infant. The income sources examined include IA, FT minimum wage, and $15/h FT for the father and MB based on PT minimum wage and $15/h for the mother. Similar to the pattern of affordability for the lone-mother postnatal households, the two-parent household would experience potential monthly deficits on IA ($575.10 if the mother breastfed and $605.63 if the infant is formula fed). Potential monthly deficits were also found in the minimum wage scenarios ($127.56 if the mother is breastfeeding and $158.09 if the infant is formula fed). Only the $15/h wage scenarios were sufficient for the purchase of a basic nutritious diet for this four-person family which includes a breastfed or formula-fed infant. None of the MB scenarios were eligible for Family Supplement as the household income was above $25,921 annually.

Table 5.

Food affordability scenarios for two-parent household (man and woman aged 19–30, 4-year-old boy) with a breastfed and formula-fed 3-month-old infant

	Breastfeeding			Formula Feeding
	Income Assistance***	Minimum wage ($10.60/h, 1 FT and 1 PT Maternity Leave)	$15/h, 1 FT and 1 PT with Maternity Leave	Income Assistance***	Minimum wage ($10.60/h, 1 FT and 1 PT Maternity Leave)	$15/h, 1 FT and 1 PT with Maternity Leave
Monthly gross income
Wages	0.00	1835.92	2598.00	0.00	1835.92	2598.00
EI Maternity Benefits	N/A	504.88	714.45	N/A	504.88	714.45
Deductions	N/A	303.29	532.37	N/A	303.29	532.37
Canada Child Tax Benefit	723.92	552.58	245.17	723.92	552.58	245.17
Universal Childcare Benefit	320.00	243.87	243.87	320.00	243.87	243.87
GST Benefit	69.17	70.17	44.26	69.17	70.17	44.26
Personal Allowance†	510.00	N/A	N/A	510.00	N/A	N/A
Shelter Allowance‡	620.00	N/A	N/A	620.00	N/A	N/A
Transportation Allowance	150.00	N/A	N/A	150.00	N/A	N/A
Special Needs Allowance	12.50	N/A	N/A	12.50	N/A	N/A
NS Affordable Living Tax Credit	31.25	31.25	N/A	31.25	31.25	N/A
Maternal Allowance	51.00	N/A	N/A	51.00	N/A	N/A
Total disposable income	2487.84	2935.38	3313.37	2487.84	2935.38	3313.37
Basic monthly expenses
Shelter	1201.00	1201.00	1201.00	1201.00	1201.00	1201.00
Power	201.53	201.53	201.53	201.53	201.53	201.53
Transportation||	415.02	415.02	415.02	415.02	415.02	415.02
Telephone	50.84	50.84	50.84	50.84	50.84	50.84
Clothing/footwear	253.38	253.38	253.38	253.38	253.38	253.38
Personal care expenses	90.43	90.43	90.43	90.43	90.43	90.43
Household cleaning supplies	29.87	29.87	29.87	29.87	29.87	29.87
Vitamin D drops*	2.43	2.43	2.43	N/A	N/A	N/A
Powdered infant formula	N/A	N/A	N/A	73.61	73.61	73.61
Total expenses	2244.48	2244.48	2244.48	2315.66	2315.66	2315.66
Total remaining for food	243.36	690.90	1068.89	172.18	619.72	997.71
Cost of food basket**	818.46	818.46	818.46	777.81	777.81	777.81
Funds remaining	− 575.10	− 127.56	250.43	− 605.63	− 158.09	219.90

^†Personal Allowance covers the cost of food, clothing and footwear, personal care expenses, and miscellaneous expenses for adults < 19

^‡Shelter Allowance covers the cost of rent, heat, and electricity

^§Transportation Allowance of up to $150 a month is available per adult if seeking employment or enrolled in an approved educational program

^||Transportation costs are based on the costs of owning and operating a private vehicle, from the Canadian Survey of Household Spending, second quintile

*The average monthly cost of vitamin D drops in 15 randomly selected Nova Scotian pharmacies in Fall 2016 ($0.08/day)

**NNFB cost for household including a lactating woman and the NNFB costs for household including a non-lactating woman

***Man attending an educational program

Discussion

Our findings demonstrate the inadequacy of Canadian income security programs, specifically those designed for maternity protection, and minimum wage in Nova Scotia to cover the cost of a basic nutritious diet necessary for pregnancy and early infancy for either breastfeeding or formula feeding situations, putting mothers and infants at risk of inadequate nutritional intake. IA entitlements for the lone pregnant woman, and the pregnant woman as a member of a two-parent/one-child household, resulted in the most severe potential monthly deficits. The IA Maternal Allowance ($51 since 2013) (Nova Scotia Department of Community Services 2013) in combination with the Personal Allowance ($255) are enough to cover the cost of prenatal vitamins and a basic nutritious diet for pregnancy in the second trimester. However, IA Shelter Allowances do not reflect the true cost of housing, leading to an overall monthly deficit. An increase in the shelter allowance would occur in the third trimester to support larger accommodations in advance of the baby being born ($570/month); however, this and other available government transfers to households on IA (poverty reduction tax credits, child benefits, GST credits) do little to bridge the gap between expenses and allowances. Previous research suggests that food budgets are often the first to be compromised in order to meet other fixed costs when households are under financial constraints (Williams et al. 2012b). Therefore, it is likely that IA policy to enhance maternal nutrition in pregnancy is ineffective when allowances are directed from nutritious food to fixed costs. Minimum wage employment income in Nova Scotia in 2015 was adequate for covering the cost of a basic nutritious diet for the lone pregnant women; however, this was not the case in the two-parent household. Only the $15/h wage (one FT, one PT) was adequate to purchase a basic nutritious diet in this household.

Overall, the postnatal scenarios showed lower potential monthly deficits than the prenatal scenarios due to the protective effect of government transfers specific to children. Similar to the prenatal scenarios, a $15/h wage was necessary for the purchase of a basic nutritious diet for both family types regardless of how the infant is fed. Our findings show that both IA and MB based on minimum wage are likely inadequate, suggesting that there is a risk of poor nutrition for these families with infants, both for breastfeeding mothers and non-breastfed infants. Breastfeeding improves the economic situation of the family by a marginal $26.65 to $30.53/month; however, the improvement does not address the unaffordability of a basic nutritious diet needed for a lactating mother. Concerning IA, the Maternal Allowance and Personal Allowance combined is short by $31.82/month in its capacity to cover the cost of a lactation diet and recommended daily doses of vitamin D drops for the breastfed infant. In NS, children in families receiving IA are not entitled to a Personal Allowance and families must rely on other government transfers specific to children for their food purchases (child benefits) which are often used to offset other necessary household expenses (Williams et al. 2012b).

HFI is a serious public health problem in Canada, and understanding how it might impact maternal and infant nutrition is important for equity-focused health policy development. Key messages to promote and support breastfeeding (at the public health and individual level) should acknowledge the realities for food-insecure families. This research shows that despite other benefits from breastfeeding, it has only a marginal effect on improving the economic situation of low-income households; should a basic nutritious diet be purchased, potential monthly deficits ranging from $158 to $605 still remain. This coupled with food-insecure mothers’ tendency to stop breastfeeding early due to worry of food insecurity (Frank 2015) demonstrates the need for public policy to ensure that families are adequately supported financially to meet public health goals and ensuing recommendations related to maternal and infant health. One public policy response, since 1994, has been to fund community projects to address health disparities for pregnant women and their infants through the Canada Prenatal Nutrition Program (CPNP) (Public Health Agency of Canada 2002). CPNP targets supports to families living in conditions of risk, including low income and food insecurity, providing breastfeeding supports and free or low-cost food supplementation (Public Health Agency of Canada 2002). Yet CPNP is not an entitlement-based program, and the current federal investment only supports 330 sites across Canada, preventing reach to all low-income families. Furthermore, CPNP program evaluation indicates that the demand for service at time exceeds capacity, whereby close to one fourth of projects have had to refuse participants (Health Canada and the Public Health Agency of Canada 2016). This research, in line with previous research (Vozoris and Tarasuk 2003), demonstrates that financial benefit received through supplemental food provision would be inadequate for compensating for the monthly deficits low-income families may face.

This research also demonstrates the inadequacy of Maternity Benefits. The lone pregnant woman working for minimum wage could afford a basic nutritious diet. However, postnatally with the reduced income of MB, along with the increased dietary costs for lactation or the additional cost of infant formula, she could not. This is the case despite the lone woman qualifying for the Family Supplement to Maternity Benefits and receiving child-focused government transfers not available in pregnancy. The two-parent family, also in a potential deficit position, does not qualify for the Family Supplement because the annual household income exceeded the annual net family income threshold of $25,921. This research provides evidence that federal Maternity Benefits and the Family Supplement to Maternity Benefits, which were designed to improve the incomes of low-income families, are inadequate to cover basic household needs. The eligibility threshold for the Family Supplement has not increased since its implementation in 1998, sitting thousands of dollars below the 2015 Low Income Measure After-Tax thresholds for a couple with one child ($30,962) or two children ($36,426) (Statistics Canada 2015c). Importantly, only 56% of families outside of Quebec with annual incomes less than $30,000 receive EI Maternity/Parental benefits at all (McKay et al. 2016), highlighting the vulnerable economic conditions that low-income families with infants may experience when maternity income protections are attached to low-income labour histories.

Limitations

The scenarios presented here are only select household/income examples illustrating the cost and affordability of a basic nutritious diet in Nova Scotia in 2015. They apply conservative estimates of costs of basic living, and with the exception of food, infant formula, prenatal vitamins, and vitamin D drops, are based on secondary data sources. These estimates do not include other costs such as those of items to support infant feeding, diapers, or those related to medical needs of the mother during pregnancy. The formula feeding costs are calculated with the lowest cost of powdered formula for a 3-month-old and do not consider the higher cost of formulas required for special nutritional needs, or the need to purchase concentrated or RTF formula when powdered formula is not available in stores. Families requiring more expensive formula would experience a greater deficit monthly. Additionally, as noted previously, the early infancy costs assume no childcare expenses, and thus no IA Allowance for childcare. The lack of need for childcare may not be realistic for all families. Finally, the Department of Community Services in NS, which is responsible for the IA program in that jurisdiction, has undergone work to transform and redesign their programs since data collection occurred. Therefore, future research to continue to monitor the cost of a nutritious diet in the prenatal, perinatal, and postnatal periods is warranted.

Conclusion

This research demonstrates the economic challenges faced by low-income families in growing and feeding a baby in Nova Scotia. These findings raise questions about the effectiveness of social welfare income security programs to mitigate food insecurity during maternity and early child development. Canada is signatory to the United Nations’ International Covenant on Economic, Social and Cultural Rights which stipulates the need for special protection for mothers in reference to social security benefits (Office of the High Commissioner for Human Rights 1966). Yet this research shows the inadequacy of Income Assistance, minimum wage, and Maternity Benefits for the purchase of a basic nutritious diet during pregnancy and early infancy and draws attention to the risk to health of both our current and future generations. Adequate state maternity protection is required to support access to nutrition at this critical time through a comprehensive, equity-focused policy framework that ensures adequate livable incomes.

Funding information

We would like to acknowledge that this project was commissioned and funded by the Nova Scotia Department of Health and Wellness, and we are grateful for their leadership and financial support to enable this work. We applied the FLAE approach for the sequence of authors.

Compliance with ethical standards

Conflict of Interest

The authors declare that they have no conflict of interest.