The Breastfeeding Food Security Assessment Scale (BFSAS): Development and Validation Among Breastfeeding Women in Lebanon

Food insecurity significantly impacts health, particularly for breastfeeding mothers, who require adequate nutrition for maternal and child health. In Lebanon, economic crises have worsened food insecurity, affecting nearly half of the population. Crrent food insecurity assessment tools do not address the specific needs of breastfeeding women. This study aimed to develop and validate the Breastfeeding Food Security Assessment Scale (BFSAS), a context-specific tool for assessing food security among breastfeeding mothers in Lebanon, and to examine sociodemographic factors associated with food insecurity within this population. A cross-sectional survey was conducted from December 2023 to March 2024 among Lebanese mothers who had given birth between 2018 and 2023. Participants were recruited through social media and completed an online questionnaire covering sociodemographic, dietary, mental health, breastfeeding, and food security-related questions. Data analysis included exploratory and confirmatory factor analyses to validate the BFSAS structure and statistical tests to explore associations with the BFSAS scores. The study included 305 participants, with the BFSAS demonstrating excellent psychometric properties and a two-factor structure, “quality” and “quantity,” with high internal consistency (Cronbach's α = 0.95). Approximately 23% of participants experienced food insecurity during breastfeeding. Older age and higher household income were associated with lower odds of food insecurity, while the number of children in the household increased the likelihood of food insecurity. The BFSAS is a valid, reliable, culturally adapted tool for assessing food insecurity among breastfeeding women in Lebanon. It facilitates targeted interventions to support breastfeeding mothers, especially in regions with lower socioeconomic status.