Nurturing Care Systems Underlying Early Childhood Food Insecurity in Brazil: A Causal Loop Diagram Approach.

Experiencing food insecurity in early childhood is associated with adverse health and nutrition outcomes. About 66% of Brazilian households with children are food insecure; however, interventions targeting early childhood have fallen short in addressing food insecurity due to a lack of funding and multisectoral coordination combined with the COVID-19 pandemic. Therefore, protecting children from food insecurity is a complex task in Brazil and requires innovative approaches. We hypothesize that applying a Nurturing Care Framework (NCF) lens and systems thinking tools can indicate pragmatic pathways to reduce early childhood food insecurity. To examine this hypothesis, we used a participatory group model-building approach to integrate the knowledge of twelve Brazilian experts working in different sectors into a qualitative causal loop diagram (CLD) underlying the dynamics of food insecurity in early childhood. By analyzing the CLD, we aimed (1) to assess whether the Brazilian food insecurity system includes the NCF components and identify how these systems affect young children, and (2) to qualitatively explore feedback loops, pivotal variables (i.e., variables with the most immediate causes and/or immediate causal consequences), and leverage points (i.e., specific variables to intervene to produce a change in the overall system) to reduce food insecurity in early childhood. The integrated CLD outlines a structure with 28 variables assigned across the NCF components. A deeper qualitative analysis of the direct and indirect links identified how food insecurity is experienced by young children. This included a description of two feedback loops reinforcing childhood food insecurity, such as Financial Hardships and Emotional Distress Spiral. Food quality emerged as the pivotal variable with the most proximate causes and/or consequences related to early childhood food insecurity. Positive parenting practices and participation in daycare emerged as direct links to address early childhood food insecurity. Expanding access to nurturing care through national and local policies can enhance the resilience of the systems underlying early childhood food insecurity to disruptions such as the COVID-19 pandemic.