Recommendations for action on food insecurity in high-income countries for preconception, pregnancy and early childhood: a modified Delphi study

Background Preventing food insecurity during preconception, pregnancy, and early childhood can improve long-term health and wellbeing for women and children. This study aimed to identify research, policy, and delivery priority actions to prevent and mitigate food insecurity across these life-course stages. Methods A modified Delphi process was used to solicit and rank expert views on priority actions across research, practice, policy, and voluntary, community, faith and social enterprise (VCFSE) sectors. Four rounds of consultation were conducted (September 2024 - September 2025). Recommendations were considered priorities if ≥ 75% of respondents rated them as such. In Rounds 1 and 2, recommendations were grouped thematically and rated for importance. Top-rated recommendations were then ranked in Rounds 3 and 4. Results Between 30 and 53 participants from 5 to 12 high-income countries responded to each round. Round 1 generated 16-30 recommendations per sector, which were distilled into 10 research, 9 practice, 13 policy, and 9 VCFSE recommendations that met the agreement threshold following Round 2. No recommendations reached this threshold in the ranking rounds. Top-ranked recommendations included: generating food insecurity prevalence data (research; 66%), ensuring universal access to prenatal, infant-feeding and breastfeeding support (practice; 67%), improving access to nutritional and financial safety nets (policy; 68%), and tailored, nutritious temporary food relief (VCFSE; 68%). Conclusion This study synthesised expert views into a set of recommendations to address food insecurity during critical life-course stages. The findings underscore that food insecurity is shaped by intersecting social, economic and policy factors, and therefore requires coordinated, cross-sectoral action across a range of priorities.