Household food insecurity has been associated with several adverse health and nutrition outcomes, such as poor nutritional status. However, the relationship between household food insecurity and nutritional status of adults and children, particularly in developing countries, is not well established. In 2008–2009, a food security module was included in the National Maternal-Infant Health Survey in Guatemala for the first time, meaning household food security data could be analyzed in relation to nutritional indicators among women of reproductive age and children under 5. This paper describes the levels of household food security in the Western Highlands of Guatemala and the characteristics of the households, the female respondents, and their children that are associated with household food security. The paper also explores the relationships between household food security and nutritional outcomes in women of reproductive age and children under 5 in the region.