The role of wild meat for subsistence or as a luxury good is debated. We investigated the role of wild meat in food security in Madagascar, where consumption is poorly understood in urban areas and at regional scales. Using semi-structured interviews (n = 1339 heads-of-households, 21 towns), we aimed to: (1) quantify the amount and purpose of, (2) understand the drivers of, and (3) examine changes in wild meat consumption. Few respondents preferred wild meat (8 ± 3%) but most had eaten it at least once in their lifetime (78 ± 7%). Consumption occurred across ethnic groups, in urban and rural settings. More food insecure areas reported higher rates of wild meat consumption in the 6–8 months prior to interviews. Consumption was best explained by individual preferences and taboos. Less than 1% of respondents had increased consumption during their lifetimes. Wild meat prices showed no change from 2005–2013. Most consumption involved wild pigs and smaller-sized animals, though they were consumed less in the years following the 2009 coup. These data illustrate the differences between urban and rural communities, the occasions in which wild meat is used a source of food security, and provide evidence that some taxa are not hunted sustainably in Madagascar.