Quick Take: Maternal Exposure to Intimate Partner Violence and Breastfeeding Practices in 51 Low-Income and Middle-Income Countries

1. Exposure to intimate partner violence, particularly among mothers in low- and middle-income countries is associated with a significantly reduced likelihood of adequate breastfeeding practices.

Evidence Rating Level: 3 (Average)

Intimate partner violence (IPV) is a global health and social concern, with incidence rates higher in low- and middle-income countries (LMICs). However, this topic’s relationship to breastfeeding practices in these countries is poorly understood and understudied. In this population-based cross-sectional study, investigators used Demographic and Health Surveys (DHS) to study the association between maternal IPV and breastfeeding practices, particularly those initiated in the recommended hour following birth as well as exclusive breastfeeding across the first six months of life. Data was obtained from 51 LMICs between January 2000 and January 2019 with relevant data available from Africa (52.9%), the Americas (11.8%), the Eastern Mediterranean (7.8%), Europe (11.8%), Southeast Asia (11.8%), and the Western Pacific (3.9%). IPV was grouped by violence category (physical, sexual, emotional) while accounting for demographic and socioeconomic variables. Depending on specification, sample sizes ranged from 95,320 to 102,318 mother-infant dyads with a 33.3% prevalence of lifetime IPV exposure (27.6% physical, 8.4% sexual, 16.4% emotional). Investigators found that mothers with lifetime IPV exposure were significantly less likely to initiate breastfeeding within the first hour of birth (OR 0.88, 95% CI 0.85 to 0.97, p<0.001). These mothers were also less likely to engage in exclusive breastfeeding in the first six months following birth (OR 0.87, 95% CI 0.82 to 0.92, p<0.001). These relationships were similar across the three forms of IPV. Exposure to physical violence was the only form of IPV independently associated with a decreased likelihood of exclusive breastfeeding in the six months following birth. Limitations of this study include its cross-sectional design as well as the likely under reporting of IPV in the countries of interest. Overall, this study highlights a clear association between IPV and breastfeeding practices in LMICs. Given the importance of these practices for both infant and maternal health, healthcare providers should inquire about these experiences in pregnant women to mitigate potential effects.

Click to read the study in PLOS Medicine

Image: PD

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