1016 Intention and initiation of breastfeeding among women with housing instability

Abstract

Exclusive breastfeeding is recommended for the first 6 months of life, yet many social and structural determinants of health influence breastfeeding intention and initiation. One such social determinant, housing stability, has not been studied. The objective of this study was to evaluate differences in breastfeeding intention and initiation associated with housing instability during pregnancy. In this secondary analysis of a cohort study of housing stability during pregnancy (2018-2020), postpartum patients were surveyed during hospitalization and their medical records were reviewed. The exposure of interest was housing instability in the year prior to delivery as defined by a positive answer to at least one of six screening items. The co-primary outcomes included 1) intention to breastfeed using the validated Infant Feeding Intentions Scale (IFIS) and 2) breastfeeding initiation. Propensity scoring was performed using relevant covariates, and logistic regression models were adjusted for propensity score weighting. Of 489 participants, 11.0% (N=54) experienced housing instability during pregnancy. Housing stability was associated with other social determinants of health, including race, education, marital status, and employment. The median IFIS score was similar for patients with unstable housing compared to those with stable housing (3.5 vs 3.4, p=0.09) and breastfeeding initiation did not differ (92.6% vs 95.2%, p=0.51) (Table). After propensity scoring, on multivariable analyses there were no statistically significant associations between housing stability and intention to breastfeed (aOR 1.39, 95% CI 0.69–2.81) or breastfeeding initiation (aOR 1.25, 95% CI 0.32-4.89). Although housing instability during pregnancy was frequent, after adjusting for other social determinants of health, it does not appear to be associated with breastfeeding intention or initiation. We note that there is a complex interplay between many social determinants of health and breastfeeding; further research must be performed to optimize lactation in all individuals.