Association of Voluntary Legal Paternity and Breastfeeding Duration and Exclusivity in a Sample of Mothers in NewYork State, United States

Abstract

Background and Objective: Globally, father engagement is deemed an important factor in mothers’ breastfeeding practices. In the U.S., the role of the father in breastfeeding is understudied. This study examines the association between voluntary legal paternity and maternal breastfeeding outcomes. Methods: Using data from a modified Pregnancy Risk Assessment Monitoring System survey (Monroe County, NY, 2015-2017) linked to New York State’s birth certificate data, we assessed breastfeeding outcomes (exclusivity and duration) by voluntary legal paternity (VLP) establishment. We examined breastfeeding duration (breastfeeding cessation at 13 weeks or less) and exclusive breastfeeding (at 13 weeks) among mothers whose infants had VLP (i.e., married, acknowledgment at birth), and those who had no-VLP (i.e., a court-mandated Paternity Affidavit or no legal paternity established). Univariate analyses were conducted, with additional variables (parental demographics, maternal social and clinical) included subsequently. The backward elimination method was used to determine the set of covariates to adjust in the model. Results: Of the 1,753 mothers initiating breastfeeding, 1,364 had VLP and 389 had no-VLP established. Mothers of infants with a no-VLP were more likely to be Black (29.49%), Hispanic (17.74%), have lower income (80.21%), have lower-education levels (44.73%) and were more likely to be <30 years old (61.7%), and had higher levels (14.4%) of reported traumatic stress before and during the most recent pregnancy. Among mothers initiating breastfeeding, those with no-VLP had a higher risk of breastfeeding cessation at 13 weeks (OR: 2.06; 95% CI, 1.25-3.42) after adjusting for maternal resilience, social support, hospital breastfeeding support, pre-pregnancy BMI, paternal age, and paternal education; and higher risk of breastfeeding cessation at 13 weeks (OR:1.46; 1.01-2.09). Conclusion and Implications for Translation: Voluntary legal establishment of paternity is associated with maternal breastfeeding outcomes. Screening of mothers may include legal paternity status as a further indication of the need for additional breastfeeding support, especially among socio-economically disadvantaged populations. Copyright © 2021 Alio et al. Published by Global Health and Education Projects, Inc. This is an open-access article distributed under the terms of the Creative Commons Attribution License CC BY 4.0.