Abstract
ObjectiveThe objective of this study was to examine whether exposure to Intimate Partner Violence (IPV) is associated with premature termination of Exclusive Breastfeeding (EB). Per WHO recommendations, this was defined as ceasing breastfeeding or supplementing with other foods or liquids before the child was 6 months old.MethodIt is a prospective cohort study set in Moshi, Tanzania consisting of 1128 pregnant women with live singleton births. Women were enrolled during pregnancy and followed up with interviews during pregnancy, after birth and 2–3 years postpartum, using structured questionnaires. Emotional, physical and sexual IPV exerted by the current partner was assessed at 34 weeks gestational age with WHO questionnaires. Months of EB was assessed 2–3 years postpartum. Premature termination of EB was defined as less than 6 months of EB. Analyses were made using a logistic regression model adjusted for maternal age, education, HIV-status, alcohol use during pregnancy and parity. Confounding variables were determined using a theoretical framework approach, i.e. a Directed Acyclic Graph model to minimize bias.ResultsWomen who were exposed to IPV had more than 50% higher odds of terminating EB before the child was 6 months old compared to women who were not exposed (aOR = 1.62, 95%CI: 1.27–2.06).Women exposed to all three types of IPV had twice the odds of early termination of EB (aOR = 1.95, 1.12; 3.37). Furthermore, the odds were tripled if exposure happened specifically during the index pregnancy (aOR = 2.93 95%CI: 1.3; 6.6). Stratified analyses showed the most severely affected groups were the mothers older than 30 and those who gave birth to girls.ConclusionsThe results indicated that exposure to IPV is associated with increased risk of premature termination of EB. The odds increase with multiple types of the IPV, especially when exposed during the index pregnancy.
Highlights
Women who were exposed to intimate partner violence (IPV) had more than 50% higher odds of terminating exclusive breastfeeding (EB) before the child was 6 months old compared to women who were not exposed
Women exposed to all three types of IPV had twice the odds of early termination of EB
The results indicated that exposure to IPV is associated with increased risk of premature termination of EB
Summary
Breastfeeding is a vital factor in maternal and child health. [1, 2] The World Health Organization (WHO) recommends initiating breastfeeding within 1 hour of birth, exclusive breastfeeding (EB) for 6 months and continued supplemental breastfeeding for 2 years.[3]. Breastfeeding is a vital factor in maternal and child health. [1, 2] The World Health Organization (WHO) recommends initiating breastfeeding within 1 hour of birth, exclusive breastfeeding (EB) for 6 months and continued supplemental breastfeeding for 2 years.[3] Child benefits are reduced mortality, lower rates of infectious diseases and diabetes,[2, 4] and improved neurological and cognitive development.[5, 6] only 37% of children worldwide are exclusively breastfed for 6 months or more.[2]. Individual decision-making regarding breastfeeding is complex and influenced by biological, social and psychological factors.[7, 8] Research indicates that psycho-sociological factors have higher predictive roles for EB compared to socio-demographic factors. Individual decision-making regarding breastfeeding is complex and influenced by biological, social and psychological factors.[7, 8] Research indicates that psycho-sociological factors have higher predictive roles for EB compared to socio-demographic factors. [9] A possible pathway is stress induced decrease in oxytocin impairing lactogenesis.[10,11,12] It was not until recently that intimate partner violence (IPV) was recognized as a potential risk factor leading to termination of EB.[13,14,15]
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