Intimate partner violence in poor countries may affect breastfeeding practices

Mothers exposed to intimate partner violence in low- and middle-income countries are less likely to initiate breastfeeding early and breastfeed exclusively in the first six months, according to a study published October 1 in the open-access journal PLOS Medicine by Rishi Caleyachetty of the University of Warwick in the UK, and colleagues. As noted by the authors, health professionals working with pregnant women in low- and middle-income countries may need to identify those who have experienced intimate partner violence and offer tailored support for breastfeeding practices.

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Intimate partner violence against women is a major global health issue, particularly in low- and middle-income countries. It is associated with poor physical and mental health, but its association with breastfeeding practices has not been well studied. Both the World Health Organization and the United Nations Children’s Fund recommend that breastfeeding be initiated within the first hour of birth, and that exclusive breastfeeding continue for the first six months of life. In the new study, the researchers examined the association of maternal exposure to intimate partner violence with early initiation of breastfeeding (i.e., within one hour of birth) and exclusive breastfeeding in the first six months. To do so, they assessed nationally representative, cross-sectional survey data collected between January 2000 and January 2019 from 51 low- and middle-income countries.

Depending on specification, the sample size varied between 95,320 and 102,318 mother-infant dyads. Mothers exposed to any intimate partner violence were less likely to initiate breastfeeding early (adjusted odds ratio [AOR]: 0.88 [95% CI 0.85-0.97], p = < 0.001) and breastfeed exclusively in the first six months. Physical, sexual and emotional violence were each independently associated with decreased likelihood of early breastfeeding initiation, but only exposure to physical violence was independently associated with a decreased likelihood of exclusive breastfeeding in the first six months. The main limitations of this study included the use of cross-sectional datasets, the possibility of residual confounding of the observed associations by household wealth, and underreporting of intimate partner violence experiences, attenuating the magnitude of observed associations.

According to the authors, these findings may inform the argument for antenatal screening of intimate partner violence in low- and middle-income countries and the provision of services to not only improve mothers’ safety and wellbeing, but also support them in adopting recommended breastfeeding practices.