Domestic violence may affect mothers' breastfeeding practices in developing countries

Reviewed by Kate Anderton, B.Sc. (Editor)Oct 1 2019

Mothers who have suffered from domestic violence are substantially less likely to follow recommended breastfeeding practices in low to middle-income countries, a new study shows.

In the first comprehensive analysis of the association between domestic violence and breastfeeding across 51 low-income and middle-income countries, researchers led by the University of Warwick have shown that mothers exposed to domestic violence are 12% less likely to initiate breastfeeding within an hour of birth and are also 13% less likely to breastfeed their infants exclusively in the first six months.

The conclusions, published in PLOS Medicine today (1 October), highlight the impact that domestic violence may have on child health, development and prevention of long-term health issues.

For this study, the researchers led by Warwick Medical School's Dr Rishi Caleyachetty used data from Demographic and Health Surveys conducted in 51 low and middle-income countries since 2000. These are nationally representative household surveys standardized across different countries and cover a range of topics including maternal and child health and reproductive health. They are the only surveys that collect data on domestic violence and breastfeeding that also cover a significant number of low and middle-income countries. Because they are standardized, the researchers are able to generate overall estimates across countries.

They found that mothers who experienced domestic violence were 12% less likely to initiate breastfeeding within an hour of birth, and this was seen with all types of violence - physical, sexual and emotional. Mothers who experienced domestic violence were also 13% less likely to breastfeed their infants exclusively in the first six months.

Domestic violence (or intimate partner violence) can involve physical or sexual abuse, rape, or emotional abuse and is a major health issue globally. A third of women worldwide have been victims of domestic violence and there is a higher risk of exposure during and after pregnancy. Domestic violence is associated with a number of detrimental health outcomes in women including trauma, sexually transmitted infections (including HIV), depression, musculoskeletal disorders, and there is emerging evidence in children of nutritional impacts such as poor growth.

Health professionals have long recommended breastfeeding as it has many health benefits for both baby and mother. Initiating breastfeeding within one hour after birth has been associated with improved survival of babies in low and middle-income countries while exclusive breastfeeding has been shown to improve child survival, and decrease gastrointestinal infections and respiratory infections. Mothers can see a long term reduction in breast cancer risk and an improvement in the contraceptive effect following pregnancy.

The World Health Organization recommends the early initiation of breastfeeding (within one hour after birth) and exclusive breastfeeding (no other food or drink, not even water, except breast milk) for at least six months. But many babies may never receive breast milk. According to UNICEF, globally, the prevalence of early initiation of breastfeeding was 45% and exclusive breastfeeding 43% in 2015. The Lancet Series on Breastfeeding estimated that over 800000 child deaths worldwide and cognitive losses totalling US$ 302 billion per year were attributable to not breastfeeding according to recommendations.

Lead author Dr Rishi Caleyachetty from Warwick Medical School says:

This is the largest study in low-income and middle-income countries to look at mothers' exposure to all three forms of domestic violence and its relation to breastfeeding practices. Maternal exposure to any form of domestic violence (physical, sexual or emotional violence) is associated with poor breastfeeding practices."

Co-author Dr Ola Uthman, also from Warwick Medical School, said:

Further research is needed to understand why mothers who experience domestic violence are less likely to engage in breastfeeding. Some suggestions are that a mother who experiences domestic violence can be more likely to be depressed, and so they may not access health and support services, or may have lower self-confidence and esteem."

Dr Rishi Caleyachetty adds:

The priority of health professionals working with pregnant women is identifying those who have experienced domestic violence and offering tailored support for breastfeeding practices. Domestic violence against women is a global problem and this study's findings could be applied not only in low-income and middle-income countries but around the world.

Breastfeeding is a human rights issue for mothers and their children, and no-one should interfere with a mother's right to breastfeed her child."

The study was conducted by an international team led by the University of Warwick in collaboration with researchers from the World Health Organization (WHO) Inter-country support team (Zimbabwe), National Center of Tropical Medicine (Spain), Pontificia Universidad Católica de Chile (Chile), and JSI Research & Training Institute (USA).