Maternal disability and initiation and duration of breastfeeding: analysis of a Canadian cross-sectional survey

Hilary K Brown; Lesley Pablo; Natalie V Scime; Amira M Aker; Cindy-Lee Dennis

doi:10.1186/s13006-023-00608-7

Maternal disability and initiation and duration of breastfeeding: analysis of a Canadian cross-sectional survey

Int Breastfeed J. 2023 Dec 21;18(1):70. doi: 10.1186/s13006-023-00608-7.

Authors

Hilary K Brown^{1

2

3}, Lesley Pablo⁴, Natalie V Scime⁴, Amira M Aker⁴, Cindy-Lee Dennis^{5

6

7}

Affiliations

¹ Department of Health & Society, University of Toronto Scarborough, Toronto, ON, Canada. hk.brown@utoronto.ca.
² Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada. hk.brown@utoronto.ca.
³ Women's College Research Institute, Women's College Hospital, Toronto, ON, Canada. hk.brown@utoronto.ca.
⁴ Department of Health & Society, University of Toronto Scarborough, Toronto, ON, Canada.
⁵ Lawrence S. Bloomberg Faculty of Nursing, Toronto, ON, Canada.
⁶ Lunenfeld-Tannenbaum Research Institute, Mount Sinai Hospital, Toronto, ON, Canada.
⁷ Department of Psychiatry, University of Toronto, Toronto, ON, Canada.

Abstract

Background: The World Health Organization recommends breastfeeding as the best method for infant feeding. Known risk factors for breastfeeding non-initiation and early cessation of breastfeeding are diverse and include low breastfeeding self-efficacy, poverty, smoking, obesity, and chronic illness. Although women with disabilities experience elevated rates of these risk factors, few studies have examined their breastfeeding outcomes. Our objective was to examine breastfeeding non-initiation and early cessation of breastfeeding in women with and without disabilities.

Methods: We used data from the 2017-2018 Canadian Community Health Survey. Included were n = 4,817 women aged 15-55 years who had a birth in the last five years, of whom 26.6% had a disability, ascertained using the Washington Group Short Set on Functioning. Prevalence ratios (aPR) of breastfeeding non-initiation, and of early cessation of any and exclusive breastfeeding before 6 months, were calculated for women with versus without disabilities. We also examined disability by severity (moderate/severe and mild, separately) and number of action domains impacted (≥ 2 and 1, separately). The main multivariable models were adjusted for maternal age, marital status, level of education, annual household income level, and immigrant status.

Results: There were no differences between women with and without disabilities in breastfeeding non-initiation (9.6% vs. 8.9%; aPR 0.88, 95% CI 0.63, 1.23). Women with disabilities were more likely to have early cessation of any (44.4% vs. 35.7%) and exclusive breastfeeding before 6 months (66.9% vs. 61.3%), with some attenuation in risk after adjustment for sociodemographic factors (aRR 1.15, 95% CI 0.99, 1.33 and aRR 1.07, 95% 0.98, 1.16, respectively). Disparities were larger for women with moderate/severe disabilities and disabilities in ≥ 2 domains, with differences attenuated by adjustment for socio-demographics.

Conclusions: Women with disabilities, and particularly those with moderate/severe and multiple disabilities, could benefit from tailored, accessible breastfeeding supports that attend to the social determinants of health.

Keywords: Breastfeeding; Cross-sectional studies; Disabled persons; Health equity; Health surveys.

MeSH terms

Breast Feeding*
Canada / epidemiology
Cross-Sectional Studies
Female
Humans
Infant
Poverty*
Surveys and Questionnaires