Date of Award

January 2013

Document Type

Open Access Thesis

Degree Name

Master of Public Health (MPH)

Department

School of Public Health

First Advisor

Rafael Pérez-Escamilla

Abstract

Objective: The objective of this study is to evaluate the association between lifetime experience of intimate partner violence (IPV) and breastfeeding in India, Nepal and Timor-Leste.

Methods: Women respondents, between the ages of 15 and 49 years, whose last child was under or equal to 2 years of age and a singleton birth and who were applied the domestic violence module, were included in the final study sample for each country. Logistic regression analyses were used to investigate any unadjusted associations between any lifetime IPV, any physical IPV, any sexual IPV or both and the following breastfeeding outcomes: early breastfeeding initiation (within 1 hour after birth), any breastfeeding and administration of prelacteal feeds. Multivariate logistic regression models with backwards elimination procedures were constructed for each infant feeding outcome with significant covariates selected based on bivariate analyses as well as a conceptual framework.

Results: About one-third of women reported experiencing some form of lifetime IPV (38.4% in India, 30.5% in Nepal and 35.0% in Timor-Leste). The prevalence of any breastfeeding, as reported by current status, was almost universal at 85.6% for India, 93.5% for Nepal and 70.0% for Timor-Leste. Experience of both physical and sexual IPV was found to decrease the likelihood of initiating breastfeeding within 1 hour after birth among women in India (ORadj: 0.72, 95% CI: 0.56-0.94). With respect to prelacteal feeds, women in India (ORadj: 1.15, 95% CI: 1.05-1.25) who experienced any lifetime IPV were more likely to give prelacteal feeds within the first three days after birth. Mothers who experienced any lifetime physical IPV in India (ORadj: 1.16, 95% CI: 1.06-1.28) were also more likely to give prelacteal feeds. For any breastfeeding, women in Nepal who experienced any lifetime IPV were 68% less likely to practice breastfeeding at the time of the survey compared to women who did not experience any lifetime IPV (ORadj: 0.32, 95% CI: 0.14-0.76). In addition, mothers in Nepal who reported only physical IPV were 79% less likely to practice any breastfeeding (ORadj: 0.21, 95% CI: 0.08-0.57).

Conclusion: Experience of both physical and sexual IPV during a respondent's lifetime is associated with decreased likelihood of initiating breastfeeding within 1 hour after birth; furthermore, reports of any lifetime IPV or of physical IPV decrease the odds that a mother will practice any breastfeeding. Experience of any lifetime IPV or of physical IPV only is also linked with increased odds of giving prelacteal feeds. These data can be used to help clarify the association between IPV and breastfeeding and to provide additional information for clinicians to help target screening and intervention programs to women who are pregnant or who have children and are at increased risk for experiencing IPV.

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This is an Open Access Thesis.

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