Date of Award

January 2022

Document Type

Thesis

Degree Name

Master of Public Health (MPH)

Department

School of Public Health

First Advisor

Ashley Hagaman

Abstract

Rationale: Prior studies have found that a history of adverse childhood experiences (ACEs) is associated with breastfeeding, but the evidence is inconsistent. Despite low and middle income countries (LMICs) carrying a disproportionate amount of poor maternal and infant health outcomes, little research has assessed the relative impact of ACEs on breastfeeding initiation and exclusive breastfeeding in LMICs.Objective: The study investigates whether maternal ACEs are associated with breastfeeding initiation and exclusive breastfeeding at 3 and 6 months postpartum among a cohort of women from rural Pakistan. Methods: The cross-sectional analysis included 869 women 18-45 years of age from the Bachpan Cohort Study. Multivariable modified log-Poisson regression models were used to assess the relationship between any ACE exposure with breastfeeding initiation (n=755) and exclusive breastfeeding at 3 (n=758) and 6 months (n=809). Models were adjusted for mother’s age at baseline, education level, number of living children, and trial arm. Results: The majority of women with a history of at least one ACE did not report breastfeeding within an hour of childbirth (82.54%) or exclusively breastfeeding within the last 24 hours at 3 (56.22%) and 6 (92.36%) months postpartum. Women with ACEs were more likely to initiate breastfeeding within one hour of childbirth (RR=1.2; 95% CI=0.8, 1.8) but less likely to recall exclusively breastfeeding within the last 24 hours at 3 (RR=0.8; 95 CI=0.7, 0.9) and 6 months (RR=0.8; 95% CI=0.5, 1.2) postpartum compared to women with no self-reported history of ACEs. Conclusion: Our findings indicate that ACEs may contribute to differences in breastfeeding outcomes, but these associations differ by ACE type and across domains. Understanding the long-term effects of ACEs on breastfeeding is important to help inform the design of intervention programs to prevent or mediate the negative repercussions of ACEs.

Comments

This thesis is restricted to Yale network users only. It will be made publicly available on 05/19/2024

Download

Share

COinS