Date of Award
Master of Public Health (MPH)
School of Public Health
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.
Bojorquez-Ramirez, Paola, "Adverse Childhood Experiences & Breastfeeding - Pakistan" (2022). Public Health Theses. 2136.