Maternal experience of intimate partner violence is associated with suboptimal breastfeeding practices in Malawi, Tanzania, and Zambia: insights from a DHS analysis

Abstract

Background Despite widespread suboptimal breastfeeding practices and maternal experiences of intimate partner violence (IPV), the association of IPV and breastfeeding practices remains unclear. This study investigated the associations between maternal experience of physical, sexual, emotional violence, and controlling behaviors with suboptimal breastfeeding practices in Malawi, Tanzania, and Zambia. Methods Data included mother-infant dyads from the most recent Demographic and Health Surveys for Malawi (n = 1878), Tanzania (n = 3184), and Zambia (n = 3879). Intimate partner violence (physical, sexual, and emotional) was measured using the Revised Conflict Tactics Scale. Breastfeeding practices were early initiation of breastfeeding (within 1 h of birth), exclusive breastfeeding (in previous 24 h), and continued breastfeeding. Associations between experience of physical, sexual, or emotional violence or controlling behaviors and breastfeeding practices, as well as associations between the frequency of IPV and breastfeeding practices were assessed. Results Many Malawian (77.6%) and Zambian (67.7%) and just over half (53.6%) of Tanzanian mothers, initiated breastfeeding within 1 h of birth. Exclusive breastfeeding was 70.6% in Zambia and 60.1% in Malawi, while 55.0% of Tanzanian mothers breastfed exclusively. Continued breastfeeding to at least 1 year was high in Malawi 92.2%, Tanzania 93.4%, and Zambia 95.0%. Most mothers reported experiences of IPV in Tanzania 79.1%, Zambia 78.9%, and Malawi 73.9%. Mothers who experienced sexual IPV were significantly more likely to delay breastfeeding (Malawi [AOR 1.55 (1.14, 2.10)]; Tanzania [AOR 1.30 (1.04, 1.62)]; and Zambia [AOR 1.28 (1.06, 1.54)]). Sexual IPV in Malawi and Zambia was associated with greater odds of not exclusively breastfeeding (Malawi [AOR 1.90 (1.05, 3.45)]; Zambia [AOR 1.75 (1.15, 2.67)]). Tanzanian mothers who experienced IPV often or sometimes were two times more likely not to breastfeed at one-year post-delivery [AOR 2.23 (1.09,4.57)]. Conclusions In the three countries investigated maternal experience of IPV was associated with suboptimal breastfeeding practices. Policies and programs targeting improved breastfeeding practices should consider screening during antenatal and postnatal care for experience of violence and support initiatives to reduce IPV.

Physical violence against women by their intimate partner during pregnancy and its relationship with breastfeeding

“…The results did not observe differences in exclusive breastfeeding duration in mothers exposed or not to any kind of violence. 17 Also, studies in Zambia, Malawi e Tanzania; Bangladesh; Africa (including eight countries), Nigeria and India 8,18,19 presented diverging results. All of these studies used, as a data source, the Demographic and Health Survey to estimate the effect of domestic violence against women during pregnancy on breastfeeding.…”

“…18 The study in Zambia, Malawi and Tanzania showed that maternal experience of various types of IPV was associated with suboptimal breastfeeding practices in all three countries. 8 A study conducted in eight African countries (Ghana, Kenya, Liberia, Malawi, Nigeria, Tanzania and Zambia) showed that violence by an intimate partner had a tendency to be associated with suboptimal breastfeeding practices, and sexual violence was more frequently associated with inappropriate breastfeeding practices. 22 Finally, the study conducted in Nigeria found that the experience of intimate partner violence is also related to improper practices of exclusive breastfeeding.…”

“…This coercion can generate stress and alter the hormonal behaviour responsible for the breast milk let-down reflex, and consequently, breastfeeding practices. 7 Overall, evidences across countries suggests that mothers who experience IPV are less likely to breastfeed optimally, [8][9][10] However, systematic reviews presently available show inconsistent results. 6,11 Even though it is very relevant to understand the phenomenon of violence against women on a global scale, and particularly that suffered from an intimate partner and its impact on the health of women and newborns, there is a lack of research on the effect of violence during pregnancy on breastfeeding.…”

Psychological Trauma and Breastfeeding: What We Know So Far

“…Mothers from Malawi (n=1,878), Tanzania (n=3,184), and Zambia (n=3,879) participated in Demographic and Health Surveys to examine the link between IPV and breastfeeding outcomes 25 . The rates of breastfeeding initiation the first hour after birth and exclusive breastfeeding were high in all three countries.…”

Correlates of intimate partner violence among pregnant and parenting adolescents: a cross-sectional household survey in Blantyre District, Malawi

“…Further, IPV survivors experiencing poor mental and physical health are more likely to be less productive, thus reducing their contributions to societal development [ 3 , 5 ]. In addition, studies have linked IPV to poor sexual and reproductive health (SRH) and child health outcomes, including HIV, unintended pregnancies, pregnancy loss, suboptimal breastfeeding, and infant and child mortality [ 6 , 7 ].…”