Intimate Partner Violence and Breastfeeding Rates
by Anne Eglash MD, IBCLC, FABM
According to the Association of Women’s Health, Obstetric and Neonatal Nurses (AWHONN), intimate partner violence (IPV), also called domestic violence, includes physical violence, sexual violence, stalking and psychological aggression by a current or former intimate partner. The relationship between IPV and breastfeeding is not well understood due to a scarcity of research. Some studies have associated IPV with postnatal depression, and postnatal depression has a strong association with decrease breastfeeding rates. The authors of the study for this week’s clinical question of the week sought to tease out the effect of psychological IPV from physical IPV on breastfeeding, since psychological abuse is under-researched.
This study was carried out in a large population in Andalusia Spain, enrolling 50 women antenatally from each of 15 different regional hospitals, for a total of 750 participants. During pregnancy, the subjects were questioned about different types of IPV within the last 12 months. Breastfeeding avoidance data was collected during the immediate postpartum period. The researchers controlled for confounders including socioeconomic status, marital status, educational level, nationality, employment status, family support, desired pregnancy, infant sex, prematurity, low birth rate, resuscitation, smoking during pregnancy, and disease during pregnancy. They found that 70% of all mothers initiated breastfeeding, and 20% of all mother reported psychological IPV within the last 12 months. The mothers who reported psychological IPV were twice as likely to not initiate breastfeeding, after controlling for the confounders.
- 1 in 3 women in the USA experience rape, physical violence, and/or stalking by current or former partners.
- Approximately 75% of IPV is directed towards women.
- Pregnant women have a reduced risk of IPV.
- Bisexual women have a lower rate of IPV as compared to heterosexual women.
- Women in rural areas have a higher risk of IPV.
- American Indian and Alaska Native women who live on reservations have the highest rates of IPV compared to all other groups.
- African American women are more likely to be murdered by their partners than White women.
- Most states do not have mandatory IPV reporting laws for health professionals.
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Abstract
Objective
To evaluate if the experience of psychological intimate partner violence (IPV) adversely affects breastfeeding rates.
Setting
Maternities in 15 public hospitals, drawn using cluster sampling of obstetric services in Andalusia, Spain. Population A total of 779 consecutive mothers receiving antenatal care including ultrasound and giving birth during February–June 2010.
Methods
Trained midwives gathered IPV data using the Index of Spouse Abuse validated in the Spanish language (score ranges: 0–100, higher scores reflect more severe IPV; cut-off: psychological IPV = 25). Sociodemographic data including lack of kin support, and obstetric and neonatal outcomes were collected. Multivariate logistic regression estimated adjusted odds ratios (aOR), with 95% confidence intervals (CI), of the relationship between psychological IPV and breastfeeding, controlling for sociodemographic characteristics and obstetric complications.
Main Outcome Measure
Breastfeeding avoidance defined as lack of breastfeeding or pumping of breast milk to feed the new baby in the immediate post-partum period.
Results
Response rate was 92.2%. A total of 70% (n = 545) of women initiated breastfeeding. Psychological IPV, reported by 21.0% (n = 151), increased the odds of breastfeeding avoidance (aOR = 2.0; 95% CI = 1.2–3.3) adjusting for the presence of obstetric complications (aOR = 1.6; 95% CI = 1.0–2.4).
Conclusions
Mothers with psychological IPV avoid breastfeeding. Clinicians should be aware of the risks to infant arising from this deficiency due to IPV in pregnancy.
Intimate partner violence (IPV) rates are higher for women who are LGBTQ, and for pregnant women, especially if the pregnancy is unplanned.
Only 3 of the 50 states in the USA (AL, NM, WY) do NOT have mandatory IPV reporting laws for health professionals.
According to the AWHONN position statement on IPV, other populations at greater risk of IPV include women of low income, adolescents, women in the military, and women who are immigrants. AWHONN recommends that all women be screened for IPV. The Center for Disease Control’s Intimate Partner Violence and Sexual Violence Assessment Instruments for Use in Healthcare Settings: Version 1 is a helpful guide on optional clinical screening tools.
Studies have shown that 68-85% of IPV survivors wanted their health care providers to ask about abuse. The American College of Obstetrics and Gynecology and the Institute of Medicine recommend that all women of child-bearing age be screened for IPV, and counseling be included during routine preventive care visit, as well as prenatal, obstetric, and postpartum visits.