New data suggest that mothers with intellectual or developmental disabilities are less likely to initiate breastfeeding or receive hospital breastfeeding support than mothers without disabilities.
In a population-based cohort study of over 600,000 mothers, patients with intellectual or developmental disabilities were approximately 18% less likely to initiate breastfeeding during hospitalization.
Dr. Hillary K. Brown
“Overall, we found that people with intellectual and developmental disabilities, as well as those with multiple disabilities, had lower rates of breastfeeding practices and support than those without disabilities,” said Dr. Study author Hilary K. Brown, Ph.D., is an assistant professor of health and development. The University of Toronto Scarborough Association in Ontario said: Medscape medical news.
This study was published in the January issue of Lancet Public Health.
Breastfeeding disparities
“There have not been many studies on the outcomes of breastfeeding in people with disabilities,” Brown said, and the findings are based on the guidelines of the WHO-UNICEF Baby Friendly Hospital Initiative. There are many qualitative studies suggesting that women experience barriers to access to breastfeeding and various challenges associated with breastfeeding, but only a handful of studies provide quantitative results.”
To examine these results, researchers analyzed health care data from Ontario, Canada. The analysis included all birth parents from her 15 years to her 49 years who gave birth to her first-born baby between April 1, 2012 and her March 31, 2018. I was. Patients with physical, sensory, intellectual or developmental, or two or more disabilities identified using the diagnostic algorithm and who had the opportunity to initiate breastfeeding, to engage in breastfeeding in the hospital, or to be fully at discharge. Women without disabilities were compared with individuals without disabilities in terms of opportunities to engage in healthy breastfeeding and to have skin-to-skin contact. With breastfeeding assistance.
Researchers considered physical disabilities, including conditions such as birth defects, musculoskeletal disorders, neuropathies, or permanent injuries. They defined sensory impairment as hearing impairment or visual impairment. Intellectual or developmental disability was defined as having an autism spectrum disorder, chromosomal abnormality, fetal alcohol spectrum disorder, or other intellectual disability. A patient with multiple disorders had two or more of these conditions.
The study population included 634,111 birth parents, of whom 54,476 (8.6%) had physical disabilities, 19,227 (3.0%) had sensory disabilities, 1048 (0.2%) had intellectual or developmental disabilities, 4050 (0.6%) had multiple disabilities. , and 555,310 (87.6%) had no failures.
Researchers found that patients with intellectual or developmental disabilities were less likely to have the opportunity to initiate breastfeeding than those without disabilities (adjusted relative risk). [aRR]0.82), engaged in breastfeeding in the hospital (aRR, 0.85), exclusively breastfeeding at discharge (aRR, 0.73), had skin-to-skin contact (aRR, 0.90), received breastfeeding assistance (aRR, 0.85) compared with patients without impairment.
Individuals with multiple disabilities were also less likely to initiate breastfeeding (aRR 0.93), less likely to breastfeed in the hospital (aRR 0.93), and less likely to exclusively breastfeed at discharge (aRR 0.90). ). , had skin-to-skin contact (aRR, 0.93) and received breastfeeding support (aRR, 0.95) compared with nondisabled patients.
understudied population
Lori Feldman-Winter (MD, MPH), professor of pediatrics at the Cooper College of Medicine at Rowan University in Camden, New Jersey, commented on the Medscape study, saying one of its strengths was its potential exclusion from the Medscape study. said that it included a patient with Breastfeeding practice. She added that the findings of little difference in breastfeeding practices and support for people with physical and sensory disabilities compared to those without disabilities are positive.
Dr. Lori Feldman Winter
“This is an understudied population, pointing out that practices related to breastfeeding care may suffer because of implicit prejudices regarding people with intellectual and multiple disabilities. “The good news is that other disorders did not show the same disparities. To ensure equal and inclusive care, the study also suggests that It shows how important it is to measure potential gaps in care across multiple sociodemographic and other variables such as disability.”
Health professionals need to be aware of disparities in breastfeeding care, she added. When it comes to providing equitable care, they need to be open to exploring potential biases. I have.
Dr. R. Douglas Wilson
R. Douglas Wilson, MD, president of the Canadian College of Obstetricians and Gynecologists and emeritus professor of obstetrics and gynecology at the University of Calgary in Alberta, said the cohort size represents the strength of the study and the findings suggest. pointed out. Potential need for close follow-up of new mothers who are breastfeeding and have intellectual or multiple disabilities.
“After hospitalizing the patient for an extra day, the home nurse may see the patient more frequently than a patient who does not require the extra monitoring,” Wilson said. If a patient is pregnant, obstetricians and gynecologists can find out if the patient intends to breastfeed and contact nurses and lactation consultants for assistance, he adds. rice field.
This study was funded by the National Institutes of Health and the Canadian Research Council Program. Brown, Feldman-Winter, and Wilson report no relevant financial relationships.
Lancet Public Health. 2023;8:e47-e56.full text
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