Research exposes inequalities in breastfeeding assistance for individuals with disabilities

Strategies to reduce disparities in breastfeeding support based on disability may improve breastfeeding outcomes, according to a recent study published in the American Journal of Public Health.

Disability, defined as impairments, activity limitations, and participation restrictions impacting an individual’s daily life, is reported in approximately 12% to 18% of reproductive-aged women. Sexual activity, future pregnancy desire, and pregnancy experiences are equally common in women with and without disabilities.

Women with disabilities have an increased risk of not receiving reproductive health care and experiencing adverse pregnancy and birth events. Breastfeeding is a key factor of reproductive care, recommended exclusively for 6 months by the American College of Obstetricians and Gynecologists and other medical organizations.

Data has indicated reduced rates of breastfeeding among women with disability, but this data is limited. To determine breastfeeding initiation based on breastfeeding status and evaluate outcomes, investigators conducted a study using data from the Pregnancy Risk Assessment Monitoring System (PRAMS).

PRAMS is a surveillance system that collects data on behaviors before and during pregnancy, as well as the postpartum period. Since gender data is not included in PRAMS, participants were defined as “women” based on their birth certificate.

Disability was determined using the Washington Group Short Set of Questions on Disability, which includes 6 questions measuring sight, hearing, walking or climbing stairs, remembering or concentrating, self-care, and communicating capabilities. Responses included no difficulty, some difficulty, a lot of difficulty, and cannot do this at all.

Participants were asked, “Did you ever breast- feed or pump breast milk to feed your new baby, even for a short period of time?” as well as if they were currently breastfeeding. Participants who were not currently breastfeeding were asked how many weeks or months they breastfed their baby.

Responses were used to determine breastfeeding status, with categories including breastfeeding initiation, breastfeeding at 1 month, breastfeeding at 2 months, and breastfeeding at 3 months.

Participants were also asked whether they had received information on breastfeeding from a list of sources. Responses included health care providers or support professionals and breastfeeding or lactation specialists.

Covariates related to breastfeeding were included in the analysis. This included race and ethnicity, age, parity, education level, prenatal participation in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC), delivery method, and gestational age at delivery.

There were 39,673 women included in the final analysis, 6% of whom had disability. The most common disability subtype was difficulty remembering in 3.7%, followed by difficulty seeing in 1.6%, walking or climbing stairs in 0.6%, hearing in 0.6%, communicating in 0.5%, and self-care in 0.3%.

Disability was more common in participants who were Hispanic, aged 20 to 24 years, multiparous, had a high school level or below education, prenatally participated in the WIC, and had infants born preterm.

Among patients with disability, breastfeeding initiation and breastfeeding at 1, 2, and 3 months were reported in 83.1%, 68.7%, 56.1%, and 48.3%, respectively. In patients without disability, these rates were 87%, 76.7%, 67%, and 60%, respectively.

The lowest rate of breastfeeding initiation based on disability was 72.4% for patients with difficulty communicating, while the highest was 84.1% for patients with difficulty remembering or concentrating. At 1 month, these rates were 57.6% for difficulty communicating and 71.4% for difficulty hearing.

At 2 months, rates were 51.5% for difficulty communicating and 61.6% for difficulty hearing. At 3 months, rates were 45.7% for difficulty remembering or concentrating and 54.1% for difficulty hearing.

Receiving information about breastfeeding by health care providers was reported by 92.2% of respondents, with information from doctors reported by 78.3%, information from a nurse, midwife, or doula by 75.4%, and information from the baby’s doctor by 71%.

The rate of receiving breastfeeding information from health care providers was 89.3% among women with disability vs 92.3% among women without disability. For lactation specialists, these rates were 78.1% and 75.2%, respectively.

These results indicated reduced rates of breastfeeding among women with a disability. Investigators concluded interventions are necessary to improve breastfeeding outcomes.

Reference:

Ramer S, Nguyen AT, Nelson JM, et al. Breastfeeding by disability status in the United States: Pregnancy risk assessment monitoring system, 2018–2020. Am J Public Health. 2024;114(1):108–117. doi:10.2105/AJPH.2023.307438

This article was initially published by our sister publication, Contemporary OB/GYN®.