Study finds gaps in breastfeeding practices and supports for birthing parents with disabilities

03/01/2023

People with intellectual, developmental, and multiple disabilities who give birth are facing disparities when it comes to breastfeeding supports and practices in hospital, according to a new study from ICES.

The Baby Friendly Hospital Initiative identifies several key breastfeeding quality-of-care indicators for birthing people in hospital following childbirth, including the opportunity to start breastfeeding after birth; exclusive breastfeeding at discharge; and skin-to-skin contact between the parent and baby.

The study, published in Lancet Public Health, is the first to address these key factors, all of which predict whether someone will still be breastfeeding exclusively at six months post-birth, in people with disabilities. Using population-based healthcare data from ICES and BORN (Better Outcomes Registry & Network), the researchers examined breastfeeding practices and supports during the hospital stay in all birthing parents with and without a disability in Ontario, Canada.

“Although breastfeeding practices and supports were similar for people with physical and sensory disabilities compared to those without a disability, there were important disparities for people with intellectual, developmental and multiple disabilities,” says lead author Hilary Brown, adjunct scientist at ICES and assistant professor in the Department of Health and Society at the University of Toronto. “The data showed that people with these disabilities are less likely to start breastfeeding right after the birth, are more likely to be supplementing with formula when they leave the hospital and are not getting as much of a chance to do skin-to-skin contact or receive assistance with latching—those are significant barriers to long-term breastfeeding.”

The data identified 15 to 49-year-old females with a single livebirth in Ontario, Canada, from 2012-2018, and included individuals with a physical (n=54 476), sensory (n=19 227), intellectual/developmental (n=1048), and two or greater (“multiple”) disabilities (n=4050). These groups were compared to 555,310 individuals without disabilities:

Compared to people without disabilities (87%), those with intellectual/developmental (70%) and multiple disabilities (79%) were less likely to have any in-hospital breastfeeding.
These two disability groups were also less likely to have an opportunity to initiate breastfeeding within two hours of birth, or to be exclusively breastfeeding when discharged from hospital.
They were also less likely to have any skin-to-skin contact with their baby two hours after birth and to have any support for breastfeeding within six hours of the birth.

Notably, after restricting the groups to low-risk births and to people who intended to breastfeed, these associations were weaker. However, exclusive breastfeeding at discharge was still less likely for those groups with disabilities.

“The data would suggest that there is a need for improved training of nurses, lactation consultants, and pediatricians on the unique needs of birthing parents with intellectual, developmental and multiple disabilities, including communication and learning needs, modifications to breastfeeding techniques, and knowledge of other structural barriers to breastfeeding for those with disabilities,” says Hilary Brown.

Further, there is a need for research on the effectiveness of accessible breastfeeding supports. These might include preconception and prenatal health promotion to address risk factors that might impact breastfeeding (for example, smoking), and educational strategies to provide individuals with intellectual/developmental and multiple disabilities with information on the benefits of breastfeeding and to increase self-confidence in breastfeeding.

The study, “Disability and in-hospital breastfeeding practices and supports in Ontario, Canada: a population-based study” was published in Lancet Public Health.

Author block: Brown H, Taylor C, Vigod S, Dennis C-L, Fung K, Chen S, Guttmann A, Havercamp S, Parish S, Ray J, Lunsky Y.

ICES is an independent, non-profit research institute that uses population-based health information to produce knowledge on a broad range of healthcare issues. Our unbiased evidence provides measures of health system performance, a clearer understanding of the shifting healthcare needs of Ontarians, and a stimulus for discussion of practical solutions to optimize scarce resources. ICES knowledge is highly regarded in Canada and abroad, and is widely used by government, hospitals, planners, and practitioners to make decisions about care delivery and to develop policy. In October 2018, the institute formerly known as the Institute for Clinical Evaluative Sciences formally adopted the initialism ICES as its official name. For the latest ICES news, follow us on Twitter: @ICESOntario