title: The Impact of a History of Adverse Childhood Experiences on Breastfeeding Initiation and Exclusivity: Findings from a National Population Health Survey.
abstract: Exclusive breastfeeding is strongly recommended by the World Health Organization. Given the low rate of exclusive breastfeeding in Canada and the increasing reports of a history of adverse childhood experiences, this study sought to investigate the association between a history of adverse childhood experiences and breastfeeding initiation and breastfeeding.
  
  
  
  Data used for this study were based on the 2011-2012 Canadian Community Health Survey, collected using a cross-sectional survey. The outcome measures were breastfeeding initiation and exclusive breastfeeding for 6 months or more. History of adverse childhood experiences was the main explanatory variable. Multivariable logistic regression models were developed to investigate the effect on breastfeeding initiation and on exclusive breastfeeding in women who gave birth within 5 years before when the surveys were conducted.
  
  
  
  The study sample included 697 and 633 women for analyses on breastfeeding initiation and breastfeeding, respectively. The proportion of women with breastfeeding initiation and exclusive breastfeeding for up to 6 months in this study were 96.8% and 42.8%, respectively. After controlling for age and highest level of education, having a history of adverse childhood experiences was not significantly associated with breastfeeding initiation (odds ratio [OR] 0.46, 95% confidence interval [CI] 0.10-1.87), but mothers with such history were less likely to exclusively breastfeed for up to 6 months compared with those without (OR 0.53, 95% CI 0.31-0.90).
  
  
  
  These findings suggest the need for more breastfeeding monitoring programs beyond the hospital environment to provide more support to Canadian mothers, especially those who have experienced adverse childhood experiences or trauma in the past.
authors.affiliation: 1 Department of Obstetrics and Gynaecology and the BCCH, University of British Columbia , Vancouver, Canada .
authors.forename: Ugochinyere Vivian
authors.initials: UV
authors.lastname: Ukah
authors.affiliation: 2 School of Population and Public Health, University of British Columbia , Vancouver, Canada .
authors.forename: Prince A
authors.initials: PA
authors.lastname: Adu
authors.affiliation: 1 Department of Obstetrics and Gynaecology and the BCCH, University of British Columbia , Vancouver, Canada .
authors.forename: Dane A
authors.initials: DA
authors.lastname: De Silva
authors.affiliation: 1 Department of Obstetrics and Gynaecology and the BCCH, University of British Columbia , Vancouver, Canada .|3 Molecular and Clinical Sciences Institute, St. George's, University of London , London, United Kingdom .|4 Department of Obstetrics and Gynaecology, St. George's University Hospitals NHS Foundation Trust , London, United Kingdom .
authors.forename: Peter
authors.initials: P
authors.lastname: von Dadelszen
mesh_terms: D000293:Adolescent; D000328:Adult; D001942:Breast Feeding / Q000523:psychology* / Q000706:statistics & numerical data; D002170:Canada / Q000453:epidemiology; D002649:Child Abuse / Q000523:psychology* / Q000706:statistics & numerical data; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D005260:Female; D006306:Health Surveys; D006801:Humans; D008425:Maternal Behavior; D009035:Mothers / Q000523:psychology
keywords: abuse; adverse childhood experiences; breastfeeding; maternal; stress